Alberto Matteelli - Academia.edu (original) (raw)

Papers by Alberto Matteelli

Clinical and Vaccine Immunology, 2002

The relative balance between Th1 and Th2 cytokines appears crucial, since the role of cytokines h... more The relative balance between Th1 and Th2 cytokines appears crucial, since the role of cytokines has been evaluated in several studies by comparison of clinically heterogeneous groups of patients. The aim of this study is to determine the role of proinflammatory Th1 cytokines, interleukin-12 (IL-12) and gamma interferon (IFN-␥), and anti-inflammatory Th2 cytokines, IL-4 and IL-10, in a homogeneous group of patients with uncomplicated Plasmodium falciparum malaria. Levels of IL-12, IFN-␥, Il-4, and IL-10 in serum for 20 adult patients and 15 healthy control subjects were determined by an immunoenzymatic assay. Serum levels of Th1 cytokines, IL-12 (8.6 ؎ 2.8 pg/ml; controls, 3.2 ؎ 0.7 pg/ml) and IFN-␥ (39.2 ؎ 67.6 pg/ml; controls, 8.4 ؎ 6.3 pg/ml), were significantly increased at admission; 3 days later, levels of IL-12 in serum remained significantly high (8.8 ؎ 2.6 pg/ml), whereas IFN-␥ levels returned to control values. The anti-inflammatory response of Th2 cytokines (IL-10 and IL-4) was distinct. Levels of IL-10 in serum were not significantly increased at day 0 and day 3 (306.6 ؎ 200.4 pg/ml and 56.6 ؎ 38.4 pg/ml, respectively; controls, 17.4 ؎ 9.0 pg/ml). In contrast, levels of IL-4 in serum were not increased on admission (3.4 ؎ 1.2 pg/ml; controls, 2.4 ؎ 0.8 pg/ml), but at day 3 a moderate and significant increase of IL-4 levels was observed (4.5 ؎ 1.7 pg/ml). In conclusion, the increase of Th1 cytokine IL-12 and IFN-␥ levels during the acute phase of uncomplicated P. falciparum malaria may reflect an early and effective immune response regulated by proinflammatory Th1 cytokines, and in particular IFN-␥ may play a role in limiting progression from uncomplicated malaria to severe and life-threatening complications.

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2014

An 18 year old man was seen at a Sexually Transmitted Infections (STIs) clinic for counselling an... more An 18 year old man was seen at a Sexually Transmitted Infections (STIs) clinic for counselling and treatment of Chlamydia trachomatis genital infection which had been diagnosed during a screening survey of high school students. For two months he had reported conjunctival hyperaemia, increased tearing, itching, and mucopurulent secretions, predominantly on the left eye. His ophthalmologist had made a diagnosis of follicular conjunctivitis and lower superficial punctate keratitis (left eye more than right eye), irresponsive to topical treatment. Chlamydial conjunctivitis was suspected and confirmed by a positive nucleic acid amplification test (NAAT) performed on conjunctival scraping. The patient was treated with azithromycin 1 g single dose orally and tetracycline/betamethasone eye ointment for one month. A complete resolution of symptoms was observed three months after aetiological treatment. This case highlights the need to include C. trachomatis infection in the differential diag...

The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is ... more The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern and a serious issue related to the occurrence of further untreatable gonorrhea infections. A retrospective analysis on 1,430 N. gonorrhoeae isolates, collected from 2003 through 2012, for antimicrobial susceptibility by Etest and molecular characterization by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was carried out in Italy. Azithromycin-resistant gonococci decreased from 14% in 2007 to 2.2% in 2012. Similarly, isolates with high MICs to cefixime (>0.125 mg/liter) decreased from 11% in 2008 to 3.3% in 2012. The ciprofloxacin resistance rate remains quite stable, following an increasing trend up to 64% in 2012. The percentage of penicillinase-producing N. gonorrhoeae (PPNG) significantly declined from 77% in 2003 to 7% in 2012.

Infection, Genetics and …, 2006

Articles Articles, All fields, Author, Advanced search. Images Images, Journal/Book title, Volume... more Articles Articles, All fields, Author, Advanced search. Images Images, Journal/Book title, Volume, Issue, Page, Search tips. Font Size: Decrease Font Size Increase Font Size. ...

