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Biomedical subjects

R Manfredi

Publications and source records attributed to R Manfredi.

At least 19 recordsLinked to original sources
PubMed2003

Stenotrophomonas (Xanthomonas) maltophilia as an emerging opportunistic pathogen in association with HIV infection: a 10-year surveillance study.

BACKGROUND: Stenotrophomonas (Xanthomonas) maltophilia has been increasingly reported as a nosocomial opportunistic pathogen, responsible for serious infectious complications in immunocompromised patients. At present very limited information is available concerning its clinical significance in the setting of HIV infection. PATIENTS AND METHODS: A retrospective survey of clinical and microbiological records of 1,374 HIV-infected patients referring to our tertiary care center during a 10-year period (1991-2000) was performed to identify all episodes of S. maltophilia infection and analyze epidemiological, clinical and laboratory variables. The episodes of S. maltophilia bacteremia were compared with those caused by non-typhoid Salmonella spp. occurring in HIV-infected patients referring to our center during the same period, in order to evaluate eventual predisposing risk factors. RESULTS: 61 episodes of S. maltophilia infection were observed in 59 HIV-infected patients: sepsis/bacteremia in 48 cases (78.7%), lower airways infection in five, urinary tract infection in four, pharyngitis in two, lymphadenitis and liver abscess in one case each. 47 of 61 episodes (77%) of S. maltophilia infection occurred as nosocomial disease (i.e. were diagnosed after the 3rd day of hospitalization) and bacterial isolates showed an elevated resistance profile against many beta-lactam compounds, aztreonam, imipenem and aminoglycosides. At the same time, 38 episodes of bacteremia due to non-typhoid Salmonella spp. were diagnosed in our patients, 13 of which were nosocomial infections. CONCLUSION: When compared with non-typhoid Salmonella spp. bacteremia, a significantly higher risk of developing S. maltophilia disseminated infection was seen in association with advanced immunodeficiency, leukopenia-neutropenia, central venous catheterization, prior broad-spectrum antimicrobial therapy and/or corticosteroid treatment.

AIDS-Related Opportunistic Infections↗
PubMed2003

Disseminated histoplasmosis with atypical cutaneous lesions in an Italian HIV-infected patient: another autochtonous case.

Disseminated histoplasmosis is recognized as a common AIDS-defining opportunistic disease in endemic areas (Americas, Africa, East Asia), while it is rarely described in Europe, usually in individuals returning from endemic regions, or following endogenous reactivation of a latent infection imported long before from overseas countries. However, reports of autochtonous cases in Europe suggest the possible, endemic presence of Histoplasma capsulatum in some European regions, such as the South of France or the Po valley in Italy. A case of disseminated histoplasmosis with atypical, papular and ulcerate skin lesions in an Italian HIV-infected patient, without history of travels outside his native region, is described. Our patient represents the fifth autochtonous case of AIDS-associated histoplasmosis described in Italy.

AIDS-Related Opportunistic Infections↗
PubMed2003

Sexually-transmitted infections in adolescents and young adults in a large city of Northern Italy: a nine-year prospective survey.

To determine demographic, epidemiological, clinical features and risk factors of sexually-transmitted diseases (STD) in adolescents and young adults referring to a STD centre in Northern Italy, patients diagnosed with a STD and aged 13-20 years, were prospectively evaluated from the year 1991. Teenagers showed an appreciable and increasing risk of a broad spectrum of STD, and represented 3.6-13.3% of patients yearly diagnosed with a STD in a nine-year period. More than 10% of patients were under the age of 18, and did not report condom use in the six months preceding diagnosis in 96.7% of cases. A significant increase in the female gender was found since 1993 (but our series was massively influenced by the recent immigration of female sex workers, who declared frequent condom use), while male homosexuals and drug addicts represented a minority. When excluding subjects engaged in prostitution, over 50% of patients declared only 0-1 sexual partners during the last six months, but a significant increase in sexual promiscuity was observed over time (1997-1999 versus 1991-1996) (p<.02). Over two thirds of our teenagers never used a condom prior to the diagnosis of STD, and the apparently increased temporal trend to condom utilization proved related only to the recent immigration of sex workers; lack of condom use proved significantly related to the male gender, and a lower education. Non-gonococcal STD and human Papillomavirus infection accounted for over 60% of overall diseases, while the frequency of molluscum contagiosum, gonorrhea, HSV genital ulcer, and Chlamydia disease ranged from 6.1 to 7.4%, and that of syphilis, phthiriasis, trichomoniasis, and HIV infection varied from 1.3 to 4.7%. Non-gonococcal STD and syphilis were increasingly diagnosed over time, especially in immigrant prostitutes (and despite their frequent condom use). According to our surveillance study of teenagers, a number of demographic, epidemiological, and clinical features of STD showed significant variations over time: recent immigration, spread of prostitution, increased sexual promiscuity, and infrequent condom use, are relevant and/or persisting risk factors. A permanent monitoring of STD in young adults and adolescents is strongly warranted, to allow a timely diagnosis and an appropriate treatment, and to plan preventive strategies specifically addressed to this target population, with special attention to immigrants and sex workers.

