Publications by authors named "Tommaso Lupia"

Background: Liver transplantation (LT) is a crucial treatment for end-stage liver disease, but the limited organ supply has led to the use of extended criteria donors (ECD). The implementation of dynamic preservation techniques like hypothermic oxygenated machine perfusion (HOPE) is crucial in improving outcomes for ECD grafts. However, graft contamination and infection are a concern.

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Background: Bloodstream infections (BSIs) are a serious threat for patients undergoing allogenic hematopoietic stem cell transplants (a-HSCT). MDR colonization is highly prevalent among a-HSCT patients, due to drug-induced intestinal dysbiosis. Primary outcome of the study was to assess the epidemiology and risk factors for BSIs in the 1st year after a-HSCT.

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Introduction: Antibiotics were originally developed to treat acute bacterial infections, and research studies focus their efforts on safety and efficacy in the short term; however, prolonged course of antibiotics has been documented in multiple clinical settings. The aim of this narrative review is to provide a new perspective on SAT and to discuss new therapeuticpossibilities.

Areas Covered: We discuss new clinical scenarios in which SAT could be considered.

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After allogeneic HSCT (allo-HSCT), the diversity of the intestinal microbiota significantly decreases. The changes can be rapid and are thought to be caused by chemotherapy, antibiotics, or intestinal inflammation. Most patients are exposed to prophylactic and therapeutic antibiotics during neutropenia and several patients are colonized by ESBL bacteria.

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Numerous drugs are known to alter the colour of human body fluids. Although drug-induced bronchial secretions staining is normally harmless, it may frighten the patient and could lead to unnecessary clinical inquiries. Cefiderocol is often removed renally as an unmodified drug; bronchial secretion staining has not been seen at doses used in clinical practice.

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Article Synopsis
  • A case study of a 52-year-old man showed he developed right ocular myositis and dacryocystitis, treated successfully with intravenous acyclovir and oral steroids; literature review of 29 patients shows a median age of 61 and a female predominance.
  • Effective treatment typically involves intravenous antiviral therapy within 72 hours and may include systemic corticosteroids, with a full resolution of symptoms achieved in about 51.7% of patients.
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Purpose: Non-tuberculous mycobacteria (NTM) account for high clinical burden, and treatment can be challenging. Moreover, accessibility of NTM medications varies across centers. These challenges may lead to unplanned therapeutic changes, discontinuations, potentially affecting patient outcomes.

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The treatment of refractory CMV is often associated with high toxicity. Maribavir (MBV) is a novel oral antiviral, known for its favourable safety profile in fragile patients. We describe a case of CMV disease with end organ damage following kidney transplantation at high risk, for recipient-donor serological mismatch.

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T-cell redirecting therapies such as chimeric antigen receptor T-cells and bispecific antibodies, are emerging as a novel class of immunotherapeutic agents for treatment of relapsed refractory multiple myeloma (MM). Their use is associated with an increased risk of infectious adverse events, fostered by cytopenias, hypogammaglobulinemia and T-cell exhaustion. Multiple ongoing clinical trials and real-world studies are investigating safety of T-cell therapy, highlighting the need for strategies to prevent and monitor the risk of infection.

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Background: Current treatments for chronic hepatitis B management include orally administered nucleos(t)ide analogues, such as tenofovir (TDF), which is an acyclic adenine nucleotide analogue used both in HBV and human immune deficiency virus (HIV). The course of HBV infection is mainly dependent on viral factors, such as HBV genotypes, immunological features and host genetic variables, but a few data are available in the context of HBV, in particular for polymorphisms of genes encoding proteins involved in drug metabolism and elimination. Consequently, the aim of this study was to evaluate the potential impact of genetic variants on TDF plasma and urine concentrations in patients with HBV, considering the role of HBV genotypes.

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: the principal purpose of this literature review is to cluster adults with hematological malignancies after treatment or on maintenance with obinutuzumab who experienced disseminated EV infection to understand clinical characteristics and outcome of this rare condition in these patients. We report the first clinical case of a male affected by follicular lymphoma treated with immune-chemotherapy including obinutuzumab who was affected by disseminated EV infection with cardiovascular involvement. : this narrative review summarizes all the research about disseminated EV infection in immunosuppressed adult patients treated with obinutuzumab from January 2000 to January 2024 using the Scale for the Assessment of Narrative Review Articles (SANRA) flow-chart.

