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2. Continuum of care among HIV-1 positive patients in a single center in Italy (2007–2017)

Author

Lagi F, Kiros ST, Campolmi I, Giachè S, Rogasi PG, Mazzetti M, Bartalesi F, Trotta M, Nizzoli P, Bartoloni A, and Sterrantino G

Subjects
HIV-1, continuum of care, Retention, Italy, Medicine (General), R5-920
Abstract

Filippo Lagi,1 Seble Tekle Kiros,1 Irene Campolmi,1 Susanna Giachè,1 Pier Giorgio Rogasi,2 Marcello Mazzetti,2 Filippo Bartalesi,2 Michele Trotta,2 Patrizia Nizzoli,3 Alessandro Bartoloni,1,2 Gaetana Sterrantino2 1Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 2Infectious and Tropical Disease Unit, Azienda Ospedaliero – Universitaria Careggi, Florence, Italy; 3Department of Pharmaceuticals, USL Toscana Centro, Florence, Italy Aim: This study aimed to determine rates of retention in care, viral suppression, and use of antiretroviral therapy (ART) and identify risk factors for loss to follow-up (FU) in an adult cohort from a tertiary teaching hospital in Florence, Italy. Methods: We included all newly diagnosed HIV-infected patients aged >18 years who were linked to our clinic from July 2007 to December 2015. On July 31, 2017, we evaluated the proportion of patients retained in care, on ART, and having HIV RNA

Published
2018

3. Valacyclovir for prevention and treatment of fetal cmv infection: Inclusion in the law 648/96 list and launch of the italian multicentre observational prospective study “megal-itali”

Author

Zammarchi, L, Lazzarotto, T, Di Tommaso, M, Tomasoni, L, Pasquini, L, Galli, L, Simonazzi, G, Castelli, F, Borchi, B, Campolmi, I, Ornaghi, S, Bartoloni, A, Andreoni, M, Pagano, I, Petraglia, S, Ramenghi, L, Clerici, P, Tavio, M, Trotta, M, Zammarchi L., Lazzarotto T., Di Tommaso M., Tomasoni L., Pasquini L., Galli L., Simonazzi G., Castelli F., Borchi B., Campolmi I., Ornaghi S., Bartoloni A., Andreoni M., Pagano I., Petraglia S., Ramenghi L., Clerici P., Tavio M., Trotta M., Zammarchi, L, Lazzarotto, T, Di Tommaso, M, Tomasoni, L, Pasquini, L, Galli, L, Simonazzi, G, Castelli, F, Borchi, B, Campolmi, I, Ornaghi, S, Bartoloni, A, Andreoni, M, Pagano, I, Petraglia, S, Ramenghi, L, Clerici, P, Tavio, M, Trotta, M, Zammarchi L., Lazzarotto T., Di Tommaso M., Tomasoni L., Pasquini L., Galli L., Simonazzi G., Castelli F., Borchi B., Campolmi I., Ornaghi S., Bartoloni A., Andreoni M., Pagano I., Petraglia S., Ramenghi L., Clerici P., Tavio M., and Trotta M.

Published
2021

4. Valacyclovir for prevention and treatment of fetal CMV infection: inclusion in the Law 648/96 list and launch of the Italian multicentre observational prospective study 'MEGAL-ITALI'

Author

Zammarchi, L., Lazzarotto, T., Di Tommaso, M., Tomasoni, L., Pasquini, L., Galli, L., Simonazzi, G., Castelli, F., Borchi, B., Campolmi, I., SARA ORNAGHI, Bartoloni, A., Andreoni, M., Pagano, I., Petraglia, S., Ramenghi, L., Clerici, P., Tavio, M., Trotta, M., Zammarchi L, Lazzarotto T, Di Tommaso M, Tomasoni L, Pasquini L, Galli L, Simonazzi G, Castelli F, Borchi B, Campolmi I, Ornaghi S, Bartoloni A, Andreoni M, Pagano I, Petraglia S, Ramenghi L, Clerici P, Tavio M, Trotta M., Zammarchi, L, Lazzarotto, T, Di Tommaso, M, Tomasoni, L, Pasquini, L, Galli, L, Simonazzi, G, Castelli, F, Borchi, B, Campolmi, I, Ornaghi, S, Bartoloni, A, Andreoni, M, Pagano, I, Petraglia, S, Ramenghi, L, Clerici, P, Tavio, M, and Trotta, M

Subjects
Valacyclovir, Citomegalovirus, pregnancy, Italy, Valacyclovir, Cytomegalovirus Infections, Infant, Newborn, Humans, Infant, Antiviral Agents, Newborn, valacyclovir, congenital, cytomegalovirus
Abstract

not available

Published
2021

5. CD4/CD8 ratio in pregnant women with HIV and its association with pregnancy outcome: data from a national study in Italy

Author

Floridia, M., Pinnetti, C., Masuelli, G., Spinillo, A., Savasi, V. M., Liuzzi, G., Degli Antoni, A. M., Sansone, M., Guaraldi, G., Dalzero, S., Maso, G., Francisci, D., Sterrantino, G., Ravizza, M., Tamburrini, E., Di Lorenzo, F., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., Mercurio, V. S., Zanaboni, D., Nardini, G., Stentarelli, C., Beghetto, B., Molinari, A., Crisalli, M. P., Donisi, A., Ruggieri, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Paradiso, L., Forlanini, F., Longoni, E., Placido, G., Milini, P., Savalli, F., Sabbatini, F., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Portelli, V., Bernardon, M., Bussolaro, S., Della Pieta, I., Sorz, A., Meloni, A., Chiodo, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., Bordoni Vicini, I., Luzi, K., Roccio, M., Vimercati, A., Calabretti, D., Gigante, S., Guerra, B., Cervi, F., Simonazzi, G., Margarito, E., Capretti, M. G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Capone, A., Maruotti, G. M., Tibaldi, C., Trentini, L., Todros, T., Frisina, V., Savasi, V., Cardellicchio, E., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Badolato, R., Forleo, M. A., Tassis, B., Ruggiero, M., Genovese, O., Cafforio, C., Casadei, A. M., Cavaliere, A. F., Cellini, M., Marconi, A. M., Ierardi, M., Simonetti, S. C., Alfieri, N., Agrati, S., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Cerioli, A., De Martino, M., Parazzini, F., Vella, S., Floridia M., Pinnetti C., Masuelli G., Spinillo A., Savasi V.M., Liuzzi G., Degli Antoni A.M., Sansone M., Guaraldi G., Dalzero S., Maso G., Francisci D., Sterrantino G., Ravizza M., Tamburrini E., Di Lorenzo F., Meli M., Campolmi I., Vichi F., Del Pin B., Marocco R., Mastroianni C., Mercurio V.S., Zanaboni D., Nardini G., Stentarelli C., Beghetto B., Molinari A., Crisalli M.P., Donisi A., Ruggieri A., Piepoli M., Cerri V., Zuccotti G., Giacomet V., Paradiso L., Forlanini F., Longoni E., Placido G., Milini P., Savalli F., Sabbatini F., Papalini C., Bernini L., Grossi P., Rizzi L., Portelli V., Bernardon M., Bussolaro S., Della Pieta I., Sorz A., Meloni A., Chiodo A., Dedoni M., Ortu F., Piano P., Citernesi A., Bordoni Vicini I., Luzi K., Roccio M., Vimercati A., Calabretti D., Gigante S., Guerra B., Cervi F., Simonazzi G., Margarito E., Capretti M.G., Marsico C., Faldella G., Martinelli P., Agangi A., Capone A., Maruotti G.M., Tibaldi C., Trentini L., Todros T., Frisina V., Savasi V., Cardellicchio E., Giaquinto C., Fiscon M., Rubino E., Franceschetti L., Badolato R., Forleo M.A., Tassis B., Ruggiero M., Genovese O., Cafforio C., Casadei A.M., Cavaliere A.F., Cellini M., Marconi A.M., Ierardi M., Simonetti S.C., Alfieri N., Agrati S., Polizzi C., Mattei A., Pirillo M.F., Amici R., Galluzzo C.M., Donnini S., Baroncelli S., Cerioli A., De Martino M., Parazzini F., and Vella S.

