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5. Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

Author

Stefano Zucchini, Stefano Tumini, Andrea Enzo Scaramuzza, Riccardo Bonfanti, Maurizio Delvecchio, Roberto Franceschi, Dario Iafusco, Lorenzo Lenzi, Enza Mozzillo, Stefano Passanisi, Claudia Piona, Ivana Rabbone, Novella Rapini, Andrea Rigamonti, Carlo Ripoli, Giuseppina Salzano, Silvia Savastio, Riccardo Schiaffini, Angela Zanfardino, Valentino Cherubini, Diabetes Study Group of the Italian Society for Pediatric Endocrinology Diabetes, Albino Claudia Accursia, Aloe Monica, Anzelotti Maria Teresa, Arnaldi Claudia, Barbetti Fabrizio, Bassi Marta, Berioli Maria Giulia, Bernardini Luca, Bertelli Enrica, Biagioni Martina, Bobbio Adriana, Bombaci Bruno, Bonfanti Riccardo, Bonura Clara, Bracciolini Giulia Patrizia, Bruzzese Mariella, Bruzzi Patrizia, Buono Pietro, Buscarino Piera, Cadario Francesco, Calcaterra Valeria, Calzi Elena, Cappa Marco, Cardani Roberta, Cardella Francesca, Cardinale Giuliana Marcella, Casertano Alberto, Castorani Valeria, Cauvin Vittoria, Cenciarelli Valentina, Ceruti Franco, Cherubini Valentino, Chiarelli Francesco, Chiari Giovanni, Cianfarani Stefano, Cicchetti Mario, Cipriano Paola, Cirillo Dante, Citriniti Felice, Coccioli Maria Susanna, Confetto Santino, Contreas Giovanna, Coro Anna, Correddu Antonella, Corsini Elisa, Crino’ Antonino, d’Annunzio Giuseppe, De Berardinis Fiorella, De Donno Valeria, De Filippo Gianpaolo, De Marco Rosaria, De Sanctis Luisa, Del Duca Elisabetta, Delvecchio Maurizio, Deodati Annalisa, Di Bonito Procolo, Di Candia Francesca, Faleschini Elena, Fattorusso Valentina, Favia Anna, Federico Giovanni, Felappi Barbara, Ferrari Mara, Ferrito Lucia, Fichera Graziella, Fontana Franco, Fornari Elena, Franceschi Roberto, Franco Francesca, Franzese Adriana, Frongia Anna Paola, Frontino Giulio, Gaiero Alberto, Galassi Sabrina Maria, Gallo Francesco, Gargantini Luigi, Giani Elisa, Gortan Anna Jolanda, Graziani Vanna, Grosso Caterina, Gualtieri Antonella, Guasti Monica, Guerraggio Lucia Paola, Guzzetti Chiara, Iafusco Dario, Iannicelli Gennaro, Iezzi Maria Laura, Ignaccolo Maria Giovanna, Innaurato Stefania, Inzaghi Elena, Iovane Brunella, Iughetti Lorenzo, Kaufmann Peter, La Loggia Alfonso, Lambertini Anna Giulia, Lapolla Rosa, Lasagni Anna, Lazzaro Nicola, Lazzeroni Pietro, Lenzi Lorenzo, Lera Riccardo, Levantini Gabriella, Lezzi Marilea, Lia Rosanna, Liguori Alice, Lo Presti Donatella, Lombardo Fortunato, Lonero Antonella, Longhi Silvia, Lorubbio Antonella, Lucchesi Sonia, Maccioni Rosella, Macedoni Maddalena, Macellaro Patrizia Cristiana, Madeo Simona Filomena, Maffeis Claudio, Mainetti Benedetta, Maltoni Giulio, Mameli Chiara, Mammì Francesco, Manca Bitti Maria Luisa, Mancioppi Valentina, Manco Melania, Marigliano Marco, Marino Monica, Marsciani Alberto, Matteoli Maria Cristina, Mazzali Elena, Minute Marta, Minuto Nicola, Monti Sara, Morandi Anita,, Morganti Gianfranco, Morotti Elisa, Mozzillo Enza, Musolino Gianluca, Olivieri Francesca, Ortolani Federica, Pampanini Valentina, Pardi Daniela, Pascarella Filomena, Pasquino Bruno, Passanisi Stefano, Patera Ippolita Patrizia, Pedini Annalisa, Pennati Maria Cristina, Peruzzi Sonia, Peverelli Paola, Pezzino Giulia, Piccini Barbara, Piccinno Elvira Eugenia Rosaria, Piona Claudia, Piredda Gavina, Piscopo Alessia, Pistone Carmelo, Pozzi Erica, Prandi Elena, Predieri Barbara, Prudente Sabrina, Pulcina Anna, Rabbone Ivana, Randazzo Emioli, Rapini Novella, Reinstadler Petra, Riboni Sara, Ricciardi Maria Rossella, Rigamonti Andrea, Ripoli Carlo, Rossi Virginia, Rossi Paolo, Rutigliano Irene, Sabbion Alberto, Salvatoni Alessandro, Salvo Caterina, Salzano Giuseppina, Sanseviero Mariateresa, Savastio Silvia, Savini Rosanna, Scanu Mariapiera, Scaramuzza Andrea Enzo, Schiaffini Riccardo, Schiavone Maurizio, Schieven Eleonardo, Scipione Mirella, Secco Andrea, Silvestri Francesca, Siri Giulia, Sogno Valin Paola, Sordelli Silvia, Spiri Daniele, Stagi Stefano, Stamati Filomena Andreina, Suprani Tosca, Talarico Valentina, Tiberi Valentina, Timpanaro Tiziana Antonia Lucia, Tinti Davide, Tirendi Antonina, Tomaselli Letizia Grazia, Toni Sonia, Torelli Cataldo, Tornese Gianluca, Trada Michela,, Trettene Adolfo Andrea, Tumini Stefano, Tumminelli Marilena, Valerio Giuliana, Vandelli Sara, Ventrici Claudia, Zampolli Maria, Zanatta Manuela, Zanfardino Angela, Zecchino Clara, Zonca Silvia, and Zucchini Stefano

Subjects
adolescents, automated insulin delivery, children, hypoglycemia, glucagon, oral glucose, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose

Published
2024
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7. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

