Madura foot: an imported case of a non-common diagnosis.

Mycetoma (or "madura foot") is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an indolent course. A number of fungal or bacterial agents that are introduced through traumatic inoculation can be responsible for the disease, but Actinomadura madurae is among the most common agents of mycetoma occurring worldwide. We report a case of madura foot caused by A. madurae in an immunocompetent young Somali man who was admitted with a diagnosis of skin and soft tissue infection of the left foot with osteomyelitis. The present report emphasizes the importance of the knowledge of this infection, which is sporadic but problematic to treat and, above all, difficult to diagnose. Moreover, a multidisciplinary approach with involvement of an infectious diseases specialist with experience in tropical diseases and a microbiology unit performing rapid molecular diagnostic tests is required for early diagnosis and an optimal antibiotic therapy.

[Eosinophils and eosinophilia]. / Eosinofili ed eosinofilia.

Eosinophils were previously considered granulocytes involved in host protection against helminth infections and in inflammation related to atopic diseases. Instead, as supported by recent studies, eosinophils are today considered multifunctional cells involved also in homeostasis of the gastrointestinal tract and other organs, conferring innate and adaptive immunity to certain bacteria and viruses, and perhaps in the control of oncogenicity. Unexplained eosinophilia could be an expression of paraneoplastic syndrome or constitutional factors. Irrespective of the underlying conditions and aetiology of eosinophilia, eosinophil-derived substances may induce potentially irreversible organ damage. A diagnostic algorithm is discussed.

[Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient]. / Istoplasmosi a presentazione cutanea simil-lepromatosa in un paziente africano HIV+.

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.

A case of Brucella endocarditis in association with subclavian artery thrombosis.

Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors.

Cystic hydatidosis: a rare case of spine localization.

Cystic hydatidosis is a zoonosis endemic both to Sicily and other Mediterranean areas. Generally, Echinococcus granulosus tapeworms develop in the liver, lung and less frequently in the peritoneum, spleen or kidney. We present a rare case of spinal hydatid disease. The patient was a 38-year-old housewife with a vertebral echinococcosis revealed by acute paraplegia of the legs. Medical treatment with albendazole and surgical intervention improved the clinical symptoms. This case is emblematic both for the unusual localization and for the need of a multidisciplinary approach for diagnosing and monitoring suspected hydatid lesions. Patients with suspected abdominal or lung echinococcosis should also be investigated for other localizations such as the brain, spine and heart. Furthermore, in endemic areas hydatidosis must be suspected in the presence of lesions occupying space in these districts.

[The return of anthrax. From bioterrorism to the zoonotic cluster of Sciacca district]. / Il ritorno del carbonchio. Dal bioterrorismo al focolaio zoonotico del distretto di Sciacca.

Anthrax is a disease caused by Bacillus anthracis which affects herbivorous animals. Humans acquire the disease incidentally by exposure to infected animals, animal products or spores on soil. The infection is still endemic in many regions in developing countries. In Italy animal clusters are very rare and human cases are exceptional. Bacillus anthrax is also a potential source for acts of bioterrorism. In the natural human infection, cutaneous anthrax is the most widespread, while the other two, pulmonary and gastrointestinal anthrax, are very rare forms. We describe the first case of human anthrax occurring in western Sicily in the last twenty years. The cutaneous lesion healed without significant scarring after antibiotic treatment with tigecycline, rifampin and ciprofloxacin. Following our diagnosis, a cluster of bovine anthrax was detected in the district of Sciacca, causing the death of 13 animals. A larger outbreak was avoided by the vaccination of over 5000 herbivores.

Children, parents and Respiratory Syncytial Virus in Palermo, Italy: prevention is primary.

A study was conducted to describe the characteristics of the Respiratory Syncytial Virus (RSV) infection cases occurring in the season 2006-7 in Palermo, Italy, and to evaluate the parents' knowledge and behaviours concerning prevention and control of acute respiratory infections (ARIs). All children aged between 0 and 2 years, admitted for a lower respiratory tract infection (LRTI) between October 2006 and May 2007, were enrolled in the study. Data were collected about demographic and household characteristics. Furthermore, their parents were asked to compile a structured questionnaire on transmission, prevention and management of ARIs in children. A total of 198 children with a diagnosis of LRTI were enrolled. Ninety-eight (62.0%) of 157 were positive for RSV. Parents were generally aware of transmission of ARIs through sneezing and/or coughing, but less through contaminated objects or hands. Nationality, age and education level of parents and also the age of the patients proved to be associated with some self-reported knowledge and behaviours. Only 24 (12.3%) of the 195 respondents had received advice from GPs or paediatricians about good hygiene practices. It seems essential to implement public health interventions promoting behavioural changes aimed at the primary prevention of ARIs at the community level.