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Multivariate analysis, 030106 microbiology, CD4-CD8 Ratio, Human immunodeficiency virus (HIV), HIV Infections, CD8-Positive T-Lymphocytes, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, CD4/CD8 ratio, Pregnancy, CD4, CD8, HIV suppression, Preterm delivery, Female, Humans, Infant, Newborn, Pregnancy Outcome, Pregnant Women, Viral Load, Pregnancy Complications, Infectious, medicine, 030212 general & internal medicine, business.industry, Obstetrics, Infectious, Infant, General Medicine, Newborn, medicine.disease, Pregnancy Complications, Infectious Diseases, Increased risk, National study, Outcome data, business
Abstract

Purpose: To evaluate associations between CD4/CD8 ratio and pregnancy outcomes in women with HIV. Methods: We evaluated, in a national study of pregnant women with HIV receiving antiretroviral treatment (ART), values of CD4/CD8 ratio at entry in pregnancy, changes between first and third trimester, and possible associations with preterm delivery, low birthweight, and HIV-RNA < 50 copies/ml at third trimester in univariate and multivariate analyses. Results: Among 934 women, 536 (57.4%) were already on ART at conception. CD4/CD8 ratio (baseline value 0.570) increased significantly between the first and third trimesters, particularly in women who started ART in pregnancy (+ 0.163, vs. + 0.036 in women already on treatment). The rate of CD4/CD8 ratio normalization, defined by achieving a ratio ≥ 1 at the third trimester, was 13.2%. In multivariable analyses, women who entered pregnancy with a CD4/CD8 ratio < 0.3, compared to women with ratio ≥ 1, were almost four-times less likely to have third-trimester HIV-RNA < 50 copies/ml (AOR 0.258, 95%CI 0.111–0.601), and more than twice as likely to have preterm delivery (AOR 2.379, 95%CI 1.082–5.232). For preterm delivery, also a baseline CD4/CD8 ratio between 0.3 and 0.45 was significantly associated with an increased risk (AOR: 3.415, 95%CI 1.690–6.900). Conclusion: We described for the first time independent associations of low CD4/CD8 ratio with preterm delivery and HIV-RNA suppression.

Published
2021

6. Atazanavir and darunavir in pregnant women with HIV: evaluation of laboratory and clinical outcomes from an observational national study

Author

Floridia, M., Masuelli, G., Ravizza, M., Tassis, B., Cetin, I., Sansone, M., Antoni, A. D., Simonazzi, G., Maccabruni, A., Francisci, D., Frisina, V., Liuzzi, G., Dalzero, S., Tamburrini, E., Di Lorenzo, F., Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., S. Mercurio V., Zanaboni, D., Guaraldi, G., Nardini, G., Stentarelli, C., Beghetto, B., Antoni, A. M. D., Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Coletto, S., Di Nello, F., Madia, C., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Bernardon, M., Maso, G., Rizzante, E., Belcaro, C., Meloni, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., Bordonivicini, I., Luzi, K., Spinillo, A., Roccio, M., Vimercati, A., Crupano, F. M., Calabretti, D., Cervi, F., Margarito, E., Capretti, M. G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Capone, A., Maruotti, G. M., Tibaldi, C., Trentini, L., Todros, T., Brambilla, T., Savasi, V., Personeni, C., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Badolato, R., Tiso, G. C., Genovese, O., Cafforio, C., Pinnetti, C., Casadei, A. M., Cavaliere, A. F., Cellini, M., Marconi, A. M., Sacchi, V., Ierardi, M., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Villani, P., Cusato, M., Cerioli, A., De Martino, M., Parazzini, F., Vella, S., Floridia, M., Masuelli, G., Ravizza, M., Tassis, B., Cetin, I., Sansone, M., Antoni, A. Degli, Simonazzi, G., Maccabruni, A., Francisci, D., Frisina, V., Liuzzi, G., Dalzero, S., Tamburrini, E., Di Lorenzo, F., Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., S.Mercurio, V., Zanaboni, D., Guaraldi, G., Nardini, G., Stentarelli, C., Beghetto, B., Antoni, A.M. Degli, Molinari, A., Crisalli, M.P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Coletto, S., Di Nello, F., Madia, C., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Bernardon, M., Maso, G., Rizzante, E., Belcaro, C., Meloni, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., BordoniVicini, I., Luzi, K., Spinillo, A., Roccio, M., Vimercati, A., Crupano, F.M., Calabretti, D., Cervi, F., Margarito, E., Capretti, M.G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Capone, A., Maruotti, G.M., Tibaldi, C., Trentini, L., Todros, T., Brambilla, T., Savasi, V., Personeni, C., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Badolato, R., Tiso, G.C., Genovese, O., Cafforio, C., Pinnetti, C., Casadei, A.M., Cavaliere, A.F., Cellini, M., Marconi, A.M., Sacchi, V., Ierardi, M., Polizzi, C., Mattei, A., Pirillo, M.F., Amici, R., Galluzzo, C.M., Donnini, S., Baroncelli, S., Villani, P., Cusato, M., Cerioli, A., De Martino, M., Parazzini, F., and Vella, S.

Subjects
Male, 0301 basic medicine, medicine.medical_treatment, HIV Infections, 0302 clinical medicine, Pregnancy, Pharmacology (medical), 030212 general & internal medicine, Pregnancy Complications, Infectious, Darunavir, medicine.diagnostic_test, Obstetrics, Pregnancy Outcome, virus diseases, Alanine Transaminase, Viral Load, Cholesterol, Treatment Outcome, Infectious Diseases, Premature birth, Gestation, Female, Drugs in pregnancy, medicine.drug, Adult, Microbiology (medical), medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, Anti-HIV Agents, Atazanavir Sulfate, Settore MED/17 - MALATTIE INFETTIVE, 03 medical and health sciences, pharmacology, pharmacology (medical), infectious diseases, medicine, Humans, Caesarean section, Triglycerides, Pharmacology, business.industry, Infant, Newborn, Infant, Bilirubin, medicine.disease, 030112 virology, Atazanavir, azatanavir sulfate, Lipid profile, business
Abstract

