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Candida lipolytica is an uncommon Candida species causing invasive fungemia. This yeast is mainly associated with the colonisation of intravascular catheters, complicated intra-abdominal infections, and infections in the paediatric population. Here, we report a case of C. lipolytica bloodstream infection in a 53-year-old man. He was admitted for an alcohol withdrawal syndrome and mild COVID-19. Among the primary risk factors for candidemia, only the use of broad-spectrum antimicrobials was reported. The empiric treatment was commenced with caspofungin and then targeted with intravenous fluconazole. Infective endocarditis was ruled out using echocardiography, and PET/TC was negative for other deep-seated foci of fungal infection. The patient was discharged after blood culture clearance and clinical healing. To the best of our knowledge, this is the first case of C. lipolytica candidemia in a patient with COVID-19 and alcohol use disorder. We performed a systematic review of bloodstream infections caused by C. lipolytica. Clinicians should be aware of the possibility of C. lipolytica bloodstream infections in patients with alcohol use disorder, especially in a COVID-19 setting.

Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.

Introduction: A lack of updated data on the burden and profile of anaerobic bloodstream infections (ABIs) exists. We assessed the incidence of ABIs and trends in antimicrobial resistance in anaerobes isolated from blood in Italy. Material and methods: We conducted a retrospective study on 17 Italian hospitals (2016-2020). Anaerobes isolated from blood culture and their in vitro susceptibility profiles (EUCAST-interpreted) were registered and analyzed. Results: A total of 1960 ABIs were identified. The mean age of ABIs patients was 68.6 ± 18.5 years, 57.6% were males. The overall incidence rate of ABIs was 1.01 per 10.000 patient-days. Forty-seven% of ABIs occurred in medical wards, 17% in ICUs, 14% in surgical wards, 7% in hemato-oncology, 14% in outpatients. The three most common anti-anaerobic tested drugs were metronidazole (92%), clindamycin (89%) and amoxicillin/clavulanate (83%). The three most common isolated anaerobes were Bacteroides fragilis (n = 529), Cutibacterium acnes (n = 262) and Clostridium perfringens (n = 134). The lowest resistance rate (1.5%) was to carbapenems, whereas the highest rate (51%) was to penicillin. Clindamycin resistance was >20% for Bacteroides spp., Prevotella spp. and Clostridium spp. Metronidazole resistance was 9.2% after excluding C. acnes and Actinomyces spp. Bacteroides spp. showed an increased prevalence of clindamycin resistance through the study period: 19% in 2016, 33% in 2020 (p ≤ 0.001). Conclusions: Our data provide a comprehensive overview of the epidemiology of ABIs in Italy, filling a gap that has existed since 1995. Caution is needed when clindamycin is used as empirical anti-anaerobic drug.

Carbapenem resistance in Pseudomonas aeruginosa strains responsible for chronic lung infections in cystic fibrosis (CF) patients is mainly due to loss of the OprD protein and, limited to meropenem and doripenem, to overexpression of efflux pumps. However, recent reports of isolates showing inconsistent genotype-phenotype combinations (e.g., susceptibility in the presence of resistance determinants and vice versa) suggest the involvement of additional factors whose role is not yet fully elucidated. Among them, the OpdP porin as an alternative route of entry for carbapenems other than OprD and the overexpression of two chromosomal carbapenemases, the Pseudomonas-derived cephalosporinase (PDC) and the PoxB oxacillinase, have recently been reconsidered and studied in specific model strains. Here, the contribution of these factors was investigated by comparing different phenotypic variants of three strains collected from the sputum of colonized CF patients. Carbapenem uptake through OpdP was investigated both at the functional level, by assessing the competition exerted by glycine-glutamate, the OpdP’s natural substrate, against imipenem uptake, and at the molecular level, by comparing the expression levels of opdP genes by quantitative real-time PCR (qRT-PCR). Moreover, overexpression of the chromosomal carbapenemases in some of the isolates was also investigated by qRT-PCR. The results showed that, even if OprD inactivation remains the most important determinant of carbapenem resistance in strains infecting the CF lung, the interplay of other determinants might have a nonnegligible impact on bacterial susceptibility, being able to modify the phenotype of part of the population and consequently complicating the choice of an appropriate therapy. IMPORTANCE This study examines the interplay of multiple factors in determining a pattern of resistance or susceptibility to carbapenems in clinical isolates of Pseudomonas aeruginosa, focusing on the role of previously poorly understood determinants. In particular, the impact of carbapenem permeability through OprD and OpdP porins was analyzed, as well as the activity of the chromosomal carbapenemases AmpC and PoxB, going beyond the simple identification of resistance determinants encoded by each isolate. Indeed, analysis of the expression levels of these determinants provides a new approach to determine the contribution of each factor, both individually and in coexistence with the other factors. The study contributes to understanding some phenotype-genotype discordances closely related to the heteroresistance frequently detected in P. aeruginosa isolates responsible for pulmonary infections in cystic fibrosis patients, which complicates the choice of an appropriate patient-specific therapy.