Adolescent↗
PubMed2002

Use of fibrates in the management of hyperlipidemia in HIV-infected patients receiving HAART.

BACKGROUND: Despite potent antiretroviral activity, protease inhibitor-based pharmacological treatment of HIV disease has recently been associated with lipid and glucose metabolism abnormalities (more frequently hypertriglyceridemia and hypercholesterolemia). The aim of our open-label, randomized, prospective study was to evaluate the role of fibrates in the management of HIV-associated hyperlipidemia. PATIENTS AND METHODS: Plasma lipid levels of 635 HIV-infected patients referred to our tertiary care center and who had been receiving protease inhibitor-based antiretroviral therapy for at least 12 months were evaluated. All patients presenting hypertriglyceridemia (> 300 mg/dl) of at least 6-month duration and unresponsive to a hypolipidemic diet and physical exercise were treated with bezafibrate (400 mg once daily), gemfibrozil (600 mg twice daily) or fenofibrate (200 mg once daily) for 12 months. RESULTS: 69 (10.9%) of the 635 observed patients received fibrate therapy: bezafibrate was employed in 25 cases, gemfibrozil in 22 and fenofibrate in 22. Hypolipidemic drugs led to a reduction of 41.2% and 23.3% vs baseline triglyceridemia and cholesterolemia, respectively, with a favorable tolerability profile. CONCLUSION: All used fibrates showed a similar, significant efficacy in the treatment of diet-resistant hyperlipidemia, but further studies seem necessary in order to establish the most appropriate guidelines for the management of dyslipidemia associated with highly active antiretroviral therapy (HAART).

Antiretroviral Therapy, Highly Active↗
PubMed2002

Gabexate mesilate and/or octreotide in human immunodeficiency virus-associated pancreatic abnormalities.

BACKGROUND: Human immunodeficiency virus (HIV)-associated pancreatic alterations are frequent, but poorly investigated, notwithstanding their potential consequences on the course and management of HIV infection. No epidemiological or clinical data on pancreatic alterations have been published since the introduction of highly active antiretroviral therapy, and no indications of the pharmacological management of symptomatic or prolonged laboratory pancreatic abnormalities have been reported. AIM: To investigate the therapeutic role of gabexate mesilate and octreotide in HIV-infected patients with elevated, symptomatic or instrumentally confirmed pancreatic anomalies persisting for more than 3 months. METHODS AND RESULTS: An open-label, prospective, 5-year case-control study was conducted involving 185 consecutive patients with pancreatic alterations. Treatment of patients with severe laboratory and/or clinical involvement with low-dose gabexate mesilate and/or somatostatin was effective and safe and led to a lower recurrence rate and a better tolerability of concomitant drug regimens compared with supportive therapy taken by control patients. Combined gabexate-octreotide proved to be more active than single drug administration. CONCLUSIONS: Epidemiological and therapeutic data on the frequency, risk factors and clinical significance of pancreatic abnormalities during HIV infection are required, as are studies investigating the need for and choice of antisecretory and/or antiprotease compounds.

Adult↗
PubMed2002

Merkel cell carcinoma in a human immunodeficiency virus-infected patient.

In the general population, Merkel cell carcinoma (MCC) is a very rare neuroendocrine primary skin cancer, known for its high propensity for local recurrence and distant metastases. Treatment for this neoplasm is individualized on the grounds of clinical staging at presentation, and may include surgical excision, radiotherapy and chemotherapy. Several studies suggest that MCC occurs more frequently and with a more aggressive course in immunocompromised patients such as organ transplant recipients and those infected with human immunodeficiency virus (HIV). A case of this cutaneous malignancy, characterized by a short-term local recurrence and systemic fatal spread in spite of surgical treatment, radiotherapy and chemotherapy, is described in a patient with advanced HIV infection.

Carcinoma, Merkel Cell↗
PubMed2002

Doxycycline and chloroquine as treatment for chronic Q fever endocarditis.

Endocarditis is a rare but severe complication of Q fever, an infectious disease caused by the intracellular pathogen Coxiella burnetii. Heart involvement is the most common clinical presentation of chronic Q fever, and it occurs almost invariably in patients with previous valvular disease or artificial valves, and in the immunocompromised host. The optimal treatment of Q fever endocarditis is still today debated, and recommended duration of treatment varies from one year to one's lifespan. A case of chronic Q fever endocarditis is described in a patient with biological prosthetic aortic valve and aortic homograft, successfully treated with doxycycline and chloroquine for 2 years.

Anti-Bacterial Agents↗
PubMed2002

Community-acquired Pseudomonas aeruginosa sacro-iliitis in a previously healthy patient.

Pyogenic sacro-iliitis is an uncommon osteo-articular infection that occurs usually in immunocompromised patients and is associated with gram-positive cocci. It is very rarely linked with a gram-negative aetiology. The first case of Pseudomonas aeruginosa sacro-iliitis is described, which occurred in a previously healthy young man, without history of prior traumatic events, hospitalisation or chronic underlying disease.