Author

Lepore, G, Bonfanti, R, Bozzetto, L, Di Blasi, V, Girelli, A, Grassi, G, Iafusco, D, Laviola, L, Rabbone, I, Schiaffini, R, Bruttomesso, D, Mammi, F, Bruzzese, M, Schettino, M, Nuzzo, M, Fresa, R, Lambiase, C, Zanfardino, A, Confetto, S, Annuzzi, G, Alderisio, A, Riccardi, G, Gentile, S, Marino, G, Guarino, G, Zucchini, S, Maltoni, G, Suprani, T, Graziani, V, Nizzoli, M, Acquati, S, Cavani, R, Romano, S, Michelini, M, Manicardi, E, Bonadonna, R, Dei Cas, A, Dall'Aglio, E, Papi, M, Riboni, S, Manicardi, V, Pugni, V, Lasagni, A, Street, M, Pagliani, U, Rossi, C, Assaloni, R, Brunato, B, Tortul, C, Zanette, G, Li Volsi, P, Zanatta, M, Tonutti, L, Agus, S, Pellegrini, M, Ceccano, P, Pozzilli, G, Anguissola, B, Buzzetti, R, Moretti C, C, Leto, G, Pozzilli, P, Manfrini, S, Maurizi, A, Leotta, S, Altomare, M, Abbruzzese, S, Carletti, S, Suraci, C, Filetti, S, Manca Bitti, M, Arcano, S, Cavallo, M, De Bernardinis, M, Pitocco, D, Caputo, S, Rizzi, A, Manto, A, Cappa, M, Benevento, D, Frontoni, S, Malandrucco, I, Morano, S, Filardi, T, Lauro, D, Marini, M, Castaldo, E, Sabato, D, Tuccinardi, F, Forte, E, Viterbori, P, Arnaldi, C, Minuto, N, D'Annunzio, G, Corsi, A, Rota, R, Scaranna, C, Trevisan, R, Valentini, U, Bonfadini, S, Zarra, E, Plebani, A, Prandi, E, Felappi, B, Rocca, A, Meneghini, E, Galli, P, Ruggeri, P, Carrai, E, Fugazza, L, Baggi, V, Conti, D, Bosi, E, Laurenzi, A, Caretto, A, Molinari, C, Orsi, E, Grancini, V, Resi, V, Favalli, V, Bonura, C, Rigamonti, A, Bonomo, M, Bertuzzi, F, Pintaudi, B, Disoteo, O, Perseghin, G, Perra, S, Chiovato, L, De Cata, P, Zerbini, F, Lovati, E, Laneri, M, Guerraggio, L, Bossi, A, De Mori, V, Galetta, M, Meloncelli, I, Aiello A, A, Di Vincenzo, S, Nuzzi, A, Fraticelli, E, Ansaldi, E, Battezzati, M, Lombardi, M, Balbo, M, Lera, R, Secco, A, De Donno, V, Cadario, F, Savastio, S, Ponzani, C, Aimaretti, G, Ignaccolo, G, Tinti, D, Cerutti, F, Bari, F, Giorgino, F, Piccinno, E, Zecchino, O, Cignarelli, M, Lamacchia, O, Picca, G, De Cosmo, S, Rauseo, A, Tomaselli, L, Tumminia, A, Egiziano, C, Scarpitta, A, Maggio, F, Cardella, F, Roppolo, R, Provenzano, V, Fleres, M, Scorsone, A, Scatena, A, Gregori, G, Lucchesi, S, Gadducci, F, Di Cianni, S, Pancani, S, Del Prato, S, Aragona, M, Crisci, I, Calianno, A, Fattor, B, Crazzolara, D, Reinstadler, P, Longhi, S, Incelli, G, Rauch, S, Romanelli, T, Orrasch, M, Cauvin, V, Franceschi, R, Lalli, C, Pianta, A, Marangoni, A, Arico, C, Marin, N, Nogara, N, Simioni, N, Filippi, A, Gidoni Guarneri, G, Contin, M, Decata, A, Bondesan, L, Confortin, L, Coracina, A, Lombardi, S, Costa Padova, S, Cipponeri, E, Scotton, R, Galasso, S, Boscari, F, Zanon, M, Vinci, C, Lisato, G, Gottardo, L, Bonora, E, Trombetta, M, Negri, C, Brangani, C, Maffeis, C, Sabbion, A, Marigliano, M, Lepore G., Bonfanti R., Bozzetto L., Di Blasi V., Girelli A., Grassi G., Iafusco D., Laviola L., Rabbone I., Schiaffini R., Bruttomesso D., Mammi F., Bruzzese M., Schettino M., Nuzzo M. G., Fresa R., Lambiase C., Zanfardino A., Confetto S., Annuzzi G., Alderisio A., Riccardi G., Gentile S., Marino G., Guarino G., Zucchini S., Maltoni G., Suprani T., Graziani V., Nizzoli M., Acquati S., Cavani R., Romano S., Michelini M., Manicardi E., Bonadonna R., Dei Cas A., Dall'aglio E., Papi M., Riboni S., Manicardi V., Pugni V., Lasagni A., Street M. E., Pagliani U., Rossi C., Assaloni R., Brunato B., Tortul C., Zanette G., Li Volsi P., Zanatta M., Tonutti L., Agus S., Pellegrini M. A., Ceccano P., Pozzilli G., Anguissola B., Buzzetti R., Moretti C C., Leto G., Pozzilli P., Manfrini S., Maurizi A. R., Leotta S., Altomare M., Abbruzzese S., Carletti S., Suraci C., Filetti S., Manca Bitti M. L., Arcano S., Cavallo M. G., De Bernardinis M., Pitocco D., Caputo S., Rizzi A., Manto A., Cappa M., Benevento D., Frontoni S., Malandrucco I., Morano S., Filardi T., Lauro D., Marini M. A., Castaldo E., Sabato D., Tuccinardi F., Forte E., Viterbori P., Arnaldi C., Minuto N., d'Annunzio G., Corsi A., Rota R., Scaranna C., Trevisan R., Valentini U., Bonfadini S., Zarra E., Plebani A., Prandi E., Felappi B., Rocca A., Meneghini E., Galli P., Ruggeri P., Carrai E., Fugazza L., Baggi V., Conti D., Bosi E., Laurenzi A., Caretto A., Molinari C., Orsi E., Grancini V., Resi V., Favalli V., Bonura C., Rigamonti A., Bonomo M., Bertuzzi F., Pintaudi B., Disoteo O., Perseghin G., Perra S., Chiovato L., De Cata P., Zerbini F., Lovati E., Laneri M., Guerraggio L., Bossi A. C., De Mori V., Galetta M., Meloncelli I., Aiello A A., Di Vincenzo S., Nuzzi A., Fraticelli E., Ansaldi E., Battezzati M., Lombardi M., Balbo M., Lera R., Secco A., De Donno V., Cadario F., Savastio S., Ponzani C., Aimaretti G., Ignaccolo G., Tinti D., Cerutti F., Bari F., Giorgino F., Piccinno E., Zecchino O., Cignarelli M., Lamacchia O., Picca G., De Cosmo S., Rauseo A., Tomaselli L., Tumminia A., Egiziano C., Scarpitta A. M., Maggio F., Cardella F., Roppolo R., Provenzano V., Fleres M., Scorsone A., Scatena A., Gregori G., Lucchesi S., Gadducci F., Di Cianni S., Pancani S., Del Prato S., Aragona M., Crisci I., Calianno A., Fattor B., Crazzolara D., Reinstadler P., Longhi S., Incelli G., Rauch S., Romanelli T., Orrasch M., Cauvin V., Franceschi R., Lalli C., Pianta A., Marangoni A., Arico C. N., Marin N., Nogara N., Simioni N., Filippi A., Gidoni Guarneri G. L., Contin M. L M. L., Decata A. P., Bondesan L., Confortin L., Coracina A., Lombardi S., Costa Padova S., Cipponeri E., Scotton R., Galasso S., Boscari F., Zanon M. S., Vinci C., Lisato G., Gottardo L., Bonora E., Trombetta M., Negri C., Brangani C., Maffeis C., Sabbion A., Marigliano