Tuberculosis: epidemiology and control, 2002

This book contains 14 chapters discussing the aetiology, pathogenesis, epidemiology, clinical pre... more This book contains 14 chapters discussing the aetiology, pathogenesis, epidemiology, clinical presentation, diagnosis, treatment, prevention and control of tuberculosis in children, women, patients with human immunodeficiency virus (HIV) infection, prisoners, refugees, ...

Background. Travelers visiting friends or relatives (VFR travelers) are a group identified with a... more Background. Travelers visiting friends or relatives (VFR travelers) are a group identified with an increased risk of travel-related illness. Changes in global mobility, travel patterns, and inter-regional travel led to reappraisal of the classic definition of the term VFR. Methods. The peer-reviewed literature was accessed through electronic searchable sites (PubMed/Medline, ProMED, GeoSentinel, TropNetEurop, Eurosurveillance) using standard search strategies for the literature related to visiting friends/relatives, determinants of health, and travel. We reviewed the historic and current use of the definition of VFR traveler in the context of changes in population dynamics and mobility. Results. The term ''VFR'' is used in different ways in the literature making it difficult to assess and compare clinical and research findings. The classic definition of VFR is no longer adequate in light of an increasingly dynamic and mobile world population. Conclusions. We propose broadening the definition of VFR travelers to include those whose primary purpose of travel is to visit friends or relatives and for whom there is a gradient of epidemiologic risk between home and destination, regardless of race, ethnicity, or administrative/legal status (eg, immigrant). The evolution and application of this proposed definition and an approach to risk assessment for VFR travelers are discussed.

The European respiratory journal, 2015

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<... more This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to t...

Journal of travel medicine

We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of d... more We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of death is discussed. The importance of prevention of malaria in nonimmune travelers is stressed. Prevention of malaria in nonimmune travelers should be regarded as a priority area for clinical practice and operational research.

Journal of travel medicine

We measured frequency and epidemiologic, clinical, and hematochemical variables associated with r... more We measured frequency and epidemiologic, clinical, and hematochemical variables associated with respiratory tract infections (RTIs) in foreign-born and national patients hospitalized with fever with a history of international travel, and compared the final diagnosis of RTI with the presence of a respiratory syndrome (RS) at presentation. A prospective, multicenter, observational study was conducted at tertiary care hospitals in Northern Italy from September 1998 to December 2000. A final diagnosis of RTI was obtained in 40 cases (7.8%), 27 (67.5%) with lower RTI and 13 (32.5%) with upper RTI. The most common RTIs were pneumonia (35%) and pulmonary tuberculosis (15%). A white blood cell count > or = 10,000 and an erythrocyte sedimentation rate > or = 20 mm/h were independently associated with a final diagnosis of RTI; onset of symptoms at > or = 16 days and > or = 75% neutrophils were independently associated with lower RTI. An RS was identified in 51 (9.9%) of 515 travel...

Journal of medical microbiology, 2014

Emerging Infectious Diseases

S taphylococcus aureus is a major pathogen associated with serious community and hospital-acquire... more S taphylococcus aureus is a major pathogen associated with serious community and hospital-acquired diseases. Methicillin-resistant S aureus 1 (MRSA) is responsible for a growing number of nosocomial infections, particularly in critically ill patients. 2,3 MRSA epidemiology seems to be changing, with MRSA strains being implicated in serious infections and nosocomial outbreaks, which appear to be disseminated globally in adult, pediatric, and neonatal intensive care units (ICUs). 4,5 The prevalence of MRSA infection varies from 5% to >50%, depending on the characteristics and size of the hospital. In Australia, 31.9% of the 2908 S aureus samples taken from 32 laboratories from all states and territories of the country were resistant BACKGROUND AND OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility. METHODS: This was a retrospective analysis of a database of all S aureus that were cultured from patients admitted to the different wards of Hospital Universiti Sains Malaysia (HUSM) over a period of 6 years. RESULTS: The MRSA infections rate was 10.0 per 1000 hospital admissions. The incidence density rate of MRSA infections during the study period was 1.8 per 1000 patient-days, with annual rates ranging from 0.95 to 3.47 per 1000 patient-days. Duration of hospitalization, previous antibiotic use, and bedside invasive procedures were significantly higher among MRSA than methicillin-sensitive S aureus patients (P>.05). The highest number of MRSA infections were found in orthopedic wards (25.3%), followed by surgical wards (18.2%) and intensive care units (ICUs) (16.4%). All MRSA isolates were resistant to erythromycin (98.0%), co-trimoxazole (94.0%) and gentamicin (92.0%). Clindamycin was the best antibiotic with only 6% resistance. All MRSA isolates were sensitive to vancomycin. CONCLUSION: The rate of nosocomial MRSA infection per 1000 admissions was higher than that in other studies. The three factors associated most significantly with acquired MRSA infections included duration of hospitalization, antibiotic use, and bedside invasive procedures. This study confirmed that vancomycin-resistant S aureus has not yet been established in HUSM.

