Non-typhoidal
Salmonella
(NTS) spp. causes about 40% of all infective aortitis and it is characterized by high morbidity and mortality. Human infection occurs by fecal–oral transmission through ...ingestion of contaminated food, milk, or water (inter-human or zoonotic transmission). Approximately 5% of patients with NTS gastroenteritis develop bacteremia and the incidence of extra-intestinal focal infection in NTS bacteremia is about 40%. The organism can reach an extra-intestinal focus through blood dissemination, direct extension from the surrounding organs and direct bacterial inoculation (e.g. invasive medical procedures). Medical and surgical interventions are both needed to successfully control the infection. Here, we report a case of abdominal sub-renal aortitis caused by
Salmonella enterica
serovar Enteritidis in an 80-year-old man.
Abstract
Background
Even though malaria incidence is decreasing worldwide, travel-related cases reported in Europe have remained stable in recent years. In Italy, incidence had increased in the ...1990s, reaching a peak in 1999; a slow decline was then reported over the subsequent decade. To our knowledge, few published data are available on imported malaria in Italy since 2010. In this article we aimed to analyse trends in imported malaria in the teaching hospital of Brescia, northern Italy, over the last 18 years.
Methods
All malaria cases diagnosed from 1999 to 2016 in Spedali Civili Hospital, Brescia, were retrospectively identified. Demographic, clinical and travel-related data were described.
Results
A total of 1200 cases of imported malaria were diagnosed in Brescia during the study period. Among them, 225 were children. A trend of increasing paediatric cases was identified over the study period, while cases in adults were stable. Most cases were diagnosed between August and October. Patients were most likely exposed in sub-Saharan Africa (87.2%). The main reported travel reason was travelling to visit friends and relatives (66.0%). A significantly higher risk of severe malaria was observed in non-immune patients and children visiting friend and relatives (P < 0.001 and P = 0.006, respectively).
Conclusions
Our study reveals a relatively stable incidence in imported malaria cases with a peak during the summertime. A large and increasing paediatric burden of disease was identified. Imported malaria requires attention since in Italy a potential reappearance of autochthonous Plasmodium vivax malaria transmission cannot be excluded. Preventive action and physician awareness should be especially directed to children visiting friends and relatives in endemic countries and to non-immune patients since they both represent high-risk groups for severe malaria.
S. typhi
infection rarely involves the genitourinary system. We report the first described case of acute epididymo-orchitis due to
S. typhi
in a 14-year-old boy from Bangladesh. A high index of ...suspicion should be maintained when evaluating patients coming from endemic countries also in case of unusual sites of infection.
Abstract
Background
Schistosomiasis is a neglected tropical disease caused by trematodes of the genus Schistosoma. Schistosoma haematobium causes urogenital schistosomiasis (UGS), a chronic disease ...characterized by pathology of the urogenital tract leading to potentially severe morbidity for which the treatment is poorly standardized. We conducted a survey in TropNet centres on the clinical presentations and management strategies of complicated urogenital schistosomiasis (cUGS).
Methods
We reviewed the clinical records of patients seen at TropNet centres over a 20-year timespan (January 2001–December 2020). Case definition for cUGS included the presence of urogenital cancer, obstructive uropathy, kidney insufficiency of all grades and female or male genital involvement leading to infertility. Collected data included demographic information, patient category (traveller or migrant), imaging data, microbiological data (serology results and presence/absence of eggs in urine), histological features and outcome at last visit recorded.
Results
Eight centres contributed with at least one case. Overall, 31 patients matched the inclusion criteria. Sub-Saharan Africa was the most likely place of infection for included patients. Median age was 30.6 years (range 21–46, interquartile ranges, IQR 27–33). Most patients (28/31, 90.3%) were males. Hydronephrosis was the most frequent complication, being present in 18 (58.1%) patients, followed by cancer, present in 5 patients (16.1%); 27 patients (87.1%) required surgical management of some sort. Use of praziquantel varied across centres, with six different regimens employed.
Discussion
Very few cases of cUGSs were found in our survey, possibly indicating underdiagnosis of this condition. Hydronephrosis was the most frequently observed urogenital complication, and most patients required invasive procedures. Infection by S. haematobium can result in considerable morbidity, resulting in clinically challenging presentations requiring a multidisciplinary approach. As such, development of common protocols for early diagnosis and treatment is urgently needed.
