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Reverse Transcription Polymerase Chain Reaction (RT-PCR) conducted on nasopharyngeal swabs is the gold standard in the diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In Italy, recent guidelines indicate that rapid antigen tests (RATs) can be used for the isolation of positive patients or for the interruption of quarantine, but they are often less sensitive to detect positive subjects. Indeed, the performance of these RATs depends on the timing and the population on which they are evaluated. Herein, we evaluated the performance of BIOCREDIT COVID-19 Ag and Fluorecare ® SARS-CoV-2 Spike Protein Test during a population screening in the Calabria Region, Southern Italy. We report that both antigen test shows low sensitivity in contrast to the high sensitivity declared by manufacturer (90% and 92%, respectively) and that the area under the curve (AUC) was good for Fluorecare ® SARS-CoV- 2 Spike Protein Test but very poor for BIOCREDIT COVID-19 Ag. We suggest that these RATs should be re-evaluated in the current pandemic era., Competing Interests: Conflict interest All authors declared no conflict of interest., (Copyright © 2016 - 2022 InfezMed.)

Chronic hepatitis B virus (HBV) infection is a major health problem worldwide. Although Italy is considered a low prevalence setting for HBV infection, following significant migration in recent years there has been an increase in the occurrence of the disease. Italian guidelines recommend that all migrants be screened, vaccinated and treated for HBV, as required. Unfortunately, screening and vaccination in this population can be challenging for several reasons. We therefore conducted an analysis to evaluate the efficacy and outcome of the pathways of care (from screening to treatment) for HBV in a population of migrants. We evaluated 330 migrants who came to our centre between August 2015 and October 2018, and who were residing in seven different centres for refugees and asylum seekers. At the first evaluation, only 30% of them had already received screening for HBV. After our intervention, 23 (6.9%) were diagnosed as HBsAg carriers, whereas 204 (61.8%) were potentially eligible for vaccination. At a follow-up evaluation of the latter group, only 56.9% had by then been vaccinated, 17.6% had the vaccination course ongoing, and 17.1% had not started their vaccination course. Among those who were HBsAg positive, 73.9% were still in care at month 6 of follow-up, and only 43.3% were in care one year later. Our results demonstrated that both screening and vaccination strategies for HBV need to be improved in migrant populations. Similarly, a reinforcement of the network to keep in care migrants who initiated treatment or deserve clinical monitoring is necessary.

Few cases of complicated infections with Listeria monocytogenes (LM) have been reported to date in patients with multiple sclerosis (MS) treated with alemtuzumab. Primary prevention strategies may be suggested in such patients to avoid infections. However, these may be ineffective because patients may already be carriers of LM. We report herein a case of bloodstream infection due to LM in a 25-year-old woman with MS treated with alemtuzumab. We searched the UMC/WHO Vigibase system for all reported cases of LM in patients treated with alemtuzumab and found 29 cases overall up to 21 July 2019. We also performed a literature review of MS cases with LM on alemtuzumab, in order to evaluate epidemiology, clinical characteristics, and outcome of this complication. Since the published cases (N=8) were mainly reported in recent years but more cases were found in the UMC/WHO Vigibase system (although not necessarily in patients with MS), we hypothesize that this complication is more frequent than currently believed and may become even more important in the future. Therefore, it is worth reaching a consensus on appropriate algorithms to stratify individuals by risk so as to implement targeted prevention strategies (whether primary or secondary).

In recent years, migration has become a significant challenge in Western countries. Migrant populations, coming from hyper-endemic areas, may present parasitic infections that remain latent and asymptomatic even for years, eventually leading to severe complications. Italian guidelines have been established to perform screening guided by the presence of symptoms and/or hypereosinophilia. Parasitological screening was conducted in a migrant population to carry out preventative measures. All migrants were asked to report any symptoms suggesting parasitic infections and list any previous treatment received. Travel data were recorded. Parasitological examination of stools and urine were conducted in all patients regardless of symptoms. In all, 208 consecutive patients were enrolled in our outpatient clinic from November 2016 to August 2017. Thirty-four patients were excluded due to the previous assumption of albendazole or because they did not exhibit suitable samples. Prevalence of parasitic infections was 33/174 (18.9%). A statistically significant difference for the prevalence of parasitic infections was not found between patients who were asymptomatic and without hypereosinophilia compared to those who presented symptoms and/or hypereosinophilia (27/151 [17.9%] vs. 6/23 [26.0%]; p=0.39). By contrast, a statistically significant difference was found for the length of time between arrival in Italy and parasitological examinations (4/51 [7.8%] migrants who arrived in Italy more than six months prior to screening vs. 29/123 [23.6%] migrants who arrived within six months; p= 0.016). Our results did not demonstrate any significant differences in prevalence of parasitic infections between symptomatic or hypereosinophilic and asymptomatic migrants. Thus we feel it inappropriate to support recent guidelines recommending parasitological examinations only in migrants with symptoms and/or hypereosinophilia. By contrast, it would appear important to perform parasitological screening in migrants as soon as possible after their arrival. Since such infestations, if untreated, could result in chronic diseases and complications, and could be transmitted in the host countries, our results have potential implications for public health.