Expert Review of Respiratory Medicine, 2009

Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) represent an emerging ... more Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) represent an emerging public health problem worldwide. The collision of the HIV epidemic with MDR- and XDR-TB has produced disastrous consequences for individual patients, with very high mortality rates reported in outbreaks among HIV-infected individuals. There is evidence of the importance of primary resistance among HIV-infected persons with XDR-TB, while the relevance of acquired resistance during inappropriate treatment among HIV-infected persons is uncertain, and TB case management of HIV-infected and -uninfected persons is based on similar standard practices to ensure treatment adherence. Current data show a limited geographical overlap of the XDR-TB and HIV epidemics: such data must be interpreted cautiously owing to the lack of adequate testing for both conditions. In fact, there are signs of an evolving epidemiological situation characterized by increased outbreak risk in concentrated areas owing to the extension of the HIV epidemic into areas of high MDR-TB prevalence and of the MDR-TB epidemic into areas of high HIV prevalence. There is a paucity of studies on treatment outcome among HIV-infected XDR-TB patients, and the only available report shows extremely high mortality rate and very short survival. Rapid diagnosis of TB and MDR-TB will be pivotal to reduce mortality among persons co-infected with HIV. However, while rapid diagnosis of MDR-TB is feasible with molecular assays on direct specimens, molecular approaches are still insensitive for XDR-TB diagnosis. There is speculative evidence that effective strategies for early HIV diagnosis and treatment will play a role in limiting the spread, and possibly improving the outcome of XDR-TB. Prevention is currently the mainstay of XDR-TB control in HIV communities. Strategies for infection control based on administrative procedures, environmental control and respiratory protection should be a priority for countries where both XDR-TB and HIV are prevalent. However, only the comprehensive implementation of the full Stop TB Strategy may be expected to curb the devastating impact of XDR-TB on HIV-infected persons.

European Respiratory Journal, 2014

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB)... more The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence.

Current HIV Research, 2007

Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare ... more Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.

Clinical Epidemiology, 2014

The advent of antibiotics for the treatment of tuberculosis (TB) represented a major breakthrough... more The advent of antibiotics for the treatment of tuberculosis (TB) represented a major breakthrough in the fight against the disease. However, since its first use, antibiotic therapy has been associated with the emergence of resistance to drugs. The incorrect use of anti-TB drugs, either due to prescription errors, low patient compliance, or poor quality of drugs, led to the widespread emergence of Mycobacterium tuberculosis strains with an expanding spectrum of resistance. The spread of multidrug-resistant (MDR) strains (ie, strains resistant to both isoniazid and rifampicin) has represented a major threat to TB control since the 1990s. In 2006, the first cases of MDR strains with further resistance to fluoroquinolone and injectable drugs were described and named extensively drug-resistant TB (XDR-TB). The emergence of XDR-TB strains is a result of mismanagement of MDR cases, and treatment relies on drugs that are less potent and more toxic than those used to treat drug-susceptible or MDR strains. Furthermore, treatment success is lower and mortality higher than achieved in MDR-TB cases, and the number of drugs necessary in the intensive phase of treatment may be higher than the four drugs recommended for MDR-TB. Linezolid may represent a valuable drug to treat cases of XDR-TB. Delamanid, bedaquiline, and PA-824 are new anti-TB agents in the development pipeline that have the potential to enhance the cure rate of XDR-TB. The best measures to prevent new cases of XDR-TB are the correct management of MDR-TB patients, early detection, and proper treatment of existing patients with XDR-TB.

Sexually transmitted …, 2001

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...

Emerging infectious …, 2001

The recent increase of population movements is paral-leled by an increase in imported malaria cas... more The recent increase of population movements is paral-leled by an increase in imported malaria cases in Europe, where malaria is not endemic (1,2). In Italy, migrants and foreign-born people visiting relatives represent an increasing proportion of imported malaria cases (3). Most ...

