[Acute renal failure in a patient undergoing oncological treatment]. / Survenue d'une insuffisance rénale aiguë chez un patient sous traitement oncologique.

With the increasing prevalence of neoplasia and kidney disease, patients undergoing oncological treatment are at greater risk of acute renal failure. Joint oncological and nephrological management requires a thorough understanding of the patient's clinical history, as well as the potential nephrotoxic effects of chemotherapy and immunotherapy. This article proposes a comprehensive approach to the assessment of acute renal failure in patients undergoing treatment for neoplasia.

Face à l'augmentation de la prévalence des néoplasies et des maladies rénales, les patients sous traitement oncologique sont plus à risque d'insuffisance rénale aiguë (IRA). Une prise en charge oncologique et néphrologique conjointe comprend une bonne connaissance du parcours clinique du patient, ainsi que des effets néphrotoxiques potentiels des chimiothérapies et immunothérapies. Cet article propose une démarche globale dans la réalisation du bilan d'une IRA chez un patient en cours de traitement pour une néoplasie.

[Intravenous drug use and kidney disease]. / Consommation de drogues par voie itraveineuse et maladies rénales.

Intravenous drug use (IVDU) is a major public health issue, associated with high mortality rates. The risk of overdose, cardiovascular and infectious complications are well known, but IVDU can also lead to different types of kidney disease. Patients can develop acute or chronic kidney injury due to direct nephrotoxicity of the drugs, or present with different types of glomerulonephritis, interstitial nephritis, and bacterial or viral infection-related nephropathy. Diagnosis can be difficult but is essential to prevent irreversible kidney damage. The number of persons with IVDU that develop end-stage kidney disease is increasing and poses challenges for dialysis and transplantation centers. This article summarizes the renal manifestations that clinicians may encounter in persons with IVDU, especially of heroin and cocaine.

La consommation de drogues par voie intraveineuse (CDVI) constitue un problème majeur de santé publique. Les risques d'overdose, de complications cardiovasculaires et infectieuses sont bien connus, mais la CDVI peut aussi mener à différentes atteintes rénales. Les patients peuvent développer une insuffisance rénale aiguë ou chronique due à la toxicité directe des drogues, mais aussi une glomérulonéphrite, une néphrite interstitielle ou une néphropathie secondaire à une infection virale ou bactérienne. Le nombre de personnes avec CDVI développant une insuffisance rénale terminale est à la hausse et représente un défi pour les centres de dialyse et de transplantation. Cet article passe en revue les manifestations rénales que les cliniciens peuvent rencontrer lors de la prise en charge de patients avec CDVI, notamment d'héroïne et de cocaïne.

Missed pertussis diagnosis during co-infection with Bordetella holmesii.

The purpose of this study is to identify predictive factors associated with missed diagnosis of B. pertussis-B. holmesii co-infection by assessing the analytical performance of a commercially available multiplexed PCR assay and by building a prediction model based on clinical signs and symptoms for detecting co-infections. This is a retrospective study on the electronic health records of all clinical samples that tested positive to either B. pertussis or B. holmesii from January 2015 to January 2018 at Geneva University Hospitals. Multivariate logistic regression was used to build a model for co-infection prediction based on the electronic health record chart review. Limit of detection was determined for all targets of the commercial multiplexed PCR assay used on respiratory samples. A regression model, developed from clinical symptoms and signs, predicted B. pertussis and B. holmesii co-infection with an accuracy of 82.9% (95% CI 67.9-92.8%, p value = .012), for respiratory samples positive with any of the two tested Bordetella species. We found that the LOD of the PCR reaction targeting ptxS1 is higher than that reported by the manufacturer by a factor 10. The current testing strategy misses B. pertussis and B. holmesii co-infections by reporting only B. holmesii infections. Thus, we advocate to perform serological testing for detecting a response against pertussis toxin whenever a sample is found positive for B. holmesii. These findings are important, both from a clinical and epidemiological point of view, as the former impacts the choice of antimicrobial drugs and the latter biases surveillance data, by underestimating B. pertussis infections during co-infections.

Atypical presentation of Lemierre's syndrome: case report and literature review.

BACKGROUND: The classic Lemierre's syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported. CASE PRESENTATION: We describe an unusual case of a previously healthy 58-year-old male with Lemierre's syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre's syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis. CONCLUSIONS: This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre's syndrome is redefined here to take into consideration non-cervical sites.

Low-dose computed tomography for the diagnosis of pneumonia in elderly patients: a prospective, interventional cohort study.

The diagnosis of pneumonia is challenging. Our objective was to assess whether low-dose computed tomography (LDCT) modified the probability of diagnosing pneumonia in elderly patients.We prospectively included patients aged over 65 years with a suspicion of pneumonia treated with antimicrobial therapy (AT). All patients had a chest radiograph and LDCT within 72 h of inclusion. The treating clinician assessed the probability of pneumonia before and after the LDCT scan using a Likert scale. An adjudication committee retrospectively rated the probability of pneumonia and was considered as the reference for diagnosis. The main outcome was the difference in the clinician's pneumonia probability estimates before and after LDCT and the proportion of modified diagnoses which matched the reference diagnosis (the net reclassification improvement (NRI)).A total of 200 patients with a median age of 84 years were included. After LDCT, the estimated probability of pneumonia changed in 90 patients (45%), of which 60 (30%) were downgraded and 30 (15%) were upgraded. The NRI was 8% (NRI event (-6%) + NRI non-event (14%)).LDCT modified the estimated probability of pneumonia in a substantial proportion of patients. It mostly helped to exclude a diagnosis of pneumonia and hence to reduce unnecessary AT.

[Acute dyspnea in the emergency room: from pathophysiology to ultrasonography]. / Dyspnée aiguë aux urgences: de la physiopathologie à l'échographie.

Acute dyspnea is one of the leading clinical symptoms encountered in the emergency room. Its differential diagnosis is wide, ranging from noisy panic attacks to threatening acute heart failure. History taking and physical examination, even when exhaustive are of limited diagnostic value. Patient reported descriptions are fairly correlated to pathophysiology. Vital signs such as the respiratory rate and pulse oximetry carry prognostic significance. Ancillary tests like the chest x-ray lack sensitivity and specificity. The most astonishing adjunct to testing is the chest ultrasound. Its integration into the emergency physician's armamentarium considerably changed clinical management. Fast and accurate, ultrasonography has become the modern era stethoscope. This review discusses acute dyspnea through the main elements useful to diagnosis.