To investigate the antimicrobial activity of a preservative-free 0.6% povidone-iodine eye drop as an antiseptic procedure in decreasing the conjunctival bacterial load in eyes scheduled for intravitreal treatment and to compare its efficacy to the untreated fellow eye used as the control group. Prospective cohort analysis in which 208 patients received preservative-free 0.6% povidone-iodine eye drops three times a day for three days before intravitreal injection. Before and after the prophylactic treatment, a conjunctival swab was collected from both the study eye and the untreated contralateral eye, used as control. The swab was inoculated on different culture media and the colony-forming units were counted. Bacteria and fungi were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Treatment with 0.6% povidone-iodine eye drops significantly reduced the conjunctival bacterial load from baseline (p

Purpose: The aim of this observational study was to highlight high resolution CT scan characteristics of COVID-19-associated pulmonary aspergillosis (CAPA) with a focus on the detection of de-novo appeared or evolved bronchiectasis. Methods: From March 2020 to May 2021, we enrolled 350 consecutive mechanically ventilated ICU patients with COVID-19. Patients with CAPA and at least one chest CT scan performed within 15 days from the diagnosis were included. Two radiologists were asked to identify typical and atypical signs of COVID-19 pneumonia. Bronchiectasis locations were described and a modified Reiff score was calculated, as severity score. A total of 19 CAPA patients (median age 71.0, Interquartile range (IQR) 62.5–75.0; male 16, 84.2%) were included. Results: According to the 2020 ECMM/ISHAM criteria, 18 patients had probable CAPA and one had proven CAPA. The median time between hospital admission and CT scan was 21 days (IQR 14.5–25.0). The incidence of bronchiectasis in the study population was 57.9% (n = 11). Tubular bronchiectasis was detected in 10 patients and were scored as follows: three patients had a score of 1, three patients had a score of score 2, one patient had a score of 5 and four patients had a score of 6. Eight patients had a previous CT scan (performed at hospital admission), among them: 5 patients developed de-novo bronchiectasis, while 2 patients demonstrated a volumetric increase of bronchiectasis. At the 6-months follow-up, the mortality rate for patients with CAPA was >60%. Conclusion: the radiologic of de-novo appearance or volumetric increase of bronchiectasis in COVID-19 should lead clinicians to search for fungal superinfections

The spread of resistance to vancomycin and other last-resort drugs in Enterococcus spp. remains of concern. In Italy, surveillance data for enterococcal bloodstream isolates in humans are scant. The aim of our study was to assess the incidence trends of bacteremias due to Enterococcus species and their prevalence trends of antimicrobial resistance. We retrospectively included all consecutive not-duplicate Enterococcus species isolated from blood cultures, in patients from 11 Italian hospitals (2011-2017). Incidence was defined as the number of isolates per 10,000 patient-days, while resistance prevalence was defined as the number of resistant strains divided by the number of tested strains. We included 4,858 isolates (59%, 36%, and 5% due to Enterococcus faecalis, E. faecium, and other Enterococcus spp., respectively). Over the study period, the incidence of bacteremias due to E. faecalis (incidence rate ratio [IRR]: 1.02, 95% confidence interval [CI]: 1.00-1.04, p = 0.008) and E. faecium increased (IRR: 1.03, 95% CI: 1.01-1.05, p