M., Lepore, G, Bonfanti, R, Bozzetto, L, Di Blasi, V, Girelli, A, Grassi, G, Iafusco, D, Laviola, L, Rabbone, I, Schiaffini, R, Bruttomesso, D, Mammi, F, Bruzzese, M, Schettino, M, Nuzzo, M, Fresa, R, Lambiase, C, Zanfardino, A, Confetto, S, Annuzzi, G, Alderisio, A, Riccardi, G, Gentile, S, Marino, G, Guarino, G, Zucchini, S, Maltoni, G, Suprani, T, Graziani, V, Nizzoli, M, Acquati, S, Cavani, R, Romano, S, Michelini, M, Manicardi, E, Bonadonna, R, Dei Cas, A, Dall'Aglio, E, Papi, M, Riboni, S, Manicardi, V, Pugni, V, Lasagni, A, Street, M, Pagliani, U, Rossi, C, Assaloni, R, Brunato, B, Tortul, C, Zanette, G, Li Volsi, P, Zanatta, M, Tonutti, L, Agus, S, Pellegrini, M, Ceccano, P, Pozzilli, G, Anguissola, B, Buzzetti, R, Moretti C, C, Leto, G, Pozzilli, P, Manfrini, S, Maurizi, A, Leotta, S, Altomare, M, Abbruzzese, S, Carletti, S, Suraci, C, Filetti, S, Manca Bitti, M, Arcano, S, Cavallo, M, De Bernardinis, M, Pitocco, D, Caputo, S, Rizzi, A, Manto, A, Cappa, M, Benevento, D, Frontoni, S, Malandrucco, I, Morano, S, Filardi, T, Lauro, D, Marini, M, Castaldo, E, Sabato, D, Tuccinardi, F, Forte, E, Viterbori, P, Arnaldi, C, Minuto, N, D'Annunzio, G, Corsi, A, Rota, R, Scaranna, C, Trevisan, R, Valentini, U, Bonfadini, S, Zarra, E, Plebani, A, Prandi, E, Felappi, B, Rocca, A, Meneghini, E, Galli, P, Ruggeri, P, Carrai, E, Fugazza, L, Baggi, V, Conti, D, Bosi, E, Laurenzi, A, Caretto, A, Molinari, C, Orsi, E, Grancini, V, Resi, V, Favalli, V, Bonura, C, Rigamonti, A, Bonomo, M, Bertuzzi, F, Pintaudi, B, Disoteo, O, Perseghin, G, Perra, S, Chiovato, L, De Cata, P, Zerbini, F, Lovati, E, Laneri, M, Guerraggio, L, Bossi, A, De Mori, V, Galetta, M, Meloncelli, I, Aiello A, A, Di Vincenzo, S, Nuzzi, A, Fraticelli, E, Ansaldi, E, Battezzati, M, Lombardi, M, Balbo, M, Lera, R, Secco, A, De Donno, V, Cadario, F, Savastio, S, Ponzani, C, Aimaretti, G, Ignaccolo, G, Tinti, D, Cerutti, F, Bari, F, Giorgino, F, Piccinno, E, Zecchino, O, Cignarelli, M, Lamacchia, O, Picca, G, De Cosmo, S, Rauseo, A, Tomaselli, L, Tumminia, A, Egiziano, C, Scarpitta, A, Maggio, F, Cardella, F, Roppolo, R, Provenzano, V, Fleres, M, Scorsone, A, Scatena, A, Gregori, G, Lucchesi, S, Gadducci, F, Di Cianni, S, Pancani, S, Del Prato, S, Aragona, M, Crisci, I, Calianno, A, Fattor, B, Crazzolara, D, Reinstadler, P, Longhi, S, Incelli, G, Rauch, S, Romanelli, T, Orrasch, M, Cauvin, V, Franceschi, R, Lalli, C, Pianta, A, Marangoni, A, Arico, C, Marin, N, Nogara, N, Simioni, N, Filippi, A, Gidoni Guarneri, G, Contin, M, Decata, A, Bondesan, L, Confortin, L, Coracina, A, Lombardi, S, Costa Padova, S, Cipponeri, E, Scotton, R, Galasso, S, Boscari, F, Zanon, M, Vinci, C, Lisato, G, Gottardo, L, Bonora, E, Trombetta, M, Negri, C, Brangani, C, Maffeis, C, Sabbion, A, Marigliano, M, Lepore G., Bonfanti R., Bozzetto L., Di Blasi V., Girelli A., Grassi G., Iafusco D., Laviola L., Rabbone I., Schiaffini R., Bruttomesso D., Mammi F., Bruzzese M., Schettino M., Nuzzo M. G., Fresa R., Lambiase C., Zanfardino A., Confetto S., Annuzzi G., Alderisio A., Riccardi G., Gentile S., Marino G., Guarino G., Zucchini S., Maltoni G., Suprani T., Graziani V., Nizzoli M., Acquati S., Cavani R., Romano S., Michelini M., Manicardi E., Bonadonna R., Dei Cas A., Dall'aglio E., Papi M., Riboni S., Manicardi V., Pugni V., Lasagni A., Street M. E., Pagliani U., Rossi C., Assaloni R., Brunato B., Tortul C., Zanette G., Li Volsi P., Zanatta M., Tonutti L., Agus S., Pellegrini M. A., Ceccano P., Pozzilli G., Anguissola B., Buzzetti R., Moretti C C., Leto G., Pozzilli P., Manfrini S., Maurizi A. R., Leotta S., Altomare M., Abbruzzese S., Carletti S., Suraci C., Filetti S., Manca Bitti M. L., Arcano S., Cavallo M. G., De Bernardinis M., Pitocco D., Caputo S., Rizzi A., Manto A., Cappa M., Benevento D., Frontoni S., Malandrucco I., Morano S., Filardi T., Lauro D., Marini M. A., Castaldo E., Sabato D., Tuccinardi F., Forte E., Viterbori P., Arnaldi C., Minuto N., d'Annunzio G., Corsi A., Rota R., Scaranna C., Trevisan R., Valentini U., Bonfadini S., Zarra E., Plebani A., Prandi E., Felappi B., Rocca A., Meneghini E., Galli P., Ruggeri P., Carrai E., Fugazza L., Baggi V., Conti D., Bosi E., Laurenzi A., Caretto A., Molinari C., Orsi E., Grancini V., Resi V., Favalli V., Bonura C., Rigamonti A., Bonomo M., Bertuzzi F., Pintaudi B., Disoteo O., Perseghin G., Perra S., Chiovato L., De Cata P., Zerbini F., Lovati E., Laneri M., Guerraggio L., Bossi A. C., De Mori V., Galetta M., Meloncelli I., Aiello A A., Di Vincenzo S., Nuzzi A., Fraticelli E., Ansaldi E., Battezzati M., Lombardi M., Balbo M., Lera R., Secco A., De Donno V., Cadario F., Savastio S., Ponzani C., Aimaretti G., Ignaccolo G., Tinti D., Cerutti F., Bari F., Giorgino F., Piccinno E., Zecchino O., Cignarelli M., Lamacchia O., Picca G., De Cosmo S., Rauseo A., Tomaselli L., Tumminia A., Egiziano C., Scarpitta A. M., Maggio F., Cardella F., Roppolo R., Provenzano V., Fleres M., Scorsone A., Scatena A., Gregori G., Lucchesi S., Gadducci F., Di Cianni S., Pancani S., Del Prato S., Aragona M., Crisci I., Calianno A., Fattor B., Crazzolara D., Reinstadler P., Longhi S., Incelli G., Rauch S., Romanelli T., Orrasch M., Cauvin V., Franceschi R., Lalli C., Pianta A., Marangoni A., Arico C. N., Marin N., Nogara N., Simioni N., Filippi A., Gidoni Guarneri G. L., Contin M. L M. L., Decata A. P., Bondesan L., Confortin L., Coracina A., Lombardi S., Costa Padova S., Cipponeri E., Scotton R., Galasso S., Boscari F., Zanon M. S., Vinci C., Lisato G., Gottardo L., Bonora E., Trombetta M., Negri C., Brangani C., Maffeis C., Sabbion A., and Marigliano M.

