RESUMEN
INTRODUCTION: There is no hematological marker that reliably differentiates between bacterial and nonbacterial acute gastroenteritis (AGE). The objective of this study is to evaluate procalcitonin (PCT) as a marker for bacterial AGE and analyze its relationship with hospital admission. PATIENTS AND METHOD: A prospective study of children diagnosed with AGE was conducted at the emergency room during a period of seven months, which required blood and stool samples. Epidemiological, clinical and analytical variables were analyzed. Patients with chronic digestive disease, prolonged diarrhea, immunodeficiency or prior antibiotic treatment were excluded. The study was approved by the Ethics Committee and an informed consent was requested. RESULTS: 45 patients were analyzed. Children with bacterial GEA were older (p=0.027) and presented higher median PCT and C-reactive protein concentrations (CRP) (p=0.001). The PCT and CRP values that best discriminated bacterial infection were PCT≥0.05 mg/L (sensibility 64.3%, specificity 83.9%, positive probability coefficient (PPC): 4), and CRP≥3 mg/dL (sensibility 78.6%, specificity 90.3%, PPC: 8). No association between the elevation of these markers and higher hospitalization probability was found. CONCLUSION: Procalcitonin, like CRP, is elevated in bacterial gastroenteritis (p=0.001), but these markers are not a predictor of hospitalization.
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Infecciones Bacterianas/diagnóstico , Proteína C-Reactiva/metabolismo , Calcitonina/metabolismo , Gastroenteritis/diagnóstico , Precursores de Proteínas/metabolismo , Enfermedad Aguda , Adolescente , Infecciones Bacterianas/microbiología , Biomarcadores/metabolismo , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Femenino , Gastroenteritis/microbiología , Hospitalización , Humanos , Lactante , Masculino , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
In the present retrospective study, we described a series of 45 non-icteric leptospirosis and 44 nephropathia epidemica (NE) patients diagnosed in the northeast of France from 1995 to 2005 and compared their clinical picture and laboratory parameters, as well as some epidemiological data. Loin pain (P < 0.001), abdominal pains (P = 0.007), rise of blood pressure (P < 0.001) and pharyngitis (P = 0.01) were more frequently found in NE patients. Aspartate aminotransferase (ASAT) (P = 0,006), creatine phosphokinase (CPK) (P < 0.0001) and C-reactive protein (CRP) (P < 0.0001) were higher in leptospirosis, whereas creatinine (P = 0.009) was higher in NE. Leptospirosis mainly concerns occupational hazards, e.g. farmers, and leisure activities like swimming, and NE concerns professional foresters or leisure activities in the forest and the cleaning of attics. During hospitalisation, patients receiving antibiotics were more frequent among leptospirosis than among NE patients (80% versus 59%, P = 0.06). Among the various common clinical signs, only acute myopia appeared to be a pathognomonic but inconsistently observed clinical sign, which was only observed in 47% of NE cases.
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Fiebre Hemorrágica con Síndrome Renal/epidemiología , Leptospirosis/epidemiología , Adulto , Anciano , Femenino , Francia/epidemiología , Fiebre Hemorrágica con Síndrome Renal/patología , Fiebre Hemorrágica con Síndrome Renal/fisiopatología , Humanos , Leptospirosis/patología , Leptospirosis/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Kawasaki disease is a systemic necrotizing vasculitides concerning medium arteries and affecting predominantly young children. CASE RECORD: We describe here an incomplete Kawasaki disease occurring in an adult with an unusual manifestation presenting as aseptic purulent meningitis. DISCUSSION: Diagnosis and treatment management of incomplete Kawasaki disease.
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Síndrome Mucocutáneo Linfonodular , Adulto , Factores de Edad , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/administración & dosificación , Aspirina/análogos & derivados , Aspirina/uso terapéutico , Urgencias Médicas , Humanos , Lisina/administración & dosificación , Lisina/análogos & derivados , Lisina/uso terapéutico , Masculino , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain further knowledge on the epidemiology of this anthropozoonosis.
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Infecciones por Hantavirus/diagnóstico , Infecciones por Hantavirus/terapia , Animales , Antivirales/uso terapéutico , Reservorios de Enfermedades , Europa (Continente)/epidemiología , Infecciones por Hantavirus/epidemiología , Infecciones por Hantavirus/fisiopatología , Humanos , Diálisis Renal , Roedores/virologíaRESUMEN
Four cases of severe strongyloidiasis in Martinique patients are reported. Clinical features were typical of the affection, and the outcome was fatal in two cases. Fibroscopy findings were negative but larvae were demonstrated in biopsy specimens in 3 out of the 4 cases. A barium meal follow-through examination showed the different radiological images of the infestation: non-specific parasitic duodenitis and pseudo-stenosis of D3 with duodenal dilatation, barium reflux into the main bile duct, and absence of jejunal folds, these images being very suggestive of strongyloidiasis.
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Duodeno/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Estrongiloidiasis/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/epidemiología , Tiabendazol/uso terapéutico , Indias OccidentalesRESUMEN
The authors report a case of mitral endocarditis diagnosed by cardiac echo-Doppler and complicating an obstructive cardiomyopathy (OCM) in a 37-year-old woman. Despite the high degree of sub-aortic obstruction and the existence of an apparently severe mitral leak by Doppler analysis, the patient remained totally asymptomatic and the outcome was favourable with appropriate antibiotics. A review of the literature revealed 11 cases of endocarditis in a context of OCM, documented by echocardiography. Echo-Doppler enables precise evaluation of this grave and often poorly tolerated complication of OCM.
