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Carleo M.A.,Third Unit of Infectious Diseases | Del Giudice A.,Microbiology Unit | Viglietti R.,Third Unit of Infectious Diseases | Rosario P.,Fifth Unit of Infectious Diseases | Esposito V.,Fifth Unit of Infectious Diseases
In Vivo | Year: 2015

Abiotrophia defectiva or nutritionally variant Streptococcus (NVS) are a rare but important cause of infectious endocarditis, with high rates of bacteriological failure and mortality. We report the case of a 74-year-old man admitted for fever, fatigue and general malaise in the absence of any underlying cardiac, immunosuppressive illness and previous dental manipulations. Transthoracic and transesophageal echocardiogram revealed bacterial vegetation and significant aortic stenosis and regurgitation. Initial blood culture reported gram-positive cocci in chains, subsequently identified as A. defectiva. The patient completed 6 weeks of antibiotic therapy with ampicillin, with a significant decrease of serum inflammatory markers. He refused cardiac surgery and had relapsing endocarditis with positive blood culture for the same pathogen. The patient was then submitted to double-valve cardiac surgery, obtaining a prompt resolution of clinical signs and symptoms, without other relapse or any complications. Conclusion: Infectious diseases caused by A. defectiva are extremely rare illnesses. Due to the difficult isolation of the pathogen and the slow clinical progression, clinicians should be aware of this bacterium when dealing with blood culturenegative infective endocarditis.

Carleo M.A.,Fifth Unit of Infectious Diseases | Di Martino F.,Third Unit of Infectious Diseases | Del Giudice A.,Microbiology Unit | Gargiulo M.,Third Unit of Infectious Diseases | And 6 more authors.
In Vivo | Year: 2015

Background: The incidence of Kaposi's sarcoma (KS), an AIDS-related malignancy, has dramatically decreased in the Highly Active Anti-retroviral Therapy (HAART) era. However, KS remains the second most frequent tumor in HIV-infected patients worldwide and has become the most common cancer in the sub-Saharan Africa. Experimental studies have demonstrated a direct anti-neoplastic effect of HAART, and overall of protease inhibitors (PIs), on KS. Case Report: We describe five cases of KS in HIV-infected patients on HAART regimen, containing PIs as atazanavir/r (ATV/r), darunavir/r (DRV/r), lopinavir/r (LPV/r) and fosamprenavir (fAMP/r). Conclusion: Clinical and experimental observations support the hypothesis that PIs may play an important role in prevention and treatment of KS. In our study, the treatment with PIs of recent generation was not protective against the development of KS. Therefore, it could be necessary to reevaluate the therapeutic effects of PIs and their role in the development and treatment of KS in HIV-infected patients.

Parrella R.,Third Unit of Infectious Diseases | Esposito V.,Third Unit of Infectious Diseases | Onofrio M.,Third Unit of Infectious Diseases | Parrella G.,Third Unit of Infectious Diseases | And 9 more authors.
In Vivo | Year: 2015

Background/Aim: HIV infection is a risk factor for re-activation of latent tubercolosis infection (LTBI). In recent years new blood tests for the detection of TB infection have been developed: Quantiferon TB Gold in Tube and TSPOT TB, which are interferon-aγ releasing assays (IGRAs), have improved the identification of LTBI. In our study we have compared IGRAs and TST in HIV-positive patients with different settings of immunodeficiency. Patients and Methods: 98 consecutive HIV patients were recruited. They underwent a blood draw, a chest radiography and a tuberculin skin test. The HIV infection setting was detected and IGRAs were carriedout. Five patients showed a complete correspondence of TST, TSPOT-TB and QFT-IT. Discordant results were observed in patients testing positive to IGRAs but negative to TST. Only 2 patients showed positive TST and negative IGRAs. Conclusion: Our study showed a poor concordance between tuberculin skin test and IGRAs, mainly in patients with a low CD4 cell count.

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