[Pulmonary hydatid disease in childhood: a case report]. / Idatidosi polmonare in età infantile: descrizione di un caso clinico.

Echinococcosis/hydatidosis is a parasitic zoonosis caused in humans by the larval stage of the Echinococcus granulosus cestode. Although notification of infestation is required, there are no reliable data on the prevalence of this parasitosis among humans in Italy. This zoonosis was first reported in ancient times (Hippocrates, fourth century BC) and since then many cases of echinococcosis/hydatidosis have been described. Currently, it is considered one of the main parasitoses affecting animals bred for income and one of the most important parasitic zoonoses. We present the clinical case of a three-year-old child, living in Palermo with a dog in his house, who came to our observation for dyspnea occurring after physical exercise. Diagnosis of echinococcosis was performed on the operating table and by histological examination. The case presented is special in its manifestation from a clinical point of view, because the young patient experienced multiple injuries only to lungs, without involvement of other organs and, although the left lung cysts appeared fissured on the operating table, our patient never presented immunoallergic disorders.

[Ileocaecal intussusception associated with adenovirus infection: a case report]. / Un caso di invaginazione ileocecale associata ad infezione da adenovirus.

Intestinal intussusception is the invagination of an intestinal segment into another. Childhood intussusception is usually idiopathic, whereas adult intussusception is usually due to a definable intraluminal lesion or to a systemic disease. Although the aetiology of idiopathic forms often remains unclear, there is appreciable evidence to support an indirect role played by certain infectious agents. In this report we present a case of childhood intussusception probably due to adenovirus infection.

[Infective endocarditis: review of 36 cases]. / Endocardite infettiva: review di 36 casi.

In a retrospective study of cases of infective endocarditis (IE) observed in adult patients, the data of patients hospitalized for definite IE in the Cardiosurgery Unit of ARNAS-Civico in Palermo (Italy) from March 2003 to September 2006 were analysed. All cases were classified according to the modified Duke criteria. In all, 36 immunocompetent patients with "definite" IE were included (20 males and 16 females with a median age of 54 years). The aortic valve (23/36, 64%) was the most commonly involved, followed by the mitral (19/36, 52.7%) and tricuspid valve (4/36, 11%). In 10 patients (27.7%), a double localization was observed. Blood culture yielded a positive result in 15 cases. Staphylococci and enterococci were the pathogens most commonly identified. Valvular diseases and previous cardiosurgical procedures were the risk factors most commonly noted. Four patients developed complications during the course of the disease, one of whom died. In patients with positive blood culture, antibiotics were prescribed on the basis of susceptibility test results. In patients with negative blood culture, empiric therapy was directed against Gram+ bacteria (glycopeptides, aminoglycosides and betalactams). Surgical therapy was necessary in 25 patients (69.4%). The patients were subsequently enrolled in a cardiological and infectivological follow-up. Our results showed that rapid diagnosis, correct antibiotic therapy and early surgical treatment improve the outcome in patients with infective endocarditis.

[Reports on nine cases of spondylodiscitis]. / Osservazioni su nove casi di spondilodiscite.

Spondylodiscitis is an infection of the intervertebral disk and the adjacent vertebrae, with or without associated epidural or psoas abscesses. It is a serious disease both due to its long-term course and the possible outcomes. It is frequently caused by S. aureus and, in endemic areas, by Mycobacterium tuberculosis and Brucella spp. We describe 9 cases, from October 2004 to August 2005, all spontaneous diseases occurring in adults (mean age 64 years). The site of infection was lumbar in 7, lumbar-sacral in 1 and dorsal in 1. None were associated to sepsis. The causative bacteria were known in 6 cases (1 BK, 1 S. aureus, 4 Brucella) and unknown in 3 cases. In all cases therapy was only medical. Significant circulation in Sicily of both Mycobacterium tuberculosis and Brucella spp. make those microorganisms the most frequent agents of spondylodiscitis.

Human toxocariasis: a report of nine cases.