Background Atazanavir and darunavir represent the main HIV PIs recommended in pregnancy, but comparative data in pregnant women are limited. We assessed the safety and activity profile of these two drugs in pregnancy using data from a national observational study. Methods Women with atazanavir or darunavir exposure in pregnancy were evaluated for laboratory measures and main pregnancy outcomes (e.g. preterm delivery, low birthweight, non-elective caesarean section and neonatal gestational age-adjusted birthweight Z-score). Results Final analysis included 500 pregnancies with either atazanavir (n = 409) or darunavir (n = 91) exposure. No differences in pregnancy outcomes, weight gain in pregnancy, drug discontinuations, undetectable HIV-RNA, haemoglobin, ALT, total cholesterol, HDL cholesterol and LDL cholesterol were observed between the two groups. At third trimester, exposure to darunavir was associated with higher levels of plasma triglycerides (median 235.5 versus 179 mg/dL; P = 0.032) and a higher total cholesterol/HDL cholesterol ratio (median 4.03 versus 3.27; P = 0.028) and exposure to atazanavir was associated with higher levels of plasma bilirubin (1.54 versus 0.32 mg/dL; P

Published
2017
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7. Weight Gain during Pregnancy in Women with HIV Receiving Different Antiretroviral Regimens

Author

Floridia, M., Masuelli, G., Tassis, B., Franceschetti, L., Savasi, V. M., Spinillo, A., Tamburrini, E., Guaraldi, G., Dalzero, S., Sansone, M., Chiodo, A., Degli Antoni, A. M., Pinnetti, C., Liuzzi, G., Ravizza, M., Di Lorenzo, F., Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., Mercurio, V. S., Zanaboni, D., Nardini, G., Stentarelli, C., Beghetto, B., Molinari, A., Crisalli, M. P., Donisi, A., Ruggieri, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Paradiso, L., Forlanini, F., Longoni, E., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Francisci, D., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Maso, G., Bernardon, M., Bussolaro, S., della Pieta, I., Sorz, A., Meloni, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., Vicini, I. B., Luzi, K., Roccio, M., Vimercati, A., Calabretti, D., Gigante, S., Guerra, B., Cervi, F., Simonazzi, G., Margarito, E., Capretti, M. G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Capone, A., Maruotti, G. M., Tibaldi, C., Trentini, L., Todros, T., Frisina, V., Cardellicchio, E., Giaquinto, C., Fiscon, M., Rubino, E., Badolato, R., Forleo, M. A., Ruggiero, M., Genovese, O., Cafforio, C., Casadei, A. M., Cavaliere, A. F., Cellini, M., Marconi, A. M., Ierardi, M., Simonetti, S. C., Alfieri, N., Agrati, S., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Cerioli, A., de Martino, M., Parazzini, F., and Vella, S.

Subjects
medicine.medical_specialty, Multivariate analysis, Anti-HIV Agents, Integrase inhibitor, HIV Infections, Overweight, Weight Gain, Cohort Studies, Pregnancy, Internal medicine, medicine, Humans, Pharmacology (medical), Settore MED/38 - Pediatria Generale e Specialistica, Pharmacology, business.industry, Weight change, Odds ratio, medicine.disease, Obesity, Infectious Diseases, Reverse Transcriptase Inhibitors, Female, medicine.symptom, business, Weight gain
Abstract

Background No published studies have evaluated in pregnant women with HIV weight gain with different antiretroviral drug classes. Methods Data from a national cohort study were used. We compared absolute weight gain and occurrence of excessive weight gain in women with HIV who received during pregnancy integrase inhibitors (INSTI), protease inhibitors (PI), or non-nucleoside reverse transcriptase inhibitors (NNRTI). Excessive weight gain was defined according to the Institute of Medicine recommendations. Possible predictors of weight gain were assessed using univariate and multivariate analyses. Results Among 273 cases (PI: 191, NNRTI: 43, INSTI: 39), the mean weight increase was 11.3 kg, and 25.4% of the mothers had an excessive weight increase. No significant differences were found among the three treatment groups for absolute weight increase, occurrence of excessive weight gain, infant birthweight, and other pregnancy and laboratory outcomes. The comparisons of individual drugs, although based on a limited number of cases, suggested no major differences. A significant positive correlation was found between weight gain and CD4+ T-cell increase during pregnancy. In multivariate analyses, drug class and nucleoside backbone were not associated with absolute or excessive weight increase. Excessive weight increase was significantly associated with week of delivery (adjusted odds ratio: 1.74, 95% CI 1.15, 2.63), obesity (5.21, 95% CI 1.85, 14.64), overweight (7.95, 95% CI 3.26, 19.39), recent substance use (5.96, 95% CI 1.13, 31.40) and fasting 2nd trimester hyperglycaemia (3.94, 95% CI 1.14, 13.65). Conclusions No significant differences in absolute weight change or occurrence of excessive weight gain were found among women with HIV who received during pregnancy different classes of antiretroviral drugs.

Published
2021

8. Early experience of an infectious and tropical diseases unit during the coronavirus disease (COVID-19) pandemic, Florence, Italy, February to March 2020

Author

Lagi, F., Piccica, M., Graziani, L., Vellere, I., Botta, A., Tilli, M., Ottino, L., Borchi, B., Pozzi, M., Bartalesi, F., Mencarini, J., Spinicci, M., Zammarchi, L., Pieralli, F., Zagli, G., Nozzoli, C., Romagnoli, S., Bartoloni, A., Campolmi, I., Di Lauria, N., Millotti, G., Basile, G., Meli, M., Rogasi, P. G., Bartolozzi, D., Corsi, P., Mazzetti, M., Farese, A., Bresci, S., Cavallo, A., Trotta, M., Corti, G., Morettini, A., Poggesi, L., de Gaudio, A. R., Peris, A., Fontanari, P., Parronchi, P., Almerigogna, F., Annunziato, F., Liotta, F., Cosmi, L., Vultaggio, A., Matucci, A., Angileri, M., Ipponi, A., Cecchi, M., Benemei, S., Vannucchi, A. M., Matucci Cerinic, Marco, and Turco, L.

Subjects
0301 basic medicine, Male, Author's Correction, Epidemiology, COVID-19, Cohort, Florence, ICU, Italy, SARS-CoV-2, pandemic, Age Distribution, Aged, Betacoronavirus, Cannula, Cohort Studies, Comorbidity, Contact Tracing, Coronavirus Infections, Critical Care, Disease Outbreaks, Female, Humans, Intensive Care Units, Middle Aged, Patient Transfer, Pneumonia, Viral, Respiratory Care Units, Sex Distribution, Treatment Outcome, Coronavirus, Pandemics, Disease, medicine.disease_cause, law.invention, 0302 clinical medicine, law, Pandemic, Medicine, 030212 general & internal medicine, Intensive care unit, Rapid Communication, medicine.medical_specialty, 030106 microbiology, 03 medical and health sciences, Virology, business.industry, Public Health, Environmental and Occupational Health, Outbreak, Tropical disease, medicine.disease, Emergency medicine, business, Contact tracing
Abstract

We analysed the first 84 coronavirus disease (COVID-19) patients hospitalised in an infectious and tropical disease unit in Florence, Italy, over 30 days after the start of the COVID-19 outbreak in Italy. A 12% reduction in the rate of intensive care unit transfer was observed after the implementation of intensity care measures in the regular ward such as increasing the nurse/patient ratio, presence of critical care physicians and using high flow nasal cannulae oxygenation.

