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BACKGROUND: Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. CASE PRESENTATION: A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). CONCLUSIONS: The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.

This thesis investigates how health officials sought to preserve or recover good health during plague epidemics in Mantua, from 1463-1577. Scholarship on health boards in Italy has focused primarily on larger cities such as Milan, Florence and Venice, while many smaller cities and states which formed part of the wider network of interdependent health offices have yet to receive significant attention. This study attempts to address this imbalance by focussing on Mantua, a hitherto neglected area in the heart of northern Italy. Historians have shown by the sixteenth century health offices had wide-ranging responsibilities, yet their most important function remained tackling plague outbreaks through measures including trade and travel bans, quarantine periods and lazaretti. An analysis of the Mantuan health office’s actions and reactions reveal that it does not fit neatly with the health board model historians have established elsewhere in northern and central Italy. I will argue that while the hallmarks of the ‘Italian system’ of public health procedures are evident, closer examination of their organisation and composition reveals that they were shaped by the incidence and severity of outbreaks. Above all, however, they were dependent upon and defined by the evolving state apparatus and by participation of the wider community, both lay and ecclesiastic. Contrary to the view that permanent Italian health offices enforced plague regulations uniformly, there was a degree of flexibility in application within the structures created to fight plague. Further, it will be argued that by examining in detail symbolic acts, such as processions, in conjunction with practical methods we see with greater clarity how civic and ecclesiastical authorities worked together in the attempt to restore the city to good health. By exploring the dialogues between civic authorities, the people they governed and interactions between specific health agencies across the peninsula, this thesis cont

This thesis investigates how health officials sought to preserve or recover good health during plague epidemics in Mantua, from 1463-1577. Scholarship on health boards in Italy has focused primarily on larger cities such as Milan, Florence and Venice, while many smaller cities and states which formed part of the wider network of interdependent health offices have yet to receive significant attention. This study attempts to address this imbalance by focussing on Mantua, a hitherto neglected area in the heart of northern Italy. Historians have shown by the sixteenth century health offices had wide-ranging responsibilities, yet their most important function remained tackling plague outbreaks through measures including trade and travel bans, quarantine periods and lazaretti. An analysis of the Mantuan health office’s actions and reactions reveal that it does not fit neatly with the health board model historians have established elsewhere in northern and central Italy. I will argue that while the hallmarks of the ‘Italian system’ of public health procedures are evident, closer examination of their organisation and composition reveals that they were shaped by the incidence and severity of outbreaks. Above all, however, they were dependent upon and defined by the evolving state apparatus and by participation of the wider community, both lay and ecclesiastic. Contrary to the view that permanent Italian health offices enforced plague regulations uniformly, there was a degree of flexibility in application within the structures created to fight plague. Further, it will be argued that by examining in detail symbolic acts, such as processions, in conjunction with practical methods we see with greater clarity how civic and ecclesiastical authorities worked together in the attempt to restore the city to good health. By exploring the dialogues between civic authorities, the people they governed and interactions between specific health agencies across the peninsula, this thesis cont

This thesis investigates how health officials sought to preserve or recover good health during plague epidemics in Mantua, from 1463-1577. Scholarship on health boards in Italy has focused primarily on larger cities such as Milan, Florence and Venice, while many smaller cities and states which formed part of the wider network of interdependent health offices have yet to receive significant attention. This study attempts to address this imbalance by focussing on Mantua, a hitherto neglected area in the heart of northern Italy. Historians have shown by the sixteenth century health offices had wide-ranging responsibilities, yet their most important function remained tackling plague outbreaks through measures including trade and travel bans, quarantine periods and lazaretti. An analysis of the Mantuan health office’s actions and reactions reveal that it does not fit neatly with the health board model historians have established elsewhere in northern and central Italy. I will argue that while the hallmarks of the ‘Italian system’ of public health procedures are evident, closer examination of their organisation and composition reveals that they were shaped by the incidence and severity of outbreaks. Above all, however, they were dependent upon and defined by the evolving state apparatus and by participation of the wider community, both lay and ecclesiastic. Contrary to the view that permanent Italian health offices enforced plague regulations uniformly, there was a degree of flexibility in application within the structures created to fight plague. Further, it will be argued that by examining in detail symbolic acts, such as processions, in conjunction with practical methods we see with greater clarity how civic and ecclesiastical authorities worked together in the attempt to restore the city to good health. By exploring the dialogues between civic authorities, the people they governed and interactions between specific health agencies across the peninsula, this thesis cont

This thesis investigates how health officials sought to preserve or recover good health during plague epidemics in Mantua, from 1463-1577. Scholarship on health boards in Italy has focused primarily on larger cities such as Milan, Florence and Venice, while many smaller cities and states which formed part of the wider network of interdependent health offices have yet to receive significant attention. This study attempts to address this imbalance by focussing on Mantua, a hitherto neglected area in the heart of northern Italy. Historians have shown by the sixteenth century health offices had wide-ranging responsibilities, yet their most important function remained tackling plague outbreaks through measures including trade and travel bans, quarantine periods and lazaretti. An analysis of the Mantuan health office’s actions and reactions reveal that it does not fit neatly with the health board model historians have established elsewhere in northern and central Italy. I will argue that while the hallmarks of the ‘Italian system’ of public health procedures are evident, closer examination of their organisation and composition reveals that they were shaped by the incidence and severity of outbreaks. Above all, however, they were dependent upon and defined by the evolving state apparatus and by participation of the wider community, both lay and ecclesiastic. Contrary to the view that permanent Italian health offices enforced plague regulations uniformly, there was a degree of flexibility in application within the structures created to fight plague. Further, it will be argued that by examining in detail symbolic acts, such as processions, in conjunction with practical methods we see with greater clarity how civic and ecclesiastical authorities worked together in the attempt to restore the city to good health. By exploring the dialogues between civic authorities, the people they governed and interactions between specific health agencies across the peninsula, this thesis cont