Abstract

Background and aim: The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). Methods and results: Questionnaires investigating the organisation of diabetes care centres, individuals’ clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and [removed]18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. Conclusions: Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. Clinical trial registration number: NCT 02620917 (ClinicalTrials.gov).

Published
2018

11. Trend in rifampicin-, multidrug- and extensively drug-resistant tuberculosis in Italy, 2009-2016

Author

Mustazzolu, A., Borroni, E., Cirillo, D. M., Giannoni, F., Iacobino, A., Fattorini, L., Ghisetti, V., Mondo, A., Avolio, M., Barbui, A., Lorenzetti, P., De Renzi, G., Chirillo, M. G., Molinari, G., Camaggi, A., Andreoni, S., Piana, F., Marchese, A., Gritti, P., Icardi, G., Varnier, O., Mazzola, E., Gesu, G., Cichero, P., Lombardi, A., Libanori, E., Viggiani, P., De Lorenzo, S., Pinsi, G., Marone, P., Monzillo, V., Barbarini, D., Farina, C., Arosio, M., Peracchi, M., Manganelli, R., Fabris, C., Di Santolo, M., Busetti, M., Scarparo, C., Sartor, A., Pedrotti, C., Caola, I., Frizzera, E., Dal Monte, P., Pietrosemoli, P., Pecorari, M., Fabio, A., La Regina, A., Matteucci, M., Piersimoni, C., Bartolesi, A., Mannino, R., Simonetti, T., Tortoli, E., Rindi, L., Mencacci, A., Cenci, E., Luciano, E., Mazzolla, R., Sanguigni, I., Parisi, G., Chiaradonna, P., Altieri, A. M., D'Arezzo, S., Mazzarelli, A., Di Caro, A., Bordi, E., Sali, M., Delogu, G., Sanguinetti, M., Russo, C., Coltella, L., Ciocco, A., Meledandri, M., Gambi, A., Tomei, G., Conte, M., Santoro, G., Del Giudice, A., Nuzzolese, N., Vitullo, E., Sinno, A., Buono, L., Costa, D., Grimaldi, A., Di Taranto, A., De Nittis, R., Palumbo, G., Dodaro, S., Giraldi, C., Cavalcanti, P., Nistico, S., Vinci, L., Di Naso, C., Bonura, C., Maida, C. M., Mammina, C., Podda, G. S., Caddeu, R., Mustazzolu A., Borroni E., Cirillo D.M., Giannoni F., Iacobino A., Fattorini L., Ghisetti V., Mondo A., Avolio M., Barbui A., Lorenzetti P., De Renzi G., Chirillo M.G., Molinari G., Camaggi A., Andreoni S., Piana F., Marchese A., Gritti P., Icardi G., Varnier O., Mazzola E., Gesu G., Cichero P., Lombardi A., Libanori E., Viggiani P., De Lorenzo S., Pinsi G., Marone P., Monzillo V., Barbarini D., Farina C., Arosio M., Peracchi M., Manganelli R., Fabris C., Di Santolo M., Busetti M., Scarparo C., Sartor A., Pedrotti C., Caola I., Frizzera E., Dal Monte P., Pietrosemoli P., Pecorari M., Fabio A., La Regina A., Matteucci M., Piersimoni C., Bartolesi A., Mannino R., Simonetti T., Tortoli E., Rindi L., Mencacci A., Cenci E., Luciano E., Mazzolla R., Sanguigni I., Parisi G., Chiaradonna P., Altieri A.M., D'Arezzo S., Mazzarelli A., Di Caro A., Bordi E., Sali M., Delogu G., Sanguinetti M., Russo C., Coltella L., Ciocco A., Meledandri M., Gambi A., Tomei G., Conte M., Santoro G., Del Giudice A., Nuzzolese N., Vitullo E., Sinno A., Buono L., Costa D., Grimaldi A., Di Taranto A., De Nittis R., Palumbo G., Dodaro S., Giraldi C., Cavalcanti P., Nistico S., Vinci L., Di Naso C., Bonura C., Maida C.M., Mammina C., Podda G.S., and Caddeu R.

Subjects
0301 basic medicine, Pulmonary and Respiratory Medicine, Extensively Drug-Resistant Tuberculosis, Antitubercular Agents, Emigrants and Immigrants, Humans, Italy, Mycobacterium tuberculosis, Rifampin, Tuberculosis, Multidrug-Resistant, 03 medical and health sciences, 0302 clinical medicine, polycyclic compounds, medicine, Tuberculosis, biology, business.industry, Extensively drug-resistant tuberculosis, Multidrug-Resistant, medicine.disease, biology.organism_classification, Virology, 030104 developmental biology, 030228 respiratory system, business, Rifampicin, medicine.drug
Abstract

In Italy, rifampicin-resistant and MDR-TB were high in foreign-born persons, but decreased from 2009 to 2016

