C-reactive protein in boutonneuse fever

ATHEROSCLEROSIS AND MARKERS OF INFLAMMATION IN PATIENTS WITH METABOLIC SYNDROME

Immunopathology of leishmaniasis: an update.

Leishmaniasis represents a severe, increasing, public health problem. The perspective of its control is highly dependent on research progress, on therapeutic manipulations of the immune system, and on vaccine development. There is a correlation between the clinical outcome of Leishmania infection and the cytokine response profile. While a protective immune response against Leishmania has been clearly identified to be related to the influence of a type-1 response and IFN-γ production, the precise role of T helper (TH) 2 cytokines in non-healing infections requires further exploration. IL-4 and IL-13 (TH2 cytokines) can promote disease progression in cutaneous leishmaniasis, whereas IL-4 woul…

Modifications of general parameters of immune activation in the sera of Sicilian patients with Boutonneuse fever

SUMMARYThe serum levels of β2-microglobulin (β2-M), soluble HLA class I antigen (sHLA-I), soluble CD4 (sCD4) and CD8 (sCD8) were studied in 98 Sicilian patients with Boutonneuse fever (BF). In different stages of infection all markers were significantly increased in sera from Sicilian patients with acute BF compared with healthy controls. sCD8 and sHLA-I reached the peak in the second week after the onset of symptoms, whereas sCD4 and β2-M reached the peak in the first week. Afterwards sCD8 decreased to the levels of controls within the third week, the other parameters decreased later and were unmodified until the third week of infection. Significant correlations were found between sCD4 and…

Leishmaniasis in travelers: A literature review.

Leishmaniasis is a vector-borne protozoan infection whose clinical spectrum ranges from asymptomatic infection to fatal visceral leishmaniasis. Over the last decades, an increase in imported leishmaniasis cases in developed, non-endemic countries, have been pointed-out from a review of the international literature. Among the possible causes are increasing international tourism, influx of immigrants from endemic regions and military operations. The main area for the acquisition of cutaneous leishmaniasis, especially for adventure travelers on long-term trips in highly-endemic forested areas, is represented from South America, whereas popular Mediterranean destinations are emerging as the mai…

Fever of unknown origin in a mediterranean survey from a division of internal medicine: report of 91 cases during a twelve-year-period (1991-2002)

Significance of persistence of antibodies against Leishmania infantum in Sicilian patients affected by acute visceral leishmaniasis.

The background of this article is as follows: Few data are available about the persistence of serum-specific IgG antibodies to L. infantum after acute VL. The objective of this article is to evaluate the persistence of antibodies against L. infantum in patients healed from acute VL, and the kinetic of the same antibodies observed in 2 cases of VL relapse and 2 cases of resistance to therapy. The methods which we used to obtain our objective are the following: 55 apparently immunocompetent, HIV-negative patients were examined for antibodies to L. infantum by IFAT over 14 years period, and we got the following results: Serum-specific IgG antibodies titers decrease slowly, but constantly. In t…

Markers of Inflammation and Infection Influence the Outcome of Patients With Baseline Asymptomatic Carotid Lesions

Background and Purpose— It is still in debate whether the evaluation of markers of infection and inflammation may be of importance for cerebrovascular and cardiovascular prevention, and we aimed to investigate this field in a prospective 5-year clinical follow-up study in patients with early stages of atherosclerosis. Methods— We studied 668 subjects divided in 3 groups according to the results of carotid ultrasound examination: (1) normal subjects, if intima-media thickness (IMT) was <0.9 mm; (2) with IMT, if IMT was between 0.9 and 1.5 mm; and (3) with asymptomatic carotid plaque, if IMT was >1.5 mm. Traditional cardiovascular risk factors were investigated, and laboratory analysis…

Impact of insulin resistance on cardiac and vascular function.

