More efficient and sustainable healthcare must pass through closer collaboration between microbiologists and clinicians. Objective: better care of patients of all ages, from pregnant women to the frail, from chronically ill to transplant recipients. This is the message that comes from the 51st edition of the National Congress of Amcli Ets – Association of Italian Clinical Microbiologists, underway in Rimini: an event that has attracted around 1,800 professionals who have been discussing seminars and symposia on various topics of great importance since 8 March. relevance to public health.
Among these, HIV, which went unnoticed during the years of the pandemic which shifted attention to Covid cases – the Amcli experts underline – consequently reducing the diagnoses of this infection. During the meeting, the progressive and exceptional decline in new infections and associated deaths was recalled, but at the same time there was a notable increase in people being treated. Evidence from recent years has shown that effective therapy eliminates viremia and this has repercussions on the non-infectivity of infected subjects through unprotected sexual intercourse. Thanks to the massive application of the therapy, which today exceeds 80% of individuals throughout the world – including Africa – the prospects for survival and quality of life of people living with HIV have drastically improved, to the point that UNAIDS and WHO have raised the objectives to be achieved by 2030 to 95% regarding the number of people with diagnosed infection and on therapy with suppressed viremia.
“Everything revolves around the diagnosis – highlights Maria Rosaria Capobianchi, research consultant, Sacro Cuore Don Calabria Irccs Negrar hospital in Valpolicella (Verona) and member of the Amcli working group – Today we have diagnostic methods to measure the presence of antibodies and antigens of HIV and treatments so effective as to lead to the U=U (Undetectable=Untransmittable) paradigm. People who are being treated have reached a life expectancy that is very similar to that of HIV-negative people. However, it is essential to understand that the virus continues to circulate and still represents a major problem, and undiagnosed infections are responsible for a transmission rate that is two and a half times higher than the transmission rate of aware individuals. Furthermore, primary infections, i.e. those recently acquired , which almost always coincide with a state of unawareness of one's condition, are in turn those most prone to the transmission of the infection”.
Among the topics addressed during the congress work are also infections of the central nervous system, the suspicion of which requires the immediate start of an empirical therapy that is promptly oriented and targeted based on the results obtained by the laboratory. In the diagnostic approach to bacterial, fungal and tuberculous meningitis, “traditional diagnostics is still fundamental in daily practice despite the introduction of syndromic molecular tests – specifies Cristina Giraldi, Amcli diagnostic pathways coordinator – It is important to integrate traditional methods with those innovative, increasingly strengthening collaboration with the clinician”.
Liliana Gabrielli, head of the Virology sector, Uo Microbiologia Irccs Aou of Bologna, reports “a curious fact: in 2020-2021, in the greater Bologna area, we did not have any cases of infection of the central nervous system by enteroviruses and this is probably thanks to the hygiene measures implemented for the prevention of Sars-CoV-2 infection. Now, however, we have the same number of cases as in the pre-pandemic phase and in elderly patients, viral infections of the central nervous system are mainly caused by the Varicella zoster virus which cause of infections in the central nervous system both in patients who present the typical skin lesions, the vesicles, and in patients who do not have epidermal manifestations. The virus that prefers the female gender is Herpes simplex type 2, in fact in our experience the 72% of patients presenting with this type of meningitis are female.”
Finally, Antonio Piralla, virologist at the San Matteo Polyclinic in Pavia, spoke on respiratory infections in the post-Covid era: “Research by the Amcli GliViRe working group, in which 8 centers collaborated – he reported – made it possible to identify the viruses present in the upper and lower respiratory tracts of patients suffering from respiratory failure, with particular attention to intubated patients. It has been demonstrated that the influenza A virus is the one most present in these patients suffering from viral pneumonia”.
“The clinician's intervention in choosing the right anti-infective therapy cannot ignore the microbiological diagnosis – concludes Pierangelo Clerici, president of Amcli – We must be synergistic with the clinical scientific societies which are, together with the patient, our interface. We are all part of the health system and only the close collaboration between microbiologist, clinician and citizen-patient allows us to be interlocutors at an institutional level in defining the best clinical-care and prevention strategies for an effective response to the requests of the National Health Service”.
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