BackgroundHerpes zoster (HZ) is a common disease, characterized by rash-associated localized pain. Its main complication, post-herpetic neuralgia (PHN), is difficult to treat and may last for months to years in the wake of rash resolution. Uncertainties remain as to the knowledge of predictors of HZ-related pain, including the role of antiviral therapy in preventing PHN in ordinary clinical practice. This prospective cohort study was aimed at investigating pain intensity at HZ presentation and its correlates, as well as the incidence of PHN and its predictors.MethodsPatients diagnosed with HZ were consecutively enrolled by a network of Italian General Practitioners and Hospital Units in the health district of Pescara, Italy, over two years. Uncertain cases were referred for microbiological investigation. Data were collected through electronic case report form (e-CRFs) at enrolment and at 1, 3, 6 and 12 months after enrolment. Pain intensity was coded on a five-degree semi-quantitative scale at each time point. PHN was defined as pain of any intensity during follow-up and quantified using an area-under-the-curve (AUC) method.ResultsFour hundred and forty-one patients composed the final sample. Mean age was 58.1 years (SD = 20.4 years); 43.5% of patients were males; 7.9% did not receive prescription of antivirals. Intense/very intense pain at presentation was reported by 25.2% of patients and was significantly associated with female gender, older age, cigarette smoking, trauma and/or surgery at HZ site (logistic regression). PHN was diagnosed in 51.2% of patients at one month and in 30.0% of patients at three months. PHN was significantly associated with pain intensity at presentation, age, smoking, trauma and missed antiviral prescription (generalized estimating equations model). The same factors were also independent predictors of the overall pain burden as described by the AUC method (linear regression).ConclusionsSmoking, traumas and surgery at the HZ site emerged as new predictors of both HZ-related pain intensity and persistence, opening new perspectives in the prevention of HZ-related pain. An independent line of evidence was provided for the efficacy of antiviral therapy in preventing PHN and reducing total pain burden.

We carried out a prospective observational study to evaluate whether Monocyte Distribution Width (MDW) may play a role in identifying patients with sepsis in comparison with Procalcitonin (PCT). We prospectively enrolled all consecutive patients hospitalized at the Infectious Diseases Unit of Pescara General Hospital for bacterial infection or sepsis. MDW values were collected for all patients. Clinical characteristics, demographic data, past and present medical history, microbiological results, PCT, as well as neutrophil and monocytes indices at entry were compared in the 2 groups. Two-hundred-sixty patients were enrolled, 63.5% males, aged 59.1±19.5 years. Sepsis was diagnosed in 105 (40.4%); in 60 (57.1%) at least 1 microorganism was isolated from blood cultures. In multivariate models, MDW as a continuous variable (OR:1.57 for each unit increase; 95%CI: 1.31-1.87, p<0.001) and PCT>1 ng/ mL (OR: 48.5; 95%CI: 14.7-160.1, p<0.001) were independently associated with sepsis. Statistical best cut points associated with sepsis were 22.0 for MDW and 1.0 ng/mL for PCT whereas MDW values<20 were invariably associated with negative blood cultures. At ROC curve analysis, the AUC of MDW (0.87) was nearly overlapping that of PCT (0.88). Our data suggest that incorporating MDW within current routine WBC counts and indices may be of remarkable use for detection of sepsis. Further research is warranted.

