RESUMO
There is evidence for the interest of (18)F-fluoro-deoxyglucose positron emission tomography with computed tomography ((18)F-FDG-PET/CT) in fever of unknown origin (FUO) clinical investigation. However, little and conflicting data exist about its place in the investigation procedure. The aim of this work was to evaluate the clinical value of (18)F-FDG-PET/CT in patients with FUO and identify patients who need early (18)F-FDG-PET/CT rather than a last-resort procedure. We performed a 2-year retrospective cohort study at the Nîmes University Hospital, France. A total of 79 patients (36 men, 43 women, mean age 54.0 ± 16.2 years) with FUO underwent (18)F-FDG-PET/CT. A final diagnosis was established in 61 (77.2 %) cases. Aetiologies of FUO were determined using (18)F-FDG-PET/CT findings in 45 (73.8 % of patients with diagnosis) cases. The sensibility and specificity value were 98 % and 87 %, respectively. The presence of adenopathy, low haemoglobin and increased C-reactive protein (CRP) were predictors of high-yield (18)F-FDG-PET/CT. (18)F-FDG-PET/CT may help to detect most causes of FUO. The predictors of high-yield (18)F-FDG-PET/CT found in this study can help identify patients likely to benefit from specific and early imaging techniques.
Assuntos
Febre de Causa Desconhecida/diagnóstico , Fluordesoxiglucose F18 , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adulto , Idoso , Algoritmos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Histoplasma capsulatum is a nonendemic fungus in Europe. Epidemiological, clinical biological features and follow-up of seven imported cases in France were reported. These cases underlined the difficulties of such diagnosis in nonendemic areas due to greatly variable asymptomatic period, and lack of specific clinical signs. Thus, anamnesis should be carefully analysed; mucocutaneous signs and immunosuppression should be systematically investigated. Biological diagnosis requires multiple sites sampling and long-term conservation of culture medium.
RESUMO
Tuberculosis is a major public health problem. In France, the vaccine against tuberculosis (Bacillus Calmette-Guerin, BCG) is in decline. This decline is firstly due to changes in BGG administration that were implemented in 2006 and secondly because of new recommandations in 2007 that ended compulsory vaccination. To determine their position on this vaccine, in 2013-2014 we asked general practitioners, pediatricians, and Maternal and Infantile Protection Center physicians in the Gard and Herault departments (in Southern France) why this vaccine was not administered and their suggestions for improvement. Most of these doctors (73.9%) stated that they did not oppose this vaccination for children. They expressed concern about potential side effects, technical problems (intradermic injection, multi-dose bottles) and parents' refusal. One quarter of these physicians would have preferred that this vaccine remains compulsory and one third that this vaccine be administered in the maternity hospital. They also requested simplified criteria for patient eligibility, technical improvements (training for intradermal injection, single-dose vaccine) and more information for the public concerning this vaccination.
Assuntos
Atitude do Pessoal de Saúde , Vacina BCG , Padrões de Prática Médica , Criança , França , Clínicos Gerais , Humanos , Vacinação em Massa/legislação & jurisprudência , Pessoa de Meia-Idade , Pais , Pediatria , Inquéritos e QuestionáriosRESUMO
Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5-78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44-1.69), septic shock (OR 5.11; 95% CI 3.84-6.80), metastatic cancer (OR 4.28; 95% CI 2.88-6.38), and unknown primary focus (OR 2.62; 95% CI 2.02-3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17-0.95) and vancomycin (OR 0.37; 95% CI 0.17-0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia.
Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Penicilinas/administração & dosagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/mortalidade , Vancomicina/administração & dosagem , Idoso , Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/mortalidade , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Prognóstico , Estudos Prospectivos , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus , Análise de Sobrevida , Centros de Atenção Terciária , Vancomicina/uso terapêuticoRESUMO
Complement system is a part of innate immunity, its main function is to protect human from bacterial infection. As genetic disorders, complement deficiencies are often diagnosed in pediatric population. However, complement deficiencies can also be revealed in adults but have been poorly investigated. Herein, we describe a case series of infections revealing complement deficiency in adults to study clinical spectrum and management of complement deficiencies.A nationwide retrospective study was conducted in French university and general hospitals in departments of internal medicine, infectious diseases enrolling patients older than 15 years old who had presented at least one infection leading to a complement deficiency diagnosis.Forty-one patients included between 2002 and 2015 in 19 different departments were enrolled in this study. The male-to-female ratio was 1.3 and the mean age at diagnosis was 28â±â14 (15-67) years. The main clinical feature was Neisseria meningitidis meningitis 75% (nâ=â31/41) often involving rare serotype: Y (nâ=â9) and W 135 (nâ=â7). The main complement deficiency observed was the common final pathway deficiency 83% (nâ=â34/41). Half of the cohort displayed severe sepsis or septic shock at diagnosis (nâ=â22/41) but no patient died. No patient had family history of complement deficiency. The mean follow-up was 1.15â±â1.95 (0.1-10) years. Half of the patients had already suffered from at least one infection before diagnosis of complement deficiency: meningitis (nâ=â13), pneumonia (nâ=â4), fulminans purpura (nâ=â1), or recurrent otitis (nâ=â1). Near one-third (nâ=â10/39) had received prophylactic antibiotics (cotrimoxazole or penicillin) after diagnosis of complement deficiency. The vaccination coverage rate, at the end of the follow-up, for N meningitidis, Streptococcus pneumonia, and Haemophilius influenzae were, respectively, 90% (nâ=â33/37), 47% (nâ=â17/36), and 35% (nâ=â14/34).This large study emphasizes that complement deficiencies can be revealed in adults by infectious episodes. Most of them were meningococcal infections revealing common final pathway deficiency. To avoid undiagnosis or late diagnosis, adult displaying first episode of N meningitidis infection should be tested for complement deficiency.
Assuntos
Infecções Bacterianas/imunologia , Proteínas do Sistema Complemento/deficiência , Diagnóstico Tardio , Adolescente , Adulto , Fatores Etários , Idoso , Infecções Bacterianas/tratamento farmacológico , Complexo de Ataque à Membrana do Sistema Complemento/deficiência , Feminino , França , Humanos , Masculino , Meningite Meningocócica/imunologia , Meningite Meningocócica/microbiologia , Pessoa de Meia-Idade , Neisseria meningitidis , Otite Média/imunologia , Pneumonia/imunologia , Púrpura Fulminante/imunologia , Estudos Retrospectivos , Sepse/imunologia , Choque Séptico/imunologia , Adulto JovemRESUMO
Anti-TNFalpha strategies can result in significant clinical benefits in rheumatoid arthritis (RA), but with an increased rate of opportunistic infections. Visceral leishmaniasis (VL) is a severe disease that can develop in immunocompromised hosts, principally in HIV patients. VL in RA patients treated with TNFalpha antagonists is an extremely rare event, and only one case has been described. Here we report a case of VL, occurring after 9 infusions of infliximab in association with azathioprine, in a patient who developed blood cytopenia, fluctuant fever, and splenomegaly.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Leishmaniose Visceral/complicações , Infecções Oportunistas/parasitologia , Artrite Reumatoide/complicações , Feminino , Humanos , Infliximab , Leishmaniose Visceral/imunologia , Pessoa de Meia-Idade , Infecções Oportunistas/imunologia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
INTRODUCTION: Despite its rare occurrence in Caucasians, thyreotoxic periodic paralysis should be evoked in young male Caucasians presenting with episodes of pseudo-paralytic hypokalemia. OBSERVATION: A 37 year-old Caucasian was admitted in intensive care for an acute episode of hypotonic tetraplegia and hypokalemia during which laboratory tests revealed hyperthyroidism due to Basedow's disease. The clinical course was rapidly favourable after a small dose of intravenous potassium. Antithyroid treatment avoided any new occurrence of similar episodes. DISCUSSION: In Caucasians, sporadic acute paralysis with hypokalemia requires testing for hyperthyroidism. Though it is well know that hypokalemia results from potassium intracellular shift, the underlying mechanism remains poorly elucidated. Treatment includes potassium administration with caution and/or beta blockers but the specific treatment is that of hyperthyroidism.