Published
2020

9. Abacavir/Lamivudine and Tenofovir/Emtricitabine in Pregnant Women with Hiv: Laboratory and Clinical Outcomes in an Observational National Study

Author

Floridia, M., Pinnetti, C., Ravizza, M., Masuelli, G., Personeni, C., Sansone, M., Antoni, A. D., Guaraldi, G., Spinillo, A., Tassis, B., Dalzero, S., Liuzzi, G., Tamburrini, E., Di Lorenzo, F., Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., Mercurio, V. S., Maccabruni, A., Zaramella, M., Mariani, B., Nardini, G., Stentarelli, C., Beghetto, B., Degli Antoni, A. M., Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Coletto, S., Di Nello, F., Madia, C., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Francisci, D., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Bernardon, M., Maso, G., Rizzante, E., Belcaro, C., Meloni, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., Vicini, I. B., Luzi, K., Roccio, M., Vimercati, A., Miccolis, A., De Gennaro, A., Guerra, B., Cervi, F., Simonazzi, G., Margarito, E., Capretti, M. G., Marsico, C., Faldella, G., Martinelli, P., Agangi, A., Capone, A., Maruotti, G. M., Tibaldi, C., Trentini, L., Todros, T., Frisina, V., Cetin, I., Brambilla, T., Savasi, V., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Badolato, R., Tiso, G. C., Genovese, O., Cafforio, C., Casadei, A. M., Cavaliere, A. F., Cellini, M., Marconi, A. M., Sacchi, V., Ierardi, M., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., and Baroncelli, S.

Subjects
0301 basic medicine, HIV Infections, Hemoglobins, 0302 clinical medicine, Abacavir, Anemia, Cholesterol, Emtricitabine, HIV-RNA, Lamivudine, Low birthweight, Pregnancy, Preterm delivery, Tenofovir, immune system diseases, Antiretroviral Therapy, Highly Active, Pharmacology (medical), 030212 general & internal medicine, Pregnancy Outcome, virus diseases, Lipoproteins, LDL, Drug Combinations, Infectious Diseases, Hypertension, RNA, Viral, Female, medicine.drug, Adult, medicine.medical_specialty, Anti-HIV Agents, Pregnancy Trimester, Third, 03 medical and health sciences, Internal medicine, medicine, Humans, AIDS-Associated Nephropathy, Cesarean Section, business.industry, Abacavir/Lamivudine, medicine.disease, 030112 virology, Dideoxynucleosides, CD4 Lymphocyte Count, Pregnancy Complications, HIV-1, Observational study, business
Abstract

Abacavir-lamivudine (ABC/3TC) and tenofovir-emtricitabine (TDF/FTC) represent in the guidelines of several countries, including Italy and United States, the preferred nucleoside/nucleotide backbones of antiretroviral regimens. We assessed their profile in pregnancy using data from a national observational study.Laboratory measures (CD4, HIV-RNA, lipid profile, glucose, hemoglobin, and alanine transferase) and pregnancy outcomes (preterm delivery, low birthweight, nonelective cesarean section, birthweight Z-score, congenital defects, HIV transmission, maternal weight gain, and pregnancy complications) were compared after prenatal exposure to ABC/3TC or TDF/FTC.The study evaluated 913 pregnancies (ABC/3TC: 252; TDF/FTC: 661). At entry in pregnancy, women on TDF/FTC were older (33.6 vs. 32.4 years, P = 0.005), less frequently on treatment (66.9% vs. 80.2%, P0.001), and had lower CD4 counts (475/mm vs. 533/mm, P = 0.003) and higher plasma HIV-RNA levels (2.48 vs. 2.22 log10 copies/mL, P = 0.003). Women on ABC/3TC had more commonly hypertension/nephropathy (5.2% vs. 2.0%, P = 0.013). No major differences were observed in the main pregnancy outcomes and in rates of undetectable HIV-RNA at third trimester. In a subgroup analysis that evaluated at third trimester only cases with regular 3-drug treatment during pregnancy, women on TDF/FTC had lower hemoglobin levels (median: 11.1 vs. 11.8 g/dL, P = 0.002) and women on ABC/3TC had higher levels of total cholesterol (median: 230 vs. 216 mg/dL, P = 0.023) and low-density lipoprotein-cholesterol (133 vs. 111 mg/dL, P = 0.030).In this study, use of TDF/FTC and ABC/3TC in pregnancy was associated with similar pregnancy outcomes and with some differences in laboratory measures that might guide physicians' prescriptions in mothers with hematologic or metabolic risk factors.

Published
2018

10. Pregnant with HIV before age 25: Data from a large national study in Italy, 2001-2016

Author

Floridia, M., Masuelli, G., Tamburrini, E., Cetin, I., Liuzzi, G., Martinelli, Paolo, Guaraldi, G., Spinillo, A., Vimercati, A., Maso, G., Pinnetti, C., Frisina, V., Dalzero, S., Ravizza, M., Di Lorenzo, F., Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Del Pin, B., Marocco, R., Mastroianni, C., Mercurio, V. S., Maccabruni, A., Zaramella, M., Mariani, Bianca, Nardini, G., Stentarelli, C., Beghetto, B., Antoni, A. M. Degli, Molinari, A., Crisalli, M. P., Donisi, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Coletto, S., Di Nello, F., Madia, C., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Francisci, D., Angeli, G., Bernini, L., Grossi, P., Rizzi, L., Bernardon, M., Rizzante, E., Belcaro, C., Meloni, Antonio, Dedoni, M., Ortu, F., Piano, Pierluigi, Citernesi, A., Vicini, I. Bordoni, Luzi, K., Roccio, M., Miccolis, A., De Gennaro, A., Guerra, B., Cervi, Filippo, Simonazzi, G., Margarito, E., Capretti, M. G., Marsico, C., Faldella, G., Sansone, M., Agangi, A., Capone, A., Maruotti, G. M., Tibaldi, C., Trentini, L., Todros, T., Brambilla, T., Savasi, V., Personeni, C., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Tassis, B., Genovese, O., Cafforio, C., Casadei, A. M., Cavaliere, A. F., Cellini, Matteo, Marconi, A. M., Sacchi, V., Ierardi, M., Polizzi, C., Mattei, A., Pirillo, M. F., Amici, R., Galluzzo, C. M., Donnini, S., Baroncelli, S., Cerioli, A., DE MARTINO, MARIA CRISTINA, Parazzini, F., and Vella, S.

Subjects
Antiretroviral treatment, HIV diagnosis, HIV testing, pregnancy, women's health, medicine.medical_specialty, Pediatrics, Longitudinal study, Adolescent, Epidemiology, Short Report, HIV Infections, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, medicine, Odds Ratio, Humans, 030212 general & internal medicine, Young adult, 030219 obstetrics & reproductive medicine, business.industry, Odds ratio, medicine.disease, Female, Italy, Infectious Diseases, Confidence interval, Family planning, business, Cohort study
Abstract

SUMMARYYoung pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001–2016, 9·0% were in women P< 0·001). Younger women had a lower rate of planned pregnancy (23·2%vs.37·7%, odds ratio (OR) 0·50, 95% confidence interval (CI) 0·36–0·69), were more frequently diagnosed with HIV in pregnancy (46·5%vs.20·9%, OR 3·29, 95% CI 2·54–4·25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (vs.99·3%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.

