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Leonardo Calza

Publications and source records attributed to Leonardo Calza.

64 records · Page 4Linked to original sources
PubMed2002

A life-long antiretroviral treatment of congenital HIV disease, associated with a mixed fat redistribution syndrome and osteopenia already occurred during pre-pubertal age.

An extraordinarily rare case report of mixed fat redistribution syndrome associated with osteopenia but not with relevant metabolic abnormalities is documented in a prepubertal child with congenital HIV infection treated with antiretroviral therapy since the age of six months, up to the present age of 12 years and two months. The possible relationship with prior and present antiretroviral treatment, and with the most recent literature evidences published in both adults and children with HIV disease are discussed, in order to focus these emerging adverse effects of long-term antiretroviral therapy in the paediatric population, and stimulate further investigation in this field.

Adolescent↗
PubMed2002

[Systemic lupus erythematosus and HIV infection. A case report and review of the literature].

Although HIV infection is often associated with several rheumatic diseases, the coexistence of this retroviral infection and systemic lupus erythematous is extremely uncommon. Etiopathogenetic relationship between these disorders is very complex and still problematic, so that diagnostic workout, because of their extensive clinical and serological overlap. Generally, HIV-related immunosuppression improves lupus-associated symptoms, and antiretroviral therapy may lead to an autoimmune disease flare, subsequent to the increase of circulating CD4+ cell number. A HIV-infected female patient with systemic lupus erythematosus, occurred few months after the highly active anti-retroviral therapy initiation, is described.

Adult↗
PubMed2002

[Reduction of antibiotic resistance of Enterococcus faecalis in infections of the genitourinary tract].

Antimicrobial susceptibility levels of Enterococcus faecalis isolated from urine were followed up at our University Hospital during three years (1999-2001), in order to evaluate the trend of antibiotic resistance of this common community-acquired pathogen of the genito-urinary tract. One thousand and 249 consecutive strains were examined, and a surprisingly low resistance profile was detected. As a result, penicillin , ampicillin, nitrofurantoin and piperacillin may still represent first-line agents in our area when community-acquired urinary tract enterococcal infections is of concern, pending in vitro susceptibility studies.

Anti-Bacterial Agents↗
PubMed2002

[Methicillin-resistant Staphylococcus aureus: a three-year epidemiological and microbiological survey of high-risk patients].

In order to assess the frequency, and epidemiological and microbiological features, of respiratory and blood stream infection due to methicillin-resistant Staphylococcus aureus in high-risk patients, all S. aureus strains cultured from reliable clinical specimens (respiratory secretions obtained by tracheo-bronchial aspirate or bronchoalveolar lavage, or blood cultures), were prospectively evaluated over a three-year period, in six inpatient wards selected on the ground of an elevated frequency of severe and/or nosocomially-acquired infections, because of the prevalence of immunocompromised patients, organ transplant recipients, or need of intensive care. Repeatedly positive cultures obtained from a single patient within 30 days were considered as one isolate. Of 507 S. aureus strains responsible for pneumonia or sepsis in the selected wards, 317 (62.5%) proved methicillin-resistant, in absence of significant variations throughout the study period, and according to the specimen origin. Methicillin-resistant S. aureus strains prevailed over sensitive ones in all examined wards (from a 95% rate of the respiratory intensive care unit, to 55.9% of the pneumology department), save the neonatal and pediatric intensive care unit (41.4%). Most of methicillin-resistant S. aureus isolates were recovered from lower airways, compared with blood cultures (p<.0001). The majority of the 317 methicillin-resistant strains were found in the general intensive care unit (42.6%), followed by the pneumology department (18%), and the respiratory intensive care unit (16.4%). Among methicillin-resistant S. aureus strains, a broad variation of sensitivity to other antimicrobial agents was observed: from 3.3% of erythromycin, to 76.9% of chloramphenicol, and 79.7% of cotrimoxazole; glycopeptide antibiotics remained effective against all cultured strains. In our three-year survey of more than 500 episodes of documented staphylococcal infection involving high-risk patients, methicillin resistance was a very common feature, observed at a greater frequency than that reported in literature studies focusing on surgical, pneumological, or intensive care settings. A long-term microbiological monitoring of high-risk inpatient wards may allow a continued update of local antimicrobial susceptibility maps, and significantly add to both chemoprophylaxis and empiric treatment strategies of patients which are either immunocompromised or hospitalized for a long period.