Staphylococcus pseudintermedius is a veterinary pathogen that has seldom been described as an agent of human disease. Features of this probably underreported coagulase-positive Staphylococcus species are depicted here through the description of a graftversus-host disease-related wound infection caused by a multidrug-resistant strain. CASE REPORTA 65-year-old male patient who had received (3 years previously) an allogeneic bone marrow transplant (BMT) for chronic lymphoblastic leukemia was admitted to the Pescara Civic Hospital (Italy) because of a wound infection, located in the periumbilical region and showing two different purulent discharges. The lesion was due to chronic graft-versus-host disease (GvHD) that complicated the BMT. The patient affirmed that he lived in proximity to a pet dog and farm cows.Pus staining revealed Gram-positive cocci within leukocytes, while cultures yielded a massive growth of mannitol-nonfermenting coagulase-positive staphylococci (CPS). Based on colony aspect (brightness of the white-gray color), two different isolates (named S32 and S33) were recognized, sharing a double-zone hemolysis on the sheep blood agar plate (Fig. 1). They were identified as Staphylococcus intermedius by both the Vitek2 and the API system (bioMérieux, Marcy l'Etoile, France). However, S. intermedius is the only species belonging to the so-called Staphylococcus intermedius group included in these systems' databases. The S. intermedius group includes S. intermedius, cultured from a wide variety of animals, Staphylococcus pseudintermedius, which recent studies indicate is the prevalent S. intermedius group species harbored by dogs and cats, and Staphylococcus delphini, first isolated from dolphins but later collected from several terrestrial animals (1, 2). Thus, we did not consider this identification as conclusive. Moreover, since the absence of mannitol fermentation, along with the double-zone hemolysis, was highly suggestive for S. intermedius/S. pseudintermedius, the patient was screened for S. intermedius group nasal and skin colonization. Five phenotypically similar organisms were grown from the nasal and the hand skin swabs. Again, they were identified as S. intermedius by the Vitek2 and the API system. Different tests (both phenotypic and genotypic) were performed to confirm the identification. Phenotypically, all the strains were colistin resistant and showed a slow positivity to the Voges-Proskauer reaction (suggesting that the isolates were S. pseudintermedius rather than S. intermedius). Among genotypic assays, 16S rRNA sequencing did not provide a definitive discrimination among S. intermedius, S. pseudintermedius, and S. delphini. The isolates were then analyzed through automated ribotyping (RiboPrinter; Qualicon DuPont, USA). The instrument provided identical fingerprints for all of the strains and identified them as S. intermedius. A specific multiplex PCR was performed, as previously described (3). The isolates were identified as S. pseudintermedius, since a clear band was obtained at 926 ...

BackgroundData on the potential efficacy of acupuncture (AC) in controlling intense or very intense pain in patients with Herpes Zoster (HZ) has not been so far adequately assessed in comparison with standard pharmacological treatment (ST) by a controlled trial design.MethodsWithin the VZV Pescara study, pain was assessed in HZ patients on a Visual Analogue Scale (VAS) and by the McGill Pain Questionnaire (MPQ) both at the beginning and at the end of treatment. Response rates, mean changes in pain intensity, differences in total pain burden with an area-under-the-curve (AUC) method over a 1-year follow-up and differences in the incidence of Post-Herpetic Neuralgia (PHN) were evaluated.ResultsOne hundred and two patients were randomized to receive either AC (n = 52) or ST (n = 50) for 4 weeks. Groups were comparable regarding age, sex, pain intensity at presentation and missed antiviral prescription. Both interventions were largely effective. No significant differences were observed in response rates (81.6% vs 89.2%, p = 0.8), mean reduction of VAS (4.1 +/- 2.3 vs 4.9 +/- 1.9, p = 0.12) and MPQ scores (1.3 +/- 0.9 vs 1.3 +/- 0.9, p = 0.9), incidence of PHN after 3 months (48.4% vs 46.8%, p = 0.5), and mean AUC during follow-up (199 +/- 136 vs 173 +/- 141, p = 0.4). No serious treatment-related adverse event was observed in both groups.ConclusionsThis controlled and randomized trial provides the first evidence of a potential role of AC for the treatment of acute herpetic pain.Trial registrationChiCTR-TRC-10001146.

Natural resistance-associated substitutions (RASs) are reported with highly variable prevalence across different HCV genotypes (GTs). Frequency of natural RASs in a large Italian real-life cohort of patients infected with the 4 main HCV-GTs was investigated. NS3, NS5A and NS5B sequences were analysed in 1445 HCV-infected DAA-naïve patients. Sanger-sequencing was performed by home-made protocols on 464 GT1a, 585 GT1b, 92 GT2c, 199 GT3a, 16 GT4a and 99 GT4d samples. Overall, 20.7% (301/1455) of patients showed natural RASs, and the prevalence of multiclass-resistance was 7.3% (29/372 patients analysed). NS3-RASs were particularly common in GT1a and GT1b (45.2-10.8%, respectively), mainly due to 80K presence in GT1a (17%). Almost all GTs showed high prevalence of NS5A-RASs (range: 10.2–45.4%), and especially of 93H (5.1%). NS5A-RASs with fold-change >100x were detected in 6.8% GT1a (30H/R-31M-93C/H), 10.3% GT1b (31V-93H), 28.4% GT2c (28C-31M-93H), 8.5% GT3a (30K-93H), 45.5% GT4a (28M-30R-93H) and 3.8% GT4d (28V-30S-93H). Sofosbuvir RAS 282T was never detected, while the 159F and 316N RASs were found in GT1b (13.4–19.1%, respectively). Natural RASs are common in Italian patients infected with HCV-GTs 1–4. High prevalence of clinically-relevant RASs (such as Y93H) supports the appropriateness of HCV resistance-test to properly guide DAA-based therapy.