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Objectives: Evaluation of the analytical performance of the Novodiag Stool Parasites biomolecular assay for the detection of intestinal parasites in faeces of the faecal microbiota transplant donor. Methodology: Comparison between the gold standard for the diagnosis of intestinal parasites, light microscopy, and the Novodiag Stool Parasites biomolecular assay through the use of 22 fecal samples. Results: Twelve out of 22 samples were positive on microscopic examination. In order to assess the overlapping between the results obtained through parasitological examination and the molecular methodology, all samples were tested to the Novodiag Stool Parasites assay. Positive samples detected by biomolecular assay were 11 out of 22. Conclusion: The preliminary evaluation of the analytical performance of the Novodiag Stool Parasites kit can be considered promising. The Novodiag Stool Parasites kit can be effectively used as a tool in the fast diagnosis of intestinal parasitoses on the faecal microbiota transplant donor faeces.

Candida glabrata is an opportunistic pathogen, associated with endocarditis, meningitis, and disseminated disease, and also with complicated vaginitis. Essential oils derived from aromatic plants are known in traditional medicine as antimicrobial agents and have antifungal properties. The aim of this work was to evaluate whether 12 tested essential oils (tea tree, laurel, anise, basil, bergamot, lavender, mint, oregano, grapefruit, rosemary, winter savory, and ginger) could have a transverse effect on C. glabrata sensitive strains but above all on strains resistant to the three main azole antifungals used (clotrimazole, fluconazole, itraconazole). For this reason, different strains of C. glabrata, vaginal isolated, were characterized (disk diffusion assay, minimal inhibitory concentration) with respect to their response to such antifungals. Electron microscopy analyses were performed to examine cellular damages in depth. Subsequently, we wanted to evaluate the effect of the oils on human cells to estimate their potential cytotoxicity. Oregano and winter savory were the two most effective essential oils, inducing growth inhibition, cell damage of C. glabrata strains (both sensitive and resistant to azole antifungal drugs), and medium–high level of toxicity against human keratinocytes. The results of this work support the research for new alternatives or complementary therapies against vaginal candidiasis.

Staphylococcus aureus is a pathogen causing infections that range from skin lesions to life threatening conditions. Methicillin resistance development in S. aureus strains represents a huge problem worldwide. The inhibition efficacy of twelve different essential oils (laurel, anise, oregano, basil, lavender, mint, rosemary, tea tree, bergamot, grapefruit, ginger and winter savory) and of the antibiotic Vancomycin was tested against S. aureus NCTC6571 and clinical isolates using paper disk diffusion assay and broth microdilution test methods. Forty-four S. aureus strains isolated from different human sample were characterized for antibiotic resistance and 41% of them were methicillin resistant. Among the twelve tested oils basil, oregano and savory showed stronger inhibition effect on S. aureus growth than Vancomycin. These results can be useful for the formulation of topical gel containing selected essential oils active against S. aureus strains.

The performance of 3 blood culture bottles (BACTEC Plus Aerobic/F, Plus Anaerobic/F, and Anaerobic Lytic/F) were analyzed with clinical specimens collected from 688 Emergency Department patients. A total of 270 strains belonging to 33 species were identified, with E. coli and S. aureus as the most frequently detected. Overall recovery rate (RR) of bacteria and yeast was equivalent in the Plus Aerobic/F vials (208 of 270 isolates; 77.0%) and Anaerobic Lytic/F vials (206 isolates; 76.3%) and significantly better than in the Plus Anaerobic/F vials (189 isolates; 70.0%). Median time to detection (TTD) was earliest with the Anaerobic Lytic/F vials (12.0 h) compared with the Plus Aerobic/F (14.6 h) and Plus Anaerobic/F vials (15.4 h). Positivity rate (PR) was similar for Anaerobic Lytic/F vials (76.9%) and Plus Aerobic/F vials (76.5%), but better if compared with Plus Anaerobic/F vials (69.4%). The PR and TTD for the combination of Plus Aerobic/F with Anaerobic Lytic/F (94.5% and 12.3 h, respectively) was significantly better than with Plus Aerobic/F with Plus Anaerobic/F (87.8% and 14.1 h).