Multidrug-resistant (MDR) Enterobacterales are a priority health issue with few treatment options. Recently, fosfomycin has been reconsidered for MDR bacterial infections. Zidovudine, licensed for the treatment of human immunodeficiency virus (HIV), has unexploited antibacterial properties and has been considered for drug repurposing. The aim of this study was to assess the effect of the combination of fosfomycin plus zidovudine against clinical MDR Enterobacterales isolates. Minimum inhibitory concentration (MIC) determination and checkerboard assays for 36 MDR Enterobacterales strains were performed. In addition, fosfomycin-resistant strains were evaluated using time–kill assay and in an in vivo Galleria mellonella infection model. Zidovudine and fosfomycin MICs ranged between 0.06 to >64 mg/L and 0.125 to >512 mg/L, respectively. A synergistic effect [fractional inhibitory concentration index (FICI) ≤0.5] was observed in 25 isolates and no antagonistic effect was observed in the remaining isolates. For 7 of 8 fosfomycin-resistant strains (MIC > 32 mg/L), zidovudine combination was able to restore fosfomycin susceptibility. These results were confirmed by time–kill assays. Fosfomycin + zidovudine presented greater larval survival (20–50%) than monotherapy. Synergistic activity was observed for fosfomycin + zidovudine in 69.4% of the tested strains. In vivo experiments confirmed the enhanced effectiveness of the combination. The zidovudine concentrations tested here can be reached in human serum using the actual licensed dosage, therefore this combination deserves further clinical investigation.

An alarming increase of vancomycin-resistant Enterococcus faecium (VREfm) isolates was detected in an Italian referral hospital subjected to policies of infection control validated by the Joint Commission International. Analysis of the population structure of 122 consecutive, nonreplicate VREfm isolates collected over an 18-month period identified a single major clone that spread around the whole hospital, rapidly establishing an endemic state. It belonged to sequence type (ST) 17 and showed a highly multidrug-resistant phenotype, being resistant to all antimicrobial classes for the carriage of several resistance determinants. Furthermore, some strains with decreased susceptibility to daptomycin were detected. Eighteen out of the 122 isolates did not group in the major clone. They showed a low spreading potential inside the hospital wards, even if most of them displayed a multidrug-resistant phenotype and belonged to a hospital-adapted lineage. Causes that led to the VREfm endemic state have not been fully elucidated. However, it is conceivable that the increase in systemic antibiotic consumption and the use of selective digestive tract decontamination, including vancomycin in critically ill patients during the period before 2014, may have played a role in the ST17 clone dissemination, but additional traits conferring high fitness in hospital environment cannot be excluded.

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.

In March 2017, a 45-year-old Italian man who has sex with men was admitted to the Infectious Diseases Department of Trieste Hospital (northeast Italy), because of fever, abdominal pain and dysentery. The patient had neither foreign travel history nor sexual contact with non-Italian partners. Stool cultures grew multidrug-resistant Shigella flexneri (resistant to ampicillin, chloramphenicol, streptomycin, tetracycline, trimethoprim, amoxicillin/clavulanic acid and ciprofloxacin) and whole genome sequencing detailed the resistance features. The phylogenetic analysis showed that the strain was unrelated to any previously reported strain. The patient was treated successfully with ceftriaxone. We hereby report the first case of locally-acquired, multidrug-resistant S. flexneri infection in Italy and also the emergence of a new clone.

Background: Multidrug-resistant (MDR) or extensively-drug-resistant (XDR) Pseudomonas aeruginosa (PSA) strains infections are a major concern in nosocomial environments being associated both with worse outcomes and with high mortality rates especially in oncologic and haematogic settings. In the Trieste University hospital, we experienced an outbreak of XDR-PSA bacteremia in the haematology unit probably caused by a reservoir in the toilets faucets. Materials/methods: The haematology unit in Trieste hospital has twelve double-bed rooms and a protected area with three single-bed rooms reserved to patients undergoing marrow transplants and severe neutropenia (neutrophils

Here, we report the first detection of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae strain belonging to sequence type 833 (ST833), collected in an Italian hospital from a patient coming from South America. Its bla KPC determinant was carried by a ColE1 plasmid, pKBuS13, that showed the Tn 4401b :: bla KPC-2 transposon inserted into the regulatory region of an Xer site-specific recombination locus. This interfered with the correct resolution of plasmid multimers into monomers, lowering plasmid stability and leading to overestimation of the number of plasmids harbored by a single host cell. Sequencing of the fragments adjacent to Tn 4401b detected a region that did not have significant matches in databases other than the genome of a carbapenem-resistant Escherichia coli strain collected during the same year at a hospital in Boston. This is interesting in an epidemiologic context, as it suggests that despite the absence of tra genes and the instability under nonselective conditions, the circulation of pKBuS13 or of analogous plasmids might be wider than reported.

