Biomedical subjects

A Matteelli

Publications and source records attributed to A Matteelli.

At least 37 records · Page 2Linked to original sources

PubMed2000

Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection.

OBJECTIVE: To assess the association between use of different antiretroviral regimens and incidence of tuberculosis among HIV-infected individuals. DESIGN: Observational, multicenter, prospective cohort study. SETTING AND PATIENTS: Twenty-eight infectious diseases hospital units in Italy. A total of 2160 HIV-infected persons were considered for enrolment in a study on the implementation of tuberculosis preventive therapy between 1 May 1995 and 30 April 1996. The 1360 subjects who completed tuberculin screening at base-line were included in this analysis. Information on the use of antiretroviral therapies over time was collected. The median duration of follow-up was 104 weeks and 997 subjects (73.3%) completed the study. MAIN OUTCOME MEASURE: Incidence of active tuberculosis according to different types of antiretroviral therapy. RESULTS: Eighteen cases of tuberculosis were observed with an overall incidence rate of 0.79 per 100 person-years of observation [95% confidence interval (CI), 0.51-1.31]. Tuberculin positivity and low CD4+ lymphocyte count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 took triple combination therapy. After adjusting for base-line characteristics of enrolled individuals, the relative hazard of tuberculosis was 0.16 (95% CI, 0.03-0.74) for double combination therapy and 0.08 (95% CI, 0.01-0.88) for triple combination therapy compared with no therapy or monotherapy. CONCLUSIONS: Combination antiretroviral therapy significantly reduced the risk of tuberculosis in HIV-infected persons. In industrialized countries, the widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, possibly contributing to a reduction in the overall incidence of tuberculosis.

Adolescent↗

PubMed2000

Prevalence and distribution of soil-transmitted helminth (STH) infections in urban and indigenous schoolchildren in Ortigueira, State of Paranà, Brasil: implications for control.

Soil-transmitted helminth (STH) infections represent a major public health problem in poor and developing countries. During the period September-October 1998 we conducted an epidemiological survey of STH infections in schoolchildren of an urban area (group A) and an indigenous reserve (group B), in the Municipality of Ortigueira, State of Paranà, Brazil, to assess potential benefits of mass treatment. Stool samples were examined for helminth eggs by quantitative (Kato-Katz) technique to determine the prevalence and intensity of intestinal parasitic infection. Moreover, we examined the relationship between prevalence and intensity of STH infections and housing/hygienic factors (by means of a 7-item questionnaire). 236 schoolchildren aged 5-15 years were enrolled, 136 in group A and 100 in group B. The prevalence of STH infections was significantly higher in group B (93%) than in group A (22%) (P < 0.001). Detected parasites were: A. lumbricoides (16.1% prevalence in group A, 88% in group B, P < 0.001), hookworms (5.8% in group A, 52% in group B, P < 0.001) and T. trichiura (5.1% in group A, 2% in group B, P = 0.2). Heavy infections were detected in 2.9% and 23% of the children in group A and B, respectively (P < 0.001). Housing/hygienic indicators were significantly poorer in group B. A statistically significant correlation was observed between total prevalence of STH infections and prevalence of high-intensity infections with most housing/hygienic variables. On the basis of these results, mass treatment and educational interventions were suggested for the indigenous community, whereas target treatment and educational interventions were suggested for the urban community. Even in a geographically homogeneous area different epidemiological realities can be found, which in turn can influence infection levels and control programmes.

Adolescent↗

PubMed2000

Passive sentinel surveillance system for sexually transmitted diseases in primary healthcare sites in Ethiopia, 1991-3.

BACKGROUND: In 1989 the ministry of health of Ethiopia launched an STD control programme to strengthen the STD case management capabilities at public health centres and hospitals. The programme included the introduction of a syndrome based system for notification of STD cases. We here report the data originated by the syndromic case reporting system under programme conditions. METHODS: 35 (17%) of the total 225 hospitals and public health centres of Ethiopia were included in the programme. Information relevant to the years 1991 to 1993 was analysed at mid 1994. RESULTS: 32 clinical sites (91% of the total) provided at least one monthly report. The proportion of monthly reports received was 65% of those due, ranging from 51% in 1991 to 73% in 1992 and 42% in 1993. A total of 77,294 consultations for STD related symptoms were recorded, including 70,200 new cases, 6588 repeated consultations, and 506 partners of STD patients. Among first attendant patients 38,459 (52.7%) were males with a male to female ratio of 1:1. Urethral discharge and vaginal discharge were the leading cause of consultation among males (58%) and females (64%) respectively. The frequency of genital ulcer diseases was 26% among males and 15% among females. Inguinal adenopathy in the absence of genital ulcers was also frequent, accounting for 10% of consulting males and 5% of females. Based on Gram stain, gonorrhoea was identified in 64% of the cases of urethral discharge, while trichomoniasis and candidiasis were identified by wet mount in 28% and 16% of the cases of vaginal discharge respectively. CONCLUSIONS: STDs are a common cause of consultation at public health centre sites in Ethiopia. A syndromic case reporting system proved to be efficient and produced valuable information to initiate assessment of the problem and to set up bases for monitoring trends of STD morbidity.