Published
2017

11. Weight Gain during Pregnancy in Women with HIV Receiving Different Antiretroviral Regimens

Author

Floridia, Marco, Masuelli, Giulia, Tassis, Beatrice, Franceschetti, Laura, Savasi, Valeria Maria, Spinillo, Arsenio, Tamburrini, Enrica, Guaraldi, Giovanni, Dalzero, Serena, Sansone, Matilde, Chiodo, Antonella, Antoni, Anna Maria Degli, Pinnetti, Carmela, Liuzzi, Giuseppina, Ravizza, Marina, Floridia, M., Ravizza, M., Tamburrini, E., Ravizza, M., Tamburrini, E., Lorenzo, F. Di, Sterrantino, G., Meli, M., Campolmi, I., Vichi, F., Pin, B. Del, Marocco, R., Mastroianni, C., Mercurio, V.S., Zanaboni, D., Guaraldi, G., Nardini, G., Stentarelli, C., Beghetto, B., Antoni, A.M. Degli, Molinari, A., Crisalli, M.P., Donisi, A., Ruggieri, A., Piepoli, M., Cerri, V., Zuccotti, G., Giacomet, V., Paradiso, L., Forlanini, F., Longoni, E., Placido, G., Milini, P., Savalli, F., Portelli, V., Sabbatini, F., Francisci, D., Papalini, C., Bernini, L., Grossi, P., Rizzi, L., Maso, G., Bernardon, M., Bussolaro, S., Pietà, I. Della, Sorz, A., Meloni, A., Chiodo, A., Dedoni, M., Ortu, F., Piano, P., Citernesi, A., Vicini, I. Bordoni, Luzi, K., Spinillo, A., Roccio, M., Vimercati, A., Calabretti, D., Gigante, S., Guerra, B., Cervi, F., Simonazzi, G., Margarito, E., Capretti, M.G., Marsico, C., Faldella, G., Sansone, M., Martinelli, P., Agangi, A., Capone, A., Maruotti, G.M., Tibaldi, C., Trentini, L., Todros, T., Masuelli, G., Frisina, V., Savasi, V., Cardellicchio, E., Giaquinto, C., Fiscon, M., Rubino, E., Franceschetti, L., Badolato, R., Forleo, M.A., Tassis, B., Ruggiero, M., Genovese, O., Cafforio, C., Pinnetti, C., Liuzzi, G., Casadei, A.M., Cavaliere, A.F., Cellini, M., Marconi, A.M., Dalzero, S., Ierardi, M., Simonetti, S.C., Alfieri, N., Agrati, S., Polizzi, C., Mattei, A., Pirillo, M.F., Amici, R., Galluzzo, C.M., Donnini, S., Baroncelli, S., Floridia, M., Cerioli, A., Martino, M. De, Parazzini, F., Tamburrini, E., Vella, S., Martinelli, P., and Ravizza, M.

Abstract

Background No published studies have evaluated in pregnant women with HIV weight gain with different antiretroviral drug classes.Methods Data from a national cohort study were used. We compared absolute weight gain and occurrence of excessive weight gain in women with HIV who received during pregnancy integrase inhibitors (INSTI), protease inhibitors (PI), or non-nucleoside reverse transcriptase inhibitors (NNRTI). Excessive weight gain was defined according to the Institute of Medicine recommendations. Possible predictors of weight gain were assessed using univariate and multivariate analyses.Results Among 273 cases (PI: 191, NNRTI: 43, INSTI: 39), the mean weight increase was 11.3 kg, and 25.4% of the mothers had an excessive weight increase. No significant differences were found among the three treatment groups for absolute weight increase, occurrence of excessive weight gain, infant birthweight, and other pregnancy and laboratory outcomes. The comparisons of individual drugs, although based on a limited number of cases, suggested no major differences. A significant positive correlation was found between weight gain and CD4+T-cell increase during pregnancy. In multivariate analyses, drug class and nucleoside backbone were not associated with absolute or excessive weight increase. Excessive weight increase was significantly associated with week of delivery (adjusted odds ratio: 1.74, 95% CI 1.15, 2.63), obesity (5.21, 95% CI 1.85, 14.64), overweight (7.95, 95% CI 3.26, 19.39), recent substance use (5.96, 95% CI 1.13, 31.40) and fasting 2nd trimester hyperglycaemia (3.94, 95% CI 1.14, 13.65).Conclusions No significant differences in absolute weight change or occurrence of excessive weight gain were found among women with HIV who received during pregnancy different classes of antiretroviral drugs.

Published
2020
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12. Valacyclovir for cytomegalovirus infection in pregnancy: additional evidences, additional questions

Author

Beatrice Borchi, Lina Rachele Tomasoni, Giuliana Simonazzi, Francesco Castelli, Susanna Giachè, Mariarosaria Di Tommaso, Pierangelo Clerici, Marcello Tavio, Tiziana Lazzarotto, Massimo Andreoni, Irene Campolmi, Lorenzo Zammarchi, Alessandro Bartoloni, Michele Trotta, Luisa Galli, Lucia Pasquini, and Zammarchi L, Lazzarotto T, Andreoni M, Giaché S, Campolmi I, Pasquini L, Di Tommaso M, Simonazzi G, Tomasoni LR, Castelli F, Galli L, Borchi B, Clerici P, Bartoloni A, Tavio M, Trotta M.

Subjects
Microbiology (medical), MEDLINE, Bioinformatics, CMV, valacyclovir, gravidanza, Antiviral Agents, Pregnancy, gravidanza, Humans, Medicine, valacyclovir, Pregnancy Complications, Infectious, Infectious disease transmission, business.industry, Infant, Newborn, CMV, virus diseases, General Medicine, medicine.disease, Infectious Disease Transmission, Vertical, Cytomegalovirus infection, Infectious Diseases, Cytomegalovirus Infections, valacyclovir in pregnant women with primary cytomegalovirus (CMV) infection to prevent vertical transmission, Female, business
Abstract

Shortly after the acceptance of our review [1] an additional study on the use of valacyclovir in pregnant women with primary cytomegalovirus (CMV) infection to prevent vertical transmission has been published by De Santis et al [2]. The authors reported a case series of 12 pregnant women treated with off-label valacyclovir 8g per day following primary CMV infection in the first half of pregnancy and stopped in case of negative amniocentesis. The observed rate of positivity at amniocentesis was 17% (2 positive amniocentesis of 12 performed) compatible with a ≈50% reduction of vertical transmission when compared to the 30-35% rate reported in literature [3]. These results are consistent to those reported by Shahar-Nissan K et al in the preliminary report on their clinical placebo-controlled trial [4] and confirm that valacyclovir may reduce the rate of vertical transmission by the time of amniocentesis. However, among the 10 pregnant women with a negative amniocentesis described by De Santis, three delivered a congenitally infected newborn of which one developed moderate unilateral sensory neural loss at 18 months of age. Amongst these three women with negative amniocentesis who delivered a congenitally infected newborn, two presented a new CMV DNAemia after valacyclovir discontinuation. The authors interpret their finding as the result of an efficient control of viral replication and prevention of during the antiviral treatment, with subsequent resurgence of viral and vertical transmission. They suggested the need of controlled trial to evaluate valacyclovir treatment prolonged until the delivery regardless of amniocentesis results. However the possibility of false negative amniocentesis cannot be completely excluded. In particular the authors used 0.4mL of amniotic fluids to extract the CMV-DNA which is lower compared to those used in other reference laboratory (1mL) [5] and this could have affected the sensitivity of the test. In another recent paper (not captured by our review of literature since indexed with the keyword “citomegalovirus” unlike “cytomegalovirus”), De Santis et al described a case series on the use of high dose valacyclovir (8g/day) until delivery in confirmed fetal asymptomatic CMV infections [6]. Of the eleven in utero treated newborns, only one was symptomatic at birth and he developed profound bilateral hearing loss at six month requiring bilateral cochlear implant. Another developed a sensorineural hearing loss at 8 months of age. Surprisingly, three newborns had negative serology and virological tests at birth inducing authors to speculate that treatment can even allow viral clearance in case of low amniotic fluids viral load. To sum up, these two studies confirmed data from previous literature, namely the excellent maternal tolerance and the benefit of valacyclovir in reducing fetal CMV infections at time of amniocentesis [4] and the possible role of the drug in the in utero treatment of confirmed fetal infection [7]. We look forward to see the results of the still partially published randomized, double-blind, placebo-controlled study [4], which will probably add further important information.

