[Brucella endocarditis: role of drug treatment associated with surgery]. / Endocardite da brucella: ruolo del trattamento medico associato a quello chirurgico.

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve, and a fearful complication is the formation of aortic root abscess. Due to the characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are achieved in combination with surgery. We describe 2 cases of brucella endocarditis involving the aortic valve. Aggressive treatment, with surgery performed during a period of active infection, produced good results in eradication of infection and in preventing fatal complications such as rupture of aortic root abscesses.

Non-typhoid Salmonella subdural empyema in a patient with AIDS.

In AIDS patients, non-typhoid salmonella metastatic abscesses in lung and brain due to bacteremia have been described previously. Here we present a case in which a group B Salmonella, serotype Copenhagen, caused right parietal subdural empyema. The etiologic diagnosis was based on culture of pus obtained from the lesion. The patient was treated for bacterial meningitis and made a good recovery. He is at present reasonably well and is taking ciprofloxacin as prophylaxis against salmonella relapse.

[Vaginitis caused by Eikenella corrodens]. / Vaginite da Eikenella corrodens.

The Authors report a case of vaginitis caused by Eikenella corrodens (E.C.) and point out it is very rare all over the world (probably the first case reported in Italy). The E.C. was the only one isolated from the vaginal specimen. They emphasized the importance of bacteria isolation in subacute or relapsing vaginitis and relevant sensibility to antibiotic assays. These are generally neglected but still able to give unexpected results then allowing a target therapy.

Amebic pleuro-pericarditis.

Author's report a case of visceral amebiasis in a 26 year old woman, clinically characterized by pericarditis, without any other symptoms related to organs usually interested in such disease. It was possible to reach an etiological diagnosis by indirect hemagglutination assay. The successful treatment with metronidazole confirmed the etiology "ex adjuvantibus".

HIV infection in children born to seropositive mothers: a laboratory and clinical follow-up study.

Several serological techniques may be used for the detection of HIV infection, however, in the case of infants, there are no methods that are effective prior to the loss of maternal antibodies. Thus, in such cases, a completed series of serological and virological assay of HIV antibodies should be performed in follow-up studies. Twenty children living in Modena (Italy) were studied since 1985. Seven of these children were of ages ranging from 3 to 10 years. Only one of them was found to be seropositive for HIV. The remaining 13 children were studied from birth. Six had lost maternal antibodies to HIV at a median age of 15.1 months. Four showed decreasing levels of the anti-body by Western blotting. HIV antigen was detected in serum samples from 2 children. The data reported stress the need for longitudinal studies that could lead to reliable methods of diagnosing HIV infections in newborns.

Heterosexual transmission of the human immunodeficiency virus: a seroepidemiological study.

The transmission of the human immunodeficiency virus (HIV) was studied in 647 subjects who presented no apparent risk factors for the infection other than having had promiscuous heterosexual relations, heterosexual relations with people with an elevated risk of infection, or heterosexual relations with people infected by human immunodeficiency virus. Thirty subjects were found to be seropositive for anti-human immunodeficiency virus antibodies. The elevated risk factors included being the habitual partner of a person at risk of infection or of a person who was infected by human immunodeficiency virus, or being the partner of a patient with acquired immunodeficiency syndrome. The transmission of the virus was verified in 13 of 284 subjects (4.57%) who had had heterosexual intercourse three or more times with persons at risk and in 16 of 101 subjects (15.84%) who had had heterosexual intercourse three or more times with persons who were seropositive for human immunodeficiency virus antibodies. No significant correlation between human immunodeficiency virus infection and a history of sexually transmitted infections, nor between human immunodeficiency virus infection and female subjects was found. These data suggest that the epidemic of acquired immunodeficiency syndrome can also spread through heterosexual relations, even if the possibility of becoming infected in this way seems at the moment limited to particular risk behaviors.

Detection of serum HIV-Ag related to the major core protein (p24) in persons at risk for AIDS.

A commercial enzyme immunoassay was utilized for the detection of the human immunodeficiency virus antigen (p24) in serum samples from persons at risk for AIDS. The test demonstrated sensitivity to 20 pg/ml of serum antigen. The results obtained showed 14.63% of the subjects (Ss) with persistent generalized lymphadenopathy or asymptomatic Ss, and 69.23% of the Ss with AIDS related complex (ARC) or AIDS to be positive for HIV-Ag. In addition, there were no false-positives in the control serum samples collected from seronegative individual. The close correlation observed between HIV-Ag presence and advanced stages of the disease, stresses the diagnostic importance of this viral marker and its usefulness in the follow-up of Ss with HIV infection.

Isolation of mumps virus from vaginal secretions in association with oophoritis.

Mumps virus was isolated from the cervico-vaginal secretions of a 31-year-old woman presenting with mild signs of oophoritis accompanied by xantholeucorrhoea. The serological finding of mumps-specific IgM antibodies was further evidence confirming the casual link between mumps virus and ovarian pathology. Rarely, ovarian involvement may be the only manifestation of mumps infection. The importance of this diagnosis and its relationship to the possible development of secondary oligomenorrhoea and early menopause is discussed.

Comparison between enzyme-linked immunosorbent and I.F. assays in the serological diagnosis of HIV infections.

A rapid, sensitive indirect immunofluorescence assay based on the use of acetone-fixed virus producing MOLT T4/LAV cells was adapted for the detection of anti-HIV antibodies. At the same time, 1486 serum samples, collected by the AIDS Surveillance and Study Centre of Modena, were tested by ELISA and IFA: the percentage of agreement of both assays was of 99.66%. Such datum suggested that IFA could be used as a serological assay for screening and confirmatory purposes.

Primary hepatic actinomycosis.

A case of primary hepatic actinomycosis is reported. Multiple liver abscesses were diagnosed in a febrile 60-year-old-man by means of non-invasive techniques such as ultrasonography, CT and radioisotope scans. The aetiology was confirmed by the unusual finding of Actinomyces israelii in anaerobic blood cultures. Other sites were not involved. Early penicillin therapy enabled surgery to be avoided.

[Description of a case of type E botulism in Italy]. / Descrizione di un caso di botulismo di tipo E in Italia.

The authors report the first documented italian case of type E botulism. The initial symptoms were typical permitting prompt diagnosis; the symptoms became severe and the patient had to be moved to intensive care. Biological tests on guinea-pigs showed the presence of type E botulin toxin in the tuna (stored in oil) which the patient had eaten 24 hours prior to admission. This tuna had been caught near the mediterranean coast of Spain several months earlier and canned at home. The authors emphasize that, even though this fish was imported, there is a danger that this intoxication could, in the future, be more widely observed.

[Tuberculous lymphadenitis. Apropos of a non-typical histological picture]. / Linfoadenite tubercolare. A proposito di un quadro istologico non tipico.

The case is presented of a young Somali with acute lymphadenitis. Whereas histological examination indicated abscessing granulomatous lymphadenitis, bacteriological studies revealed the presence of M. tuberculosis in the pus taken from the lymph node. Hence the aetiological diagnosis contradicted the morphological picture.

Human subcutaneous dirofilariasis. 2. A report of 5 new cases of Dirofilaria repens in central and northern Italy and of a sixth case with uncertain parasitological diagnosis.

Six new human cases of subcutaneous filariasis (histological sections) in Lombardia, Emilia-Romagna and Toscana are described. Five of them are to attribute to Dirofilaria repens, whereas some doubts exist with regard to one case. The findings are compared with histological sections of male and female specimens of D. repens and D. immitis recovered from naturally infected dogs.