The diagnosis of bloodstream infection requires the optimum combination of media in an automated blood culture system for maximum recovery of pathogens with the earliest time to detection. In a previous work, we showed that for patients admitted to the Emergency Department of our hospital, the combination of BACTEC lytic anaerobic and BACTEC aerobic vials was more efficient than BACTEC anaerobic and BACTEC aerobic vial. In this study, we extended the work including a broader patient population, representative of all hospital. A total of 8629 cultures were collected during the pre-lytic phase, from 01 July 2013 to 30 June 2014 and 7940 cultures during the post-lytic phase, ranged from 01 July 2015 to 30 June 2016. The number of positive blood cultures was higher during the post-lytic phase (19.74%) than in the pre-lytic phase (17.52%), particularly for Escherichia coli, Staphylococcus spp., Enterococcus spp., and anaerobes. We also observed a significant decreased of the time to detection, with the mean and median in the post-lytic phase of 17.68 and 13.05 h compared with 19.49 and 14.47 h in the pre-lytic phase. Whereas the time to detection was the same for organisms recovered in the aerobic Plus bottles for both time periods, time to detection for the anaerobic lytic bottles was significantly faster than with the anaerobic Plus bottles. This study carried out on a long time observation reported that a simple modification of composition of blood culture set could lead to better results in bloodstream infection detection.

Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2–15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.

Background New strategies at implementing HIV testing including rapid HIV assays are highly recommended to avoid late diagnosis. To shorten the diagnostic window period, the first point-of-care HIV assay, Determine HIV ½ Ag/Ab Combo (D4G, Alere, I) for the combined detection of p24 and anti-HIV antibody has been recently marketed and mainly tested in high prevalence setting. Objectives To establish D4G performances in acute HIV infection (AHI) in a setting at low HIV-1 prevalence. Study design D4G performances were compared with HIV-1 RNA levels in a panel of well-characterized serum specimens from 17 patients with AHI. For specificity, 124 anti-HIV negative serum specimens from patients seeking HIV testing were studied. Results D4G detected HIV infection in 15/17 patients. D4G antigen was positive in only 5 patients (29.4%), 4 of them with a viral load >10 million copies/mL. D4G antibody was reactive in other 10 patients (sensitivity: 58.8%, viral load from 70,161 to 8,120,000 copies/mL). Combined D4G sensitivity for acute HIV-1 infection was 88.2%; no false positive or invalid result was recorded (100% specificity, positive and negative predictive values: 100% and 98.4%, respectively). Conclusion In spite of a poor antigen sensitivity with optimal performances only for viral load >10 million copies/mL, D4G performances in acute HIV-1 infection were enhanced by the addition of p24 testing to the antibody. Improved HIV rapid testing to shorten the window period is important as rapid tests play a major role in expanding access to HIV testing and preventing HIV transmission.

Salmonella bongori 48:z35:– is considered endemic to Sicily (Italy) due to its epidemiological peculiarity. To our knowledge, no previous cases of human infection caused by S. bongori 48:z35:– have ever been reported in mainland Italy. Here we describe the isolation of S. bongori 48:z35:– from a 1-year-old symptomatic child in northwest Italy (Piedmont Region). The strain showed no antimicrobial resistance. Reporting of S. bongori 48:z35:– in a previously safe area is important to identify epidemiological changes.

The authors evaluated the performance of the MycArray™ Yeast ID (Myconostica Ltd, UK) assay in the identification of a total of 88 yeast isolates recovered in culture as compared to that obtained through routine methods. The turn-around time for species identification directly from cultures by the MycArray was 6 hours, much quicker than classical methods and all yeasts were correctly identified. In two cases a double identification including Saccharomyces cerevisiae was noted, but it was not confirmed by culture. The results show that MycArray Yeast ID can be a potential tool for rapid detection and identification of Candida species.

Visceral leishmaniasis is endemic in Italy as well as in the entire Mediterranean area and Campania is the italian region in which most cases occur. Dog leishmaniasis, common along the coast from Liguria to Southern Italy, is nowadays reported in areas as far inland as Monferrato hills, the outskirts of Turin and lake Garda southern shores. Mr. B.B. (male 67 years old) came almost by chance to the attention of our Medical department for acute fever and pancytopenia; further symptoms comprised subacute weight loss, splenic and limph node enlargment, an ulcerative lesion on the right arm. The patient appeared to be unavoidably destined to splenectomy until a Leishmania antibody test was requested to our laboratory. The assay was performed using an immunocromathographic method for specific IgM and by immunofluorescence to determine the total antibody titre towards Leishmania. Microscopic examination (Giemsa stain) and PCR were also performed to look for Leishmania infantum amastigotes in blood, bone marrow and skin. All tests, except microscopic examination, corroborated a Leishmania infection, and a dramatical clinical improvement was seen with Amphothericin B treatment. We conclude that an accurate anamnesis is mandatory if the Laboratory must be perform a rational diagnosis.