Background Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries. Methods We studied 32 patients (62.06 ± 11.19 years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria …

The Acute Phase Response in Sicilian Patients with Boutonneuse Fever Admitted to Hospitals in Palermo, 1992–1997

Abstract Objectives : To study the modifications of some components of the acute phase response (APR) in Sicilian patients with boutonneuse fever (BF) caused by Rickettsia conorii . Methods : Sera from 500 Sicilian patients with confirmed BF were studied at the time of diagnosis and every week after treatment, and after recovery for the presence of various inflammatory mediators. Tumour necrosis factor α (TNFα), interleukin(IL)-6, IL-1α, IL-8, soluble TNF receptors (sTNF-R) and sIL-6R were assayed by commercially ELISA kits. C3, C4, factor B, C-reactive protein (CRP), fibrinogen, ceruloplasmin (Cp) and α 1 -antitrypsin (AAT) were assayed by a rate nephelometry. Results : Interferon gamma (I…

Does the level of serum antimüllerian hormone predict ovulatory function in women with polycystic ovary syndrome with aging?

Abstract OBJECTIVE: To determine possible prediction of regular menses with aging in anovulatory women with polycystic ovary syndrome (PCOS). DESIGN: Cohort. SETTING: Academic practice. PATIENT(S): A total of 54 anovulatory women with PCOS and 28 age- and weight-matched control subjects. INTERVENTION(S): Blood and ovarian ultrasound at baseline and after 5 years. MAJOR OUTCOME MEASURE(S): Serum antimüllerian hormone (AMH), gonadotropins, androgens, insulin sensitivity, and ovarian ultrasound. RESULT(S): After 5 years, there was a significant decrease in AMH in women with PCOS and control subjects (10 of 54 anovulatory women became ovulatory after 5 years). There was a significant negative c…

Isolation and characterization of Bartonella quintana from parotid gland of an immunocompetent man.

We describe a case of the isolation of Bartonella quintana from the parotid gland of an apparently healthy man. Pathological examination showed intraparotid granulomatous abscessual lymphadenitis. Diagnosis was made on the basis of high titers of immunoglobulin G (IgG) and IgM antibodies and of culture isolation of a causative agent from parotid aspirate.

Presence of Rickettsia conorii subsp. israelensis , the Causative Agent of Israeli Spotted Fever, in Sicily, Italy, Ascertained in a Retrospective Study

ABSTRACT A retrospective analysis by molecular-sequence-based techniques was performed to correctly identify the etiological agent of 24 Mediterranean spotted fever cases occurring in Western Sicily, Italy, from 1987 to 2001. Restriction analysis of a 632-bp PCR-amplified portion of the ompA gene allowed presumptive identification of five clinical isolates as belonging to Rickettsia conorii subsp. israelensis , the etiological agent of Israeli spotted fever (ISF). The remaining 19 rickettsial isolates were Rickettsia conorii subsp. conorii , the only pathogenic rickettsia of the spotted fever group reported in Italy until the present. Sequence analysis of the ompA gene confirmed the identif…

Evaluation of serum levels of soluble CD4, CD8 and β2-microglobulin in visceral human leishmaniasis

SUMMARY The levels of soluble CD4 (sCD4), sCD8 and β2-microglobulin (β2-M) were measured in sera from patients with visceral leishmaniasis during the course of infection. Levels of sCD4. sCD8 and β2-M were raised significantly above levels In normal sera and returned to the normal range after recovery. The decrease in the levels of CDS was related to a reduction of anaemia, leukopenia and thrombocytopenia. In contrast, sCD4 levels fluctuated during the period of infection. β2-M returned within normal range more rapidly than sCD8 secretion. Our results suggest that T cells are activated during infection, and that it is also possible that the raised levels of these soluble molecules play a ro…

Hepatosplenic cat-scratch fever with seropositivity for Bartonella quintana?

Hypogonadism and Hormone Replacement Therapy on Bone Mass of Adult Women with Thalassemia Major

We studied bone mass and metabolism in 30 adult women (age 28.5 +/- 1.3) with thalassemia major (TM) and evaluated whether prolonged hormone replacement therapy (HRT) was able to optimize bone accrual. TM patients had reduced bone mass, increased bone turnover and lower serum gonadotropin and estradiol levels compared with 10 normal women of similar age. A significant correlation was found between bone mass and sex hormone levels. Six TM patients with normal ovarian function had normal bone turnover markers and modestly low bone mass (lumbar spine -1.29 +/- 0.31; femoral neck -0.60+/-0.21; Z-score). The other 24 TM women were hypogonadic and had significantly lower bone mass for age (lumbar…

Associazione dei polimorfismi dei geni INF-γ ed IL-10 con la suscettibilità alla Febbre bottonosa.

