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OBJECTIVES: Adequacy of imported malaria management with respect to guidelines in emergency departments (ED) is low. We aimed to identify factors associated with this non-compliance, and a potential impact of the SARS-CoV-2 pandemic. PATIENTS AND METHODS: Patients presenting with imported malaria at the ED of the hospital of Melun (France), from January 1, 2017 to February 14, 2022 were retrospectively included. RESULTS: Among 205 adults and 25 children, biological criteria of severity were fully assessed in 10% of cases; lactates (40%) and blood pH (21%) levels were the main missing variables. Of 74 patients (32%) with severe malaria, 13 were misclassified as uncomplicated malaria. The choice and dosage of treatment were adequate in 85% and 92% of cases, respectively. Treatment conformity was lower in severe malaria cases than in non-severe malaria cases (OR 0.15 [95% CI 0.07-0.31]), with oral treatment in 17 patients with severe malaria; conformity was higher in the intensive care unit (OR 4.10 [95% CI 1.21-13.95]). Patients with severe malaria were more likely to start treatment within 6hours than patients with uncomplicated malaria (OR 1.97 [95% CI 1.08-3.43]), as were patients infected by P.falciparum compared to other species (OR 4.63 [95% CI 1.03-20.90]). Consulting during the SARS-CoV-2 pandemic was the only organizational factor associated with a lower probability of adequate management (OR 0.42 [95% CI 0.23-0.75]). CONCLUSION: Initial evaluation of malaria severity and time to treatment administration could be improved. These have been adversely impacted by the SARS-CoV-2 pandemic.
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COVID-19 , Malaria , Adulto , Niño , Humanos , SARS-CoV-2 , Pandemias , Estudios Retrospectivos , COVID-19/epidemiología , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Malaria/epidemiología , Servicio de Urgencia en HospitalRESUMEN
Background: The outbreak of SARS-CoV-2 has resulted in anxiety, depression and post-traumatic stress disorder (PTSD) among hospital staff. The factors associated with this psychological impact remain to be determined. Methods: A cross-sectional study using an online questionnaire completed by the staff of a French hospital, two months after the SARS-CoV-2 outbreak. Results: Among the 353 participants (of whom 67% were healthcare professionals), 32% had symptoms of anxiety, 16% of depression and 16% of PTSD. Eleven per cent had initiated or increased treatment with sleeping pills, and 6% with anxiolytics. In a multivariate analysis, factors independently associated with anxiety were: change of professional team, having a relative infected by SARS-CoV-2 and a new/increased treatment with sleeping pills or anxiolytics. The only factor associated with depression was the feeling of risk during professional practice. The factors associated with PTSD were: having a relative infected by SARS-CoV-2, the feeling of risk during professional practice, the increase in smoking and treatment with sleeping pills. The observance of transmission preventive measures (TPM) was not associated with the psychological impact of SARS-CoV-2. A personal history of SARS-CoV-2 infection and age < 36 years were associated with insufficient use of protective equipment. Age < 36 years, and being a healthcare professional were associated with the non-observance of social distancing. Conclusion: The hospital staff displayed psychological consequences, resulting in the use of anxiolytics and sleeping pills. Belonging to a group with low-risk of severe disease was associated with lower observance of TPM.
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OBJECTIVE: We aimed to determine the proportion of elderly patients hospitalised for community-acquired pneumonia (CAP) in whom a 5-day antibiotic therapy would achieve clinical stability according to American Thoracic Society (ATS) criteria. METHODS: Patients aged≥75 years, hospitalised for CAP between November 2018 and August 2019, were analysed retrospectively. The American Thoracic Society (ATS) clinical stability criteria (temperature≤37°C, heart rate≤100/min, respiratory rate≤24/min, systolic blood pressure≥90mmHg, oxygen saturation≥90% in room air) were assessed after five days of antibiotic therapy. RESULTS: Seventy-five patients (mean age 88 years, 49% requiring oxygen therapy) were included. Six died, and at day 5, 36/69 (52%) fulfilled 4/5 stability criteria. The median duration of treatment was 9 days. In 28 patients (41%), it was ≤7 days. CONCLUSION: In 52% of elderly patients with CAP, a 5-day treatment regimen resulted in clinical stability.
