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In migrants coming to Italy from 106 countries, MDR-TB was high from the former Soviet Union and low from Africa http://ow.ly/WZDbo

Background. The number of patients with severe Clostrid- ium difficile-associated diarrhoea (CDAD) increases. Health care facilities are requested to establish rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. Objective. Aim of the single-center surveillance project was to establish local prevalence rates of N-CDAD in adult acute care medical patients. Methods. For a period of at least one year, all diarrhoeal stools from inpatients of a general internal medicine ward were tested for Clostridium difficile toxin A. Case record files were retrospectively analysed and questionnaires were completed for patients with positive stool assays who met the case definitions. Results and discussion. During the surveillance period, 2,610 medical patients had been acutely hospitalized. Stools had been submitted to the hospital laboratory from 163 patients (6.2%) because of diarrhoea and were screened for Clostridium difficile cytotoxin. Complete data sets were available for analysis from 150 patients. Of 137 identified potential cases, 77 (56.2%) met the case definitions for nosocomial diarrhoea. Thirteen of the patients with nosocomial diarrhoea (16.9%) were detected positive by the Clostridium difficile toxin A assay. The overall prevalence of N-CDAD among inpatients was 8.7 cases/100 diarrhoeal stools. The mean number of N-CDAD cases was 62.3 cases/100,000 patient days and 5 cases/1,000 patient admissions. The mean age of N-CDAD patients was 79.4 years (range 71 to 92). All patients were given broad-spectrum antibiotics before acute diarrhoea developed. Four patients died for reasons not directly related to N-CDAD which confirms increased disease severity as an important risk factor . Conclusions. This single-center surveillance project, which established N-CDAD rates at frequencies currently reported from international surveys, is useful as benchmark and will help in understanding patterns and impact of N-CDAD at the regional level., Journal of Preventive Medicine and Hygiene, Vol 50, No 2 (2009)

The epidemiology of the genetic sublineages of human metapneumovirus (hMPV) and their clinical relevance are not fully understood. We compared hMPV genotypes isolated in the province of Bolzano in Northern Italy with strains from nearby Italian and Austrian regions by sequencing of NP- and L-gene fragments. Our results suggest that similar strains cycle through adjacent geographic areas, with the respective subtypes replacing each other on a seasonal basis.

To determine the prevalence of Vero cytotoxin-producing Escherichia coli (VTEC) serotype O157 associated diarrhea in the Austrian patient population, we surveyed all stool specimens of liquid consistency submitted to the Federal Public Health Laboratory (FPHL) in Innsbruck for 2 years for this organism. This laboratory serves a population of approximately 1 Million people. Of 5,265 stool specimens, 7 yielded O157 VTEC. Five isolates of E. coli O157 phage type 32, VT2 were cultured from specimens received during a three day period from residents in the county of Schwaz. During the investigation of this "outbreak" E. coli O157 strains were also isolated from two household contacts. Only 1 out of 8 persons with E. coli O157 diarrhea had bloody stools, although 5 of 7 tested specimens (= 71%) also yielded Campylobacter jejuni. None of our patients received antimicrobial therapy directed against E. coli O157 (one child had josamycin). There were no fatalities and no cases of hemolytic uremic syndrome (follow up period: 6 months). Consumption of hamburger, roast beef, and unpasteurized milk was not confirmed in this study. In Austria, no O157 VTEC strain was isolated till June 1992, although at the FPHL in Innsbruck stool specimens of liquid consistency were cultured for this organism since January 1991.

Human cell lines (the T-cell lines H9, Jurkat, and HUT102, the myeloid lines U937 and HL60, and the Raji B cell line) were infected with HIV-1. HIV-1 antigen could be detected by immunofluorescence analysis in more than 50% of T cells and myeloid cells 15 days after infection. Infection of Raji cells took more than 2-3 months. Studies of cell surface marker expression revealed remarkable changes after HIV-1 infection of Raji cells: expression of CR2 (C3d/EBV receptor, CD19, CD20, CD22, CD23, CD10, and surface IgM) were highly reduced, in the case of CR2 and membrane-IgM from 100 to 0%, whereas levels of CD37 and CD38 remained unaltered by HIV-1 infection. U937 cells showed a reduction of CD4 expression from 14 to 5% after HIV-1 infection; the CR3 expression slightly increased from 25 to 30%. In contrast, HLA-DR was only expressed (21%) after HIV-1 infection but not in uninfected U937 cells. Expression of HLA-DR could be detected also in HL60 cells (33%) after HIV-1 infection. In H9 cells, CD4 was reduced from 60 to 30% after HIV-1 infection, whereas HLA-DR and CD25/IL-2 receptor expression increased from 16 to 90% and from 0 to 50%, respectively. CD4 was reduced from 70 to 0% from Jurkat cells after HIV-1 infection, whereas expression of CR2 was only slightly diminished from 8 to 4%. Expression of CR1 and HLA-DR was slightly increased in these cells (1 to 3%).(ABSTRACT TRUNCATED AT 250 WORDS)