Humans↗
PubMed2002

[HIV genotypic mutation selectively induced by the protease inhibitor nelfinavir at codon 30. Case series and consequences for antiretroviral management].

In a survey of 247 HIV-infected patients which received at least six months of combined antiretroviral therapy including the protease inhibitor nelfinavir during the last two years (2000-2001), the specific primary genotypic mutation D30N (with or without the minor mutation N88D), was detected in only four of the 149 (2.7%) subjects who received genotypization after virological failure. Three of these cases of primary nelfinavir resistance occurred among the 84 patients who were protease inhibitor- and/or non-nucleoside reverse transcriptase inhibitor-na ve, while the last episode was registered in a female patient treated since five years, who received an indinavir-based therapy of nearly 12-month duration (interrupted because of untoward kidney effects). During the subsequent follow-up, the substitution of nelfinavir had a favourable laboratory and clinical outcome in all reported patients who continued a different highly active anti-HIV treatment, while a significantly less positive virological and immunological response was seen in all the remaining subjects, and especially in those who experienced virological failure after undergoing at least two prior changes of combined antiretroviral therapy, and were borne by a broad spectrum of protease gene mutations (save those regarding codons 30 and 88). Due to its exclusive resistance pattern, nelfinavir may represent a favorable first-line choice among protease inhibitor-based regimens, since it may spare further treatment options even in the same pharmacological class. In fact, cross-resistance with other protease inhibitors may be limited also in patients experiencing prior long-term antiretroviral therapy, from second-line to rescue regimens, provided that they were pre-treated with drugs other than nelfinavir.

Anti-HIV Agents↗
PubMed2001

Iliac osteomyelitis and gluteal muscle abscess caused by Streptococcus intermedius.

Streptococcus intermedius, included in the 'milleri group', is a commensal of the mouth and upper respiratory tract but it has often been associated with various pyogenic infections, such as endocarditis, pneumonia, abdominal or cerebral abscess, rarely with osteomyelitis, and exceptionally with muscular abscess. The first observed case of iliac osteomyelitis with gluteal muscle abscess caused by S. intermedius is reported. It is essential to recognise members of the 'milleri group' as possible agents of bone and muscle pyogenic infection because its management requires a timely diagnosis and prolonged antimicrobial treatment to achieve complete clinical and radiological recovery.

Abscess↗
PubMedDate not supplied

Prospective, open-label comparative study of liver toxicity in an unselected population of HIV-infected patients treated for the first time with efavirenz or nevirapine.

OBJECTIVE: To compare the two nonnucleoside reverse transcriptase inhibitors (NNRTIs) when first introduced in an antiretroviral regimen, a prospective open-label assessment of the frequency, severity, risk factors, and outcome of hepatotoxicity was performed. METHOD: Liver enzymes were followed-up during 18 months in patients who received efavirenz (EFV; 324 patients) or nevirapine (NVP; 299). RESULTS: The two study groups were comparable, except for the lower baseline CD4+ count found in the EFV group. No differences were found when considering the type and duration of eventual prior anti-HIV therapy; frequency and length of protease inhibitors, methadone, or anti-tubercular drug use; HCV-HBV co-infection; other hepatobiliary disorders; and alcohol-drug abuse. The frequency of overall and first-month drug interruption proved similar in the two study groups. A hepatotoxicity characterized by at least a 2-fold increase of transaminases versus baseline was significantly linked with NVP, and the number of patients showing hepatotoxicity tended to a reduction in the EFV group. Also the time to peak transaminase alterations was shorter in the NVP group. All significant differences regarding liver-pancreatic toxicities were controlled per eventual baseline hepatobiliary-pancreatic diseases, HIV stage, and concurrent drug therapies. DISCUSSION: Hepatotoxicity is a significant concern in the setting of antiretroviral-treated HIV disease. NVP-based HAART may be more hepatotoxic than EFV-based HAART, and a role is played by chronic liver disorders. Although concurrent hepatobiliary disorders and the possible hepatotoxicity of antiretrovirals do not represent contraindications to nonnucleoside inhibitor use, strict monitoring is recommended.