Children under 5 years of age are at risk for tuberculosis after occasional contact with highly contagious patients http://ow.ly/RqAn30fKdGk

Elastin is a fibrous protein that confers elasticity to tissues such as skin, arteries and lung. It is extensively cross-linked, highly hydrophobic and insoluble. Nevertheless, elastin can be hydrolysed by bacterial proteases in infectious diseases, resulting in more or less severe tissue damage. Thus, development of substrates able to reliably and specifically detect pathogen-secreted elastolytic activity is needed to improve the in vitro evaluation of the injury that bacterial proteases may provoke. In this work, two human biomimetic elastin polypeptides, HELP and HELP1, as well as the matrices derived from HELP, have been probed as substrates for elastolytic activity detection. Thirty strains of Pseudomonas aeruginosa isolated from cystic fibrosis patients were analyzed in parallel with standard substrates, to detect proteolytic and elastolytic activity. Results point to the HELP-based 3D matrix as an interesting biomimetic model of elastin to assess bacterial elastolytic activity in vitro. Moreover, this model substrate enables to further elucidate the mechanism underlying elastin degradation at molecular level, as well as to develop biomimetic material-based devices responsive to external stimuli.

PURPOSE: The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. METHODS: Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. RESULTS: The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p = 0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p = 0.007 and p = 0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p = 0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p = 0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p = 0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. CONCLUSIONS: An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.

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BACKGROUND: The sector of the market that deals with contraception offers a long list of different contraceptive methods. Within the estroprogestinic choice the routes of administration are oral transdermic and vaginal one. Even though efficacy is comparable with these methods secondary and adverse effects are directly involved in the acceptability of the method. STUDY DESIGN: This was a prospective comparative study. During 1 year we enrolled 60 asymptomatic women who voluntarily requested combined oral contraception (COC) or combined contraceptive vaginal ring (CCVR group). After a baseline study of vaginal milieu prior to starting hormonal contraception we performed a follow-up. For each woman we examined vaginal pH; quantification of leukocytes lactobacilli Candida and cocci on saline microscopy fluid; Gram stain with Nugent score and the presence of vaginal infection [culture for Trichomonas vaginalis albicans and nonalbicans Candida Group B Streptococcus (GBS)]. RESULTS: At the end of follow-up there was a little change of vaginal milieu in both groups. We noted an increase of lactobacilli in the CCVR users and an increase of GBS in COC users. CONCLUSION: CCVR compared to COC users showed an increase of the number of lactobacilli in vaginal flora. It means that an increase of leukorrhea in that group could be protective in terms of prevention of vaginal imbalance/infection. Copyright (c) 2012 Elsevier Inc. All rights reserved.

