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Multiple sclerosis is a chronic inflammatory disease of the central nervous system characterized by damage to myelin and axons, over time leading to progressive neuronal degeneration and microglial activation. There is still no curative treatment, but during the last 20 years eight different therapies have become available including interferon beta, glatiramer acetate, teriflunomide, dimethyl fumarate, natalizumab, fingolimod, alemtuzumab, mitoxantrone and teriflunomide. Teriflunomide is an immunomodulatory drug that exerts an inhibitory effect on T cell activation in central nervous system of the patients with multiple sclerosis. We determined whether teriflunomide affect the production of interferon-gamma, interleukin-2 and tumor-necrosis-factor-α in the QuantiFERON-TB in-Tube-assay. Blood from 24 adults with latent tuberculosis infection was added to one standard set of QuantiFERON tubes and one further set containing teriflunomide. Teriflunomide resulted in a change in QuantiFERON results from positive to negative in four patients with a marked reduction in interferon-γ. Our data indicated that results from QuantiFERON in patients on teriflunomide therapy should be interpreted with caution.

Nontuberculous mycobacteria (NTM) are a heterogeneous group of pathogens including all mycobacteria other than Mycobacterium tuberculosis complex and Mycobacterium leprae [1]. The rate of NTM infection has increased substantially over the last decades, especially in high-income countries, as recently illustrated by Diel et al. [2] who have highlighted the relevant clinical and economic burden of NTM disease in Germany. The main reasons include the aging of the population, the increasing number of patients with immunodepressive disorders, the use of immunosuppressive agents and a substantial increase in awareness of the disease [3]. Epidemiological data on NTM worldwide are lacking and very few reports have been published based on the Italian population [4, 5].

The present study aimed to use QuantiFERON TB Gold in tube (Cellestis Limited, Carnegie, Victoria, Australia) as a tool for the screening for tubercular infection in HIV-positive patients. Seventy-three HIV-positive subjects were tested. For each individual, QuantiFERON TB in tube was performed. The immunoassay was negative in 53 subjects, positive in eight and indeterminate in 12. The data obtained indicate that factors such as the CD4 cell count and their percentage, as well as the stage of the disease, could affect the performance of the interferon-γ release assay in populations at risk such as HIV-positive subjects.

The effectiveness of the QuantiFERON-TB-Gold in tube was compared with PPD to detect tuberculosis infection in the staff of cattle-farms, as a consequence of an outbreak of bovine tuberculosis in livestock. The data revealed the advantage of the immunological test for the specific detection of subjects infected by Mycobacterium tuberculosis complex.

The study pointed out that since every strain is different, there was no TB transmission in any of the subpopulations and between immigrants and natives. This showed that the presence of immigrants was not a risk factor for contracting TB in the community.

RIASSUNTO -La diagnosi e la terapia delle lesioni delle vie ottiche, in pazienti affetti da Neurofibromatosi tipo 1, rappresentano argomenti problematici che non godono ancora di linee guida uniformemente accettate. In particolare il decorso benigno della maggior parte di queste alterazioni e soprattutto la loro non evolutivita nel tempo, sembrerebbero giustificare una cauta sorveglianza clinico strumentale.Anche la nostra osservazione permetterebbe di considerare benigno, simil amartomatoso displastico, il decorso delle lesioni che coinvolgono i nervi ottici od il chiasma: in tutti i nostri casi infatti, alla stabilita del quadro radiologico si sono associate assenza di rilevanti modificazioni cliniche o strumentali.Un comportamento aggressivo ha caratterizzato invece le lesioni piu posteriori, a sede ipotalamo-chiasmatica: in questi casi riteniamo indispensabili controlli radiologici ravvicinati nel tempo per stabilire il timing di un'eventuale terapia citoriduttiva.SUMMARY -Diseases of the optic nerves and pathways, especially optic gliomas are the most common complications of neurofibromatosis type 1. However, as yet there are no standard guidelines for the diagnosis and treatment of such lesions. The benign course of most morphological changes to the optic pathways associated with neurofibromatosis 1 and above all their long-term stability justify cautious clinical and instrumental monitoring. Concomitant MR scans, ophthalmologic and neurophysiological examination will determine the presence and extent of disease, possible progression and the degree of functional impairment of the optic nerve in patients who are often symptom-free. The wide-ranging clinical effects of these lesions and literature reports of spontaneous regression raise doubts as to whether they are tumours.We studied 170 children and adults with a definite diagnosis of neurofibromatosis 1 being treated at the Neurofibromatosis Centre Bergamo and referred for neurological examination, MR imaging of the brain and orbits and ophthalmological examination between 1991 and 1996. MR signal changes to the optic nerves and pathways were detected in 21 patients.Our observations show that lesions confined to the optic nerves or chiasma without contrast enhancement can be deemed benign. More posterior lesion locations involving the hypothalamus and chiasma are more aggressive with a high growth index and strong MR enhancement.Larger series and longer patient follow-up are needed to confirm literature hypotheses that, in addition to the fast-growing gliomas typical of childhood, hamartoma-like or dysplastic lesions to the optic nerves are found in neurofibromatosis type 1.

The aim of this study was to investigate the Mycobacterium tuberculosis transmission among high school student and teacher populations in a high school in Northern Sardinia. Tuberculin skin-test screening, chest-X-rays, QuantiFERON-TB Gold, microbiological examination, spoligotyping and variable numbers of tandem repeats (VNTR) analysis of M. tuberculosis isolates were performed. This study indicates the effectiveness of the epidemiological investigation.