Clinical Infectious …, 2008

Clinical and Vaccine Immunology, 2002

The relative balance between Th1 and Th2 cytokines appears crucial, since the role of cytokines h... more The relative balance between Th1 and Th2 cytokines appears crucial, since the role of cytokines has been evaluated in several studies by comparison of clinically heterogeneous groups of patients. The aim of this study is to determine the role of proinflammatory Th1 cytokines, interleukin-12 (IL-12) and gamma interferon (IFN-␥), and anti-inflammatory Th2 cytokines, IL-4 and IL-10, in a homogeneous group of patients with uncomplicated Plasmodium falciparum malaria. Levels of IL-12, IFN-␥, Il-4, and IL-10 in serum for 20 adult patients and 15 healthy control subjects were determined by an immunoenzymatic assay. Serum levels of Th1 cytokines, IL-12 (8.6 ؎ 2.8 pg/ml; controls, 3.2 ؎ 0.7 pg/ml) and IFN-␥ (39.2 ؎ 67.6 pg/ml; controls, 8.4 ؎ 6.3 pg/ml), were significantly increased at admission; 3 days later, levels of IL-12 in serum remained significantly high (8.8 ؎ 2.6 pg/ml), whereas IFN-␥ levels returned to control values. The anti-inflammatory response of Th2 cytokines (IL-10 and IL-4) was distinct. Levels of IL-10 in serum were not significantly increased at day 0 and day 3 (306.6 ؎ 200.4 pg/ml and 56.6 ؎ 38.4 pg/ml, respectively; controls, 17.4 ؎ 9.0 pg/ml). In contrast, levels of IL-4 in serum were not increased on admission (3.4 ؎ 1.2 pg/ml; controls, 2.4 ؎ 0.8 pg/ml), but at day 3 a moderate and significant increase of IL-4 levels was observed (4.5 ؎ 1.7 pg/ml). In conclusion, the increase of Th1 cytokine IL-12 and IFN-␥ levels during the acute phase of uncomplicated P. falciparum malaria may reflect an early and effective immune response regulated by proinflammatory Th1 cytokines, and in particular IFN-␥ may play a role in limiting progression from uncomplicated malaria to severe and life-threatening complications.

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2014

An 18 year old man was seen at a Sexually Transmitted Infections (STIs) clinic for counselling an... more An 18 year old man was seen at a Sexually Transmitted Infections (STIs) clinic for counselling and treatment of Chlamydia trachomatis genital infection which had been diagnosed during a screening survey of high school students. For two months he had reported conjunctival hyperaemia, increased tearing, itching, and mucopurulent secretions, predominantly on the left eye. His ophthalmologist had made a diagnosis of follicular conjunctivitis and lower superficial punctate keratitis (left eye more than right eye), irresponsive to topical treatment. Chlamydial conjunctivitis was suspected and confirmed by a positive nucleic acid amplification test (NAAT) performed on conjunctival scraping. The patient was treated with azithromycin 1 g single dose orally and tetracycline/betamethasone eye ointment for one month. A complete resolution of symptoms was observed three months after aetiological treatment. This case highlights the need to include C. trachomatis infection in the differential diag...

The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is ... more The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern and a serious issue related to the occurrence of further untreatable gonorrhea infections. A retrospective analysis on 1,430 N. gonorrhoeae isolates, collected from 2003 through 2012, for antimicrobial susceptibility by Etest and molecular characterization by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was carried out in Italy. Azithromycin-resistant gonococci decreased from 14% in 2007 to 2.2% in 2012. Similarly, isolates with high MICs to cefixime (>0.125 mg/liter) decreased from 11% in 2008 to 3.3% in 2012. The ciprofloxacin resistance rate remains quite stable, following an increasing trend up to 64% in 2012. The percentage of penicillinase-producing N. gonorrhoeae (PPNG) significantly declined from 77% in 2003 to 7% in 2012.

Infection, Genetics and …, 2006

Articles Articles, All fields, Author, Advanced search. Images Images, Journal/Book title, Volume... more Articles Articles, All fields, Author, Advanced search. Images Images, Journal/Book title, Volume, Issue, Page, Search tips. Font Size: Decrease Font Size Increase Font Size. ...

Tuberculosis: epidemiology and control, 2002

This book contains 14 chapters discussing the aetiology, pathogenesis, epidemiology, clinical pre... more This book contains 14 chapters discussing the aetiology, pathogenesis, epidemiology, clinical presentation, diagnosis, treatment, prevention and control of tuberculosis in children, women, patients with human immunodeficiency virus (HIV) infection, prisoners, refugees, ...

