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Prevalenza ed identificazione genotipica di HPV, da brushing cervicale, nell'area Irpina della regione Campania SUMMARY Cervical cancer is due to persistent genital infection with Human Papillomavirus (HPV).The purpose of this study was to evaluate prevalence of HPV in Irpinia (Campania region, Italy), distribution of different viral genotypes, correlating cytological results and virological investigations. In the period 2006-2011, were made 1080 cervical samples of women aged 18-65 years for HPV identification and genotyping. Detection of the virus was performed by Multiplex-PCR System (Seegene, Arrow) and typing with INNO-LiPA HPV Genotyping Extra test (Innogenetics). Out of the 1080 tested samples, 330 (30.6%) samples were positive for HPV DNA. The most frequently occurring High Risk (HR)-HPV genotype in single infections was HPV16 (16.6%), followed by HPV51 (10.7%), in multiple infections HPV16 (15.7%) and 31 (14.6%). The prevalence of infection, correlated with age of patients studied, is greater in the group aged 26-30 years (42.5%). HR-HPV were detected in different percent in patients with Pap test scores: 22.5% in normal Pap smear (20% HPV16), 14.5% ASCUS (47.6% HPV16), 24% LSIL (20% HPV16), 79.3% HSIL (72.7% HPV16; 9.1% HPV18 detected only in this type of cellular alteration). The high prevalence of HR-HPV in patients with ASCUS or normal Pap test, suggesting the real advantage of HPV screening test, more sensitive in selecting the actual population at risk. Based on the findings of our epidemiological study, HR-HPV screening and HPV genotyping test should be strongly advised also to the vaccinated population for the high incidence of genotypes which are not included in vaccines (67%).

INTRODUZIONEIl Polyomavirus hominis di tipo 1, conosciuto anche come virus BK (BKV) dalle iniziali del paziente dal quale è stato isolato per la prima volta nel 1971, infetta fino al 90% della popolazione. Diversi studi hanno dimostrato che più del 70% della popolazione adulta possiede anticorpi per BKV, avendo contratto, per via respiratoria, un'infezione primaria durante l'infanzia, di solito nei primi 3-4 anni di età. Negli individui immunocompetenti ciò avviene tipicamente senza particolari sintomi clinici. Dopo l'infezione iniziale il virus rimane latente sia in forma episomica che integrato nel genoma cellulare a livello del tratto urogenitale e nei linfociti B. Dopo l'infezione primaria, le cellule epiteliali dei tubuli renali e, più in generale, dell'urotelio costituiscono i siti di latenza e riattivazione virale (24). La patologia da BKV è rara, e per lo più conseguente ad uno stato di immunodeficienza. Il virus è stato associato a diverse patologie, tra le quali cistite emorragica, stenosi uretrali, vasculopatie e quadri di multiorgan failure (13). Inoltre, casi aneddotici di interessamento renale da BKV sono stati riportati in pazienti con immunodeficienze ereditarie o acquisite, ed in riceventi di trapianti d'organo diversi dal rene. Tuttavia, la nefropatia interstiziale associata all'infezione da BKV (PVAN) è emersa recentemente come causa importante di disfunzione renale dopo trapianto di rene (13, 15). Quasi tutti gli eventi clinici si verificano in condizione di immunosoppressione per la riattivazione dell'infezione latente. Le manifestazioni più importanti colpiscono i trapiantati di rene, sottoposti a Objectives. The aim of our study was to evaluate the clinical utility of quantification of BKV viruria and especially viremia detected by real-time PCR method to select the patients at risk of PVAN. Study Design. We carried out a quantitative (dosing) assay of BKV-DNA in 24 patients transplanted in Salerno's hospital, or elsewhere, all treated with cyclosporine or tacrolimus and mycophenolate mofetil or Prednisolone. The enrollment was made on the basis of impaired renal function, in particular of the values of serum creatinine (> 25% of baseline level) and / or appearance of proteinuria. The nucleic acid extraction was performed by EXTRAgen kit (Nanogen); the extracts were submitted to quantitative evaluation by BKV Q-PCR Alert Kit indicare regione target in Real Time PCR (Nanogen) using the instrument ABI7300 (Applied Biosystems).Results. 16 patients were negative both for viremia and viruria,4 patients showed positive viruria but viremia <10,000 copies / ml, 4 patients showed positive viruria and viremia > 10,000 copies / ml. In the last group, biopsy, performed to diagnose PVAN was positive and immunosuppressive therapy was reformulate leading to the decline, but never to the negativity of viral load. Conclusions.The renal impairement combined with the quantification of BKV's viral load in urine and especially in plasma, can also be effective predictors of PVAN.

Riattivazione di CMV a livello intestinale in paziente trapiantato renale a distanza di 10 anni dal trapianto SUMMARY Introduction. We analyzed the clinical case of a 51 years old man, kidney transplanted on December 2002. On April 2011, he had acute rectal bleeding, renal chronic rejection (creatinine 2.9 mg/dl), Hgb 8.7 g/dl, positive anti-CMV antibodies (IgG). A colonoscopy showed diverticulosis of the rectum associated with deepithelialisation.The patient was treated with maintenance immunosuppressive post-transplant therapy. On June 2011, the colonoscopy showed a stenosing lesion of the sigmoid colon, and blood sampling and intestinal biopsy were performed to search Cytomegalovirus (CMV) DNA by PCR. Methods. The presence of CMV-DNA was sought by automatic extractor QIACUBE, using QIAamp DNA BLOOD Mini Kit (Qiagen) for whole blood and QIAamp DNA Mini Kit (Qiagen) for biopsy.The extracted DNA was then amplified by Real Time PCR using Q-CMV RealTime Complete Kit (Nanogen), on instrument Applied Biosystems 7300. Results. At disease onset the viral load in whole blood was 208000 Geq/ml, and biopsy was positive. Antiviral therapy with Ganciclovir led to the negativity of the viral load and remission of symptoms. Conclusions. The clinical case described presented a reactivation of CMV infection in the intestine after more than 10 years from kidney transplantation, while the highest incidence of CMV reactivation usually occurs during the first year. In our opinion, the reactivation can be traced to long-term immunosuppressive therapy (maintenance posttransplant therapy) in combination with a state of inflammation of the intestinal mucosa. In fact, patients with IBD treated with steroid drugs, in particular the group of refractory to therapy and thus have a recovery of the inflammatory process, are exposed to reactivation of CMV with intestinal localization. Figura I. Cytomegalovirus.