Communicable Disease Control↗

PubMed2000

Supervised preventive therapy for latent tuberculosis infection in illegal immigrants in Italy.

In a multicenter, prospective, randomized, open-label study of isoniazid-preventive therapy (IPT) for latent tuberculosis infection, illegal immigrants from countries where tuberculosis is highly endemic were enrolled at two clinical sites in Northern Italy. Of 208 eligible subjects, 82 received supervised IPT at a dose of 900 mg twice weekly for 6 mo (Regimen A), 73 received unsupervised IPT 900 mg twice weekly for 6 mo (Regimen B), and 53 received unsupervised IPT 300 mg daily for 6 mo (Regimen C). Supervised IPT was delivered at either one tuberculosis clinic or one migrant clinic. The probability of completing a 26-wk regimen was 7, 26, and 41% in Regimens A, B, and C, respectively (p < 0.005, Log- rank test calculated using Kaplan-Meier plots). The mean time to dropout was 3. 8, 6, and 6.2 wk in Regimens A, B, and C, respectively (p = 0.003 for regimen A versus either Regimens B or C). Treatment was stopped in five subjects (2.4%) because of adverse events. The rate of completion of preventive therapy for latent tuberculosis infection among illegal immigrants was low. Supervised, clinic-based administration of IPT significantly reduced adherence. Alternative strategies to implement preventive therapy in illegal immigrants are clearly required.

Adolescent↗

PubMed2000

[Classic and emerging sexually transmitted diseases in industrialized countries and in developing countries].

In industrialised countries, there has been a drastic decrease in the number of reported cases of syphilis, gonorrhoea, and tropical sexually transmitted diseases (STD) since the introduction of antibiotics in the 1950s, whereas among the general population of non-industrialised countries, the number of cases of these diseases has remained extremely high. The World Health Organization has estimated that, worldwide, 333,000,000 new cases of curable STD occur every year and that 90% of these cases come from non-industrialised countries. Moreover, viral STD, such as genital herpes, condyloma, hepatitis B infection, and HIV-1 infection, represent an even greater problem in that they are not curable. STD are also a cause of serious complications in the genital and reproductive tracts of both genders, and curing these complications requires substantial economic resources.

Developed Countries↗

PubMed1999

Epidemiological features and case management practices of imported malaria in northern Italy 1991-1995.

We report the results of a retrospective analysis of the clinical charts of imported malaria cases notified during the period 1991-95 in the Lombardy region of northern Italy. We analysed 694 admissions related to 683 individuals. The proportion of immigrants increased during the observation period from 34.4% in 1991 to 59.9% in 1995 (P = 0.002). P. falciparum was the causative species in 534 cases (78. 2%), and 591 (90.1%) of 656 cases with a full travel history had travelled to Africa. Information on chemoprophylaxis was available in 604 cases: 429 (71.0%) reported no drug intake, 140 (23.2%) an incomplete, and 35 (5.8%) a complete chemoprophylactic course. The proportion of subjects who had initiated malaria chemoprophylaxis was significantly lower among immigrants (7.4%) than nonimmigrants (50.2%) (P < 0.001). Severe disease was diagnosed in 26 (4.7%) of 551 cases of falciparum malaria, with a significantly lower incidence among immigrants (1.3% vs. 9.2%; P < 0.001). Eight deaths were recorded, all among nonimmigrants, whose fatality rate was significantly higher (P = 0.02). Mefloquine treatment of cases of uncomplicated falciparum malaria was associated with a significantly shorter fever clearance time (2.8 days +/- 1.5 vs. 3.5 days +/- 1.9; P < 0.001) and mean hospital stay (5.9 days +/- 4.4 vs. 8.3 days +/- 5.1; P < 0.001) compared to quinine treatment.

Adult↗

PubMed1999

Pediatric migration and hepatitis A risk in host population.