Relevance of gamma interferon, tumor necrosis factor alpha, and interleukin-10 gene polymorphisms to susceptibility to Mediterranean spotted fever.

Several studies have demonstrated that cellular immunity plays a critical role in the protective immune response against Rickettsia conorii. Immune CD4+ and CD8+ T cells are both involved in the control of rickettsial infection (38). Perivascular infiltrated CD4+ and CD8+ T lymphocytes, macrophages, and natural killer cells produce chemokines and cytokines that activate endothelial rickettsicidal activities. Infected human cells, including endothelial cells, hepatocytes, and macrophages, activated by gamma interferon (IFN-γ), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), kill intracellular rickettsiae by one or a combination of three mechanisms, involving nitric oxide syn…

Rickettsiae of the spotted fever group in dog fleas (Ctenocephalides spp.) in Western Sicily

Early subclinical ventricular dysfunction in patients with insulin resistance

AIMS: The aim of our study was to evaluate the relationship between insulin resistance and the detection of precocious echocardiographic signs of heart failure in patients with cardiovascular risk factors. METHODS: We enrolled 34 consecutive patients with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, and laboratory tests. Exclusion criteria were diabetes (fasting glucose greater than 126 mg/dl or treatment with insulin or oral hypoglycemic agents), coronary artery disease, creatinine above 1.5 mg/dl, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%, atrial fibrillation, or other severe arrhythmia. The presence of…

Comparison of anti-transglutaminase ELISAs and an anti-endomysial antibody assay in the diagnosis of celiac disease: A prospective study

Abstract Background: Most studies of anti-transglutaminase (anti-tTG) assays have considered preselected groups of patients. This study compared the sensitivity, specificity, and predictive value of an immunofluorescence method for anti-endomysial antibodies (EmAs) and two anti-tTG ELISAs, one using guinea pig tTG (gp-tTG) and the other human tTG (h-tTG) as antigen, in consecutive patients investigated for suspected celiac disease (CD). Methods: We studied 207 consecutive patients (99 men, 108 women; age range, 17–84 years) who underwent intestinal biopsy for suspected CD. Patients presented with one or more of the following: weight loss, anemia, chronic diarrhea, abdominal pain, dyspepsia,…

CD4+ CCR5+ and CD4+ CCR3+ lymphocyte subset and monocyte apoptosis in patients with acute visceral leishmaniasis

The potential involvement of apoptosis in the pathogenesis of visceral leishmaniasis (VL) was examined by studying spontaneous and Leishmania antigen (LAg)-induced apoptosis using cryopreserved peripheral blood mononuclear cells (PBMC) of Sicilian patients with VL. Results indicate that monocytes and T lymphocytes from acute VL patients show a significantly higher level of apoptosis compared with that observed in healed subjects. The percentage of apoptotic cells was higher in monocytes than in T lymphocytes. T cells involved in programmed cell death (PCD) were mainly of the CD4(+) phenotype. In particular, the T helper 1-type (Th1) subset, as evaluated by chemokine receptor-5 (CCR5) expres…

High Levels Of Interferon-  In Boutonneuse Fever

IL-15 in human visceral leishmaniasis caused byLeishmania infantum

SummaryInterleukin (IL)-15 is a recently discovered cytokine with the ability to stimulate the proliferation activity of Th1 and/or Th2 lymphocytes. Here, we investigated the involvement of IL-15 in the immune response to Leishmania infantum infection by studying patients with visceral leishmaniasis (VL). We found that IL-15 is produced by leishmanial antigen (LAg)-stimulated peripheral blood mononuclear cells (PBMC) from active VL patients at a significantly higher level than those produced by cells from healed VL subjects or healthy controls. A significant increase in IL-15 serum blood levels was also observed in acute VL patients compared with healed ones. Furthermore, recombinant IL-15 …

