Oral itraconazole plus nasal amphotericin B for prophylaxis of invasive aspergillosis in patients with hematological malignancies

The use of oral itraconazole (200 mg daily) plus nasal amphotericin B (10 mg daily) for prophylaxis of invasive aspergillosis was evaluated in 164 patients with hematological malignancies at risk due to presence of neutropenia and/or steroid therapy. This prophylactic regimen was evaluated for a period of two years. Two hundred and ninety patients with similar characteristics who were observed over the three-year period prior to the introduction of prophylaxis served as historical control group. Environmental surveillance during the study period showed constant contamination of the air withAspergillus. Prophylaxis significantly reduced the incidence of proven invasive aspergillosis from 12/290 to 0/164 (p=0.004), and reduced the mortality rate from 8/290 to 0/164. The incidence of proven plus probable aspergillosis amounted to 34/290 in the control group and 8/164 in the study group (p=0.01); the mortality rates were 11/290 (3.7 %) and 2/164 (1.2 %) respectively. All nasal cultures in the study group were negative forAspergillus. The prophylactic regimen was well tolerated. Larger studies assessing each agent alone and in combination are necessary to confirm these observations.     

Mixed infections with influenza A and B viruses

In the course of an influenza A and B epidemic, influenza virus was isolated from 46 patients. Seven of these patients showed seroconversion against influenza virus plus another respiratory virus. In 9 patients, simultaneous antibody increase against both influenza A and B viruses was demonstrated, but only a single virus type was isolated. In one case the isolated virus population could be separated into type A and B viruses.     

Intrauterine undernutrition in rats interferes with leukocyte migration, decreasing adhesion molecule expression in leukocytes and endothelial cells

Experimental and epidemiologic data have shown that malnutrition predisposes individuals to infections. Immune responses are compromised, particularly in undernourished children. Therefore, we investigated the migratory capacity of leukocytes, using the intravital microscopy technique, in male Wistar rats (8-9 wk of age) that were undernourished in utero after their dams were fed 50% less food than the amount consumed by control dams. The number of leukocytes rolling along the venular endothelium, sticking after stimulation with leukotriene B4, tumor necrosis factor-alpha (TNF-alpha) or zymosan-activated plasma, or migrating after TNF-alpha stimulation was significantly reduced in the undernourished rat offspring. Compared with nourished rat offspring, undernourished offspring had significantly reduced numbers of circulating leukocytes, higher blood pressure, and higher leukocyte rolling velocity (V(WBC)), as well as a higher ratio between V(WBC) and RBC velocity (V(RBC)). Endothelial P-selectin and intercellular adhesion molecule-1 (ICAM-1) expression, analyzed by immunohistochemistry, and basal leukocyte L-selectin expression, analyzed by flow cytometry, were significantly reduced in the undernourished rat offspring. Because the groups did not differ in leukocyte CD11/18 expression, endothelial expression of platelet-endothelial cell adhesion molecule-1, or venular blood flow velocity and, consequently, venular shear rate, we conclude that intrauterine undernutrition in rats reduces leukocyte migration, downregulates endothelial expression of P-selectin and ICAM-1, as well as leukocyte expression of L-selectin, while reducing leukocyte counts. The higher V(WBC) and V(WBC)/V(RBC) ratio may also play a role in this reduced leukocyte migration. Our data suggest that this phenomenon is involved in the increased predisposition to infections in undernourished subjects.     

Precursors of atherosclerosis in children: The Cittadella study. Follow-up and tracking of total serum cholesterol,triglycerides, and blood glucose

As part of a WHO project, precursors of atherosclerosis in children, a survey was made in Cittadella, a town in Northern Italy. Four hundred and eight children (49.7% males) aged 6, 9, 12, and 15 were examined and a blood sample for total cholesterol (TC), triglycerides (TG), and blood glucose (BG) was drawn one hour after an oral glucose load of 50 g. The same procedure was performed in the same subjects 3 years later. The mean values of TC in the age groups 6, 9, 12, and 15 were 155.2, 176.1, 191.5, 170.5 mg/dl, respectively. TG values were 54.4, 53.1, 55.8, 62.2 mg/dl and BG, 108.3, 85.2, 92.1, 97.4 mg/dl, respectively. A marked fall of TC at reexamination was found in initial age groups of 12 and 15. BG levels fell significantly only in those subjects initially examined at age 6, while TG showed a longitudinal increase in all age groups, though more markedly in the younger ones. Different body composition, and possibly a secular trend, might explain these findings. The tracking analysis showed that serum TC tends to maintain its percentile with increasing age in contrast to serum TG and BG tracking which was less consistent, suggesting the influence of factors other than those affecting changes in TC.