Published
2021

13. Impact of rapid-antiretroviral therapy in a cohort of treatment-naïve migrants living with HIV in a high income setting.

Author

Trevisan S, Gasparro G, Kiros ST, Pozzi M, Malcontenti C, Campolmi I, Paggi R, Cavallo A, Farese A, Ducci F, Meli M, Pittorru M, Bartoloni A, Sterrantino G, and Lagi F

Subjects
Humans, Male, Adult, Female, Retrospective Studies, Italy epidemiology, Middle Aged, Lost to Follow-Up, Treatment Outcome, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV Infections drug therapy, Viral Load, Transients and Migrants statistics & numerical data, Anti-HIV Agents therapeutic use
Abstract

Background: We evaluated the effect of rapid ART (RA) compared to delayed ART (DA) on viral load suppression (viral load <50 cp/mL) and loss to follow-up (LTFU) in a cohort of migrants living with HIV (MLWHs) in Italy., Methods: Data were retrospectively gathered from MLWHs who began care at the Infectious and Tropical Diseases Unit of the Careggi University Hospital from January 2014 to December 2022. RA was defined as antiretrovirals prescribed within 7 days of HIV diagnosis. The study ended on April 30, 2023, or upon patient LTFU. Chi-square and non-parametric tests assessed differences in categorical and continuous variables, respectively. Kaplan-Meyer survival analysis was performed to estimate the probability of loss to follow-up. Cox regression analysis was performed to evaluate factors associated with a loss to follow-up., Results: 87 MLWHs were enrolled: 20 (23%) on RA and 67 (77%) on DA. In the RA group there were more PLWH with a previous AIDS event ( p < .001) however, there was no significant difference in the LTFU rates between the groups (aHR 0.6, 95%CI 0.1-3.1; p = .560; Logrank = 0.2823). Being an out-of-status MLWH was the only predictor of LTFU. By 6 months, virological suppression was achieved in 61.2% (n = 41) in DA and 70.0% in the RA group (n = 14) (Logrank p = .6747)., Conclusions: RA did not significantly affect LTFU rates or the achievement of viral load suppression. The study suggests that further research is needed to assess the impact of RA in high income settings., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article:• Prof. Alessandro Bartoloni: MSD, GSK, ViiV, Pfizer and Gilead;• Dr. Filippo Lagi: consultant/participated on advisory boards sponsored by ViiV Healthcare, Janssen and educational and grant support from Gilead;• Dr. Marco Pozzi: Abbvie, ViiV, Gilead, MSD, Janssen;• Dr. Sasha Trevisan and the other authors: none.

Published
2024
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14. Prevention, diagnosis and pharmacological treatment of infections in pregnancy: The mobile app GAIA! for healthcare providers and patients.

Author

Bonaiuti R, Zammarchi L, Giaché S, Modi G, Borchi B, Campolmi I, Trotta M, Ravaldi C, Ornaghi S, Di Tommaso M, Bartoloni A, Costa P, Lombardi N, Crescioli G, Vannacci A, and Levi M

Subjects
Humans, Pregnancy, Female, Health Personnel, Italy, Mobile Applications, Pregnancy Complications, Infectious drug therapy, Pregnancy Complications, Infectious diagnosis
Abstract

Objective: To develop and assess the GAIA! app, designed to assist pregnant women and healthcare professionals in managing infectious diseases during pregnancy, and to bridge the information gap between health professionals and expectant mothers., Study Design: This collaborative initiative in Italy involved partnerships with the University of Florence, Careggi University Hospital, and other institutions. The app, built on the Ionic framework, is available on both Apple and Google App Stores. It offers two distinct modes: "healthcare providers" and "patients." Content for the app was derived from extensive literature reviews and clinical guidelines., Results: Since its August 2022 launch, the GAIA! app has garnered over 2,500 downloads, indicating its effectiveness and acceptance within the community. The app differentiates itself from others, such as the Sanford Guide, by focusing specifically on the needs of pregnant women. It ensures cross-platform compatibility, a user-friendly interface, and offline functionality., Conclusions: The GAIA! app has successfully addressed a niche in infectious disease management for pregnant women, gaining significant traction within the community. While it has seen substantial success, challenges like continuous updates and potential language expansion remain. Future endeavors will address these challenges and further evaluate the app's impact on maternal and child health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2024
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15. Parenchymal Cavitations in Pulmonary Tuberculosis: Comparison between Lung Ultrasound, Chest X-ray and Computed Tomography.

Author

Cozzi D, Bartolucci M, Giannelli F, Cavigli E, Campolmi I, Rinaldi F, and Miele V

Abstract

This article aims to detect lung cavitations using lung ultrasound (LUS) in a cohort of patients with pulmonary tuberculosis (TB) and correlate the findings with chest computed tomography (CT) and chest X-ray (CXR) to obtain LUS diagnostic sensitivity. Patients with suspected TB were enrolled after being evaluated with CXR and chest CT. A blinded radiologist performed LUS within 3 days after admission at the Infectious Diseases Department. Finally, 82 patients were enrolled in this study. Bronchoalveolar lavage (BAL) confirmed TB in 58/82 (71%). Chest CT showed pulmonary cavitations in 38/82 (43.6%; 32 TB patients and 6 non-TB ones), LUS in 15/82 (18.3%; 11 TB patients and 4 non-TB ones) and CXR in 27/82 (33%; 23 TB patients and 4 non-TB ones). Twelve patients with multiple cavitations were detected with CT and only one with LUS. LUS sensitivity was 39.5%, specificity 100%, PPV 100% and NPV 65.7%. CXR sensitivity was 68.4% and specificity 97.8%. No false positive cases were found. LUS sensitivity was rather low, as many cavitated consolidations did not reach the pleural surface. Aerated cavitations could be detected with LUS with relative confidence, highlighting a thin air crescent sign towards the pleural surface within a hypoechoic area of consolidation, easily distinguishable from a dynamic or static air bronchogram.

Published
2024
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16. Asymptomatic CMV infection at birth following maternal primary infection despite valacyclovir treatment and a subsequent negative amniocentesis. Case report.

Author

Toti MS, Zammarchi L, Pasquini L, Campolmi I, Modi G, Borchi B, Bartoloni A, Trotta M, Galli L, and Bernardini R

Subjects
Pregnancy, Infant, Newborn, Female, Child, Humans, Valacyclovir therapeutic use, Amniocentesis, Mothers, Infectious Disease Transmission, Vertical prevention & control, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious drug therapy, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections drug therapy
Abstract

Valacyclovir is currently the only pharmacological intervention demonstrated to reduce the risk of vertical CMV congenital infection within a randomized clinical trial in case of primary infection during pregnancy. So far, no data are available on the prognosis of children with congenital CMV infection diagnosed at birth after a negative amniocentesis whose mother were treated with valacyclovir during pregnancy, therefore it is essential to carry out a rigorous neurocognitive follow-up in these children in order to investigate the potential clinical consequence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2023
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17. Orbital Infiltration in a Patient with Waldenström Macroglobulinemia: Need for Multidisciplinary Approach and Comparison with the Literature.