Familial cases of boutonneuse fever

Pairs of cases of Boutonneuse Fever (BF) occurred in three families. The illness appeared almost simultaneously in both members of each family, but was generally more serious in one as judged by clinical and laboratory parameters. The possibility of a "bed rickettsiosis", that is reactivation of rickettsiae by the blood meal obtained from the first individual by the same tick which fed upon the second individual, could be excluded in two of the three pairs of cases. In only one of the case pairs were the individuals sharing the same bed. The differences in severity of symptoms may be related to the different immunological pattern observed in these patients. Previous rickettsial infection ma…

New Insight into Immunity and Immunopathology of Rickettsial Diseases

Human rickettsial diseases comprise a variety of clinical entities caused by microorganisms belonging to the generaRickettsia,Orientia,Ehrlichia, andAnaplasma. These microorganisms are characterized by a strictly intracellular location which has, for long, impaired their detailed study. In this paper, the critical steps taken by these microorganisms to play their pathogenic roles are discussed in detail on the basis of recent advances in our understanding of molecularRickettsia-host interactions, preferential target cells, virulence mechanisms, three-dimensional structures of bacteria effector proteins, upstream signalling pathways and signal transduction systems, and modulation of gene exp…

EPIDEMIOLOGY OF BOUTONNEUSE FEVER IN WESTERN SICILY

The distribution and prevalence of spotted fever group rickettsial infection in the ixodid dog tick Rhipicephalus sanguineus were found to occur at a rate of 19.7% with variation related to geographic and sociooccupational factors. A higher rate of infection was demonstrated in ticks removed from dogs associated with documented cases of boutonneuse fever. The results fit into available clinical and seroepidemiologic data on Rickettsia conorii infection in western Sicily.

Asymptomatic Carotid Lesions and Aging: Role of Hypertension and Other Traditional and Emerging Risk Factors

Background We evaluated the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF). Methods There were 631 subjects (313 male and 318 female) aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. The following measurements were used: anamnesis, physical examination, height and sitting blood pressure. Biochemistry variables were also considered: total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, high sensitive C-reactive protein, IgG antibodies for Helicobacter pylori (HP), cytotoxic HP, cytomegalovirus and Chlamydia pneumoniae . Finally, an …

Israeli Spotted FeverRickettsiain SicilianRhipicephalus sanguineusTicks

To the Editor: Mediterranean spotted fever (MSF) is endemic in Italy, where it is a reportable disease. From 1992 to 1998, the Italian Ministry of Health was notified of approximately 8,500 cases of human rickettsioses presumed to be MSF. MSF occurs more commonly in some central (Lazio) and southern (Sardinia, Sicily, and Calabria) regions (1,2); in 1998, an average of 8.8 cases occurred for every 100,000 persons in Sicily, compared with the national average of 1.6 cases per 100,000 persons. Rickettsia conorii has been thought to be the only pathogenic Rickettsia of the spotted fever group in Sicily (3,4) or the western Mediterranean area. Recently, three different spotted fever group ricke…

PREVALENCE OF ANTIBODIES ANTI-BARTONELLA HENSELAEIN WESTERN SICILY: CHILDREN, BLOOD DONORS, AND CATS

To evaluate seroprevalence of B. henselae infection both in Sicilian children and healthy blood donors. Furthermore, circulation of Bartonella in the natural reservoir was also studied. Two hundred forty-three children, living in Sicily (Palermo), affected by various diseases, without clinical features suggesting B. henselae infection, together with 122 healthy blood donors were serologically investigated for IgG and IgM antibodies by indirect fluorescent antibody test (IFAT). One hundred twenty stray and 62 pet cats were also analyzed only for IgG. Among children 25.1% had IgG antibodies to B. henselae; 18.5% showed a titer 1:64, 2.4% 1:128, 2.4% 1:256, 0.8% 1:512, 0.4% 1:1024, and 0.4% 1:…