Published
2018

13. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study

Author

Rabbone, I., Minuto, N., Bonfanti, R., Marigliano, M., Cerutti, F., Cherubini, V., d(')Annunzio, G., Frongia, A. P., Iafusco, D., Ignaccolo, G., Lombardo, F., Schiaffini, R., Toni, S., Tumini, S., Zucchini, S., Pistorio, A., Scaramuzza, A. E., Scaramuuzza, A. E., Lera, R., Secco, A., Bobbio, A., Bechaz, M., Piccinno, E., Natale, M. P., Ortolani, F., Zecchino, C., Lonero, A., Maltoni, G., Pasquino, B., Gallo, F., Frongia, P., Ripoli, C., Lo Presti, D., Timpanaro, T., Citriniti, F., Suprani, T., Carinci, S., Cipriano, P., Lazzaro, N., De Donno, V., Gallarotti, F., Lenzi, L., Piccini, B., Vittorio, L., Russo, C., Borea, R., Mamm(`i), F., Bruzzese, M., Ventrici, C., Salzano, G., Frontino, G., Bonura, C., Favalli, V., Scaramuzza, A., Zuccotti, G. V., Ferrari, M., Iughetti, L., Predieri, B., Franzese, A., Mozzillo, E., Buono, P., Confetto, S., Zanfardino, A., Cadario, F., Savastio, S., Fiorito, C., Barbieri, P., Piredda, G., Cardella, F., Ropolo, R., Federico, G., Marchi, B., Benevento, D., Carducci, C., Mancabitti, M. L., Delvecchio, M., Lapolla, R., Gaiero, A., Fichera, G., Ignaccolo, M. G., Tinti, D., Cauvin, V., Franceschi, R., Biagioni, M., Salvatoni, A., Scolari, A., Maffeis, C., Sabbion, A., Arnaldi, C., Tosini, D., Rabbone, I, Minuto, N., Bonfanti, R., Marigliano, M., Cerutti, F., Cherubini, V., D'Annunzio, G., Frongia, A. P., Iafusco, Dario, Ignaccolo, G., Lombardo, F., Schiaffini, R., Toni, S., Tumini, S., Zucchini, S., Pistorio, A., Scaramuzza, A. E., Rabbone, I., Iafusco, D., Lera, R., Secco, A., Bobbio, A., Bechaz, M., Piccinno, E., Natale, M. P., Ortolani, F., Zecchino, C., Lonero, A., Maltoni, G., Pasquino, B., Gallo, F., Frongia, P., Ripoli, C., Lo Presti, D., Timpanaro, T., Citriniti, F., Suprani, T., Carinci, S., Cipriano, P., Lazzaro, N., De Donno, V., Gallarotti, F., Lenzi, L., Piccini, B., Vittorio, L., Russo, C., Borea, R., Mammi, F., Bruzzese, M., Ventrici, C., Salzano, G., Frontino, G., Bonura, C., Favalli, V., Scaramuzza, A., Zuccotti, G. V., Ferrari, M., Iughetti, L., Predieri, B., Franzese, A., Mozzillo, E., Buono, P., Confetto, S., Zanfardino, A., Cadario, F., Savastio, S., Fiorito, C., Barbieri, P., Piredda, G., Cardella, F., Ropolo, R., Federico, G., Marchi, B., Benevento, D., Carducci, C., Mancabitti, M. L., Del Vecchio, M., Lapolla, R., Gaiero, A., Fichera, G., Ignaccolo, M. G., Tinti, D., Cauvin, V., Franceschi, R., Biagioni, M., Salvatoni, A., Scolari, A., Maffeis, C., Sabbion, A., Arnaldi, C., Tosini, D., Rabbone, Minuto, Mammì, F., and Mozzillo, Enza.

Subjects
Blood Glucose, Male, Pediatrics, Adolescent, Blood Glucose Self-Monitoring, Child, Child, Preschool, Diabetes Mellitus, Type 1, Equipment Failure, Female, Humans, Infant, Insulin, Italy, Retrospective Studies, Insulin Infusion Systems, type 1 diabetes, medicine.medical_treatment, Endocrinology, Diabetes and Metabolism, Internal Medicine, Endocrinology, 0302 clinical medicine, Retrospective Studie, Medicine, 030212 general & internal medicine, Diabetes, Diabetology, failure, Diabetes and Metabolism, children and adolescents, insulin pump, Cohort study, Type 1, Human, Insulin pump, medicine.medical_specialty, Disease duration, 030209 endocrinology & metabolism, 03 medical and health sciences, Diabetes mellitus, Diabetes Mellitus, Preschool, Type 1 diabetes, business.industry, Diabetes, Type1, Pump, Insulin, Type1, Retrospective cohort study, Pump, medicine.disease, Surgery, Insulin Infusion System, business
Abstract

Aims Insulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy. Methods Data were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013. Results Data were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE™, 9.4% Medtronic MiniMed 715/515™, 34.3% Medtronic MiniMed VEO™, 24.3% Accu-Check Spirit Combo™ and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE™ (22.1%) and Medtronic MiniMed VEO™ (17.7%) were the most replaced. Conclusions In a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models. This article is protected by copyright. All rights reserved.

Published
2017

17. Analysis of a cohort of pediatric patients treated with continuous subcutaneous insulin infusion

Author

Rubino C., Rigamonti A., Frontino G., Battaglino R., Favalli V., Bonura C., Barera G., Meschi F., Bonfanti R., Rubino, C., Rigamonti, A., Frontino, G., Battaglino, R., Favalli, V., Bonura, C., Barera, G., Meschi, F., and Bonfanti, R.

Subjects
Type 1 diabetes, Insulin pump, Children
Abstract

We analyzed a cohort of pediatric patients with type 1 diabetes mellitus treated with continuous insulin infusion (CSII), followed at the San Raffaele Hospital (Milan, Italy) in the period 2007-2014. We collected data from a questionnaire and from outpatient charts for 206 patients, whose average age was 12.93 years; 93.2% followed our protocol for starting CSII. The drop-out rate was 3.4%. Mean HbA1c was comparable to that of patients on multiple daily injections (MDI) and long-term analysis did not show any significant changes before and after CSII. The incidence of acute complications was low: 1.42 episodes/100 patients/year for severe hypoglycemia (about 50% fewer than in those using MDI), 1.11 episodes/100 patients/year for diabetic ketoacidosis. CSII patients did not gain weight and we found a significant relation between follow-up BMI and HbA1c. There was also a correlation between the use of a vertical cannula and HbA1c reduction. Most of these patients used advanced functions (bolus calculator, temporary basal rates), telemedicine and carbohydrate counting, but only carbohydrate counting was related to the improvement in HbA1c: 60.2% used continuous glucose monitoring (CGM) but here too there was no relation with reduced HbA1c; 53.4% replaced the pump at least once and 41.7% reported malfunctions (no adverse events). The distribution of insulin basal rates differed between age groups 0-6, 7-12, and 13-18 years; this confirms other reports and the advantage of CSII over MDI in children under the age of six. The average number of bolus injections was lower than expected and was not significantly related with HbA1c. CSII is safe and effective. Most studies report no significant improvement in HbA1c, but there is a lower incidence of acute complications. CSII therapy is a mandatory step towards the application of new diabetes technology (artificial pancreas) but further studies need to assess long-term cost and benefits.

Published
2015

18. Real-time PCR for early diagnosis of Rickettsia conorii and prompt management in patients with septic shock and multiple organ failure: two case reports

Author

Di Carlo, P, Trizzino, M, Giarratano, A, Giammanco,A, Montalto,F, Raineri,M, Dones,P, Bonura,C, Di Carlo, P, Trizzino, M, Giarratano, A, Giammanco,A, Montalto,F, Raineri,M, Dones,P, and Bonura,C

Subjects
Rickettsia conorii, Settore MED/17 - Malattie Infettive
Abstract

We herein describe two severe cases of Mediterranean spotted fever caused by Rickettsia conorii. The ar- ticle presents polymerase chain reaction-restriction analysis as an early diagnostic tool for rickettsiosis caused by spotted fever group Rickettsiae. Timely microbiological diagnosis, the combined use of antibi- otics, intensive care measures and a multidisciplinary team approach are fundamental to manage these serious diseases.

Published
2015

19. Hypoglycemia in insulin-dependent diabetic children

Author

Rigamonti A., Favalli V., Bonura C., Frontino G., Barera G., Meschi F., Bonfanti R., Rigamonti, A., Favalli, V., Bonura, C., Frontino, G., Barera, G., Meschi, F., and Bonfanti, R.