Author

Paggi R, Mariotti F, Mencarini J, Bresci S, Campolmi I, Bartalesi F, Borchi B, Nassi L, Sordi B, Vannucchi AM, and Bartoloni A

Abstract

The use of specific inhibitory drugs of intracellular signalling pathways (such as Bruton-Kinase inhibitors) for the treatment of Waldenström's macroglobulinaemia (WM) is a recognised risk factor for Aspergillus spp . infections. The overlapping clinical manifestations of the two diseases may require the involvement of different medical specialities. We describe the clinical course of a patient with pulmonary and encephalic aspergillosis, with concomitant orbital infiltration, which represented a difficult diagnosis: the case required a multidisciplinary approach to define the ocular lesions and an in-depth study of the literature., Competing Interests: Competing interests: The authors declare no conflict of Interest.

Published
2023
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19. Infection with SARS-CoV-2 Variants Is Associated with Different Long COVID Phenotypes.

Author

Spinicci M, Graziani L, Tilli M, Nkurunziza J, Vellere I, Borchi B, Mencarini J, Campolmi I, Gori L, Giovannoni L, Amato C, Livi L, Rasero L, Fattirolli F, Marcucci R, Giusti B, Olivotto I, Tomassetti S, Lavorini F, Maggi L, Annunziato F, Marchionni N, Zammarchi L, and Bartoloni A

Subjects
Female, Humans, Male, Pandemics, Phenotype, Retrospective Studies, SARS-CoV-2 genetics, Middle Aged, Post-Acute COVID-19 Syndrome, COVID-19 epidemiology, Fatigue Syndrome, Chronic complications
Abstract

COVID-19 has been associated with a broad range of long-term sequelae, commonly referred to as "long-COVID" or "post-COVID-19" syndrome. Despite an increasing body of literature, long COVID remains poorly characterized. We retrospectively analysed data from electronic medical records of patients admitted to the post-COVID-19 outpatient service of the Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy, between June 2020 and June 2021, 4-12 weeks after hospital discharge. A total of 428 patients, 41% women, median age 64 years, underwent a follow-up visit a median 53 days after hospital discharge. Overall, 76% patients reported at least one persistent symptom, including dyspnoea (37%), chronic fatigue (36%), insomnia (16%), visual disorders (13%) and brain fog (13%). Increasing oxygen support (OR 1.4, 95% CI 1.1-1.8), use of immunosuppressants (OR 6.4, 95% CI 1.5-28) and female sex (OR 1.8, 95% CI 1.1-2.9) were associated with a higher risk of long COVID symptoms. Comparison between symptomatic patients infected in the period March-December 2020 (prevalent circulation of wild-type SARS-CoV-2) with those infected in the period January-April 2021 (prevalent circulation of B.1.1.7 Alpha variant) showed a significant modification in the pattern of symptoms belonging to the neurological and cognitive/emotional categories. Our findings confirmed shortness of breath and chronic fatigue as the most frequent long COVID manifestations, while female sex and severe COVID-19 course were the main risk factors for developing lingering symptoms. SARS-CoV-2 variants may induce different long COVID phenotypes, possibly due to changes in cell tropism and differences in viral-host interaction.

Published
2022
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20. Treatment with anti-SARS-CoV-2 monoclonal antibodies in pregnant and postpartum women: first experiences in Florence, Italy.

Author

Manciulli T, Modi G, Campolmi I, Borchi B, Trotta M, Spinicci M, Lagi F, Bartoloni A, and Zammarchi L

Subjects
Adult, Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal, Humanized, Antibodies, Viral, Antiviral Agents, Female, Humans, Infant, Oxygen, Postpartum Period, Pregnancy, COVID-19 Drug Treatment
Abstract

Purpose: Pregnant and postpartum women are at increased risk of developing severe COVID-19. Monoclonal antibodies (mAbs) are now widely used in high-income countries to treat mild to moderate COVID-19 outpatients at risk for developing severe disease. Very few data are available on the use of mAbs in special populations, including pregnant and postpartum women. Here we present our early experience with mAbs in these two populations., Methods: Electronic records of pregnant and postpartum women treated with mAbs at Careggi University Hospital, Florence, were retrieved. Relevant data were extracted (age, presence of risk factors for COVID-19, oxygen support, mAb type, gestational age, and pregnancy status). When available, outcomes at 28 days after administration were also included., Results: From March 1st to September 30th 2021, eight pregnant and two postpartum women have been treated with mAbs at our center. The median age was 31 years (IQR 30-33.5, range 29-38), median gestational age was 24 weeks. Seven patients had additional risk factors. According to the Italian disposition, all patients received casirivimab/imdevimab, with five receiving a 2.4 mg dose and five receiving a 8 g dose. Eight patients improved. One developed myocarditis, considered a COVID-19 complication. Another required a transient increase of low flow oxygen support before improving and being discharged. At a 28 days follow-up, all patients were clinically recovered. We did not observe mAbs related adverse events., Conclusion: Although preliminary data should be interpreted with caution, it is remarkable how mAbs were well tolerated by pregnant women with COVID-19. Further data on mAbs in this special population should be collected but the use of mAbs in pregnant and postpartum patients should be considered. Even thus oral antivirals are becoming available, they are not recommended in pregnant and postpartum women. This population may specifically benefit from treatment with last generation mAbs., (© 2022. The Author(s).)

Published
2022
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21. Lung ultrasound (LUS) in pulmonary tuberculosis: correlation with chest CT and X-ray findings.

Author

Giannelli F, Cozzi D, Cavigli E, Campolmi I, Rinaldi F, Giachè S, Rogasi PG, Miele V, and Bartolucci M

Subjects
Humans, Prospective Studies, Tomography, X-Ray Computed, Ultrasonography methods, X-Rays, Lung diagnostic imaging, Tuberculosis, Pulmonary diagnostic imaging
Abstract

Aims: The aim is to describe lung ultrasound (LUS) findings in a cohort of patients with suspected pulmonary tuberculosis (PTB) and compare them with computed tomography (CT) and chest x-ray (CXR) findings in order to evaluate the potentiality of LUS in TB diagnosis., Methods: In this prospective study, 82 subjects with suspected TB were enrolled after being evaluated with CXR and chest CT. LUS was performed by blinded radiologists within 3 days after admission. A semiquantitative index was used: score 1 (lesions that extend for about 1-15% of the affected zone), score 2 (15-40%) and score 3 (40-100%)., Results: Microbiological analysis confirmed TB diagnosis in 58/82 (70.7%). CT was positive in all patients, LUS in 79/82 (96.3%) CXR in 78/82 (95.1%) and adding LUS and CXR in 100%. In PTB patients we found a great number of lungs zones with micronodules and with total findings than non-TPB patients (p < 0.05). Overall LUS sensitivity was 80%, greater for micronodules (82%) and nodules (95%), lower for consolidation with air bronchogram (72%) and cavitations (33%). We reported 5 complicated pleural effusion at LUS, only 1 in CT. CXR overall sensitivity was 81%. Adding CXR and LUS findings we reported a sensitivity of 90%., Conclusions: LUS could be considered a valid, non-invasive and cost-effective diagnostic tool especially in world regions where CT were not available, also in addiction with CXR., Trial Registration: This study was approved by the Ethics Committee of our University Hospital (rif. CEAVC 14,816)., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Published
2022
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22. Primary toxoplasmosis acquired during early pregnancy: Is it currently overestimated?