Late/chronic Lyme neuroborreliosis (LNB) represents a challenging entity whose diagnosis requires a combination of clinical and laboratory findings, surrounded by much controversy. Here we describe a patient who had a peculiar form of late LNB with CNS lesions shown by magnetic resonance imaging (MRI), and epileptic seizures, etiologically diagnosed by conventional and molecular methods. The current case provides evidence that patients presenting with epileptic seizures and MRI-detected multifocal lesions, particularly when a facial palsy has also occurred, should raise the suspicion of LNB, as this diagnosis has important implications for treatment and prognosis.

We describe a case of brain abscesses in a cirrhotic and diabetic 57-year-old woman showing fever, aphasia, right hemiparesis and seizures. Neuroradiological investigation revealed unilateral cerebritis evolving in multiple abscesses. From blood and surgical drainage samples Listeria monocytogenes grew in pure culture. Despite decompressive craniotomy, the patient died two months after hospital admission.

Pantoea agglomerans is an environmental organism which may seldom cause opportunistic infections. Here we report on a 6 case outbreak in a teaching hospital. Within three months . agglomerans was isolated from blood cultures of 5 patients from oncology and 1 patient from ICU departments. P. agglomerans was in pure culture in 5 cases, while in the last one Rahnella aquatilis and Candida famata were also isolated. Therefore, P. agglomerans is able to produce nosocomial infections in patients with primary pathology often associated with immune suppression.

We evaluated the applicability of the LightCycler Staphylococcus M(GRADE0 assay on artificially infected blood samples from healthy donors and on clinical specimens of 31 hospitalized patients. The sensitivity and specificity of the assay for detecting Staphylococcus aureus was 100% in blood samples, and 100% in blood culture bottles, when data from the BACTEC 9120 blood culture system were taken as gold standard. The same specificity and sensitivity was found during the search for CoNS (Coagulase Negative Staphylococci) in blood culture bottles, whereas a 93.33% sensitivity and 100% specificity was observed for detecting CoNS directly in blood clinical specimens.

Stenotrophomonas maltophilia is an emerging pathogen implicated in an increasing number of severe pulmonary infections and nosocomial sepsis. We evaluated the influence of four different antibiotics on the bacterial count and LPS activity found in broth cultures of S. maltophilia. After 4 h ceftazidime (CTZ) decreased live bacteria but increased endotoxin activity, whilst isepamicin (ISE), tobramycin (TB), and polymyxin B (PB) reduced both of them. We also investigated the influence of the above mentioned antibiotics on the ability of S. maltophilia culture filtrates and S. maltophilia LPS, extracted in our laboratory, to stimulate sepsis mediators such as tumor necrosis factor a (TNF-a), interleukin 8 (IL-8), interleukin 10 (IL-10), Nitric Oxide (NO) and as bactericidal/permeability-increasing protein (BPI) in human whole blood. Our results demonstrated that both single polycationic antibiotics and the combination of two molecules are able to kill bacteria and neutralize released S. maltophilia LPS. Combination between beta-lactams and aminoglycosides is often able to reduce the pro-inflammatory effects of S. maltophilia culture filtrates.

Geographical position, an increasing flow of immigrants and refugees coming from regions where malaria is endemic might further increase those cases of malaria imported to Calabria due to travel on military missions, visiting relatives, business and leisure. However, few reports have been published regarding malaria imported into the southern Italian region of Calabria. Based on data from our laboratory, official reports received from the Italian Ministry of Health and Regional Health Offices, an epidemiological analysis of malaria cases registered in Calabria from January 1988 to December 2001 is reported. The epidemiological and clinical features concerning the cases are discussed. A total of 34 slide-confirmed malaria cases were observed in Calabria during the period in question. Infections were mostly acquired in Africa (84.8%), while remaining infections came from Asia (9.1%) and South America and Europe (6.0%). Length of stay in the endemic area did not increase the infection risk. Etiological diagnosis indicated Plasmodium falciparum as the species most often involved (60.6%), followed by Plasmodium vivax (36.3%) and P. vivax/Plasmodium malariae mixed infection (3.0%). The mortality rate was about 3.0%. The number of cases during the second seven-year period of this study was almost double that of the first seven-year period. Correct chemoprophylaxis was performed by only 27.3% of our studied subjects. Delay of malaria diagnosis ranged between 4 days and 1 month. In conclusion, increases in malaria cases, mostly due to P. falciparum, delay in diagnosis and reporting to the Regional Health Office, as well as the increasing arrival of refugees from endemic areas, are epidemiological concerns in Calabria, the southernmost region of continental Italy.