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Antibacterianos/administración & dosificación , Hospitalización/estadística & datos numéricos , Neumonía/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/mortalidad , Femenino , Humanos , Masculino , Neumonía/mortalidad , Guías de Práctica Clínica como Asunto , Frecuencia Respiratoria , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Wells' syndrome, also called eosinophilic cellulitis, is a rare eosinophilic dermatosis characterized by an unspecific inflammatory erythematous eruption often associated with systemic symptoms. Here we report the case of a 57-year-old female with bilateral painful pitting and pruritic feet progressive for two weeks despite one week of oral antibiotics. Skin biopsy was performed showing dermal eosinophilic infiltration. The patient showed a spontaneous progressive improvement of the condition. The presented case demonstrates both clinical and histologic presence of lesions of Wells' syndrome in the course of the disease. A careful diagnostic approach is needed because of the lack of specific signs. The global outcome is favorable and spontaneous resolution is possible.
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Celulitis (Flemón)/complicaciones , Eosinofilia/complicaciones , Dermatosis del Pie/etiología , Biopsia , Celulitis (Flemón)/patología , Eosinofilia/patología , Femenino , Dermatosis del Pie/patología , Humanos , Persona de Mediana Edad , Fotograbar , Piel/patologíaAsunto(s)
Eritema/etiología , Neoplasias del Mediastino/diagnóstico , Neoplasias de la Próstata/diagnóstico , Síndrome de la Vena Cava Superior/complicaciones , Síndrome de la Vena Cava Superior/diagnóstico , Síncope/etiología , Anciano , Brazo/fisiología , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/patología , Cara/patología , Humanos , Masculino , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/secundario , Movimiento/fisiología , Examen Físico/métodos , Neoplasias de la Próstata/complicaciones , Neoplasias de la Próstata/patología , Síncope/diagnósticoRESUMEN
Causes of hypereosinophilia among travelers returning from North Africa are dominated by helminth infections, especially when associated with gastrointestinal signs. Non-infectious causes must nonetheless be investigated after negative microbiological assessment and failure of a broad empiric antiparasite treatment. We report the case of a young man with epigastralgia and major weight loss since a stay in Tunisia. Empiric treatment with albendazole was not successful. Eosinophilic gastroenteritis was diagnosed and resolved under corticosteroid treatment.
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Enteritis/diagnóstico , Eosinofilia/diagnóstico , Gastritis/diagnóstico , Helmintiasis/diagnóstico , Enfermedad Relacionada con los Viajes , Adulto , Diagnóstico Diferencial , Enteritis/complicaciones , Enteritis/parasitología , Eosinofilia/complicaciones , Eosinofilia/parasitología , Gastritis/complicaciones , Gastritis/parasitología , Helmintiasis/complicaciones , Humanos , Masculino , Dolor/etiología , TúnezAsunto(s)
Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Bacteriuria/diagnóstico , Infecciones Comunitarias Adquiridas/diagnóstico , Diagnóstico Diferencial , Manejo de la Enfermedad , Farmacorresistencia Microbiana , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Tiras Reactivas , Recurrencia , Infecciones Urinarias/diagnóstico , Orina/microbiologíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Capnocytophaga/aislamiento & purificación , Infecciones Comunitarias Adquiridas/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , VIH-1 , Neumonía Bacteriana/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Anciano , Diagnóstico Diferencial , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Huésped Inmunocomprometido , Masculino , Neumonía por Pneumocystis/diagnósticoRESUMEN
BACKGROUND: Vascular thromboembolism (VTE) complicating cytomegalovirus (CMV) primary infection is increasingly reported in immunocompetent adults. No guideline is, however, currently available for the management of these infections and particularly for the antiviral therapy indication. METHODS: We performed a literature review of VTE complicating CMV primary infection in immunocompetent adults using PubMed. RESULTS: Sixty-nine case patients of VTE complicating CMV primary infection were reported. The main sites of venous thrombosis were the splanchnic veins (30 patients) or those of the lower limbs (18 patients). One-third of patients presented with pulmonary embolism (25 patients). Forty-nine patients (76%) had at least one VTE risk factor, inherited or acquired thrombophilia for 37 patients (58%), and another risk factor for 27 patients (42%). Only 11 patients received an antiviral therapy. A positive outcome was observed in all patients. CONCLUSION: We suggest that antiviral therapy should be considered for patients presenting with severe VTE, VTE with a negative outcome despite anticoagulation, severe organ involvement, or for patients managed in the intensive care unit.
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Antivirales/uso terapéutico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/tratamiento farmacológico , Trombosis/virología , Humanos , InmunocompetenciaRESUMEN
Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.