Hepatitis A virus (HAV) circulation in a given area is closely related to socioeconomic standards. Following the improvement of living conditions, HAV seroprevalence rates in the population have decreased steadily during the last decades in many Western European countries, including Italy, thereby leading to a shift of risk of disease towards older age groups. Since the severity of the disease closely parallels age, a higher incidence of symptomatic cases in adults is now reported in Europe and the United States, being travel-related to a large extent. Intrafamilial person-to-person spread is also an important source of infection and transmission from children to parents may occur due to the lack of immunity in the general population. In the last two decades, Italy has been the destination of an increasing number of migrants from developing countries, where HAV is highly endemic. Furthermore, international adoption programmes cause pediatric populations from HAV endemic countries to increase in low endemic areas, possibly leading to secondary cases in close contacts.7 The aim of this paper is to report the epidemic HAV outbreak which occurred among the voluntary nursing staff of a pediatric Rwandan refugee community hosted in a village of the Brescia Province, in northern Italy.

Adult↗

PubMed1999

Neurocysticercosis in an Italian traveler to Latin America.

Neurocysticercosis is rarely reported in short-term travelers, although the disease remains a major public health problem in tropical regions. We present a case of neurocysticercosis that was probably acquired by ingestion of Taenia solium eggs contained in the stomach of a pig butchered by the traveler. Complete clinical resolution was obtained by medical treatment, underlying the importance of early suspicion and diagnosis of the disease.

Adult↗

PubMed1999

Short report: Diagnosis of tick-borne relapsing fever by the quantitative buffy coat fluorescence method.

The quantitative buffy coat (QBC) parasite detection method is a sensitive and specific tool for the diagnosis of malaria parasites. It is also useful for the diagnoses of other hemoparasites, including Trypanosoma, Babesia, and Leptospira. We report a case of relapsing fever diagnosed by this technique in a short-term traveler from Senegal. The diagnosis was confirmed by the standard Giemsa hemoscopy and by the identification of significant titers of antibodies to Borrelia spp. of tick-borne relapsing fevers by specific immunofluorescence and Western blot tests. The QBC technique seems to be useful in the diagnosis of tick-borne relapsing fever in blood samples and should be included in the management of fever in the traveler returning from tropical regions.

Blood↗

PubMed1999

Incidence of tuberculosis in a community of Senegalese immigrants in Northern Italy.

SETTING: Tuberculosis is the world's foremost cause of death from a single infectious agent among adults. Although morbidity and mortality rates are highest in low income countries, industrialized countries have also faced a recent resurgence of the tuberculosis epidemic. In Europe and the United States increasing tuberculosis incidence rates are observed, particularly among persons with the human immunodeficiency virus infection and immigrants from highly endemic countries. OBJECTIVE: To measure the incidence of tuberculosis in a retrospective cohort of Senegalese immigrants in a closed community. DESIGN: During 1991, 721 of 794 (91%) community residents were actively screened using the tuberculin skin test and chest X-ray. In 1995 the out-patient clinical charts and the tuberculosis notification registers were reviewed to determine tuberculosis incidence. RESULTS AND CONCLUSION: A total of 328 subjects (45.4% of those screened) was retrospectively followed for a cumulative period of 10 147 months. Ten cases of active tuberculosis were detected. The annual incidence rate for tuberculosis was 11.8/1000, compared to 15.1/ 100 000 in the general population. Tuberculosis incidence was similar in subjects with a positive (12.3/1000), compared to a negative baseline tuberculin test (12.5/1000). Tuberculosis incidence is very high, and recent infections might account for a substantial proportion of cases among immigrants living in closed communities.

Adolescent↗

PubMed1999

Tolerability of twice-weekly rifabutin-isoniazid combinations versus daily isoniazid for latent tuberculosis in HIV-infected subjects: a pilot study.

The tolerability of and adherence to intermittent short-term rifabutin-isoniazid preventive treatment was assessed in subjects dually infected with Mycobacterium tuberculosis and the human immunodeficiency virus (HIV). In a randomised, open-label, phase II pilot study, 44 subjects received either rifabutin 300 mg and isoniazid 750 mg twice weekly for 3 months (group A, n = 16) or the same regimen with rifabutin at 600 mg (group B, n = 14), or isoniazid 300 mg/day for 6 months (group C, n = 14). Three, two and four subjects in groups A, B, and C, respectively, did not complete their treatment (one case of flu-like syndrome in group B; one methadone withdrawal syndrome in group A; and patient decision in two cases in group A and four in group C). Overall, adverse events were reported by four, nine, and seven subjects in groups A, B and C, respectively. Intermittent combined rifabutin + isoniazid for 3 months had lower default rates than daily standard isoniazid for 6 months. The regimen with rifabutin at 300 mg dose compared favourably to standard isoniazid, and warrants larger efficacy studies to assess its role for the prevention of latent tuberculosis in HIV-infected subjects.