Assuntos
Doença de Graves/complicações , Paralisia Periódica Hipopotassêmica/diagnóstico , Paralisias Periódicas Familiares/diagnóstico , Tireotoxicose/complicações , População Branca , Adulto , Diagnóstico Diferencial , Doença de Graves/tratamento farmacológico , Humanos , Infusões Intravenosas , Masculino , Potássio/administração & dosagem , Potássio/uso terapêuticoRESUMO
Staphylococcus caprae has been recently classified as a human pathogen, but the incidence of S. caprae in human bone and joint infections (BJIs) is under-reported. In this study, we report 25 cases of S. caprae BJI, and we review the 31 cases published in the literature. Molecular techniques and matrix-assisted laser desorption ionization time-of-flight mass spectrometry improved the identification of clinically relevant S. caprae strains. In this study, 96% of S. caprae BJIs were localized to the lower limbs, and 88% of the cases involved orthopaedic device infections. S. caprae joint prosthesis infections (JPIs), internal osteosynthesis device infections (I-ODIs) and BJIs without orthopaedic device infections were recorded in 60%, 28% and 12% of cases, respectively. Ten (40%) S. caprae BJIs were polymicrobial infections. These infections were associated with past histories of malignancy (p 0.024). Of the 14 bacterial species related to S. caprae BJI, 57% were staphylococci. I-ODIs were significantly associated with polymicrobial infections (p 0.0068), unlike JPIs, which were monomicrobial infections (p 0.0344). Treatment with rifampicin and fluoroquinolone was recorded in 40% of cases. Surgical treatment was performed in 76% of cases, e.g. prosthesis removal (36%), osteosynthesis device removal (24%), and surgical debridement (16%). Thirty per cent of cases were not treated. Relapses were observed mainly in the patients treated by surgical debridement only (p 0.033). In summary, S. caprae BJI is an underestimated hospital-acquired emerging infection. S. caprae BJI is correlated with infections in orthopaedic devices, which must be removed to control the infection.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Osteoartrite/epidemiologia , Osteoartrite/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis Emergentes/terapia , Desbridamento/métodos , Tratamento Farmacológico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/terapia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Infecções Estafilocócicas/terapia , Resultado do Tratamento , Adulto JovemAssuntos
Gonorreia/complicações , Peritonite/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/transmissão , Ceftriaxona/uso terapêutico , Ciprofloxacina/uso terapêutico , Quimioterapia Combinada , Feminino , Gonorreia/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Peritonite/etiologiaAssuntos
Abscesso/complicações , Infecções por Escherichia coli/complicações , Bócio Nodular/complicações , Doenças da Glândula Tireoide/complicações , Abscesso/diagnóstico , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/terapia , Bócio Nodular/diagnóstico , Bócio Nodular/terapia , Humanos , Masculino , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/terapia , Tireoidectomia , Resultado do TratamentoAssuntos
Linfoma não Hodgkin/complicações , Tuberculose Osteoarticular/complicações , Idoso , Antígenos CD/sangue , Humanos , Linfócitos/imunologia , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/imunologia , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Osteoarticular/diagnóstico , Tuberculose Osteoarticular/imunologiaRESUMO
INTRODUCTION: Methods used for the assessment of professional practices must be dependable and reproducible. The aim of this study was to assess a method used in our hospital to assess antibiotic therapy for acute community-acquired pneumonia (CAP). METHOD: In this study, a pharmacist and two infectious disease specialists retrospectively and independently evaluated the compliance to local antibiotic guidelines for 124 patients. The assessment tool was a Medical Appropriateness Index (MAI) (nine items). The kappa agreement index (K) among experts was calculated. RESULTS: The agreement among experts was poor for the initial antibiotic treatment (K=0.16) and route of administration (K=0.14), low for the duration of treatment (K=0.34), and null for the dose and adjustment to 72 hours. CONCLUSION: Differences between experts can be explained by the complexity of medical records, the number of items assessed, the complexity of the MAI, but also by the specialization and experience of experts. Thus, the assessment of CAP antibiotic therapy requires the use of appropriate methods targeting reliable criteria.
