Utilidad clínica de la procalcitonina en gastroenteritis aguda / Use of procalcitonin as diagnostic marker in acute gastroenteritis

Introducción: No hay ningún marcador hematológico que diferencie con seguridad entre gastroenteritis aguda (GEA) bacteriana y no bacteriana. Nuestro objetivo fue evaluar la procalcitonina (PCT) como marcador de GEA de origen bacteriano y analizar su correlación con el ingreso hospitalario. Pacientes y Método: Estudio prospectivo de niños diagnosticados de GEA en el departamento de Urgencias durante un período de 7 meses que requirieron de analítica sanguínea y muestras de heces. Se analizaron variables epidemiológicas, clínicas y analíticas. Se excluyeron pacientes con enfermedad digestiva crónica, diarrea prolongada, inmunodeficiencia o tratamiento antibiótico previo. El estudio fue aprobado por el Comité de Ética y se solicitó consentimiento informado. Resultados: Se analizaron 45 pacientes. Los niños con GEA bacteriana tenían mayor edad (p = 0,027), mayor mediana de PCT y proteína C reactiva (PCR) (p = 0,001). Los valores de PCT y PCR que mejor discriminaron la etiología bacteriana fueron PCT > 0,5 mg/L (sensibilidad: 64,3 por ciento, especificidad: 83,9 por ciento, cociente de probabilidad positivo (CPP): 4) y PCR > 3 mg/dL (sensibilidad: 78,6 por ciento, especificidad: 90,3 por ciento, CPP: 8). No se encontró asociación entre la elevación de dichos marcadores y una mayor probabilidad de hospitalización. Conclusión: La procalcitonina, al igual que la PCR, se eleva en gastroenteritis bacterianas (p = 0,001), no siendo estos marcadores predictores de hospitalización.

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 percent specificity 83.9 percent, positive probability coefficient (PPC): 4), and CRP > 3mg/dL (sensibility 78.6 percent, specificity 90.3 percent, 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.

[Use of procalcitonin as diagnostic marker in acute gastroenteritis]. / Utilidad clínica de la procalcitonina en gastroenteritis aguda.

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.

[Blood-stream catheter related infection in inpatient children receiving parenteral nutrition]. / Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral.

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.

Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral / Blood-stream catheter related infection in inpatient children receiving parenteral nutrition

Las infecciones relacionadas con el catéter son la complicación más grave en los pacientes portadores de un catéter venoso central. Se considera que la nutrición parenteral (NP) constituye un factor de riesgo de desarrollar una infección relacionada con el catéter (IRCat). Material y métodos: para conocer la tasa de infección y poder establecer estrategias de prevención de la infección nosocomial, se revisaron todas las historias de los 120 pacientes que recibieron NP a lo largo de 2008. Todas las historias de los pacientes con un episodio fiebre y hemocultivo positivo fueron consideradas. La tasa de infección se definió como número de episodios por cada 1000 días de NP. Resultados: Se obtuvieron 48 hemocultivos positivos. La tasa global de bacteriemia asociada a catéter fue de 37,8/1000 días de NP. La incidencia fue significativamente mayor en lactantes menores de 2 años de edad. Los gérmenes que se encontraron con mayor frecuencia fueron Estafilococo coagulasa negativo (56,8%), seguidos de bacilos Gram (20,8%), Staph aureus (12,5%) y los hongos (12,5%). No encontramos diferencias en la tasa de infección cuando ajustamos por la enfermedad de base o la duración de la NP. Conclusiones: La tasa de infección en niños con NP en el hospital es considerablemente elevada. La NP parece constituir un factor de riesgo de desarrollar IRCat. Es necesario establecer políticas adecuadas y continuadas para conseguir disminuir la tasa de infección nosocomial (AU)

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 (AU)

Nephropathia epidemica and leptospirosis in Champagne-Ardenne, France: comparison of clinical, biological and epidemiological profiles.

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.

Risk factors for anaemia in human immunodeficiency virus/hepatitis C virus-coinfected patients treated with interferon plus ribavirin.

The most frequent and the most troublesome adverse effect of interferon plus ribavirin-based therapy is anaemia. The aim of this analysis was to determine the incidence and risk factors of anaemia (Hb < 10 g/dL) in human immunodeficiency virus/hepatitis C virus (HCV)-coinfected patients receiving anti-HCV therapy. We reviewed all cases of anaemia occurring among 416 patients participating in a randomized, controlled 48-week trial comparing peginterferon (peg-IFN) alpha 2b plus ribavirin with interferon alpha-2b plus ribavirin. Univariate and multivariate analyses were used to identify links with antiretroviral treatments, HCV therapy and clinical and laboratory findings. Sixty-one (15.9%) of the 383 patients who received at least one dose of anti-HCV treatment developed anaemia. In multivariate analysis the risk of anaemia was significantly associated with zidovudine (OR, 3.27 95% CI, 1.64-6.54, P = 0.0008) and peg-IFN (OR, 2.35; 95% CI, 1.16-4.57, P = 0.0179). The risk of anaemia was lower in patients with higher baseline haemoglobin levels (OR, 0.35 95% CI, 0.26-0.49, P < 0.0001) and in patients receiving protease inhibitor-based antiretroviral therapy (OR, 0.51 95% CI, 0.30-0.86, P = 0.0114). Zidovudine discontinuation could help to avoid anaemia associated with anti-HCV therapy.

[Kawasaki adult disease: case report]. / Maladie de Kawasaki de l'adulte: à propos d'un cas.

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.

[Hantavirus infections]. / Infections a hantavirus.

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.

Puumala hantavirus infection in humans and in the reservoir host, Ardennes region, France.

We compared the occurrence of nephropathia epidemica cases, over a multi-annual population cycle, in northeastern France with the hantavirus serology for bank voles captured in the same area. We discuss hypotheses to explain the pattern of infection in both humans and rodents and their synchrony.

[Respiratory manifestations of hemorrhagic fever with renal syndrome. Retrospective study of 129 cases in Champagne-Ardenne and Lorraine]. / Manifestations respiratoires de la fièvre hémorragique avec syndrome rénal. Etude rétrospective de 129 cas en Champagne-Ardenne et Lorraine.

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.

Relationships between work and HIV/AIDS status.

The aim of this study was to assess reasons contributing to a cessation of occupational activities in HIV-infected persons. One hundred patients were studied, 55 of whom were working at the time of the study while 45 were unemployed. Twenty of the patients had been diagnosed as having AIDS and the remaining patients were HIV-positive. The main causes of work cessation were psychological, not physical, symptoms. Disclosure of HIV status to work colleagues or employers does not seem to have an effect on employment.

[Research of Lyme's disease in facial paralysis. A French multicenter study]. / Recherche de maladie de Lyme dans les paralysies faciales. Une étude multicentrique Française.

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.

[Diagnosis and evaluation of mitral endocarditis complicating obstructive cardiomyopathy using cardiac echo-Doppler]. / Diagnostic et bilan d'une endocardite mitrale compliquant une cardiomyopathie obstructive par écho-Doppler cardiaque.

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.