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Toxocariasis is a zoonosis transmitted by the nematode spp. Immunocompromised hosts are more susceptible than general population to bacterial, viral, fungal and parasitic infections. In this population toxocariasis may present as exacerbation or reactivation and could have severe or atypical manifestations being a diagnostic challenge for healthcare providers.

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The role of different genotypes in nucleos(t)ide analogs (NAs) treatment is still debated. Previous studies conducted on special populations evidenced that the E genotype had the lower virological and serological response. This descriptive study aims to recognize the hepatitis B "s" antigen (HBsAg) decline during tenofovir disoproxil fumarate (TDF) treatment in a cohort of patient affected by chronic hepatitis B (CHB).

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Article Synopsis
  • * The case series involved 10 patients with an average age of 67, most of whom had significant health issues and common blood disorders like acute myeloid leukaemia and non-Hodgkin's lymphoma.
  • * Despite a 90% improvement rate after starting treatment, the study reported high mortality rates of 30% within 30 days and 50% during hospital stays for these patients.
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  • Prolonged SARS-CoV-2 infections are common in immunosuppressed patients, and current treatment options are limited, prompting a study on effective strategies.
  • The study involved 15 immunosuppressed patients treated between March 2022 and February 2023, using various combinations of antivirals and monoclonal antibodies, aiming for complete virological response.
  • Results showed that 93% of patients tested negative for SARS-CoV-2 within 16 days post-treatment, demonstrating that both sequential and combination therapies can be effective and safe for this high-risk group.
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  • Cytomegalovirus (CMV) co-infections are infrequently documented but pose significant health risks, particularly for immunocompromised individuals, with substantial morbidity and mortality rates.
  • The literature review indicates that most affected patients are middle-aged males who often received steroid treatments before their CMV diagnosis, typically linked to conditions like solid organ transplants or hematological diseases.
  • Common early symptoms include gastrointestinal and respiratory issues, with high treatment mortality rates of about 52.4%, while secondary bacterial infections often accompany CMV infections.
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To our knowledge, we have described the first case of /Cytomegalovirus (CMV) concomitant infection that occurred in a European country. The patient was a 76-year-old woman affected by relapsed non-Hodgkin lymphoma who presented interstitial pneumonia with a rapidly progressive worsening of respiratory insufficiency, leading to cardiac dysfunction and consequent death. CMV reactivation is a common complication in immunocompromised patients, while hyperinfection/disseminated strongyloidiasis (HS/DS) is rare in low endemic regions, but has been widely described in Southeast Asia and American countries.

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Oritavancin is a long-acting lipoglycopeptide with in vitro activity against Gram-positive pathogens, as well as good bactericidal activity and sterilisation ability in biofilm. It has been approved for acute bacterial skin and skin structure infections (ABSSSI), but recent reports have demonstrated possible off-label uses, such as for vancomycin resistant enterococci (VRE), deep-seated infections including those involving prosthetic material and invasive infections. The aim of this work is to review the uses of oritavancin outside of ABSSSI, focusing on its real-life applications on infective endocarditis, catheter- or device-related infections, bloodstream infections, and bone and prosthetic joint infections in humans, as well as possible future applications.

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Bloodstream infections (BSI) are life-threatening complications for onco-hematologic patients. Fluoroquinolones prophylaxis (FQP) was recommended for patients with neutropenia. Later, it was correlated with increased resistance rates among this population and its role became debated.

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The continuous spread of carbapenem-resistant (CP-Kp) strains presents a severe challenge to the healthcare system due to limited therapeutic options and high mortality. Since its availability, ceftazidime/avibactam (C/A) has become a first-line option against KPC-Kp, but C/A-resistant strains have been reported increasingly, especially with pneumonia or prior suboptimal blood exposure to C/A treatment. A retrospective, observational study was conducted with all patients admitted to the Intensive Care Unit (ICU) dedicated to COVID-19 patients at the City of Health & Sciences in Turin, between 1 May 2021 and 31 January 2022, with the primary endpoint to study strains with resistance to C/A, and secondly to describe the characteristics of this population, with or without previous exposure to C/A.

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