Adult↗
PubMed2002

Long-term maintenance antiretroviral therapy with saquinavir hard gel, after voluntary abandonment of successful induction HAART.

HIV-infected patients who voluntarily resorted to an apparently suboptimal drug association including saquinavir hard gel after attaining viral suppression thanks to an antiretroviral regimen based on potent protease inhibitors, had a satisfactory 12-18-month clinical and laboratory outcome. The effects of a potent and sufficiently prolonged induction antiretroviral therapy may be maintained for 12 months or more, especially when the maintenance regimen includes novel nucleoside analogues, and specific genotypical mutations are absent.

Antiretroviral Therapy, Highly Active↗
PubMed2002

Frequency, epidemiology, risk factors, clinical and bacteriological features of enterococcal disease in patients with HIV infection in a decade survey.

In order to assess the frequency and clinical significance of Enterococcus spp. infection during HIV disease, the epidemiological features, risk factors, microbiological issues, and therapeutic perspectives of all the 148 consecutive episodes observed in the past decade were analyzed. The overall frequency of these complications (which involved the genito-urinary tract in over 75% of cases) regarded 5.3% of all admission for HIV disease, with a clear prevalence of Enterococcus faecalis as the causative agent (86.5% of episodes), and a proportionally elevated frequency of polymicrobial infection (45.9% of cases). Among the 148 cultured bacterial strains, a complete susceptibility to glycopeptide antibiotics was documented, together with favorable sensitivity levels against semisynthetic penicillins, followed by chloramphenicol, macrolides, and clindamycin. An advanced underlying HIV disease characterized by a concurrent, severe immunodeficiency, concomitant, prolonged neurological complications, hospitalization itself (with prevalence of nosocomial infection), recourse to invasive diagnostic and/or therapeutic procedures, and prior administration of broad spectrum antimicrobial agents, all seem to support HIV-associated enterococcal disease (mostly involving the genito-urinary tract). The adjunct of neutropenia, a very low CD4+ lymphocyte count, and severe AIDS-defining illnesses represented significant risk factors for hematogenous dissemination of this bacterial infection with potentially life-threatening consequences (16.1% of lethal cases among our septic patients).

AIDS-Related Opportunistic Infections↗
PubMed2001

Is there a place for a less extensive radical surgery in locally advanced cervical cancer patients?

OBJECTIVE: The aim of this study was to assess the association among the pathological status of different lymph node groups and parametrium in a single institutional population of 103 locally advanced cervical cancer (LACC) cases who underwent surgery after a neoadjuvant approach. A series of 29 early cervical cancer patients was also included in the analysis. METHODS: Eighty-two LACC patients with documented clinical response to neoadjuvant treatment and 29 early stage cases underwent radical surgery. The operative technique consisted of a type II-V radical hysterectomy and systematic pelvic lymphadenectomy (median number of lymph nodes removed 46; range 5-140). Sixty-four cases were submitted to para-aortic lymphadenectomy up to the level of the inferior mesenteric artery (median number of lymph nodes removed 13; range 1-37). RESULTS: Two subgroups of lymph nodes were defined: lower pelvic lymph nodes (LPN), including obturator and external iliac nodes, and upper pelvic nodes (UPN) including common iliac, presacral, and internal iliac nodes. Metastatic UPN involvement showed a strict association with LPN involvement: in LACC cases, 6 of 7 (86%) positive UPN cases had tumor disease at the LPN level. The single positive UPN case with negative LPN was intraoperatively identified by palpation and frozen section. Similarly, in early cervical cancer patients, 100% of positive UPN cases showed metastatic involvement at the LPN level. Sixty-three of 70 (90%) LACC patients with negative histological parametrium had negative LPN. Among 12 cases with metastatic involvement of parametrium, 5 cases (41.7%) had positive LPN. In early stage cervical cancer, 23 of 27 (85%) cases with negative parametrium showed no lymph nodal involvement. Intraoperative palpation of the parametrium could identify all cases with parametrial involvement not predicted by LPN status. CONCLUSIONS: These data offer the basis for tailoring the extent of radical surgery in LACC patients, through the selection of those lymph node stations likely to provide reliable information on the pathological status of UPN and parametrium.

Adult↗
PubMed2001

Carpal tunnel syndrome in HIV-infected patients treated with highly active antiretroviral therapy: other case reports.

A possible association between carpal tunnel syndrome and HIV infection has been suggested only once until now. Two patients with HIV infection are described who presented confirmed carpal tunnel syndrome while on prolonged protease inhibitor-containing highly active antiretroviral therapy (HAART). Their disease course and long-term outcome after medical and/or surgical interventions is presented and discussed according to available evidence from the literature. In our patients, carpal tunnel syndrome occurred in apparent absence of all presumed risk factors of this disease and metabolic abnormalities potentially related to HIV protease inhibitor administration.

Adult↗