Background. Travelers visiting friends or relatives (VFR travelers) are a group identified with a... more Background. Travelers visiting friends or relatives (VFR travelers) are a group identified with an increased risk of travel-related illness. Changes in global mobility, travel patterns, and inter-regional travel led to reappraisal of the classic definition of the term VFR. Methods. The peer-reviewed literature was accessed through electronic searchable sites (PubMed/Medline, ProMED, GeoSentinel, TropNetEurop, Eurosurveillance) using standard search strategies for the literature related to visiting friends/relatives, determinants of health, and travel. We reviewed the historic and current use of the definition of VFR traveler in the context of changes in population dynamics and mobility. Results. The term ''VFR'' is used in different ways in the literature making it difficult to assess and compare clinical and research findings. The classic definition of VFR is no longer adequate in light of an increasingly dynamic and mobile world population. Conclusions. We propose broadening the definition of VFR travelers to include those whose primary purpose of travel is to visit friends or relatives and for whom there is a gradient of epidemiologic risk between home and destination, regardless of race, ethnicity, or administrative/legal status (eg, immigrant). The evolution and application of this proposed definition and an approach to risk assessment for VFR travelers are discussed.

The European respiratory journal, 2015

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<... more This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to t...

Journal of travel medicine

We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of d... more We report a fatal case of malaria in an HIV-coinfected nonimmune traveler. The primary cause of death is discussed. The importance of prevention of malaria in nonimmune travelers is stressed. Prevention of malaria in nonimmune travelers should be regarded as a priority area for clinical practice and operational research.

Journal of travel medicine

We measured frequency and epidemiologic, clinical, and hematochemical variables associated with r... more We measured frequency and epidemiologic, clinical, and hematochemical variables associated with respiratory tract infections (RTIs) in foreign-born and national patients hospitalized with fever with a history of international travel, and compared the final diagnosis of RTI with the presence of a respiratory syndrome (RS) at presentation. A prospective, multicenter, observational study was conducted at tertiary care hospitals in Northern Italy from September 1998 to December 2000. A final diagnosis of RTI was obtained in 40 cases (7.8%), 27 (67.5%) with lower RTI and 13 (32.5%) with upper RTI. The most common RTIs were pneumonia (35%) and pulmonary tuberculosis (15%). A white blood cell count > or = 10,000 and an erythrocyte sedimentation rate > or = 20 mm/h were independently associated with a final diagnosis of RTI; onset of symptoms at > or = 16 days and > or = 75% neutrophils were independently associated with lower RTI. An RS was identified in 51 (9.9%) of 515 travel...

Journal of medical microbiology, 2014

Emerging Infectious Diseases

S taphylococcus aureus is a major pathogen associated with serious community and hospital-acquire... more S taphylococcus aureus is a major pathogen associated with serious community and hospital-acquired diseases. Methicillin-resistant S aureus 1 (MRSA) is responsible for a growing number of nosocomial infections, particularly in critically ill patients. 2,3 MRSA epidemiology seems to be changing, with MRSA strains being implicated in serious infections and nosocomial outbreaks, which appear to be disseminated globally in adult, pediatric, and neonatal intensive care units (ICUs). 4,5 The prevalence of MRSA infection varies from 5% to >50%, depending on the characteristics and size of the hospital. In Australia, 31.9% of the 2908 S aureus samples taken from 32 laboratories from all states and territories of the country were resistant BACKGROUND AND OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility. METHODS: This was a retrospective analysis of a database of all S aureus that were cultured from patients admitted to the different wards of Hospital Universiti Sains Malaysia (HUSM) over a period of 6 years. RESULTS: The MRSA infections rate was 10.0 per 1000 hospital admissions. The incidence density rate of MRSA infections during the study period was 1.8 per 1000 patient-days, with annual rates ranging from 0.95 to 3.47 per 1000 patient-days. Duration of hospitalization, previous antibiotic use, and bedside invasive procedures were significantly higher among MRSA than methicillin-sensitive S aureus patients (P>.05). The highest number of MRSA infections were found in orthopedic wards (25.3%), followed by surgical wards (18.2%) and intensive care units (ICUs) (16.4%). All MRSA isolates were resistant to erythromycin (98.0%), co-trimoxazole (94.0%) and gentamicin (92.0%). Clindamycin was the best antibiotic with only 6% resistance. All MRSA isolates were sensitive to vancomycin. CONCLUSION: The rate of nosocomial MRSA infection per 1000 admissions was higher than that in other studies. The three factors associated most significantly with acquired MRSA infections included duration of hospitalization, antibiotic use, and bedside invasive procedures. This study confirmed that vancomycin-resistant S aureus has not yet been established in HUSM.

