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A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of >10 3 CFU liter ؊1 , and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

We explored whether influenza vaccination (IV) affects susceptibility to SARS-CoV-2 infection and clinical outcomes in COVID-19 patients in 17,608 residents of the Italian province of Reggio Emilia undergoing a SARS-CoV-2 test. Exposure to IV was ascertained and the strength of the association with SARS-CoV-2 positivity expressed with odds ratios (OR). Rates of hospitalisations and death in those found positive were assessed and hazard ratios (HR) were estimated. The prevalence of IV was 34.3% in the 4885 SARS-CoV-2 positive and 29.5% in the 12,723 negative subjects, but the adjusted OR indicated that vaccinated individuals had a lower probability of testing positive (OR = 0.89; 95% CI 0.80–0.99). Among the 4885 positive individuals, 1676 had received IV. After adjusting for confounding factors, there was no association between IV and hospitalisation (1.00; 95% CI 0.84–1.29) or death (HR = 1.14; 95% CI 0.95–1.37). However, for patients age ≥65 vaccinated close to the SARS-CoV-2 outbreak, HRs were 0.66 (95% CI: 0.44–0.98) and 0.70 (95% CI 0.50–1.00), for hospitalisation and death, respectively. In this study, IV was associated with a lower probability of COVID-19 diagnosis. In COVID-19 patients, overall, IV did not affect outcomes, although a protective effect was observed for the elderly receiving IV almost in parallel with the SARS-CoV-2 outbreak. These findings provide reassurance in planning IV campaigns and underscore the need for exploring further their impact on COVID-19.

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Objective Klinefelter Syndrome (KS) is classically described as characterized by hyperestrogenism, although solid evidence is lacking. This study aims to test the hypothesis that men with KS have higher serum estradiol than normal controls. Design Meta-analysis of all studies extracted by MEDLINE from 1942 to 31 January 2018. All studies reporting serum estradiol measurement were considered, among them only case-control studies were included in the meta-analysis. Methods Meta-analysis was conducted according to the PRISMA statement using RevMan. Results Out of 4120 articles, 23 case-control studies, 14 case series, and 19 case reports reported data on serum estradiol. A total of 707 KS and 1019 controls were included in the meta-analysis. Serum estradiol was slightly, but significantly higher in KS than controls (mean difference 4.25 pg/mL; CI: 0.41, 8.10 pg/mL; p = 0.030). This difference was lost considering only studies using estradiol assays with good accuracy (5.48 pg/mL, CI: −2.11, 13.07 pg/mL; p = 0.160). Serum testosterone and estradiol/testosterone ratio were significantly lower and higher in KS than controls, respectively. Data from KS case series and case reports confirmed that serum estradiol is within the normal ranges. Conclusions Serum estradiol is not increased in KS although slightly higher than controls. However, the meta-analysis that included only studies using a serum estradiol assay with good accuracy showed no difference in serum estradiol between KS and controls. The traditional belief that KS is associated with elevated serum estradiol should be reconsidered. This metaanalysis shows that men with KS have relative hyperestrogenism (increased estradiol/testosterone ratio) compared to controls.