In this study the structures of the AIDS-virus are presented, furthermore the cross-reactivity of HIV-1 and HIV-2 is described as well as the known genes of both viruses. The mechanism of cell infection, its kinetics and the special role of activated T-cells and macrophages in this process are outlined. This interrelation characterized phenomenologically based on the neopterin data available is now supported by experiments at a molecular level. This should lead to therapeutical and diagnostical consequences.

The effect of D-penicillamine on the replication of the Human Immunodeficiency Virus (HIV) in H9 T-lymphoblastoid cells was evaluated. HIV-infected and uninfected H9 cells were incubated for a period of 6 weeks with various concentrations of D-penicillamine. During the first 8 days, D-penicillamine (at concentrations of 0-150 micrograms/ml) did not influence growth and viability of H9/H9-IIIB cells. However, long term cultures and higher doses of the drug caused a decay in cell number and viability of the cultured cells. Up to the 8th day of culture, D-penicillamine did not exert an inhibiting effect on the number of HIV-infected cells but did suppress HIV-antigen production by up to 29%. After 6 weeks, in addition to a decrease of the relative viral antigen concentration from 390-500 ng/ml in the medium control to 210-320 ng/ml in cultures containing 150 micrograms D-penicillamine/ml, D-penicillamine also reduced the percentage of HIV-positive cells. Thus our results demonstrate an antiviral effect of D-penicillamine in H9 cultures.

Since its discovery in 1983, a lot of knowledge about the human immunodeficiency virus (HIV) has been accumulated. Our paper gives a brief survey on what is known at present about the structure, molecular biology, and the cell tropism of this virus. We discuss its relationship to other lentiviruses as well as its possible origin; in addition, we refer to the immune response to HIV and its interactions with the infected host. We also briefly summarize the difficulties encountered in the attempts to produce a vaccine against HIV and highlight some promising approaches in the development of such a vaccine.

The performance of C. difficile toxin A test (Oxoid, Basingstoke, UK), an immunoassay for the detection of C. difficile toxin A in fecal samples, for the diagnosis of C. difficile-associated diarrhea was compared with those of cytotoxin assay, culture, and a latex agglutination assay (Culturette Brand CDT Rapid Clostridium difficile test; Becton Dickinson, Cockeysville, MD). A total of 105 stool specimens from 71 patients were tested. Of the 105 specimens analyzed, 6 (5.7%) samples were positive by all four methods, 66 samples (62.9%) were concordant negative. Two patients fulfilled all clinical criteria for C. difficile-associated diarrhea but had negative results in the cytotoxicity tests. The sensitivity and specificity, as determined against cytotoxin assay results, were, respectively 52.4% and 93.9% for latex agglutination, 68.2% and 84.3% for rapid immunoassay and 36.4% and 92.8% for culture. No single laboratory test yields a definitive diagnosis of C. difficile-associated diarrhea at present. Test results by any of these methods must be used in conjunction with patient history when making the diagnosis to avoid indiscriminate treatment of individuals without disease or the lack of treatment for individuals with a serious infection. We consider the rapid and easy-to-perform C. difficile toxin A test not to be an essential adjunct for the diagnosis of C. difficile-associated diarrhea.

Acute cytomegalovirus (CMV) disease and indirect effects caused by the virus alter the outcome after solid organ transplantation. Long-term results after 54 lung and 139 cardiac transplants at a single center have been retrospectively analyzed with regard to CMV status. Standard CMV prophylaxis consisted of ganciclovir for 100 days. Lung recipients were pretransplant CMV negative in 32 per cent as compared to heart recipients with 23 per cent. Patient survival after mismatch transplants (donor positive, recipient negative) was significantly reduced as compared to the other match groups (42% vs 76% at five years, P = 0.01). In heart recipients, CMV positive patients receiving a CMV negative graft showed best survival, whereas in the group of lung recipients negative/negative matched transplants produced best results. In both groups, CMV negative grafts had a better outcome than CMV positive grafts, and a survival difference between heart and lung recipients was only observed in recipients of a CMV positive grafts. Despite ganciclovir prophylaxis, CMV match remains an important factor for survival follwing heart and, even more profoundly, lung transplantation. Because survival was least favorable in the mismatched group, prophylactic regimens warrant improvement. For CMV negative lung recipients, CMV matching might be considered.