Adult↗
PubMedDate not supplied

A decade surveillance study of Mycobacterium xenopi disease and antimicrobial susceptibility levels in a reference teaching hospital of northern Italy: HIV-associated versus non-HIV-associated infection.

OBJECTIVE AND METHOD: The aim of our survey is to investigate the epidemiology and in vitro antimicrobial susceptibility levels of 35 consecutive Mycobacterium xenopi strains responsible for confirmed disease at a University Hospital from 1993 to 2002 and to identify eventual differences in the in vitro sensitivity profile between the 17 strains isolated from patients with HIV disease and the 18 isolates cultured from non-HIV-infected individuals. RESULTS: The involvement of lower airways accounted for 88.6% of cases; but atypical pulmonary findings, including cavitation and a prominent inflammatory reaction, recently emerged in HIV-infected patients successfully treated with HAART, which raises the possible role of immune reconstitution syndrome in the clinical pathomorphism of this opportunistic disease. When compared with non-HIV-infected patients, patients with HIV disease had a lower mean age and a tendency to suffer from late relapses. The greatest overall in vitro sensitivity rate was registered for capreomycin and protionamide (100% of strains) followed by kanamicin (96.6%), whereas susceptibility rates for the first-line compounds such as ethambutol, isoniazid, and rifampicin were slightly lower (85.7% to 91.4%). No temporal variation in the susceptibility index was seen over the study decade. Non-HIV-infected patients experienced a higher frequency of M. xenopi isolates that proved to be resistant to at least one tested compound compared with HIV-associated episodes, despite the heavy and prolonged exposure of HIV-infected patients to broad spectrum antimicrobials, which included agents effective on atypical mycobacteria. Only one HIV-positive patient developed rifampicin resistance in his third disease recurrence. CONCLUSION: A rapid diagnosis, a reliable differentiation between colonization and disease, and an optimal therapeutic choice for atypical mycobacterial disease (including M. xenopi one) are still serious challenges for clinicians and bacteriologists who treat immunocompromised patients, such as those with HIV disease. In the immunocompromised host, diagnostic difficulties posed by late identification and eventually concurrent opportunistic disorders add their negative effects to therapeutic problems due to the unpredictable in vitro susceptibility profile of atypical mycobacteria, such as M. xenopi.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[SARS: a new emergency in the world health].

The Severe Acute Respiratory Syndrome (SARS) is a new life-threatening respiratory disease which has its origins in Guangdong province, China, where the earliest known cases were identified in November 2002. Since then, probable cases of SARS have been reported in 30 countries and the current cumulative number of cases is 8,240 with 745 deaths and a global fatality rate of 9%. The most frequently involved areas include China, Hong Kong, Singapore, Canada, Vietnam and Philippines. Most cases of SARS to date have occurred in young adults and this disease appears to spread most commonly by close person-to-person contact, involving exposure to infectious droplets and body fluids. This transmission pattern generally involves household members, health care workers and international travellers, while a large and sudden cluster of almost simultaneous cases in an housing estate of Hong Kong has raised the possibility of transmission from an environmental source. The most common presenting symptoms are fever, malaise, non-productive cough and dyspnea, associated with pulmonary interstitial infiltrates on chest radiography. A novel coronavirus is associated with this outbreak, and the laboratory evidences indicate that this virus has an etiologic role in SARS, but the role of other concurrent viral agents (such as metapneumovirus) identified in these patients requires further investigation.

Adult↗