The significance of serum soluble IL-2 receptor as a marker for active visceral leishmaniasis in Sicilian patients

SUMMARY Sera from nine Sicilian patients with confirmed visceral leishmaniasis (Leishmania donovani infantum; VL), at the moment of the diagnosis, during the course of the disease and after clinical recovery, were analysed for the concentration of soluble IL-2 receptor (sIL-2R). The results show that sIL-2R is a marker of disease activity, since it is in high concentration at the beginning of infection and returns to the normal range following successful chemotherapy. At the same time of serum analysis for sIL-2R, peripheral blood mononuclear cells (PBMC) of VL patients were stimulated with phytohaemagglutinin (PHA) or antigen and supernatant tested for IL-2 and interferon-gamma (IFN-γ) pro…

Vitamin D Deficiency in HIV Infection: Not Only a Bone Disorder

Hypovitaminosis D is a worldwide disorder, with a high prevalence in the general population of both Western and developing countries. In HIV patients, several studies have linked vitamin D status with bone disease, neurocognitive impairment, depression, cardiovascular disease, high blood pressure, metabolic syndrome, type 2 diabetes mellitus, infections, autoimmune diseases like type 1 diabetes mellitus, and cancer. In this review, we focus on the most recent epidemiological and experimental data dealing with the relationship between vitamin D deficiency and HIV infection. We analysed the extent of the problem, pathogenic mechanisms, clinical implications, and potential benefits of vitamin …

High serum CXCL10 in Rickettsia conorii infection is endothelial cell ă mediated subsequent to whole blood activation

International audience; Background: The pathophysiological hallmark of Rickettsia conorii (R. ă conorii) infection comprises infection of endothelial cells with ă perivascular infiltration of T-cells and macrophages. Although ă interferon (IFN)-gamma-induced protein 10 (IP-10)/CXCL10 is induced ă during vascular inflammation, data on CXCL10 in R. conorii infection is ă scarce. ă Methods: Serum CXCL10 was analyzed in two cohorts of southern European ă patients with R. conorii infection using multiplex cytokine assays. The ă mechanism of R. conorii-induced CXCL10 release was examined ex vivo ă using human whole blood interacting with endothelial cells. ă Results: (i) At admission, R. conorii …

Louseborne relapsing fever in young migrants, sicily, Italy, july-september 2015

To the Editor: During the early 20th century, at the end of World War I, and during World War II, louseborne relapsing fever (LBRF) caused by Borrelia recurrentis was a major public health problem, especially in eastern Europe and northern Africa (1,2). Currently, poor living conditions, famine, war, and refugee camps are major risk factors for epidemics of LBRF in resource-poor countries, such as those in the Horn of Africa (3,4). Increased migration from resource-poor countries and war/violence create new routes for spread of vectorborne diseases. Recently, several cases of LBRF have been reported among asylum seekers from Eritrea in the Netherlands, Switzerland, and Germany (5–8). All of…

In vivo and in vitro cytokine profiles and mononuclear cell subsets in sicilian patients with active visceral leishmaniasis

Sera from Sicilian patients with confirmed visceral leishmaniasis (Leishmania donovani infantum) were analysed at the moment of the diagnosis, during the course of the disease and after clinical recovery, for the concentration of IL-10, IFN-gamma, IL-4 and IL-2. The results show high concentrations of IL-10 and IFN-gamma in the sera at the beginning of infection that return to the normal range following successful chemotherapy. By contrast, PBMC stimulated in vitro with Ag and mitogen produced low levels of IL-10 and IFN-gamma when collected at the time of the diagnosis and normal levels when assayed after recovery. IL-2 was undetected in the sera and was significantly reduced in the supern…

Increased levels of C-reactive protein and fibrinogen influence the risk of vascular events in patients with NIDDM

