Imported malaria at Italy's National Institute for Infectious Diseases Lazzaro Spallanzani, 1984-2003.

Imported malaria is the most common cause of fatal infections in returning travellers. The increased amount of both tourist movement and migration has resulted in a growing number of people at risk of infection. In the present study, 507 malaria patients admitted to Italy's National Institute for Infectious Diseases in Rome between January 1984 and December 2003 were studied. Overall, 445 cases, or 87.7%, were acquired in Africa, of which 55% were acquired in five sub-Saharan countries. Plasmodium falciparum accounted for 393 (77.5%) of the imported cases. Patients consisted of short-term travellers (n = 213, 42%), long-term visitors (n = 134, 26.4%), and immigrants from endemic areas (n = 137, 27%). Malaria chemoprophylaxis was completed in less than one-quarter of all patients, with immigrants having the lowest rate of completion: only 3.6% of immigrants fully completed chemoprophylaxis compared to 31% of short-term travellers and 29.1% of long-term visitors (p < 0.001). Upon multivariate analysis, the lack of chemoprophylaxis was independently associated with the occurrence of severe malaria (p = 0.009). Severe malaria was reported in 59 (11.6%) individuals: all 11 deaths due to severe P. falciparum infection occurred in patients from sub-Saharan countries, two of whom were immigrants from countries where malaria is endemic. Malaria poses a serious health threat to individuals visiting endemic areas. Ensuring the correct chemoprophylaxis for all travellers, including immigrants from endemic areas, and providing prompt access to healthcare providers for unhealthy returning travellers are major points still to be addressed in Italy.

Pulmonary cryptosporidiosis in patients with acquired immunodeficiency syndrome.

Several reports have showed Cryptosporidium species as a cause of intractable diarrhea and malabsorption in patients with acquired immunodeficiency syndrome (HIV). A case of chronic diarrhea in a drug addict woman associated with a symptomatic interstitial pulmonary infection due to Cryptosporidium parvum is described. This unusual C. parvum spread into the bronchial tree is underlined and a survey of the literature is made.

Beta-endorphins ACTH and cortisol in CSF and plasma of HIV infected patients.

Interactions between HPA (Hypothalamic-pituitary-axis) and immune system seem to involve the EPO (endogenous opioid peptides) system, as shown by some recent findings. Possible relationships between beta-endorphin (beta-End) synthesis and severity rate of immunodeficiency have been studied in 48 HIV Ab positive patients, at different stages of infection. A statistically significant decrease in the beta-End synthesis was observed in these patients, as compared to a control group of 19 healthy subjects, but this decrease was not related to the CD4+T lymphocytes number. Plasmatic levels modifications of HPA-related peptides were not observed in the IVC1 CDC group.

[Amebic liver abscess: review of 9 cases]. / Ascesso amebico epatico: revisione di una casistica relativa a 9 casi.

Amoebiasis is an infection of the large intestine produced by the protozoan Entamoeba histolytica. More than 10% of the world population is estimated to be infected. The italian pattern of this infection is similar to the EEC trend: the prevalence is approximately 0.012% during the years '88 and '89. Hepatic abscesses usually present with moderate fever, weight loss and abdominal pain. During the last ten years nine patients with amoebic liver abscesses were admitted to our hospital, six males and three females (all had acquired the infection in tropical countries). After ultrasonographic and computed tomography scanning evaluation, all patients were treated with metronidazole at the dosage of 750 mg three times a day for a period ranging from 30 to 60 days. In five patients Chloroquine was added at the dosage of 1.2 g a day for fourteen days. In five patients became necessary a surgical drainage under ultrasonographic control.

[An outbreak of legionnaires' disease in the Danish community in Rome: clinical-therapeutic-epidemiologic aspects]. / Focolaio epidemico di malattia dei legionari in una comunità danese a Roma: aspetti clinico-terapeutico-epidemiologici.

The authors report five Danish patients affected by Legionnaire's disease observed during the 1987 spring. They focus on the epidemiological, clinical, and therapeutic aspect of the outbreak.

Response of circulating adrenocorticotropin, beta-endorphin, beta-lipotropin and cortisol to athletic competition.

Acute physical exercise stimulates the activity of the hypothalamus-pituitary-adrenal axis in man. In the present study we measured plasma adrenocorticotropin, beta-endorphin, beta-lipotropin and cortisol levels in 27 male trained athletes in basal conditions, 60 min before and immediately after an official competition. The endocrine responses were evaluated in different groups of athletes participating in races (100 m, 1500 m, 10,000 m) or in the disc throw. The athletes competing for the runs showed a statistically significant increase in plasma adrenocorticotropin, beta-endorphin, beta-lipotropin and cortisol levels after the race (P less than 0.01), whereas the disc throwers showed no significant change in the hypothalamus-pituitary-adrenal axis hormones after the competition. The percent increase in plasma adrenocorticotropin, beta-endorphin, beta-lipotropin and cortisol was higher in the athletes who run 1500 m and 10,000 m than in those participating in the short distance race (100 m). The present results showed that plasma proopiomelanocortin-related peptides and cortisol levels increase in trained athletes following running competition and that this increase is related to the duration of the physical exercise.