Author

Trotta M, Trotta A, Spataro E, Giache S, Borchi B, Zammarchi L, Campolmi I, Galli L, and Pasquini L

Subjects
Amniotic Fluid, Antibodies, Protozoan, Antibody Affinity, Female, Humans, Immunoglobulin G, Infant, Newborn, Pregnancy, Retrospective Studies, Pregnancy Complications, Infectious diagnosis, Pregnancy Complications, Infectious epidemiology, Toxoplasmosis diagnosis, Toxoplasmosis epidemiology
Abstract

Objective: Toxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study., Study Design: We retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999-2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP)., Results: 237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%-2.61%)], 0% [0/178 (95% CI 0%-2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%-14.53%)] in CAIP group., Conclusions: Toxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Published
2021
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24. Valacyclovir for prevention and treatment of fetal CMV infection: inclusion in the Law 648/96 list and launch of the Italian multicentre observational prospective study "MEGAL-ITALI".

Author

Zammarchi L, Lazzarotto T, Di Tommaso M, Tomasoni L, Pasquini L, Galli L, Simonazzi G, Castelli F, Borchi B, Campolmi I, Ornaghi S, Bartoloni A, Andreoni M, Pagano I, Petraglia S, Ramenghi L, Clerici P, Tavio M, and Trotta M

Subjects
Antiviral Agents therapeutic use, Humans, Infant, Newborn, Italy, Cytomegalovirus Infections congenital, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections prevention & control, Valacyclovir therapeutic use
Abstract

Not available.

Published
2021

25. Valacyclovir for cytomegalovirus infection in pregnancy: additional evidences, additional questions.

Author

Zammarchi L, Lazzarotto T, Andreoni M, Giaché S, Campolmi I, Pasquini L, Di Tommaso M, Simonazzi G, Tomasoni LR, Castelli F, Galli L, Borchi B, Clerici P, Bartoloni A, Tavio M, and Trotta M

Subjects
Antiviral Agents adverse effects, Female, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical prevention & control, Pregnancy, Valacyclovir adverse effects, Antiviral Agents therapeutic use, Cytomegalovirus Infections drug therapy, Pregnancy Complications, Infectious drug therapy, Valacyclovir therapeutic use
Published
2021
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26. Clinical and Laboratory Follow-up After Hospitalization for COVID-19 at an Italian Tertiary Care Center.

Author

Spinicci M, Vellere I, Graziani L, Tilli M, Borchi B, Mencarini J, Campolmi I, Gori L, Rasero L, Fattirolli F, Olivotto I, Lavorini F, Marchionni N, Zammarchi L, and Bartoloni A

Abstract

We evaluated 100 postacute coronavirus disease 2019 (COVID-19) patients a median (interquartile range) of 60 (48-67) days after discharge from the Careggi University Hospital, Italy. Eighty-four (84%) had at least 1 persistent symptom, irrespective of COVID-19 severity. A considerable number of hospital readmissions (10%) and/or infectious diseases (14%) during the postdischarge period were reported., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Published
2021
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27. Should obstetricians working in non-endemic countries care about emerging tropical diseases?

Author

Giaché S, Modi G, Borchi B, Campolmi I, Trotta M, Di Tommaso M, Seravalli V, Bartoloni A, and Zammarchi L

Subjects
Female, Humans, Infant, Newborn, Pregnancy, Prevalence, Travel, Zika Virus, Zika Virus Infection diagnosis, Zika Virus Infection epidemiology, Zika Virus Infection therapy
Abstract

Due to migration and international travels, obstetricians are increasingly faced with a globalized obstetric setting and should adapt their daily clinical and diagnostic approach to the modifications of tropical and subtropical infections epidemiology. This paper is focused on five emerging infectious diseases, namely Chagas disease, HTLV-1 infection, malaria, schistosomiasis and Zika virus infection, having a high prevalence in migrant populations and which can affect international travelers. These diseases frequently pass unrecognized since they are characterized by few or no symptoms during pregnancy, however they may cause a relevant maternal, fetal and neonatal impact. Specific and reliable diagnostic and treatment options are available but are rarely used during routine obstetrical practice., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Published
2021
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28. Emerging Infectious Diseases in Pregnant Women in a Non-Endemic Area: Almost One Out of Four Is at Risk.

Author

Modi G, Borchi B, Giaché S, Campolmi I, Trotta M, Di Tommaso M, Strambi N, Bartoloni A, and Zammarchi L

Abstract

We report the results of a targeted testing strategy for five emerging infectious diseases (Chagas disease, human T-lymphotropic virus 1 infection, malaria, schistosomiasis, and Zika virus infection) in pregnant women accessing an Italian referral centre for infectious diseases in pregnancy for unrelated reasons. The strategy is based on a quick five-question questionnaire which allows the identification of pregnant women at risk who should be tested for a specific disease. One hundred and three (24%) out of 429 pregnant women evaluated in a 20 month period were at risk for at least one emerging infectious disease. Three (2.9%, all from sub-Saharan Africa) out of 103 at-risk women resulted in being affected (one case of Plasmodium falciparum malaria, two cases of schistosomiasis) and were appropriately managed. Prevalence of emerging infectious disease was particularly high in pregnant women from Africa (three out of 25 pregnant women tested, 12%). The proposed strategy could be used by health care professionals managing pregnant women in non-endemic setting, to identify those at risk for one of the five infection which could benefit for a targeted test and treatment.

Published
2021
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30. Seroprevalence of Hepatitis A Virus, Hepatitis E Virus, and Helicobacter pylori in Rural Communities of the Bolivian Chaco, 2013.

Author

Campolmi I, Spinicci M, Mayaregua DR, Barahona HG, Mantella A, Lara Y, Roselli M, Strohmeyer M, Corti G, Tolari F, Pinckert JM, Dalton HR, and Bartoloni A

Subjects
Adolescent, Adult, Bolivia, Child, Child, Preschool, Female, Humans, Immunoglobulin G blood, Infant, Male, Middle Aged, Rural Population, Young Adult, Antibodies, Bacterial blood, Antibodies, Viral blood, Helicobacter pylori immunology, Hepatitis A virus immunology, Hepatitis E virus immunology, Seroepidemiologic Studies
Abstract

In the Bolivian Chaco, south-east of Bolivia, studies conducted over the past three decades reported hepatitis A virus (HAV) and Helicobacter pylori seroprevalences above 90% and 60%, respectively. Hepatitis E virus (HEV) prevalence was previously found to be 6-7% but is probably an underestimate because of the poor sensitivity of the assays used. In November 2013, we conducted a cross-sectional study of 263 healthy volunteers from two rural communities of the Bolivian Chaco, aiming to reassess HAV, HEV, and H. pylori seroprevalence 10-20 years following the previous surveys. Hepatitis A virus seroprevalence was 95%, with universal exposure after the first decade of life; HEV seroprevalence was considerably higher (31-35%) than that previously reported; H. pylori seroprevalence was 59%, with an age-dependent distribution. The high prevalence of these infections suggests that major efforts are still needed to reduce fecal-oral transmission and to improve human health in the Bolivian Chaco.

Published
2018
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