2007/2008 L’obiettivo della presente tesi di Dottarato è lo studio della sequenza sedimentaria marina e continentale e del substrato di Flysch sottostante, presente nella Riviera di Miramare (Golfo di Trieste) al fine di comprendere l’evoluzione deposizionale e tettonica dell’area. A tale scopo è stato eseguito uno studio geofisico integrato con cinque metologie geofisiche marine ad alta risoluzione, due di tipo sismico e tre di tipo Sonar: 1. Sub-bottom profiler Boomer; 2. Sub-bottom profiler CHIRP; 3. Singlebeam Echosaunder (SBES); 4. Multibeam Echosounder (MBES); 5. Side Scan Sonar (SSS). I rilievi sub-bottom profiler Boomer e CHIRP hanno fornito le informazioni necessarie per l’interpretazione del basamento acustico costituito dal Flysch eocenico, con da morfologia caratterizzata da scarpate e piattaforme costiere di origine tettonica ed erosione marina, le strutture tettoniche principali, e dei sedimenti marini e continentali quaternari, con strutture progradanti HST oloceniche e pleistoceniche, depositi fluviali e canali sepolti ricollegabili ad una rete idrica superficiale. I rilievi Sonar Singlebeam, Multibeam e Side Scan Sonar, ad alta frequenza, hanno permesso di rilevare la batimetria e la morfologia dei fondali marini antistanti la riviera di Miramare e Barcola, all’interno della Riserva Naturale Marina di Miramare. E’ stata realizzato un modello tridimensionale digitale del fondo mare e una cartografia tematica ove sono riportate le batimetrie con isobate a 1 m, le morfologie rocciose sub-affioranti, la tessitura dei depositi sedimentari e le forme di fondo, inoltre alcune praterie di fanerogame, ormeggi, relitti e condotte sottomarine. Nel Capitolo 1 – Introduzione è esposto il tema della Ricerca di Dottorato in Scienze Ambientali, sono descritti i principali obiettivi del lavoro e una sintesi dello stato dell’arte sul tema proposto. Nel Capitolo 2 - Inquadramento geologico e studi precedenti sono presentate una descrizione generale del Golfo di Trieste, con le caratteristiche delle coste, la batimetria e la geomorfologia del fondale marino, il mare (correnti e clima), la geologia della Provincia di Trieste (la Formazione dei Calcari del Carso Triestino e la Formazione del Flysch di Trieste), i depositi recenti continentali e marini, datazioni di sedimenti recenti, gli studi geofisici marini precedenti, gli aspetti strutturali, una ricostruzione paleogeografica generale, la sismicità, i sondaggi geognostici presenti in bibliografia ed utilizzati nella taratura sismo-stratigrafica e nella conversione tempi in profondità dei profili sismici, un inquadramento topografico dell’area oggetto di studio e la descrizione del Parco WWF della Riserva Naturale Marina di Miramare. Nel Capitolo 3 - Acquisizione dati sismici e morfo-batimetrici sono descritte le imbarcazioni utilizzate nei rilievi geofisici, il sistema di riferimento adottato, le metodologie adottate, la strumentazione utilizzata, ed i rilievi relativi ad ogni metodologia ad alta risoluzione che è stata esaminata nel lavoro di dottorato. Nel Capitolo 4 - Elaborazione dati e conversione tempi-profondità vengono descritte le procedure per l’elaborazione dei dati geofisici digitali, suddivisi per paragrafi separati per ogni metodologia utilizzata, i sistemi di taratura e le operazioni per la conversione della scala verticale da tempi (TWT two way time) in profondità metrica con l’ausilio delle stratigrafie dei sondaggi geognostici. Il Capitolo 5 - Interpretazione geologica e geomorfologia: risultati e discussione comincia con una valutazione qualitativa fra la metodologia sub-bottom Boomer e quella Chirp. Si prosegue con l’interpretazione sismostratigrafica delle sezioni sismiche Boomer, valutate con miglior risoluzione e maggior penetrazione investigativa. E’ stato interpretato il basamento acustico in Flysch caratterizzato da una serie di scarpate e piattaforme di origine erosiva e tettonica, e in prossimità della costa da faglie inverse relative alla struttura dinarica. E’stata interpretata la successione di depositi sedimentari Quaternari, distinta in diverse facies acustiche separate da orizzonti significativi, in cui sono stati riconosciuti il piano di emersione riferibile al massimo glaciale würmiano e i soprastanti deposti marini olocenici con il cuneo progradante di stazionamento alto, e la correlazione di un cuneo progradante a profondità compresa fra 45 e 50 metri, relativo allo stazionamento alto probabilmente della base Pleistocene Superiore (125.000 anni fa), datate attraverso la correlazione con datazioni dei sedimenti nel Golfo di Trieste e mediante l’utilizzo delle curve eustatiche. Segue l’interpretazione batimetrica e geomorfologica dell’area di Miramare e Cedas, con la descrizione del DTM generato dai dati Multibeam e con la descrizione degli elementi riconosciuti nei rilievi Side Scan Sonar, con la mappatura del substrato roccioso sub-affiorante e di blocchi isolati, la tessitura dei sedimenti e delle forme di fondo, la mappatura di facies biologiche delle praterie di fanerogame, ormeggi, relitti e condotte sottomarine. Nel Capitolo 6 – Conclusioni vengono sintetizzate le metodologiche utilizzate, evidenziando i metodi di elaborazione del dato per migliorare la risoluzione, ed i risultati dell’interpretazione che ha permesso la ricostruzione dell’evoluzione del Pleistocene Superiore e dell’Olocene nell’area di studio. Viene infine descritta in un modello tridimensionale una sintesi dei risultati della Ricerca di Dottorato. The aim of the present thesis is the study of the marine and continental