AIM: Human toxocariasis is caused by infection with the larval stage of nematode parasites of dogs and cats, Toxocara canis or Toxocara cati. These helminths are not able to complete their life cycle in undefinitive hosts and so undergo aberrant migrations in the tissues causing a wide spectrum of signs and symptoms. Eosinophilia is often severe and sometimes represents the only sign of infection, except in ocular and neurological forms. METHODS: We describe the clinical features of nine children affected by toxocariasis admitted to our Infectious Diseases department from 2004 to 2006. RESULTS: Fever and hepatomegaly were the most common clinical findings. In two cases eosinophilia was not present. Diagnosis was performed by enzyme-linked immunosorbent assay employing excretory-secretory antigens of Toxocara. canis larvae. All patients were successfully treated with oral albendazole with no side effects. CONCLUSION: Toxocariasis should be considered in differential diagnosis of eosinophilia and in patients with seizures of uncertain origin, isolated hepatomegaly and splenomegaly, bronchospasms or skin rash.

[Serological screening for Leishmania infantum in asymptomatic blood donors and HIV+ patients living in an endemic area]. / Screening sierologico per Leishmania infantum su donatori di sangue e HIV+ asintomatici residenti in area endemica.

Visceral leishmaniasis (VL) is endemic in Sicily (48 new cases in 2004, of which nine were in Agrigento). In southern Europe between 25-70 per cent of adult VL cases are related to HIV infection. The HIV cases have a high risk (1.5-9%) of developing VL either as a new infection or as the revival of a latent infection. We therefore carried out serologic screening to detect antibodies against L. infantum by IFAT in 1449 blood donors in Agrigento and the surrounding area (May-December 2005) and in 120 HIV+ in western Sicily, all of whom were asymptomatic and had no history of VL. L. DNA was assessed by nested PCR in blood samples of some seropositive donors. Of the 1449 blood donors, 11 (0.75%) were positive by IFAT and three of them were also positive in PCR. L. infantum seropositivity is most probably the expression of recent infection because the clearance of serum antibodies is rather fast (6-12 months) after VL. This is why blood donation by Leishmania seropositive donors, whether positive or negative by PCR, could constitute an infection risk especially for immunosuppressed recipients, who should receive deleukocyted blood. Moreover it could be useful to monitor HIV/Leishmania coinfection cases to avoid the risk of slatentization of L. infection when CD4+ levels are very low.

[Acute abdomen due to massive intestinal ascaridiasis: a case report]. / Un caso di addome acuto da infestazione massiva da ascaridi.

Ascaridiasis is a geohelminthiasis with a worldwide distribution, especially occurring in countries with hot-humid climates. The infection occurs most frequently in children between three and nine years of age. We report a case of ascaridiasis regarding a ten-year-old girl born in Bangladesh who arrived in Italy about one year before. During laparotomy for suspected acute appendicitis, a large number of ascaridia nematodes were seen in the small intestine.

Asymptomatic Leishmania infantum/chagasi infection in blood donors of western Sicily.

The purpose of this study was to evaluate whether the risk of transfusion-transmitted visceral leishmaniasis was present in an area of western Sicily where the incidence of the disease is higher than the regional average. From May to December 2005, 1449 blood donors from Agrigento district (Sicily, Italy) were screened for the presence of anti-Leishmania antibodies by an indirect immunofluorescent antibody test (IFAT). Blood samples from IFAT-positive donors were examined by PCR to detect Leishmania DNA. Anti-Leishmania antibodies were found in 11 (0.75%) cases, among which Leishmania DNA was detected from four (36.4%). Particular techniques to inactivate different pathogens would be considered mandatory in the case of immunosuppressed recipients.

[Two cases of actinomycosis]. / Due casi di infezione actinomicotica.

Actinomycosis is a bacterial infection due to Gram-positive bacteria of the Actinomyces genus. The authors describe two cases: one of them occurred in a woman with a clinical presentation of a right submandibular indurative mass. After surgery, histological examination showed a granulomatous tissue with many actinomycetes. The second case was observed in a man admitted to hospital with a diagnosis of pulmonary heteroplastic lesion. Also in this case, histological examination showed many actinomycotic colonies. Actinomycosis is an uncommon disease. Establishment of definite diagnosis requires a high index of suspicion in all cases of relapsing cervical lesions. Pulmonary actinomycosis is a rare diagnosis; respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing.