Browsing by Author "Lapadula, Giuseppe"

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    Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering.
    (Mediterranean journal of hematology and infectious diseases, 2013-01) Lapadula, Giuseppe; Zanini, Fabio; Codecasa, Luigi; Franzetti, Fabio; Ferrarese, Maurizio; Carugati, Manuela; Mazzola, Ester; Schiroli, Consuelo; Motta, Davide; Iemmi, Diego; Gori, Andrea

    Setting

    Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999).

    Objective

    To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clustering.

    Design

    Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clustering.

    Results

    Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clustering (OR 1.06, 95%CI 0.75-1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37-0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41-0.76; p<0.001) were running a lower risk of clustering. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20-2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46-4.25, p=0.001) were significantly more likely to be involved in clusters.

    Conclusion

    In our cohort, domiciliary treatment was not associated with TB clustering. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.
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    Mycobacterium tuberculosis Beijing family: analysis of the epidemiological and clinical factors associated with an emerging lineage in the urban area of Milan.
    (Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, 2014-07) Zanini, Fabio; Carugati, Manuela; Schiroli, Consuelo; Lapadula, Giuseppe; Lombardi, Alessandra; Codecasa, Luigi; Gori, Andrea; Franzetti, Fabio
    The Mycobacterium tuberculosis Beijing genotype raises major concern because of global spreading, hyper-virulence and association with multi-drug resistance (MDR). The aims of the study were to evaluate role of Beijing family in the epidemiological setting of Milan and to identify predictors associated with the spreading of this lineage. Overall 3830TB cases were included. Beijing family accounted for 100 isolates (2.6%). Prevalence grew from 1.7% to 5.4% in the period 1996-2009. Foreign origin increased significantly the risk of having a Beijing strain: the greatest risk was observed among patients coming either from China [AOR=57.7, 95%CI (26.3-126.8)] or from Former Soviet countries [AOR=33.9, 95%CI (12.8-99.6)]. Also MDR was independently associated with Beijing family [AOR=2.7, 95%CI (1.3-5.8)], whereas male gender and younger age only approximated the statistical significance [p 0.051 and p 0.099, respectively]. However, the percentage of cases attributable to MDR strains decreased over time, both in the Beijing group and in the non-Beijing group. 97 isolates were grouped in 37 sub-lineages: MT11, MT33 were predominant. Beijing family is an emerging lineage in Milan. Origin from countries like China and Ukraine and MDR are significantly associated with Beijing. The broad range of the sub-lineages reflects the recent dynamics of the migration flows to our area. This scenario can prelude to a constant increase in the spreading of Beijing strains in the near future.