RESUMEN
INTRODUCTION: In case of pneumonia, some biological findings are suggestive for Legionnaire's disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for negative Legionella Urinary-Antigen-Test (L-UAT). METHOD: Observational retrospective study in Nord-Franche-Comté Hospital with external validation in Besançon University Hospital, France which included all adults with L-UAT performed during January 2018 to December 2022. The objective was to determine CRP optimal threshold to predict a L-UAT negative result. RESULTS: URINELLA included 5051 patients (83 with positive L-UAT). CRP optimal threshold was 131.9 mg/L, with a negative predictive value (NPV) at 100%, sensitivity at 100% and specificity at 58.0%. The AUC of the ROC-Curve was at 88.7% (95% CI, 86.3-91.1). External validation in Besançon Hospital patients showed an AUC at 89.8% (95% CI, 85.5-94.1) and NPV, sensitivity and specificity was respectively 99.9%, 97.6% and 59.1% for a CRP threshold at 131.9 mg/L; after exclusion of immunosuppressed patients, index sensitivity and NPV reached also 100%. CONCLUSION: In case of pneumonia suspicion with a CRP level under 130 mg/L (independently of the severity) L-UAT is useless in immunocompetent patients with a NPV at 100%. We must remain cautious in patients with symptoms onset less than 48 h before CRP dosage.
Asunto(s)
Proteína C-Reactiva , Legionella pneumophila , Enfermedad de los Legionarios , Humanos , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/microbiología , Legionella pneumophila/aislamiento & purificación , Proteína C-Reactiva/análisis , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Sensibilidad y Especificidad , Serogrupo , Adulto , Francia , Curva ROC , Valor Predictivo de las PruebasRESUMEN
We report an outbreak of confirmed Mycoplasma pneumoniae community-acquired pneumonia (CAP) in Nord Franche-Comté Hospital, France, from 14 November 2023 to 31 January 2024. All 13 inpatients (11 adults with a mean age of 45.5 years and 2 children) were diagnosed with positive serology and/or positive reverse transcription polymerase chain reaction (RT-PCR) on respiratory specimens. All patients were immunocompetent and required oxygen support with a mean duration of oxygen support of 6.2 days. Two patients were transferred to the intensive care unit (ICU) but were not mechanically ventilated. Patients were treated with macrolides (n = 12, 92.3%) with recovery in all cases. No significant epidemiological link was reported in these patients.
Asunto(s)
Infecciones Comunitarias Adquiridas , Neumonía por Mycoplasma , Niño , Adulto , Humanos , Persona de Mediana Edad , Mycoplasma pneumoniae/genética , Neumonía por Mycoplasma/tratamiento farmacológico , Neumonía por Mycoplasma/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Hospitales , Oxígeno , Francia/epidemiología , Brotes de EnfermedadesRESUMEN
We report a rare case of confirmed early neurosyphilis with serofast state in HIV-negative patient, with uncontrolled type 2 diabetes mellitus. Syphilitic meningitis was diagnosed initially on serology and cerebrospinal fluid (CSF) analysis. The patient had persistently raised non-treponemal titres on serum with negative CSF venereal disease research laboratory result, following treatment during 3 years of follow-up.
Asunto(s)
Neurosífilis , Humanos , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Neurosífilis/complicaciones , Masculino , Treponema pallidum/aislamiento & purificación , Treponema pallidum/inmunología , Diabetes Mellitus Tipo 2/complicaciones , Antibacterianos/uso terapéutico , Persona de Mediana Edad , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/líquido cefalorraquídeoRESUMEN
We report a case of posterior reversible encephalopathy syndrome in an adult patient fulfilling criteria for proven early Lyme neuroborreliosis.