The final document was published 4, and a summary of major changes is provided herewith.1 Bite prevention The use of insect repellents was broadenened on the basis of publications, international ...guidelines and statements consequent to the Zika virus epidemics 5,6,7, allowing their use in children over 3 months and pregnant women.2 Chemoprophylaxis The use of chemoprophylaxis and ED/SBET as first line choice has been modified in some areas: -India (Madya Pradesh), Colombia (Pacific coast area), and Venezuela (South of Orinoco): chemoprophylaxis; -Nairobi urban area, Kenya: ED/SBET; -Sri Lanka: ED; In case of drug switch, atovaquone/proguanil must be continued for 7 days after leaving or after the switch, and Mefloquine and doxycycline up to 4 weeks after leaving the risk area. Chemoprophylaxis in pregnancy has been revised, with mefloquine allowed and atovaquone/proguanil acceptable after an accurate risk-benefit assessment in every single case 8.3 Early diagnosis, SBET The use of rapid diagnostic tests for ED has been introduced, but only in expatriates, long term or repeated travels, or health care workers accompanying travellers. All Authors approved the final manuscript.Funding statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Declaration of competing interest The Authors have no conflicts of interest.Acknowledgements We thank prof Alessandro Bartoloni, President of the Italian Society for Tropical Medicine and Global Health, for establishing the working group and for his continuous support.
At admission, his blood test showed a white cell count of 5.5 × 103/μl, a hemoglobin level of 15 g/dl, elevated C-reactive protein (CRP, 105 mg/l), and low sodium level (129 mmol/l). On March 9th, ...Salmonella spp was identified by MALDI-TOF (Matrix Assisted Laser Desorption/Ionization; BioMérieux, Florence, Italy) in blood cultures. By comparing sequences of ceftriaxone-sensitive, MDR and XDR strains available at the European Nucleotide Archive under accession ERP001718, SalBs19 resulted as part of the XDR Pakistan clone sharing maximum three Single Nucleotide Polymorphisms (SNPs) with XDR Pakistan strains and with the European XDR strains isolated from travelers 3,4 (Fig. 1).
•Colchicine is not superior to standard of care in reducing the risk of mortality, clinical worsening or mechanical ventilation in hospitalized patients with COVID-19 pneumonia.•Colchicine should be ...administered with caution in the advanced phases of the disease.•Older patients with comorbidities (pre-existent heart, lung, upper-gastrointestinal, lower-gastrointestinal diseases, and cancer) are characterized by worse outcome.
To evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19.
This interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death.
152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group.
Colchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.
To describe the infant feeding practices in the general population in Uganda, and to assess the impact of maternal HIV status on these practices, a questionnaire was administered to women attending ...the follow-up clinics for child vaccination. Among the mothers who were still breastfeeding at the time of interview (N=838), 61.4% of the HIV-infected women had planned to breastfeed for a maximum of 6 months, compared with 12.1% of the HIV-uninfected women (p<0.001). Among the women who were not breastfeeding at the time of interview (N=108), 82.5% of the HIV-infected women had stopped breastfeeding within 3 months, compared with 23.5% of the HIV-uninfected women (p<0.001). Only 2.1% of HIV-infected women seen up to 14 weeks postnatally practised mixed feeding, compared with 23.6% of HIV-uninfected women (p<0.001). After 6 months, however, 30% of the HIV-infected women and 55% of the HIV-uninfected mothers were using mixed feeding, with no significant differences. Programmes for the prevention of mother-to-child transmission of HIV should re-enforce counselling activities to address the issue of early weaning by HIV-infected women, and to support safe breastfeeding up to 6 months.
Introduction
Due to the increasing number of refugees from East Africa, louse-borne relapsing fever (LBRF) has become an emergent disease in Europe. No single case of LBRF has been reported in Europe ...in refugees from other parts of Africa.
Case report
We report a case of LBRF in a refugee from Mali, likely acquired in Libya, where several migration routes into Europe meet. The disease must be considered in any febrile refugee regardless the country of origin.
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