AIDS-Related Opportunistic Infections↗

PubMed1999

Malaria in migrants.

An increasing proportion of malaria cases in Italy is observed in immigrants revisiting their country of origin, but little specific research work has been carried out in this field. All malaria cases occurring from 1990 to 1998 at the Reference Clinic for Infectious and Tropical Diseases in Brescia were prospectically evaluated to compare clinical outcome in migrant and non-immune cases. No difference was observed between parasitaemia at diagnosis and time to clearance of peripheral parasitaemia. Clinical presentation was milder in migrants than in non-immunes, with an OR for severe malaria of 0.27 (c.i. = 0.09-0.84) (p = 0.01). Fever clearance time was significantly shorter in migrants (3.0 days, SD = 1.2) than in non-immunes (4.3 days, SD = 1.7) (p < 0.001). Among immigrants, the proportion of severe cases was higher in residents since 2 years or less (12.5%) compared to residents since 2 to 5 years (3.3%) and residents since more than 5 years (0.9%) (p = 0.02). The proportion of malaria cases who had used chemoprophylaxis was significantly lower among immigrants (30/272, 11.0%) compared to non-immunes (41/74, 55.4%) (p < 0.001). In a population based malaria KAP analysis among 504 migrants from malaria endemic countries, correct knowledge of malaria risk was reported by 351 (69.5%). Of 170 subjects who reported at least one visit back to the home country, 30 (17.6%) had sought pre-travel advice, 24 (14.1%) had started chemoprophylaxis and 7 (4.1%) had completed it during the last visit. Of 140 migrants who failed to seek pre-travel advice, 73 (52%) were unaware of malaria risk, 56 (40%) did not know how to protect themselves, and 11 (8%) refused to use protective measures. Migrants account for a significant proportion of imported malaria cases in industrialised countries. Clinical presentation is milder compared to non-immune subjects. The proportion of migrants who adopt malaria protective measure while returning home is very low, due to both unawareness of risk and inappropriateness of medical advice.

Adult↗

PubMed1998

Long term treatment with clarithromycin for cryptosporidiosis and emergence of drug resistant disseminated infection due to Mycobacterium avium: case report.

Macrolide resistance in disseminated Mycobacterium avium infection is of major concern in AIDS patients as these drugs represent the main component of combination therapy. Clarithromycin and azithromycin should not be used alone for the treatment and prophylaxis of the disease because of the risk of selecting resistant strains. We report the case of a clarithromycin resistant disseminated M. avium infection in an AIDS patient, acquired after long term monotherapy with clarithromycin for the treatment of cryptosporidiosis.

AIDS-Related Opportunistic Infections↗

PubMed1998

Tuberculosis due to drug-resistant Mycobacterium bovis in pregnancy.

We describe the management practices adopted in a case of pulmonary and extra-pulmonary tuberculosis caused by an isoniazid/pyrazinamide resistant strain of Mycobacterium bovis in a 26-week pregnant woman. She was initially treated with rifampin, isoniazid and ethambutol, pre-term delivery was induced and streptomycin was then added to the regimen. Screening of the new-born revealed no signs of either disease or infection. Isoniazid prophylaxis was not administered and the new-born was vaccinated and isolated from the mother for two months; however she continued to be fed with her mother's milk for the whole period.

Adult↗

PubMed1997

The placenta and malaria.

Placental malaria is recognized as a common complication of malaria in pregnancy in areas of stable transmission, and is particularly frequent and severe in primigravidae. Many hypotheses, based on a systemic or local failure of the immunological response to malaria, have been proposed to explain the 'preference' of the parasites for replication in the placenta. Some of the hypotheses are briefly reviewed here, with a particular focus on the discovery of an uncommon subpopulation of Plasmodium falciparum which can adhere and massively sequester in the placenta. Histologically, placental malaria is characterized by the presence of parasites and leucocytes within the intervillous spaces, pigment within macrophages, fibrin deposits and trophoblasts, proliferation of cytotrophoblastic cells and thickening of the trophoblastic basement membrane. The exact mechanisms leading to placental changes and determining the observed impairment of materno-foetal exchange are incompletely understood. Parasites are unlikely to be directly responsible for the placental pathology, but leucocytes, through the production of non-chemotactic cytokines, might be associated with the thickening of the trophoblastic basement membrane, and might cause a mechanical blockage of oxygen and nutrient transport across the placenta. There is sound epidemiological evidence that placental malaria determines low birthweight, mainly mediated by intrauterine growth retardation, and increases the risk of death and disease during the first year of life. Antimalarial chemoprophylaxis significantly reduces placental malaria and prevents the development of low birthweight. It is likely that, in areas of high endemicity, the placenta is where the drama of maternal malaria is mostly played. A deeper understanding of the mechanisms involved in this process is of key importance in the design of protective interventions which are effective and acceptable during the gestation period.

