BackgroundHIV-infected children have a lower seroconversion rate to hepatitis B virus (HBV) immunization than healthy children. Previous studies have produced conflicting results on CD4 cell counts as predictors of vaccine response. No study has evaluated the response rate to HBV vaccination in HIV-infected children receiving highly active antiretroviral therapy (HAART). Our aim was to vaccinate HIV-infected children living in a close community and to investigate the anamnestic response rate after vaccination with its predictors. MethodsEighty-four HIV-positive children aged 1-10 years who were negative for antibodies to the HBV core antigen (anti-HBc) completed immunization with three doses of 5 mg HBVAXPRO (Aventis, Milan, Italy). Quantitative testing for antibodies to the HBV surface antigen (anti-HBs) was performed: a seroprotective titre was defined as anti-HBs410 mUI/mL. ResultsAfter the vaccination, the anti-HBs seroconversion rate was 59.5%. It was higher in individuals in Centers for Disease Control and Prevention (CDC) immune category 1 than in those in CDC categories 2 and 3. Seroconversion was found in 70.8% of HAART-treated and 44.4% of treatmentnaïve children. In multivariable models, HAART use and absolute CD4 cell counts were independently associated with probability of seroconversion and with higher anti-HBs titres. ConclusionsWe found a higher seroconversion rate compared with previous studies in HIV-infected children. In children who are candidates to receive antiretroviral therapy, it may be advisable to defer HBV vaccination until after treatment initiation.

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We describe a case of a febrile patient returning from Senegal in which haemoscopic and molecular investigation confirmed tick-borne relapsing fever (TBRF), suggesting Borrelia crocidurae as the causative agent. This case emphasises the need to include TBRF in the differential diagnosis of fever following a journey from endemic countries, including malarial areas.

Introduction: In this survey we evaluated the usefulness of ultrasonography (US) in the diagnosis, and in the treatment of complicated hydatid cysts. Materials and methods: From June 1985 to June 2004, 221 patients with 294 hydatid cysts were examined. Twenty patients (9.0%) presented 22 complicated cysts (7.4%): 9 with infection, 5 ruptured into the bile ducts, 2 bilomas, 2 cysto-pleural fistulas, 2 allergic reactions, 1 rupture into the peritoneum and 1 intrasplenic hematoma. In all cases, US yielded a specific or suspected diagnosis, also in complications affecting non-hepatic sites, confirmed by computed tomography (CT), endoscopic papillotomy or percutaneous US-guided sampling. All patients with complicated cystic echinococcosis were treated with Albendazole 800 mg/day for at least 3 months. In addition to this therapy, 12 underwent US-guided drainage (9 infected cysts, 2 bilomas, 2 cysto-pleural fistulas, 1 intrasplenic hematoma); of these patients 3 subsequently underwent surgery because US-guided treatment was ineffective. Five patients were treated with perendoscopic sphincterotomy for obstruction of the bile passages, while 3 patients received only medical therapy. Results: Medical, echoguided and surgical treatments led to resolution of the complications and complete remission of the parasitic pathology in 19/20 patients (95%) and in 21/22 cysts (95.4%). There was partial remission in 1 case only. The therapy did not cause major complications and the results were confirmed during follow-up lasting from 5 months to 15 years (mean time 3 years). Discussion and conclusion: This study shows that the incidence of complications of hydatid cysts is low and that correct echographic management allows a rapid diagnosis and optimization of treatment in most cases.Sommario Introduzione: Gli autori valutano in questo lavoro l'utilità dell'ecografia nella diagnosi e nel trattamento ecoguidato delle cisti idatidee complicate. Materiali e metodi: Dal giugno 1985 al giugno 2004 gli autori hanno seguito 221 pazienti affetti da 294 cisti idatidee. 20 pazienti (9,0%) presentavano 22 cisti complicate (7,4%): 9 erano infettate, 5 rotte nelle vie biliari, 2 bilomi, 2 fistole cisto-pleuriche, 2 reazioni allergiche, 1 rotta in peritoneo ed 1 ematoma intrasplenico. In tutti i casi l'ecografia permise di sospettare la diagnosi, anche per le complicanze extraepatiche, che venivano confermate dalla TC, dalla papillosfinterotomia perendoscopica, o dai prelievi ecoguidati. Tutti i pazienti affetti da cisti idatidee complicate furono trattati con 800 mg/die di albendazolo, per almeno 3 mesi. Oltre a questa terapia 12 furono sottoposti a drenaggio ecoguidato (9 cisti infettate, 2 bilomi, 2 fistole cisto-pleuriche, 1 ematoma intrasplenico); di questi 3 furono successivamente operati in quanto il trattamento ecoguidato era risultato inefficace, 5 pazienti furono trattati con papillosfinterotomia perendoscopica per ostruzione delle vie biliari, mentre 3 pazienti ricevettero solo terapia medica. Risultati: Il trattamento medico,...

KEYWORDSCirrhosis; Transplantation; Interferon.Abstract Liver transplantation is indicated in end-stage chronic viral liver disease, but unless adequate prophylaxis is administered, the patient will in most cases develop recurrent hepatitis B (HBV) and C (HCV) virus infection. Today, patients receiving prophylaxis using nucleoside analogue drugs with or without specific immune globulin drugs in connection with orthotopic liver transplantation for HBV related cirrhosis, present low risk of relapse and high 5e10 year survival rates. Lamivudine was the first drug used in the prophylactic treatment, but this drug has increasingly been combined with or replaced by adefovir due to the low genetic barrier, which causes viral resistance. Most patients develop viral recurrence after orthotopic liver transplantation for HCV related cirrhosis, and in an elevated number of cases, cirrhosis and hepatic insufficiency set in after a few years. Prophylaxis before transplantation and pre-emptive treatment using interferon and ribavirin present numerous side effects resulting in reduction of doses and suspension of therapy, with consequently low sustained virological remission rates and risk of rejection.The treatment is better tolerated by patients with histologically confirmed chronic disease, but also in these patients virological remission rates are low. This pathology requires new therapeutic protocols and/or new drugs in order to obtain better compliance and better responses.Sommario Il trapianto di fegato rappresenta il trattamento indicato nella malattia epatica cronica virale in fase avanzata, ma senza un'adeguata profilassi l'infezione da virus B o C recidiva nella maggior parte dei casi.In questi ultima anni il paziente con cirrosi HBV correlata che necessita di trapianto ortotopico di fegato utilizzando una profilassi con farmaci analoghi nucleosidici, associati o meno alle immunoglobuline specifiche, presenta un basso rischio di recidiva e ottima percentuale di sopravvivenza a 5e10 anni. La lamivudina è stato il primo farmaco utilizzato nella profilassi, ma sempre più viene associato o sostituto dall'adevovir per la bassa barriera genetica, responsabile di produzione da parte del virus di resistenze.Nella quasi totalità dei pazienti con cirrosi C si assiste a una recidiva virale dopo il trapianto di fegato a cui consegue, in una elevata percentuale di casi, cirrosi e insufficenza epatica nell'arco di pochi anni. La profilassi prima del trapianto e il trattamento preemtive con interferone e ribavirina sono gravati da molti effetti collaterali, riduzione della dose fino alla sospensione della terapia con percentuali di remissioni virologiche sostenute non molto elevate, con rischio inoltre di rigetto.La terapia è meglio sopportata nella malattia cronica, accertata istologicamente, ma anche in questo caso il numero di remissioni virologiche rimane basso.In questa patologia saranno necessari nuovi protocolli e/o nuovi farmaci che consentano di ottenere una compliance migliore associata a migliori risposte. ª