Subjects
Type 1 diabetes mellitus, Children, Hypoglycemia
Abstract

Hypoglycemia is a major obstacle to reaching optimal glucose control in type 1 diabetes patients. Diabetic children present a particular situation, with specific symptoms, consequences and treatment. Epidemiological data regarding the incidence of hypoglycemia indicate that pre-school children and adolescents are at higher-than-normal risk. To reduce the risk of hypoglycemia these patients and their caregivers must all be involved. Advances in technology (telemedicine, insulin pumps, continuous glucose monitors, artificial pancreas, etc.) offer additional tools for preventing hypoglycemia and its consequences in pediatric patients.

Published
2015

20. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

Author

Lepore, Giuseppe, primary, Bonfanti, Riccardo, additional, Bozzetto, Lutgarda, additional, Di Blasi, Vincenzo, additional, Girelli, Angela, additional, Grassi, Giorgio, additional, Iafusco, Dario, additional, Laviola, Luigi, additional, Rabbone, Ivana, additional, Schiaffini, Riccardo, additional, Bruttomesso, Daniela, additional, Mammì, F., additional, Bruzzese, M., additional, Schettino, M., additional, Nuzzo, M.G., additional, Di Blasi, V., additional, Fresa, R., additional, Lambiase, C., additional, Iafusco, D., additional, Zanfardino, A., additional, Confetto, S., additional, Bozzetto, L., additional, Annuzzi, G., additional, Alderisio, A., additional, Riccardi, G., additional, Gentile, S., additional, Marino, G., additional, Guarino, G., additional, Zucchini, S., additional, Maltoni, G., additional, Suprani, T., additional, Graziani, V., additional, Nizzoli, M., additional, Acquati, S., additional, Cavani, R., additional, Romano, S., additional, Michelini, M., additional, Manicardi, E., additional, Bonadonna, R., additional, Dei Cas, A., additional, Dall'aglio, E., additional, Papi, M., additional, Riboni, S., additional, Manicardi, V., additional, Pugni, V., additional, Lasagni, A., additional, Street, M.E., additional, Pagliani, U., additional, Rossi, C., additional, Assaloni, R., additional, Brunato, B., additional, Tortul, C., additional, Zanette, G., additional, Li Volsi, P., additional, Zanatta, M., additional, Tonutti, L., additional, Agus, S., additional, Pellegrini, M.A., additional, Ceccano, P., additional, Pozzilli, G., additional, Anguissola, Beretta, additional, Buzzetti, R., additional, Moretti C, C., additional, Leto, G., additional, Pozzilli, P., additional, Manfrini, S., additional, Maurizi, A.R., additional, Leotta, S., additional, Altomare, M., additional, Abbruzzese, S., additional, Carletti, S., additional, Suraci, C., additional, Filetti, S., additional, Manca Bitti, M.L., additional, Arcano, S., additional, Cavallo, M.G., additional, De Bernardinis, M., additional, Pitocco, D., additional, Caputo, S., additional, Rizzi, A., additional, Manto, A., additional, Schiaffini, R., additional, Cappa, M., additional, Benevento, D., additional, Frontoni, S., additional, Malandrucco, I., additional, Morano, S., additional, Filardi, T., additional, Lauro, D., additional, Marini, M.A., additional, Castaldo, E., additional, Sabato, D., additional, Tuccinardi, F., additional, Forte, E., additional, Viterbori, P., additional, Arnaldi, C., additional, Minuto, N., additional, d'Annunzio, G., additional, Corsi, A., additional, Rota, R., additional, Scaranna, C., additional, Trevisan, R., additional, Valentini, U., additional, Girelli, A., additional, Bonfadini, S., additional, Zarra, E., additional, Plebani, A., additional, Prandi, E., additional, Felappi, B., additional, Rocca, A., additional, Meneghini, E., additional, Galli, P., additional, Ruggeri, P., additional, Carrai, E., additional, Fugazza, L., additional, Baggi, V., additional, Conti, D., additional, Bosi, E., additional, Laurenzi, A., additional, Caretto, A., additional, Molinari, C., additional, Orsi, E., additional, Grancini, V., additional, Resi, V., additional, Bonfanti, R., additional, Favalli, V., additional, Bonura, C., additional, Rigamonti, A., additional, Bonomo, M., additional, Bertuzzi, F., additional, Pintaudi, B., additional, Disoteo, O., additional, Perseghin, G., additional, Perra, S., additional, Chiovato, L., additional, De Cata, P., additional, Zerbini, F., additional, Lovati, E., additional, Laneri, M., additional, Guerraggio, L., additional, Bossi, A.C., additional, De Mori, V., additional, Galetta, M., additional, Meloncelli, I., additional, Aiello A, A., additional, Di Vincenzo, S., additional, Nuzzi, A., additional, Fraticelli, E., additional, Ansaldi, E., additional, Battezzati, M., additional, Lombardi, M., additional, Balbo, M., additional, Lera, R., additional, Secco, A., additional, De Donno, V., additional, Cadario, F., additional, Savastio, S., additional, Ponzani, C., additional, Aimaretti, G., additional, Rabbone, I., additional, Ignaccolo, G., additional, Tinti, D., additional, Cerutti, F., additional, Bari, F., additional, Giorgino, F., additional, Piccinno, E., additional, Zecchino, O., additional, Cignarelli, M., additional, Lamacchia, O., additional, Picca, G., additional, De Cosmo, S., additional, Rauseo, A., additional, Tomaselli, L., additional, Tumminia, A., additional, Egiziano, C., additional, Scarpitta, A.M., additional, Maggio, F., additional, Cardella, F., additional, Roppolo, R., additional, Provenzano, V., additional, Fleres, M., additional, Scorsone, A., additional, Scatena, A., additional, Gregori, G., additional, Lucchesi, S., additional, Gadducci, F., additional, Di Cianni, S., additional, Pancani, S., additional, Del Prato, S., additional, Aragona, M., additional, Crisci, I., additional, Calianno, A., additional, Fattor, B., additional, Crazzolara, D., additional, Reinstadler, P., additional, Longhi, S., additional, Incelli, G., additional, Rauch, S., additional, Romanelli, T., additional, Orrasch, M., additional, Cauvin, V., additional, Franceschi, R., additional, Lalli, C., additional, Pianta, A., additional, Marangoni, A., additional, Aricò, C.N., additional, Marin, N., additional, Nogara, N., additional, Simioni, N., additional, Filippi, A., additional, Gidoni Guarneri, G.L., additional, Contin M.L, M.L., additional, Decata, A.P., additional, Bondesan, L., additional, Confortin, L., additional, Coracina, A., additional, Lombardi, S., additional, Costa Padova, S., additional, Cipponeri, E., additional, Scotton, R., additional, Galasso, S., additional, Boscari, F., additional, Zanon, M.S., additional, Vinci, C., additional, Lisato, G., additional, Gottardo, L., additional, Bonora, E., additional, Trombetta, M., additional, Negri, C., additional, Brangani, C., additional, Maffeis, C., additional, Sabbion, A., additional, and Marigliano, M., additional

Published
2018
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21. La sorveglianza della tubercolosi in Sicilia

Author

Mammina, C., Bonura, C., Barchitta, M., Quattrocchi, A., Palermo, M., Agodi, A., Mammina, C., Bonura, C., Barchitta, M., Quattrocchi, A., Palermo, M., and Agodi, A.