Disease Susceptibility↗

PubMed1996

Malaric placentas. A quantitative study and clinico-pathological correlations.

A histological and morphometric study was conducted on 372 placentae out of a total 440 delivered in Zanzibar. Fibrin (F), intervillous space (IVS) and Villi (V) relative volumes were determined by the point-counting system and the ratio of syncytium to blood capillaries by the linear intercept method. Parasitemia load and inflammatory reaction were graded semiquantitatively by the use of a 1 mm square grid. Parasitised red cells identified active malaria (AM), the presence of malarial pigment only identified past malaria (PM), and the absence of both characterized non-malarial placentae (NM). AM(17.87%), PM(21.61%) and NM(60.52%) placentae did not vary significantly in weight. Newborns from AM had a significantly lower weight than those from PM and NM. Peripheral and placental parasitemia were not coincident. Placental parasitemia load increased parallel with birthweight. The latter decreased with the increasing severity of the inflammation, particularly with the prevalence of lymphocytes in the IVS. Significantly increased volume of F was found in AM and PM placentae, while no significant variation was noticed in IVS and V volumes. The syncytium/capillaries ratio was significantly increased in AM. We conclude that low birthweight in malaria is linked to IVS inflammation but not to F deposits or parasitemia load. Non-leukotactic lymphokines might play some role. Morphologic aspects bespeak for a less mature placenta than expected and this might represent an adaptive change.

Birth Weight↗

PubMed1996

Malarial infection and birthweight in urban Zanzibar, Tanzania.

In urban Zanzibar, Tanzania, 389 women with full-term pregnancies were studied to see what effect their infection with malaria (at delivery) had on the birthweight (BW) of their infants. The overall prevalence of low birthweight (LBW) (i.e. < 2500 g) was 3.9% (15 out of 389). Overall, 21.3% (82/384) of the women only had peripheral parasitaemias at delivery, 17.6% (58/329) only had active placental infections and 47.9% (157/328) had both. The youngest women (< 20 years), the primiparae and those with Plasmodium infection gave birth to neonates with relatively low mean BW. The lowest mean BW (2967 g) was found among the offspring of women with active placental infection (N = 58). The women with past/chronic infection (N = 73) or no infection (N = 201) generally produced heavier infants, with mean BW of 3242 and 3338 g, respectively. The women with active placental infection were also far more likely to have babies of LBW (15.5%) than those with past/chronic infection (1.4%) or no infection (1.5%). Multivariate analysis indicated that the highest relative risk of LBW (10.1, with a 95% confidence interval of 2.9-35.4) was associated with active placental infection, with no significant difference between primiparae and multiparae. In the study population, therefore, with its low prevalence of LBW, malaria infection increased the risk of LBW in full-term neonates by about 10-fold, with a population-attributable proportion of 55.4%.

Adult↗

PubMed1996

Prophylaxis for tuberculosis in Europe--ongoing research.

The incidence of tuberculosis (TB) in patients with human immunodeficiency virus (HIV) infection has increased in recent years, raising issues regarding preventive therapy for TB in this high-risk patient population. To determine if an HIV-positive individual is at risk for reactivation of latent infection, testing with purified protein derivative (PPD) is recommended; however, many people with impaired cell-mediated immunity due to HIV are anergic. Strategies regarding PPD testing and criteria for HIV-positive patients are presented. Isoniazid has been the accepted drug for use as prophylaxis for TB in immunocompetent patients, and there is evidence that isoniazid is also effective in HIV-positive, PPD-positive patients. Data from efficacy and feasibility trials and the risks and benefits of preventive therapy with isoniazid are discussed. Because of toxicity and compliance problems with isoniazid, there is a continuing need for development of alternative therapies. The results of some preliminary studies of newer therapies are presented here.

AIDS-Related Opportunistic Infections↗