Assuntos
Antibacterianos/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Pneumonia Bacteriana/tratamento farmacológico , Doença Aguda , Idoso , Infecções Comunitárias Adquiridas/tratamento farmacológico , Prescrições de Medicamentos/normas , Feminino , Humanos , MasculinoAssuntos
Adenoma Viloso/complicações , Abscesso Encefálico/complicações , Infecções por Fusobacterium/complicações , Fusobacterium necrophorum , Pólipos Intestinais/complicações , Abscesso Hepático/complicações , Choque Séptico/microbiologia , Adenoma Viloso/diagnóstico , Adenoma Viloso/terapia , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Colectomia , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/terapia , Humanos , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/terapia , Abscesso Hepático/diagnóstico , Abscesso Hepático/terapia , Masculino , Testes de Sensibilidade MicrobianaAssuntos
Discite/microbiologia , Endocardite Bacteriana/microbiologia , Neisseria sicca/isolamento & purificação , Infecções por Neisseriaceae/microbiologia , Vértebras Torácicas/microbiologia , Idoso , Antibacterianos/uso terapêutico , Valva Aórtica/microbiologia , Ceftriaxona/uso terapêutico , Ciprofloxacina/uso terapêutico , Discite/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Degeneração do Disco Intervertebral/complicações , Masculino , Neisseria sicca/enzimologia , Infecções por Neisseriaceae/tratamento farmacológico , Penicilinase/metabolismoAssuntos
Doenças do Ceco/diagnóstico , Enterobíase/diagnóstico , Enterobius/isolamento & purificação , Enteropatias Parasitárias/diagnóstico , Dor Abdominal/etiologia , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Astenia/etiologia , Doenças do Ceco/tratamento farmacológico , Doenças do Ceco/parasitologia , Colonoscopia , Enterobíase/tratamento farmacológico , Enterobíase/parasitologia , Feminino , Humanos , Índia , Enteropatias Parasitárias/tratamento farmacológico , Enteropatias Parasitárias/parasitologia , Mebendazol/análogos & derivados , Mebendazol/uso terapêutico , Viagem , Redução de PesoRESUMO
OBJECTIVE: Retrospective study of patients presenting Aeromonas spp. infections admitted to Nîmes hospital from January 1997 to December 2004. PATIENTS AND METHOD: Aeromonas spp. infections were collected from the database of the bacteriology department. The Aeromonas species, suceptibility phenotype, epidemiological data, site and type (nosocomial or not) of infection, and evolution were collected from medical files. RESULTS: Thirty infections were notified corresponding to 22 male and eight female of 50.6 years old (mean) and a mean stay duration of 31 days. Skin and soft tissues (50%), digestive tract (26.7%), bones and articulations (10%), blood stream (6.7%), urinary tract (3.3%) and lymph nodes (3.3%) were the sites of infection. Ten infections were nosocomial, four were associated with medical leeches. All strains were resistants to amoxicillin and amoxicillin- clavulanic acid, whereas resistance rate to other beta-lactams was under 10% and all were suceptible to fluoroquinolones and aminoglycosides. All patients received antibiotic treatment: 31% a single molecule, 69% an association and 62% needed a second line treatment. Strain was suceptible to the antibiotic in 78.5% of cases. Only one death occured not directly linked to Aeromonas infection. DISCUSSION: Most of Aeromonas spp. infection sites were cutaneous and digestive. Nosocomial infections associated with medical leeches are not so uncommon and strict conditions of storage and administration are necessary. According to the susceptibility phenotype of our strains which is similar to literature data, a third generation cephalosporin or a fluoroquinolone should be used evenly associated with an aminoglycoside.
Assuntos
Aeromonas , Infecções por Bactérias Gram-Negativas/epidemiologia , Adulto , Idoso , Infecção Hospitalar/epidemiologia , Feminino , França/epidemiologia , Infecções por Bactérias Gram-Negativas/transmissão , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Non-iatrogenic spondylodiscitis caused by anaerobic bacteria remains exceptional. We describe 2 cases of spondylodiscitis with epidural abscess due to Bacteroides fragilis, 1 after colonoscopy with biopsy and 1 in a cirrhotic patient. The clinical and imaging findings were not discriminant relative to other pyogenic spondylodiscitis. One should consider B. fragilis when treating a spondylodiscitis with epidural abscess, especially in patients with a possibly digestive portal of entry.
Assuntos
Bacteroides fragilis/isolamento & purificação , Vértebras Cervicais/microbiologia , Discite/microbiologia , Abscesso Epidural/microbiologia , Vértebras Lombares/microbiologia , Abscesso/microbiologia , Idoso , Infecções por Bacteroides/microbiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Periaortic fibrosis is defined as the development of aortic perianeuvrysmal fibrosis either resulting from a focal inflammatory reaction or a self-perpetuating process. Compression of neighboring organs is a possible complication. Bile duct obstruction is exceptional.