To evaluate, for the first time, circulation and clinical expression of Toscana virus (ToSv) in Umbria region we studied: (1) 93 cases of aseptic meningitis and meningoencephalitis admitted to our Department from 1989 to 2001 with negative results for common neurotropic virus; (2) 50 healthy subjects. Specific antibodies (IgM and IgG) anti-TOSv were found in 36.6% of aseptic meningitis, in 6.06% of meningoencephalitis and (IgG) in 16% of healthy subjects.

Since HIV infection could condition the natural history of parenterally transmitted viral hepatitis (HBV, HCV, HDV), with possibly differing effects in different risk groups, we decided to retrospectively examine sera from a cohort of 637 HIV seropositive patients in different stages of infection, seen from 1985 to 1992, to study the prevalence and temporal course of these infections. Virological markers of HBV, HCV and HDV were determined by ELISA and RIBA methods. The severity of HIV infection was higher in homosexuals than in drug addicts. Prevalence of antiHBc antibodies was 82% in drug addicts and 77% in homosexuals, whereas antiHCV antibodies prevalence was 72% in drug addicts and only 7% in homosexuals (p < 0.000001). When only antiHBc-positive patients were considered, there was a significant difference in antiHBs antibodies between drug addicts (DA) and homosexuals (OR for DA 0.29, 95% CI 0.08/0.83, p = 0.02), suggesting that drug addicts are less able to produce a protective response. This fact cannot be explained by the severity of HIV infection (which was higher among the homosexual group) and suggests some immunodepressive effect of drug abuse. Delta infection was only detected in the drug addict group, and the prevalence was low. Finally, we cannot confirm the interference of HCV infection with the speed of HBsAg clearance: in this study the prevalence of HBsAg was almost the same in HCV-positive and negative patients.

BackgroundThere is no clear relationship between in vitro bactericidal activity tests and clinical outcome. We studied bactericidal activity of oxacillin, vancomycin and teicoplanin against Staphylococcus aureus isolates in patients with endocarditis and then we sought to determine if there was a relationship between in vitro bactericidal activity and clinical outcome.MethodsMinimal bacteriostatic and minimal bactericidal concentrations were determined for Staphylococcus aureus strains isolated from patients with endocarditis following standardized methods. Medical records were reviewed retrospectively to collect data on antimicrobial susceptibility at admission, antimicrobial therapy, need for surgery, embolic events and outcome.Results and DiscussionSixty-two Staphylococcus aureus strains were studied in 62 patients with endocarditis. Overall, 91.9% definite, 21% methicillin resistant and 72.6% cured. Surgery was performed in 32.3% and embolic events were documented in 64.5%. Tolerance to oxacillin and teicoplanin was more common than vancomycin tolerance among methicillin susceptible Staphylococcus aureus. Among methicillin resistant Staphylococcus aureus teicoplanin was shown to have a higher rate of tolerance than vancomycin. No statistically significant differences on clinical outcome between oxacillin tolerant and oxacillin non tolerant Staphylococcus aureus infections were observed. Tolerance to oxacillin did not adversely affect clinical outcomes of patients with methicillin susceptible Staphylococcus aureus endocarditis treated with a combination of antimicrobials including oxacillin. The cure rate was significantly lower among patients with methicillin resistant Staphylococcus aureus endocarditis.ConclusionsIn vitro bactericidal test results were not valid predictors of clinical outcome. Physicians need to use additional parameters when treating patients with staphylococcal endocarditis.

Infestazioni ed infezioni intestinali parassitari nel biennio 2006 -2007 nell'esperienza perugina SUMMARYBetween 2006-07 faecal specimens of 2.132 subjects (1.508 adults and 624 children) were examined for ova & parasites, using direct and after formalin-ethylacetate concentration microscopy, and permanent specific stains. 380 bubjects (17.8 %) were infected: 313 adults (20.8 %) and 67 children (10.7 %). 331 cases (15.5 %) were infected by pathogens, 275 adults (18.2 %) and 56 children (9.0 %). 389 pathogenic or not pathogenic protozoa (18.2 %) and 60 helminths (2.8 %) were identified, more among adults than children (21.0 % vs 11.5 % and 3.2 % vs 1.8 % respectively).Among protozoa, D. fragilis was in all observed in 145 cases (6.8 %), G. duodenalis in 74 cases (3.5 %), other were very rare.Among helminths nematodes were more frequent than trematodes and cestodes, with S. stercoralis (14 cases) and E. vermicularis (13 cases) the most frequent ones. 2.302 subjects (1.505 adults and 797 children) were examined for microbiological tests because affected by acute or prolonged diarrhoea. 82 cases (3.6 %) of protozoal infections were observed, 70 among adults (4.7 %) and 12 among children (1.5 %). D. fragilis was in all prevalent (2.0 %) in respect of G. duodenalis (1.0 %) or other ones (0.6 %). For S. stercoralis specific investigation, modified Baermann method / larvae colture were performed: 20/189 cases (10.6 %) od strongyloidiasis was diagnosed in adults. For E. vermicularis investigation, scotch test was performer: 43/179 cases (24.0%) of enterobiasis was diagnosed. The Authors underline the application of standard operative procedures for O & P with permanent specific stains in subject affected by enterites too, and the analysis of more specimens for each subjects for good diagnostical performances.

Durable virological suppression during HAART is associated with immunological recovery in patients with HIV infection. Current guidelines recommend to initiate HAART when CD4+ cell count falls <350/μl. However, recent studies have shown a higher immune restoration when HAART was started at CD4+ baseline level > 350 cells/μl. We retrospectively assessed the long-term immunological outcome in patients with sustained virological suppression during HAART, for up to 8 years. MethodsHIV-infected consecutive patients attending to our clinic were included, with the following inclusion criteria: follow-up >1 year while on HAART and sustained virologic suppression (HIV-RNA <400 copies/ml) for at least 6 consecutive months. We analyzed the immunological outcome by of annual determination of: 1) CD4+ cell count; and 2) change in CD4+ cell count from baseline. Complete immunological recovery was defined as CD4+ cell count ≥700/μl. Patients were stratified according to baseline CD4+ cell (counts of <200/μl, 200-350/μl and >350/ μl), age, HIV risk group, HCV co-infection, HAART regimen, sex, and race. A statistical analysis was performed by linear regression. Summary of results352 patients were observed: 172, 85 and 95 patients had baseline CD4+ cell count <200/μl, 200-350/μl and >350/ μl, respectively. After 5 years of therapy, 29%, 69% and 82% of patients with baseline CD4+ cell count, respectively, <200/μl, 200-350/μl and >350/μl, exceeded the threshold of 500 cells/μl (p = 0.034).Among patients with baseline CD4+ cell count >350/μl, mean CD4+ cell count reached a plateau with a complete immunological recovery by 4 years of suppressive HAART. CD4+ cell count increased even after 8 years without ever reaching a full immunological recovery in patients with baseline CD4+ cell count <200/μl. Patients aged ≥50 years had a slower but similar immune recovery (p > 0.05). We found no significant differences in immunological response according to baseline viral load, HIV risk factor, sex, HCV co-infection and HAART regimen. ConclusionIn our study, patients with sustained viral suppression experienced a significant immune recovery over 8 years of HAART. We found that complete immune recovery was achieved only in patients with baseline CD4+ cell count >350/μl. This observation strengthens the hypothesis that starting HAART at CD4+ cell counts < 50/μl could not be adequate to obtain a complete immunological recovery.