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Taponamiento Cardíaco/microbiología , Pericarditis/microbiología , Tuberculosis/complicaciones , Enfermedad Aguda , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis/diagnóstico , VíscerasRESUMEN
INTRODUCTION: Mycoplasma pneumonia (MP) infection may be associated with several neurological complications. Encephalitis, which affects children and rarely young adults, is the most frequent. CASE REPORT: A 23-year-old man was admitted for pneumonia with encephalitis. Mycoplasma pneumoniae infection was documented by serology, and polymerase chain reaction in the cerebrospinal fluid. Despite serious initial presentation, outcome was favourable with levofloxacin treatment. CONCLUSION: MP infection should be considered as a potential aetiology in acute encephalitis in young people and in individuals with respiratory symptoms. Antibiotic therapy (fluoroquinolones or macrolides) should be used if MP is strongly suspected or in case of severe acute meningo-encephalitis.
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Encefalitis/tratamiento farmacológico , Levofloxacino/uso terapéutico , Mycoplasma pneumoniae , Neumonía por Mycoplasma/complicaciones , Neumonía por Mycoplasma/tratamiento farmacológico , Adulto , Encefalitis/microbiología , Humanos , Masculino , Mycoplasma pneumoniae/aislamiento & purificación , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Infectious diseases are a frequent cause of morbidity in French troops deployed abroad. They are usually minor in severity and managed by field practitioners. We aimed to describe the etiological spectrum of travel-related infections in French soldiers evacuated to a level 4 military treatment facility. METHODS: We evaluated the diagnoses of all service members who were medically evacuated from abroad to our infectious diseases department from January 1, 2004 to October 30, 2013. RESULTS: One hundred and twenty five cases, median age 32 years were referred, 117 (94%) were male and 78 (62%) were from the Army. Main areas of deployment were Africa in 80 cases (64%), Afghanistan in 15 cases (12%), and French Guiana in 10 cases (8%). Median time between initial consultation and hospitalization in the reference center was 5 days (IQ 2-7 d). Thirty (24%) immediate aeromedical evacuations were carried out. The top five diagnoses were Plasmodium falciparum malaria (30), fever of unknown origin (15), cerebro-meningeal infections (10), invasive amebiasis (9), and HIV primary infections (9). Thirteen individuals were admitted in ICU. No death was recorded. CONCLUSIONS: Infectious diseases were a rare of cause of medevac. Most of them were preventable. Lethal etiologies were represented by malaria and cerebro-meningeal infections.
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Enfermedades Transmisibles/epidemiología , Urgencias Médicas/epidemiología , Personal Militar/estadística & datos numéricos , Transporte de Pacientes/estadística & datos numéricos , Adulto , Aeronaves , Femenino , Francia , Humanos , Malaria , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Daptomicina/administración & dosificación , Daptomicina/efectos adversos , Endocarditis/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Femenino , Humanos , MasculinoRESUMEN
We report the case of a patient who presented with a thrombus of the aortic arch complicated with splenic, renal and peroneal artery embolisms, associated with transient lupus anticoagulant, during a Mycoplasma pneumoniae infection. The outcome was good under antibiotic and anticoagulant treatment. We also review the medical literature on M. pneumoniae-related thromboses.
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Enfermedades de la Aorta/complicaciones , Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/complicaciones , Tromboembolia/complicaciones , Tromboembolia/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Enfermedades de la Aorta/microbiología , Ecocardiografía Transesofágica , Humanos , Riñón/patología , Masculino , Perineo/patología , Neumonía por Mycoplasma/microbiología , Bazo/patología , Tromboembolia/patología , Resultado del TratamientoAsunto(s)
Trasplante de Corazón , Nocardiosis/microbiología , Nocardia/aislamiento & purificación , Neumonía Bacteriana/microbiología , Complicaciones Posoperatorias/microbiología , Acetamidas/administración & dosificación , Acetamidas/uso terapéutico , Adulto , Ciprofloxacina/administración & dosificación , Ciprofloxacina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Humanos , Imipenem/administración & dosificación , Imipenem/farmacología , Imipenem/uso terapéutico , Huésped Inmunocomprometido , Linezolid , Masculino , Nocardia/efectos de los fármacos , Nocardiosis/diagnóstico por imagen , Nocardiosis/tratamiento farmacológico , Oxazolidinonas/administración & dosificación , Oxazolidinonas/uso terapéutico , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Combinación Trimetoprim y Sulfametoxazol/farmacologíaRESUMEN
We report the first case of cerebral abscess due to a novel species of Nocardia in a heart transplant patient and describe the antimicrobial susceptibility of this isolate. As our patient was intolerant to trimethoprim-sulfamethoxazole, we also discuss alternative therapeutic options in brain abscess due to Nocardia sp.