Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
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Case Reports
[Cutaneous myiasis from Cordylobia anthropophaga in a traveller returning from Senegal: a case study].
Myiasis is the infestation of human or animal tissues by fly larvae. The disease is widespread especially in tropical countries. Here we report a case of myiasis due to Cordylobia anthropophaga that occurred in a traveller returning from Senegal. This case has some peculiar characteristics, regarding the site of the lesion and the clinical presentation.
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A 28-year-old woman previously known to have a ventricular septal defect presented with fever, headache, abdominal pain and nausea. Positive blood culture of methicillin-sensitive Staphylococcus aureus and the detection of vegetation attached to the right ventricular wall near the ostium of the ventricular septal defect confirmed diagnosis of infective endocarditis. After four weeks' treatment with proper antibiotics the patient recovered.
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Review Comparative Study
[Guidelines for treatment of pneumonia in intensive care units].
Patients affected by pneumonia can be admitted in Intensive Care Units (ICUs) independently by the setting where the infection has been acquired (community, hospital, long-term care facilities); even more frequently pneumonia can develop in patients already hospitalized in ICU especially in those requiring mechanical ventilation for different reasons. Within the severe community acquired pneumonia requiring admission in ICU, the most frequently responsible micro-organisms are mainly represented by Streptococcus pneumoniae, but also by Legionella and Haemophilus. Pseudomonas aeruginona, anyway, cannot be excluded. ⋯ Late onset VAP and HAP in patients with risk factors for multi-resistant, by contrast, should be treated with a combination therapy: in case of defined or suspected P. aeruginosa, Klebsiella pneumoniae (ESbL+), Acinetobacter sp etiology, it is required the use of an anti-pseudomonas cephalosporin or an anti-pseudomonas carbapenem or b-lactam + beta-lactamase inhibitor associated with an anti-pseudomonas fluoroquinolone or an aminoglicoside. The possible presence of MRSA or Legionella pneumophila suggests the use of anti-Gram positive antibiotics such as glycopeptides or linezolid. These quidelines confirm the role of ciprofloxacin combined with beta-lactams whenever P. aeruginosa, Klebsiella pneumoniae (ESbL+), Acinetobacter sp. etiology is suspected.
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The life expectancy of HIV-infected patients treated with highly active antiretroviral therapy (HAART) has increased and now approaches that of the general population, while also the definition of AIDS has lost most of its epidemiological and clinical significance, due to the immune recovery obtained by large-scale administration of potent antiretroviral combinations. The prolonged survival of subjects with HIV infection, and the late recognition of patients with occult disease, will contribute to a progressive increase in disease incidence in patients aged 50-60 years or more in the near future. Unfortunately, the large majority of therapeutic trials addressed to assess and compare novel antiretroviral molecules and associations, as well as studies regarding antimicrobial chemotherapy of prophylaxis of AIDS-related opportunistic infections, have just advanced age and/or underlying chronic disorders (i.e. liver or kidney failure) among main exclusion criteria, or do not allow the extrapolation of data regarding older subjects, compared with younger ones. ⋯ However, immune reconstitution is often slower and blunted according to age progression, although some well-designed studies have shown that the thymic function (which controls most quantitative and functional immune recovery) can be preserved in adults and even in advanced age. When facing older subjects, the Infectious Disease specialist has to pay careful attention to any chronic end-organ disorders, all possible pharmacological interactions, and overwhelming toxicity due to underlying drug therapies: all these issues may significantly interfere with HAART efficacy, patients' adherence to prescribed treatments, and frequency and severity of untoward events. Guidelines for antiretroviral therapy and treatment and prophylaxis of AIDS-associated illnesses should be appropriately updated, given the novel features due to the emerging increase in the mean age of the HIV-infected patient population.
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In a survey of 25 Divisions of Internal Medicine and Pneumology throughout Italy, our study aimed to ascertain the diagnostic and therapeutic pathway, the gravity in accordance with Fine's score (PSI), the median hospital length of stay and mortality rate among patients consecutively hospitalized for community-acquired pneumonia (CAP), from January 1 to March 31, 2002. Overall 407 patients were evaluated, with a mean age of 69 years; the following Fine's scores: 28% less than 70, 21.4% between 71 and 90, 31.25% between 91 and 130, 19.4% more than130. A single chest radiography was performed in 27.2% of the patients, two chest radiographs in 55.2% of the patients, more than two chest radiographs in 13.2% of the patients. ⋯ Antibiotics were used as follows: beta-lactams in 46.5% of the patients, fluoroquinolones in 30% of the patients, macrolides in 13.2% of the patients, glycopeptides in 2.2% of the patients, others in 2.9% of the patients. Mean hospital stay was 11 days; the 30-day in-hospital mortality was 9.6%. This study showed that a large number of patients with low-risk CAP were unnecessarily hospitalized.