AIM: To evaluate the predictive role of hs-CRP and fibrinogen for cardio- and cerebrovascular events in a population of patients with type 2 diabetes. METHODS: We studied 156 patients with type 2 diabetes, mean age 66+10 years, and 156 sex and age matched control subjects. Patients underwent physical examination, EKG, measurement of body mass index and blood pressure. A blood sample was drawn to evaluate glycaemia, total and HDL/LDL cholesterol, triglycerides, high sensitive C-reactive protein (hs-CRP), fibrinogen. Finally, patients underwent an ecocolordoppler examination of the common carotid arteries until the bifurcation. In a follow-up of 5+/-1.2 years we evaluated the following events…

Interleukin-15, as Interferon-gamma, Induces the Killing of Leishmania infantum in Phorbol-Myristate-Acetate-Activated Macrophages Increasing Interleukin-12

The potential leishmanicidal activity of interleukin-15 (IL-15) was examined while priming with the cytokine phorbol-myristate-acetate (PMA)-activated macrophages and infecting them with Leishmania infantum parasites. The activation of macrophage cultures with IL-15 determined a significant anti-leishmanial activity, comparable with that induced by interferon-gamma (IFN-gamma). The killing of Leishmania in macrophages primed with IL-15, as well as with IFN-gamma, was followed by an increase in the IL-12 synthesis. The neutralization of IL-15 or IFN-gamma, by specific monoclonal antibodies (MoAb) caused a significant reduction in leishmanicidal activity. Furthermore, in PMA-activated macroph…

Human leptospirosis cases in Palermo Italy. The role of rodents and climate

Many regions of the world are increasingly exposed to leptospirosis due to poverty, global warming and high urban density. Here, we report a molecular survey for pathogenic Leptospira spp. in rodents and two symptomatic human cases of leptospirosis in the city of Palermo, Italy.Four rodent species were captured in six areas of the city, and a molecular analysis for pathogenic Leptospira spp. on DNA from the kidney samples showed a different prevalence of leptospirosis in all the species of rodents. In addition, two human cases that occurred in May and October of 2009 in the city were also reported. A 67-year-old woman recovered after antibiotic treatment, whereas a 71-year-old woman did not…

Transfusion transmitted leishmaniasis. What to do with blood donors from endemic areas?

Summary Leishmaniasis clinical spectrum ranges from cryptic infection to fatal visceral leishmaniasis. Cryptic infection can be found in blood donors from areas endemic for leishmaniasis all over the world. Although leishmaniasis is a classic vector-borne disease, cases of transfusion transmitted leishmaniasis have been reported especially in nonendemic areas. Most of these cases regarded infants or children. This paper reviews the literature on this specific feature and the impact of leishmaniasis on transfusion medicine. Relevant literature was found through PubMed. The reference lists of selected articles identified further sources. Conclusions: Blood donations by emigrants or travelers f…

Increased expression of the homeostatic chemokines CCL19 and CCL21 in clinical and experimental Rickettsia conorii infection

Background: Based on their essential role in concerting immunological and inflammatory responses we hypothesized that the homeostatic chemokines CCL19 and CCL21 may play a pathogenic role in rickettsiae infection. Methods: Serum levels of CCL19 and CCL21 in patients with R. africae and R. conorii infection were analyzed by enzyme immunoassays. Lungs from R. conorii infected mice were examined for CCL19, CCL21 and CCR7 expression by immunohistochemistry. Results: We found that patients with R. africae infection (n = 15) and in particular those with R. conorii infection (n = 16) had elevated serum levels of CCL19 on admission, with a decline during follow-up. While a similar pattern was seen …

Cryptic Leishmania infantum infection in Italian HIV infected patients.

Abstract Background Visceral leishmaniasis (VL) is a protozoan diseases caused in Europe by Leishmania (L.) infantum. Asymptomatic Leishmania infection is more frequent than clinically apparent disease. Among HIV infected patients the risk of clinical VL is increased due to immunosuppression, which can reactivate a latent infection. The aims of our study were to assess the prevalence of asymptomatic L. infantum infection in HIV infected patients and to study a possible correlation between Leishmania parasitemia and HIV infection markers. Methods One hundred and forty-five HIV infected patients were screened for the presence of anti-Leishmania antibodies and L. infantum DNA in peripheral blo…