Expert Review of Respiratory Medicine, 2009

Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) represent an emerging ... more Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) represent an emerging public health problem worldwide. The collision of the HIV epidemic with MDR- and XDR-TB has produced disastrous consequences for individual patients, with very high mortality rates reported in outbreaks among HIV-infected individuals. There is evidence of the importance of primary resistance among HIV-infected persons with XDR-TB, while the relevance of acquired resistance during inappropriate treatment among HIV-infected persons is uncertain, and TB case management of HIV-infected and -uninfected persons is based on similar standard practices to ensure treatment adherence. Current data show a limited geographical overlap of the XDR-TB and HIV epidemics: such data must be interpreted cautiously owing to the lack of adequate testing for both conditions. In fact, there are signs of an evolving epidemiological situation characterized by increased outbreak risk in concentrated areas owing to the extension of the HIV epidemic into areas of high MDR-TB prevalence and of the MDR-TB epidemic into areas of high HIV prevalence. There is a paucity of studies on treatment outcome among HIV-infected XDR-TB patients, and the only available report shows extremely high mortality rate and very short survival. Rapid diagnosis of TB and MDR-TB will be pivotal to reduce mortality among persons co-infected with HIV. However, while rapid diagnosis of MDR-TB is feasible with molecular assays on direct specimens, molecular approaches are still insensitive for XDR-TB diagnosis. There is speculative evidence that effective strategies for early HIV diagnosis and treatment will play a role in limiting the spread, and possibly improving the outcome of XDR-TB. Prevention is currently the mainstay of XDR-TB control in HIV communities. Strategies for infection control based on administrative procedures, environmental control and respiratory protection should be a priority for countries where both XDR-TB and HIV are prevalent. However, only the comprehensive implementation of the full Stop TB Strategy may be expected to curb the devastating impact of XDR-TB on HIV-infected persons.

European Respiratory Journal, 2014

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB)... more The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence.

Current HIV Research, 2007

Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare ... more Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.

Clinical Epidemiology, 2014

The advent of antibiotics for the treatment of tuberculosis (TB) represented a major breakthrough... more The advent of antibiotics for the treatment of tuberculosis (TB) represented a major breakthrough in the fight against the disease. However, since its first use, antibiotic therapy has been associated with the emergence of resistance to drugs. The incorrect use of anti-TB drugs, either due to prescription errors, low patient compliance, or poor quality of drugs, led to the widespread emergence of Mycobacterium tuberculosis strains with an expanding spectrum of resistance. The spread of multidrug-resistant (MDR) strains (ie, strains resistant to both isoniazid and rifampicin) has represented a major threat to TB control since the 1990s. In 2006, the first cases of MDR strains with further resistance to fluoroquinolone and injectable drugs were described and named extensively drug-resistant TB (XDR-TB). The emergence of XDR-TB strains is a result of mismanagement of MDR cases, and treatment relies on drugs that are less potent and more toxic than those used to treat drug-susceptible or MDR strains. Furthermore, treatment success is lower and mortality higher than achieved in MDR-TB cases, and the number of drugs necessary in the intensive phase of treatment may be higher than the four drugs recommended for MDR-TB. Linezolid may represent a valuable drug to treat cases of XDR-TB. Delamanid, bedaquiline, and PA-824 are new anti-TB agents in the development pipeline that have the potential to enhance the cure rate of XDR-TB. The best measures to prevent new cases of XDR-TB are the correct management of MDR-TB patients, early detection, and proper treatment of existing patients with XDR-TB.

Sexually transmitted …, 2001

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > June ...

Emerging infectious …, 2001

The recent increase of population movements is paral-leled by an increase in imported malaria cas... more The recent increase of population movements is paral-leled by an increase in imported malaria cases in Europe, where malaria is not endemic (1,2). In Italy, migrants and foreign-born people visiting relatives represent an increasing proportion of imported malaria cases (3). Most ...

Clinical Infectious …, 2008