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Cardiomiopatía Hipertrófica/complicaciones , Ecocardiografía Doppler , Endocarditis Bacteriana/diagnóstico , Válvula Mitral , Adulto , Endocarditis Bacteriana/etiología , Femenino , HumanosRESUMEN
OBJECTIVES: The contradiction between airborne transmission of Puumala virus and the low rate of airway manifestations reported in hemorrhagic fever with renal syndrome (HFRS) caused by this virus led us to conduct this study to check whether the incidence of respiratory manifestations may have been underestimated. PATIENTS AND METHODS: We retrospectively reviewed 129 consecutive cases of HFRS diagnosed between 1983 and 1995 in the eastern France. RESULTS: Clinical manifestations of airway involvement and chest X-ray abnormalities were observed in 30% and 50% of the patients respectively. Analysing the radiological anomalies by serum creatinine level showed that in two-thirds of the cases (33% of all the HFRS cases) they were concomitant with acute renal failure and probably related to pulmonary edema, and that in one-third (17% of the HFRS cases) they were compatible with pneumonia. These cases of pneumonia could correspond to specific manifestations of the hantavirus Puumala at the site of penetration. CONCLUSION: Although minimally expressive, respiratory manifestations were found to be more frequent than expected in hemorrhagic fever with renal syndrome. Incidence may have been formerly underestimated.
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Fiebre Hemorrágica con Síndrome Renal/complicaciones , Neumonía Viral/virología , Edema Pulmonar/virología , Adolescente , Adulto , Anciano , Creatinina/sangre , Femenino , Francia/epidemiología , Fiebre Hemorrágica con Síndrome Renal/sangre , Fiebre Hemorrágica con Síndrome Renal/transmisión , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/epidemiología , Radiografía , Estudios RetrospectivosRESUMEN
Liver biopsies were systematically performed in 20 patients with evidence of an acquired immunodeficiency syndrome (18 with opportunistic infections, 9 with Kaposi's sarcoma). Hepatitis, related to hepatitis-B virus in 3 cases and to cytomegalovirus in 3 cases, was present in 6 of them. All patients had at least one of the three following lesions: non-specific portal inflammatory infiltration (6 cases), granulomatous lesions (12 cases), vascular abnormalities (12 cases). Among hepatic granulomatous lesions: 3 were due to acid-fast bacilli and 1 to Cryptococcus. Sinusoidal abnormality included proliferation of Küpffer cells (9 cases), sinusoidal dilatation (2 cases), peliosis (4 cases) and Kaposi's sarcoma (1 case). A relationship between these abnormalities cannot be excluded.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Hepatopatías/etiología , Hígado/patología , Síndrome de Inmunodeficiencia Adquirida/patología , Adulto , Infecciones Bacterianas/microbiología , Femenino , Hepatitis/microbiología , Virus de Hepatitis/aislamiento & purificación , Hepatitis Viral Humana/etiología , Humanos , Hígado/irrigación sanguínea , Hígado/microbiología , Hepatopatías/patología , Masculino , Micosis/microbiologíaRESUMEN
OBJECTIVES: Apparent a frigore facial palsy could possibly mask manifestations of unrecognized Lyme's disease. Since commonly used corticosteroid treatment could be deleterious if Borrelia burgdorferi infection was indeed the cause, we conducted a prospective study to search for possible infections in cases of recently diagnosed a frigore facial palsy. METHODS: For 3 years, 1990-1992, 49 French centres diagnosed a facial palsy in 346 patients (310 adults, 36 children under 15 years of age; mean age 38; range 16 months to 83 years). The patients were divided into three groups: a) facial palsy alone, b) zoster origin recognized due to outer ear eruption and c) cases with meningoradiculitis or joint signs or cases with facial diplegia. A questionnaire was used to evaluate exposure to risk of tick bits. A control group was established with 246 serum samples from subjects matched with the patients for age, geographical origin and exposure to risk of tick bits. Laboratory tests (indirect immunofluorescence and Western blot) were performed to search for anti-Borrelia burgdorferi antibodies in serum samples, and cerebral spinal fluid when possible, collected at presentation, on day 30 and on day 90. RESULTS: Sixty percent of the patients were urban dwellers, 15% lived in rural and 25% in semi-rural areas. There were 294 patients with facial palsy alone and their serum results were compared with those of the matched controls. There was no significant difference in the positivity for Borrelia burgdorferi antibodies between these two groups. CONCLUSION: These findings indicate that, unless there are clinical signs suggestive of borreliosis, it would not be necessary to test for Lyme's disease in patients with apparent a frigore facial palsy.
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Grupo Borrelia Burgdorferi/aislamiento & purificación , Parálisis Facial/etiología , Enfermedad de Lyme/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Niño , Preescolar , Parálisis Facial/líquido cefalorraquídeo , Parálisis Facial/microbiología , Femenino , Técnica del Anticuerpo Fluorescente , Francia/epidemiología , Humanos , Lactante , Enfermedad de Lyme/líquido cefalorraquídeo , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Valores de ReferenciaRESUMEN
UNLABELLED: Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN) use seems to be a risk factor for developing a catheter-related infection (CRI). MATERIAL & METHODS: In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years) who received parenteral nutrition while in hospital. All episodes of fever + positive blood culture were recorded. Infection rate was defined as number of episodes/1000 Parenteral nutrition days. RESULTS: 48 positive blood cultures was obtained from 120 patients. Infection rate was 37.8/1000 days. Incidence was significantly higher in infants and toddlers (52% vs 29.8%, p = 0.016). Most frequent organisms were coagulase negative Staph. (56.8%), Gram negative bacilli (20.8%), Staph aureus (12.5%) and fungus (12.5%). No difference in incidence were found according to the underlying disease or the length of PN use. CONCLUSIONS: Infection rate in our PN inpatient patients was significantly higher. PN may represent a risk factor for developing a CRI. Specific measurements and policies need to be implemented to overcome present situation.