Subjects
Settore MED/07 - Microbiologia E Microbiologia Clinica, tubercolosi, sorveglianza, epidemiologia, notifiche, tipizzazione molecolare
Abstract

Obiettivi. Descrivere l’andamento dei casi di tubercolosi (TB) in Sicilia negli anni 2010-2013. Disegno e partecipanti. Indagine osservazionale delle notifiche di TB relative agli anni 2010-2013 mediante l’analisi dei dati del Sistema informativo delle malattie infettive (SIMI) e indagine epidemiologico-molecolare mediante tipizzazione spoligo- e 24- loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) dei ceppi di Mycobacterium tuberculosis complex (MTBC) isolati a Palermo negli anni 2012-2013. Risultati. Negli anni 2010-2013 sono stati notificati in Sicilia 876 casi di TB con un tasso medio annuale di notifica pari a 4,4 casi per 100.000 abitanti. La proporzione di casi di TB in soggetti nati all’estero è crescente e nel 2012 e 2013 supera quella nella popolazione autoctona. L’età mediana dei pazienti stranieri è risultata significativamente inferiore agli italiani (30,5 vs. 51,2 anni, p 64 anni. Nell’82,5% dei casi è stata diagnosticata una localizzazione polmonare. La tipizzazione molecolare è stata effettuata su 151 ceppi di MTBC. Mediante spoligotyping essi sono stati attribuiti a 14 differenti lineage e 33 sublineage rappresentati con frequenza diversa tra le due subpopolazioni di pazienti. Soltanto nove ceppi (6,2%) sono stati inclusi in quattro cluster. Sono stati identificati, infine, due ceppi multiresistenti. Conclusioni. L’epidemiologia della TB in Sicilia è complessa e in rapida evoluzione, con una crescente proporzione di casi in soggetti non italiani e una grande eterogeneità dei ceppi di MTBC circolanti. L’integrazione di strumenti convenzionali e molecolari è necessaria per una sorveglianza efficace e un’interpretazione accurata dell’epidemiologia della TB in Sicilia.

Published
2014

26. Panton-Valentine leukocidin positive sequence type 80 methicillin-resistant Staphylococcus aureus carrying a staphylococcal cassette chromosome mec type IVc is dominant in neonates and children in an Algiers hospital

Author

Djoudi, F., Bonura, C., Benallaoua, S., Touati, A., Touati, D., Aleo, A., Cala, C., Fasciana, T., Caterina Mammina, Djoudi F, Bonura C, Benallaoua S, Touati A, Touati D, Aleo A, Cala C, Fasciana T, and Mammina C.

Subjects
Methicillin-Resistant Staphylococcus aureus, Cross Infection, Molecular Epidemiology, Adolescent, Bacterial Toxins, Exotoxins, Infant, Microbial Sensitivity Tests, Staphylococcal Infections, Settore MED/42 - Igiene Generale E Applicata, Polymerase Chain Reaction, Bacterial Typing Techniques, Electrophoresis, Gel, Pulsed-Field, Community-Acquired Infections, MRSA, PVL, CA-MRSA, ST80, neonates, children, Leukocidins, Algeria, Child, Preschool, Humans, Child, Multilocus Sequence Typing
Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a major antimicrobial drug-resistant pathogen causing serious infections. It was first detected in healthcare settings, but in recent years it has also become disseminated in the community. Children and young adults are most susceptible to infection by community-acquired (CA) MRSA strains. In this study 25 MRSA isolates implicated in infections of neonates and children admitted to an Algiers hospital during an 18 month period were characterized by molecular methods including staphylococcal cassette chromosome (SCC) mec typing, PCR amplification of pvl genes, pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Fifteen out of 25 isolates were from hospital-acquired infections. Twenty-four isolates carried SCCmec type IVc and belonged to the sequence type (ST) 80, one isolate carried SCCmec type II and was ST 39. Twenty-two out of 24 ST80-MRSA-IVc isolates carried pvl genes. Our results suggest that the Panton-Valentine leukocidin positive ST80- MRSA-IVc is the dominant MRSA clone causing disease in neonates and children in Algiers.

Published
2012

27. Rapidly growing mycobacteria in TB/HIV co-infection: a report of two cases focusing on difficulties in diagnosis and management

Author

Bonura, C., Di Carlo, P., Spicola, D., Calà, C., Caterina Mammina, Fasciana, T., Giammanco, A., Bonura, C, Di Carlo, P, Spicola, D, Calà, C, Mammina, C, Fasciana, T, and Giammanco, A

Subjects
Settore MED/07 - Microbiologia E Microbiologia Clinica, Settore MED/17 - Malattie Infettive, RGM, TB/HIV coinfection, Diagnosis
Abstract

Recent reports indicate an increase in rates of infection and disease due to rapidly growing mycobacteria (RGM) in patients with pre-existing chronic lung disease. Studies have described difficulties in correctly identifying closely related species, even when proper methodologies are adopted, and several different gene targets have been proposed. We describe two cases of RGM infection in a 29-year-old HIV-1 positive Congolese man and a 19-year-old HIV-1 positive Liberian woman, respectively, both with bronchiectasis due to previous Mycobacterium tuberculosis (MTB) infection. Mycobacterium porcinum and Mycobacterium bolletii were identified in bronchoalveolar lavage fluid and sputum, respectively. After starting the patients on antiretroviral treatment and primary prophylaxis against non-tuberculous mycobacteria (NTM), and ensuring that they adhered to their prescribed regimen, we observed an improvement in their clinical condition and mycobacteria cleared from their respiratory specimens. Management of RGM respiratory infection in immunocompromised patients has to be evaluated on a case-by-case basis, taking into account the patient's pulmonary sequelae, adherence to multiple treatments and immune profile.

Published
2012

33. Assessment of humoral and cell-mediated immunity against Bordetella pertussis in adolescent, adult, and senior subjects in Italy

Author

Gabutti, Giovanni, Bergamini, M., Bonanni, P., Signorino, Guido, Fenoglio, D., Giammanco, A., Sindoni, L., Zotti, C., Boddi, V., Bamfi, F., Severini, R., Bechini, A., Boccalini, S., Crovari, P., Ditommaso, S., Gentile, M., Lanci, G., Durando, P., Sticchi, L., Renzoni, A., Fuliano, P., Tripodi, G., Cavallaro, A., Pesavento, G., Silei Secchini, T., Innocenti, B., Squeri, R., La Fauci, V., Calimeri, S., Lo Giudice, D., De Donno, A., Quattrocchi, M., Sanapo, F., Pasanisi, G. C., Taormina, S., Bonura, C., Calã , C., Ferrera, A., Gabutti, G, Bergamini, M, Bonanni, P, Guido, Marcello, Fenoglio, D, Giammanco, A, Sindoni, L, Zotti, C, Boddi, V, Bamfi, F, Severini, R, Bechini, A, Boccalini, S, Crovari, P, AND COLLABORATIVE GROUP FOR STUDY OF, Pertussis, GABUTTI G, BERGAMINI M, BONANNI P, GUIDO M, FENOGLIO D, GIAMMANCO A, SINDONI L, ZOTTI C, BODDI V, BAMFI F, SEVERINI R, BECHINI A, BOCCALINI S, CROVARI P, DITOMMASO S, GENTILE M, LANCI G, DURANDO P, STICCHI L, RENZONI A, FULIANO P, TRIPODI G, CAVALLARO A, PESAVENTO G, SILEI SECCHINI T, INNOCENTI B, SQUERI R, LA FAUCI V, CALIMERI S, LO GIUDICE D, DE DONNO A, QUATTROCCHI M, SANAPO F, PASANISI GC, TAORMINA S, BONURA C, CALA C, and FERRERA A

