PPT Ferrarese "The diagnosis of the disease: laboratory & clinic"StopTb Italia
PPT Ferrarese "The diagnosis of the disease: laboratory & clinic", Symposium on TB, 14 October, III Session (nurses & healthcare providers), Monza, Italy.
PPT Ferrarese "The diagnosis of the disease: laboratory & clinic"StopTb Italia
PPT Ferrarese "The diagnosis of the disease: laboratory & clinic", Symposium on TB, 14 October, III Session (nurses & healthcare providers), Monza, Italy.
Valganciclovir is a prodrug of ganciclovir used for CMV prophylaxis and treatment. A key study (PV16000) found that valganciclovir prophylaxis for 100 days was as effective as oral ganciclovir for preventing CMV disease in high-risk transplant patients. Valganciclovir had a higher bioavailability than oral ganciclovir but was associated with a higher rate of neutropenia as an adverse effect. Long-term follow up of patients in the VICTOR study found rates of CMV disease recurrence after stopping prophylaxis of 15.1% at 1 year. Factors like viral load at baseline and
This document summarizes important viral pathogens affecting solid organ transplant recipients. It discusses several common viruses like CMV, HHV-6, EBV, adenovirus, and BKV polyomavirus. It notes their clinical manifestations and impacts in transplant recipients. The document also reviews prevention and treatment strategies for many of these viruses, including vaccination, antiviral prophylaxis, and immunosuppression management. Meta-analyses show antiviral prophylaxis is effective at preventing CMV infection and disease, and may reduce indirect effects like other infections and rejection.
This document discusses waterborne diseases and epidemics caused by contaminated drinking water. It outlines various bacteria, viruses, and protozoa that can be transmitted through water and cause diseases like cholera, typhoid fever, diarrhea, and jaundice. Treatment of drinking water through chlorination and water filtration has reduced waterborne disease outbreaks in developed nations. However, in developing parts of the world where water treatment is not universal, waterborne illnesses remain a major public health issue. The document emphasizes the importance of access to safe drinking water and proper sanitation globally.
Polio eradication is close to being achieved, as the disease is now only endemic in three countries - Pakistan, Afghanistan, and Nigeria. However, ongoing conflicts and security issues in parts of these countries, especially in Pakistan, are preventing vaccination workers from accessing all areas and populations. This has led to a rise in polio cases in Pakistan in 2014. Additional challenges include lack of funding for vaccination programs and cultural resistance to vaccination efforts. Continued international cooperation and addressing security concerns will be needed to fully eradicate the disease.
1. Non solo ESKAPE
Dr. Dino Sgarabotto
Malattie Infettive e Tropicali
Azienda Ospedaliera di Padova
2. Altri patogeni da tenere d’occhio
• In ospedale:
– Tox Clostridium difficile NAP1 (o ribotype 027) che
produce alti livelli di tossina A; si tratta di ceppi
resistenti ai chinolonici, un po’ meno sensibile al
metronidazolo nei casi gravi
– La causa più comune di diarrea nosocomiale
– Quasi sempre (ma non solo) associata a
somministrazione di antibiotici
– Due i test diagnostici: uno è una ricerca antigenica
della tossina (A o AeB) del Clostridium diff:
specificità>90% sensibilità 60-70%); l’altro la ricerca
genetica RNA (una PCR, test molecolare) dei geni per
la tox del Cl diff: secificità e sensibilità > 90%)
3. Infection control e Cl. Diff.
• Lavarsi le mani con acqua e sapone è meglio che i
preparati con alcool/glicerina a cui il Cl. Diff e le sue
spore sono resistenti
• Pulizia ambientale delle maniglie e delle superficie
comuni oltre ai bagni
• Metronidazolo e vancomicina per via orale per
microclismi e per ev
• Fidaxomicina disponibile ed efficace verso tutti i ceppi
soprattuto nelle recidive
• In valutazione l’uso della tigecyclina e Igvena ad alte
dosi
• Nessuna efficacia dei probiotici ma interessanti risultati
col trapianto di feci
4. Stenotrophomonas maltophila
• Quasi sempre sensibile al Bactrim a dosi alte
• In alternativa l’associazione Levofloxacina,
tigecyclina, ceftazidime
• Si presenta dopo una prolungata e intensiva
terapia antibiotica a cui questo patogeno e
muliresistente
5. Patogeni emergenti in comunità
di cui tenere conto
• CA-MRSA contrapposto al comune MSSA
• Streptococco pneumoniae resistente alla
penicillina (… e a tutte le beta-lattamine
compreso il meropenem); attenzione che si
cominciano a vedere ceppi resistenti alla
levofloxacina
• Escherichia coli resistente ad amoxicillina,
Bactrim e ciprofloxacina
6. Bibliografia
• Health Protection Agency and Department of Health. Clostridium
difficile infection: how to deal with the problem. 203.
www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1232006607827203
Health Protection Agency. Results of the mandatory Clostridium
difficile reportingscheme.
www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195
733750761
• Advisory Committee on Antimicrobial Resistance and healthcare
Associated Infection. Updated guidance on the diagnosis and
reporting of Clostridium difficile. NHS department of health, UK
(2012). www.dh.gov.uk/publications
• Academic Medical Center. The FECAL trial, Faecal therapy to
eliminate Clostridium difficile associated longstanding diarrhoea.
[Nederlands Trial Register number 1171]. Nederlands Trial Register
[online]. www.trialregister.nl/trialreg/admin/rctview. asp?TC=1177