Bartonella quintana is an epi- and intracellular gram-negative rod responsible for both acute and chronic clinical manifestations. We review the literature about pathogenic mechanisms of B. quintana and discuss our data. Our efforts to clarify Bartonella quintana pathogenesis run on two parallel tracks. The first one concerns interactions between Bartonella quintana and endothelial cells by evaluation and modulation of apoptosis, signal transduction pathways and inflammation. The second one concerns some biological activities of Bartonella quintana endotoxin on human whole blood and endothelium. The elucidation of the mechanisms regulating the inflammatory/proliferative pattern of chronic clinical manifestations of Bartonella quintana infections may offer a contribution for addressing the pathogenesis of intracellular bacterial persistence.

Bartonella quintana has been reported as the cause of trench fever, persistent endocarditis, bacteriaemia and has been isolated with an increasing incidence in clinical specimens from AIDS patients. One of the main pathogenic factors of gram-negative bacteria, including B. quintana, is the lipopolysaccharide (LPS). However, very little information is available on the features of Bartonella LPS. The aim of the present study was to extract, purify and characterise B. quintana LPS. The effect of the LPS under scrutiny was also evaluated on TNFa release by means of the "in vitro" human whole blood model of sepsis. The Oklahoma strain of B. quintana was grown on sheep blood agar, at 37 C, in a moist atmosphere containing 5% carbon dioxide. Cells were harvested and washed in sterile and apyrogenic saline solution and LPS extracted following the procedure of Westphal e Jann (1965), modified by Minnick (1994). The LPS of B. quintana showed the migration pattern of a deep rough chemotype, and the chromogenic limulus amoebocyte lysate test (LAL test) revealed strong reactivity at low concentrations (6.2 pg/ml). Samples of human whole blood stimulated by 1000 ng/ml of B. quintana LPS released 1707 378 pg/ml of TNFa.

An in vitro model for the study of sepsis mediators was used to investigate the effects of two different lipopolysaccharides (LPS), a smooth (LPS-S) and a rough (LPS-R) type, on the release of chemokines (IL-8 and MIP-1 alpha) and cytokines (TNF alpha, IL-1 beta, IL-1ra and IL-10) from human whole blood samples. TNF alpha level increased significantly vs. control, at 4 h and 8 h after the challenge with smooth and rough type of LPS respectively. Concentrations of the two chemokines studied, IL-8 and MIP-1 alpha, were significantly elevated following stimulation by both LPS, and reached concentrations significantly different from controls at 4, 8 and 24 h. After 24 h of incubation both LPS produced a significant IL-10 increase, although such change was more substantial with the rough type. Present data suggest an early and maintained release of chemokines regardless of the type of LPS used and often in absence of a significant increase in primary pro-inflammatory cytokines.

Four novel glycopeptide antibiotics, namely MDL 62708, MDL 63155, MDL 62827, MDL 62873 (mideplanin), plus teicoplanin, which differ in their chemical structure, were used to examine the relationship between the structure of glycopeptides and their LPS neutralization activity. Compound MDL 62708 (100 micrograms/ml) significantly reduced (P < 0.01 vs. antibiotic-free LPS, by Fisher's PLSD Test) metachromatic reactivity of S. minnesota R595 LPS (500 micrograms/ml) as evaluated by the DMB test. The remaining glycopeptides showed a significant reduction of the metachromatic reactivity, although at concentrations (333 and 1000 micrograms/ml) higher than MDL 62708. Data obtained with LAL test appeared in accordance with those of the other techniques: all the glycopeptides used (100 and 1000 micrograms/ml) significantly (P < 0.05) reduced the reactivity of S. minnesota R595 LPS (50 pg/ml), and the lowest concentration of MDL 62708 (10 pg/ml) used produced a substantial, although not significant, reduction of the LPS reactivity with LAL. The antibiotic/LPS ratios associated to a significant reduction of LPS reactivity were 3.3/5 (wt/wt) and 2/1 (wt/wt) for DMB and LAL tests respectively. Such ratio appeared to be even lower for MDL 62708. In conclusion, the four new glycopeptides, when tested at an antibiotic/LPS ratio about 1000 times lower than that which can be found in vivo, were able to reduce the reactivity of LPS in the in vitro models used. Teicoplanin aglycone MDL 62708, which also lacks the teicoplanin fatty acid, seems to have the same anti-LPS activity as the parental antibiotic, thus suggesting an important role for the glycopeptide backbone and NH2 groups in LPS-neutralizing effect.