Subjects
Male, Settore MED/07 - Microbiologia E Microbiologia Clinica, Cellular immunity, Bordetella pertussis, Epidemiology, Whooping Cough, Seroepidemiologic Studies, 80 and over, Lymphocytes, Aged, 80 and over, education.field_of_study, biology, adult, Bacterial, Middle Aged, Original Papers, Antibodies, Bacterial, senior, Infectious Diseases, B. pertussis, Humoral and cell-mediated immunity, ELISA, Italy, Female, Antibody, Adult, medicine.medical_specialty, Bordetella pertussi, Adolescent, Aged, Antitoxins, Enzyme-Linked Immunosorbent Assay, Humans, Immunoglobulin G, Population, Antibodies, NO, Immunity, medicine, education, immunità cellulo mediata, business.industry, biology.organism_classification, adolescent, Humoral immunity, Immunology, Etiology, biology.protein, immunità umorale, business
Abstract

SUMMARYHumoral and cell-mediated immunity (CMI) againstB. pertussiswas assessed in a sample of adolescent, adult and senior subjects distributed in five different geographical areas in Italy. Most (99·1%) subjects had IgG anti-pertussis toxin (PT) antibodies exceeding the minimum detection level [⩾2 ELISA units (EU)/ml]. There were no significant differences between the genders; 6·2% samples recorded titres ⩾100 EU/ml. CMI was positive [stimulation index (SI) ⩾5] against PT in 39·0% of all samples. This study suggests thatB. pertussiscontinues to circulate in age groups that have been previously considered to be uninvolved in the circulation of this pathogen and that adolescent and adult pertussis boosters may be of value in these populations. Nevertheless, over the last 10 years, large increases in vaccination coverage rates have contributed to reduce the spread of the aetiological agent, especially in the immunized population.

Published
2008

34. Genotyping of Legionella pneumophila serogroup 1 strains isolated in Northern Sicily, Italy

Author

Chiarini, A., Bonura, C., Donatella Ferraro, Barbaro, R., Calà, C., Distefano, S., Casuccio, N., Belfiore, S., Giammanco, A., Chiarini, A, Bonura, C, Ferraro, D, Barbaro, R, Di Stefano, S, Casuccio, N, Belfiore, S, Giammanco, A, and Cala', C

Subjects
DNA, Bacterial, Disinfection, Molecular Epidemiology, Settore MED/07 - Microbiologia E Microbiologia Clinica, Genotype, Cluster Analysis, Fresh Water, Sequence Analysis, DNA, Amplified Fragment Length Polymorphism Analysis, Legionella pneumophila, Surveillance, Water distribution system, Molecular typing, Amplified fragment length polymorphism, Sicily, Bacterial Typing Techniques, Legionella pneumophila
Abstract

During a three-year period, from April 2002 to May 2005, one hundred-forty-seven samples, taken from technical systems of water distribution at point of use, were repeatedly collected at six different sites in Northern Sicily and assayed for the presence of Legionella pneumophila serogroup 1 and serogroups 2 to 14. At the first samplings, the water distribution systems of all the sites were heavily contaminated, and disinfection treatments by the superheat and flush method were therefore performed. Treatments were always successful against L. pneumophila sg.1, but only in a few cases against all other serogroups. Eighty-six strains of L. pneumophila sg. 1, isolated from 26 of these samples, were characterized by amplified fragment length polymorphism (AFLP) analysis and sequence-based typing (SBT) procedure. Perfectly overlapping results were obtained by both the procedures and four genotypes were identified, accounting for all the isolates. The easy transferability of the SBT data through a web-based database made it possible to identify the presence in Northern Sicily of the two SBT types most commonly circulating in Europe.

Published
2008

35. Occult HBV infection and suppression of HCV replication in the early phase of combination therapy for chronic hepatitis C

Author

Ferraro, D., Bonura, C., Giglio, M., Di Stefano, R., Almasio, P. L., Di Marco, V., Antonio Craxi, Cacciola, I., Squadrito, G., Raimondo, G., Ferraro, D., Bonura, C., Giglio, M., DI STEFANO, R., Almasio, P., DI MARCO, V., Craxi, A., Cacciola, I., Squadrito, G., and Raimondo, G.

Subjects
Adult, Male, Hepatitis B virus, pegylated interferon-alpha, Genotype, Biopsy, Hepacivirus, Interferon alpha-2, Virus Replication, Antiviral Agents, Polyethylene Glycols, Hepatitis B Antibodie, Ribavirin, chronic hepatitis C, Humans, Hepatitis B Antibodies, Antiviral Agent, Hepaciviru, occult HBV infection, viral dynamics, treatment response, Interferon-alpha, Alanine Transaminase, Hepatitis B viru, Hepatitis C Antibodies, Hepatitis C, Chronic, Middle Aged, Recombinant Protein, Viral Load, Hepatitis B, Recombinant Proteins, Treatment Outcome, Liver, DNA, Viral, RNA, Viral, Drug Therapy, Combination, Female, Hepatitis C Antibodie, Human
Abstract

Occult HBV infection in subjects with chronic hepatitis C is related to more severe disease outcome. It has been suggested that it might reduce sensitivity to antiviral treatment.To assess in HBsAg negative subjects with chronic hepatitis C any effect of the presence of HBV genomes in the liver on the early kinetics of HCV-RNA under PEG-IFN plus ribavirin.Twenty-two anti-HCV and HCV-RNA positive subjects, with biopsy-proven chronic hepatitis C (M/F 15/7; 50 +/- 8.6 years, 16 genotype 1b) were given PEG-IFN alpha 2b 1.0 microg qw plus ribavirin (800 to 1,200 mg daily according to body weight) for an intended 52 week period. Early virological response was assessed over the first 4 weeks of therapy by quantifying HCV-RNA. Occult HBV infection was assessed by testing for HBV-DNA in the liver before therapy.HBV genomes were found in the liver of 7 of 22 (31.4%) patients, unrelated to anti-HBc status. Kinetics of HCV-RNA during the first 4 weeks of antiviral treatment was unaffected by occult HBV infection, both in terms of absolute reduction of viral load and of number of cases with a reduction ofor = 2 log10 on treatment.Occult HBV infection does not affect the early phase of response to combination therapy. Further follow-up of patients into the maintenance phase of antiviral treatment and after stopping it will clarify if and when occult HBV has a role in reducing sustained virological response.

Published
2003

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