sedimentary sequences and of the underlying Flysch bedrock occurring in the Riviera di Miramare (Gulf of Trieste), to enhance the comprehension of the sedimentary and tectonic evolution of the area. An integrated geophysical study with five different geophysical methodologies, has been done. The first two methodologies are seismic, while the last three belong to the sonar kind: 1. Sub-bottom profiler Boomer; 2. Sub-bottom profiler CHIRP; 3. Singlebeam Echosaunder (SBES); 4. Multibeam Echosounder (MBES); 5. Side Scan Sonar (SSS). The Sub-bottom profiler Boomer and CHIRP surveys provide information for the interpretation of the acoustic basement constituted by the Eocene Flysch, with the morphology characterized by escarpments and shore platforms of tectonic and marine erosion origin, the main tectonic structures, and the Quaternary marine sediments, with Holocenic and Pleistocenic prograding HST features, fluvial deposit and buried channels linked to the subaerial hydrographic network. The Singlebeam Sonar, the Multibeam Sonar and the Side Scan Sonar high-frequency surveys allowed to investigate the bathymetries and the morphologies of the sea bottom in front of the Miramare seacoast and Barcola, within the Natural Sea Reserve. It has been produced a three-dimensional digital model of the sea bottom as well as a thematic cartography with 1 m interval isobaths, the sub-outcropping rock, the weaving of the sedimentary deposits and the bottom shapes, some prairies of marine phanerogams, moorings, marine wrecks and submarine conducts. Chapter 1 - Introduction. I have explained the subject of my research for the Ph.D. in Environmental Sciences, where I have described the main purposes of the work and a summary of the state of the art of the above subject. Chapter 2 – Geological note and bibliography. I have provide a general description of the Gulf of Trieste with some notes on the seacoasts, the bathymetry and the geomorphology of the sea bottom, the sea (currents and climate), the geology of the Province of Trieste (formation of Trieste Karst’s limestones and Flysch), the recent continental and sea deposits, the previous marine geophysical studies, the structural framework, the seismicity, the geognostic surveys (four wells) used to seismostratigraphic calibration and for times to depth conversion, a general paleogeographic reconstruction, a topographic framework of the examined area and the description of the WWF Park inside the Natural Marine Reserve of Miramare. Chapter 3 – Acquisition seismic and morpho-bathimetric data. I have described the seismic and morphobathymetric data acquisition, the boats used for the geophysical surveys, the reference system, a short description of the methodologies, and then in detail the instruments and the surveys of every high-resolution methodology which has been examined during the Ph.D. Chapter 4 – Geophysical data processing and times-depth conversion. For each methodology I have described the procedures of calibration system and data processing, and the operations for times to depth conversion, using the stratigraphies of geognostic surveys. Chapter 5 - The geological and geomorphological interpretation: results and discussion, begins with a qualitative assessment between the Sub-bottom Boomer and the Chirp methodologies, continuing with the seismic-stratigraphic analysis of the Boomer seismic sections, evaluated with a better resolution and penetration. The seismic interpretation provide the identification of the Flysch bedrock, characterized by escarpments and shore platforms of marine erosion and tectonic origin and by inverse faults related to the coastal Dinaric thrust. Different acoustic facies have been identified in the Quaternary sediment: the sub-aerial surface dating back to the Würm glacial maximum overlying by marine deposit and close to the coast by the Holocenic prograding wedge of HST, the 45-50 m deep prograding wedge of HST probably related, according to the eustatic curves, to the base of the Late Pleistocene (125.000 year B.P.). Then, it is described the bathymetric and geo-morphological interpretation of the areas of Miramare and Cedas, together with the DTM created by the Multibeam data, the identified elements in the Side Scan Sonar surveys and the mapping of the rock sub-outcropping substrate and isolated blocks, ripples, bottom shapes, biological facies as the prairies of marine phanerogams, moorings, marine wrecks and submarine conducts. Chapter 6 - Conclusions. I have described the methodological conclusions, pointing out the processing methods in order to improve the resolution, as well as the experimental conclusions, to highlight and comment upon the results which I have obtained from the data processing and the interpretation. In the end I have presented through a three-dimensional model a summary of the results of the Ph.D. research. XX Ciclo 1971

Streptococcus pyogenes (Group A streptococcus, GAS) is a rare cause of bacterial meningitis, accounting for less than 1% of cases. GAS meningitis has rarely been reported in children, and is associated with a high (46%) rate of morbidity and a high (10-17%) case fatality rate. This paper describes a case of meningitis caused by GAS in a previously healthy child; M protein genotyping demonstrated an emm type 12. Although not common, GAS meningitis must be considered in children vaccinated for other invasive pathogens. Continuous monitoring of the molecular epidemiology of circulating invasive GAS strains is of crucial importance for planning intervention policies.