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OBJECTIVE: To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology. MATERIAL AND METHODS: Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies. RESULTS: Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection. CONCLUSION: Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.
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Infecciones Urinarias , Urología , Anciano , Antibacterianos/uso terapéutico , Ecosistema , Urgencias Médicas , Humanos , Masculino , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
BACKGROUND: Urinary tract infections (UTIs) are common and diverse. Even when not severe, UTIs regularly lead to hospitalization, but their hospital burden remains unknown. This study aimed to estimate the national incidence of hospitalized UTIs in France. METHODS: A historic five-year cohort of adult patients hospitalized with UTIs in France was extracted from the medico-administrative databases using an ICD-10 code algorithm built by a multidisciplinary team. The performance parameters were estimated blindly, by reviewing 1122 cases, using medical reports as the gold standard, giving a global predictive positive value of 70.4% (95% confidence interval 66.6-74.1). The national incidence of UTIs was then estimated. RESULTS: A total of 2,083,973 patients with UTIs were hospitalized over the period, giving an adjusted incidence rate of â¼900 cases/100,000 inhabitants, stable over the period, higher in females and increasing with age; 1.2% were device-associated UTIs. Unspecific acute cystitis represented almost two-thirds of cases (63.5%); followed by pyelonephritis (23.6%) and prostatitis (12.4%). More than three-quarters of patients had at least one comorbid condition (76.8%). CONCLUSIONS: This national cohort study is the first to date to estimate the incidence of UTI-related hospitalizations in France. UTIs represent a substantial burden of care. Further analysis will provide data for more informed goal-of-care discussions targeting each type of UTI, their management and outcomes.
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Pielonefritis , Infecciones Urinarias , Adulto , Estudios de Cohortes , Atención a la Salud , Femenino , Hospitalización , Humanos , Lactante , Masculino , Infecciones Urinarias/epidemiologíaRESUMEN
Cefoxitin has demonstrated good in vitro activity against extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec) and is regarded as a carbapenem-sparing beta-lactam alternative in urinary tract infections. Its efficacy has never been compared to carbapenems in male UTIs. Our study aimed to compare the clinical and microbiological efficacy of cefoxitin (FOX) and carbapenems (CP) in febrile M-UTI due to ESBL-Ec (F-M-UTI). We conducted a multicenter retrospective cohort study of patients with F-M-UTI treated with FOX or CP as definitive therapy, between January 2013 and June 2015, in six French acute care teaching hospitals. The clinical and microbiological efficacies of FOX and CP were compared using multivariable logistic regression models, adjusting for propensity scores. Of the 66 patients included, 23 patients in FOX group and 27 in CP group had clinical assessment at follow-up. Median follow-up after end of treatment was 63 days (interquartile range 26-114). Clinical success was observed for 17/23 (73.9%) and 22/27 (81.5%) patients and microbiological success for 11/19 (57.9%) and for 6/12 (50.0%) patients in FOX and CP groups respectively. We did not find any significant difference for clinical (OR = 0.90, 95% CI [0.12; 6.70]) neither microbiological (OR = 0.85, 95% CI [0.05; 14.00]) success between CP and FOX groups in univariate and multivariable models. In the FOX group, high dose with use of continuous infusion was associated with clinical success. These results add evidence that FOX is an effective alternative treatment to carbapenems for M-UTI caused by ESBL-Ec, particularly when high doses and continuous infusion are used.
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Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Cefoxitina/uso terapéutico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Anciano , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Infecciones por Escherichia coli/microbiología , Fiebre/microbiología , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Estudios Retrospectivos , beta-LactamasasRESUMEN
Incidence of obesity is constantly rising all over the world; obesity has developed into an important problem of public health. Clinical experience, supported by many clinical trials, shows that obesity constitutes a risk factor for numerous cardiovascular, metabolic, cancer and even infectious diseases. In this revue we summarize the present knowledge on immunological properties and functions of adipose tissue and their modifications in obese subjects, with a bending to a potentially deleterious chronic inflammatory state. We will discuss the negative impact of this chronic inflammation on physiological acute inflammatory reaction during infectious episodes. However, the modifications of anti-infectious immune response in obese subjects are not well known at present and need further investigations.
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Infecciones/inmunología , Inflamación/inmunología , Obesidad/inmunología , Tejido Adiposo/inmunología , Tejido Adiposo/fisiopatología , Citocinas/metabolismo , Humanos , Sistema Inmunológico/fisiopatología , Obesidad/fisiopatologíaRESUMEN
The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.
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Antígenos Fúngicos/análisis , Aspergillus/inmunología , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Mananos/análisis , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Femenino , Galactosa/análogos & derivados , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Histoplasma/inmunología , Humanos , Inmunoensayo/métodos , Valor Predictivo de las PruebasAsunto(s)
Francisella tularensis/aislamiento & purificación , Ingle/patología , Tularemia/diagnóstico , Absceso/tratamiento farmacológico , Absceso/etiología , Absceso/cirugía , Adulto , Antiinfecciosos/uso terapéutico , Doxiciclina/uso terapéutico , Humanos , Masculino , Piel/patología , Resultado del Tratamiento , Tularemia/complicaciones , Tularemia/tratamiento farmacológicoRESUMEN
We report a 30-year-old woman who presented with a hypokaliemia-related subacute quadriparesis. The various causes of hypokalemia induced paresis were discussed but the association of hypokalemia with metabolic acidosis and normal anion gap was diagnostic of distal renal tubular acidosis. The renal tubulopathy was the presenting manifestation of a primary Sjogren's syndrome. Distal renal tubular acidosis concerns a third of the patients affected by this auto-immune disease.
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Hipopotasemia/complicaciones , Cuadriplejía/etiología , Síndrome de Sjögren/diagnóstico , Acidosis Tubular Renal/diagnóstico , Adulto , Femenino , HumanosRESUMEN
Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.
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Anemia de Células Falciformes/complicaciones , Bacteriemia/etiología , Infecciones por Bordetella/etiología , Adulto , Humanos , MasculinoRESUMEN
AIM OF THE STUDY: Diagnosing the presence of cytomegalovirus (CMV) in the blood of immunodepressed patients is often done by quantitative polymerase chain reaction (Q-PCR) even though the reference method remains the antigenemia pp65 (Ag-pp65) test. OBJECTIVES: To define the predictive value of the Q-PCR in the diagnosis of CMV disease and assess treatment efficacy using the CMV R-gene test. To compare the Q-PCR results and feasibility with those of the Ag-pp65 test. PATIENTS AND METHODS: The Q-PCR was performed in 34 whole blood samples (frozen at -80 degrees C until use) from five patients diagnosed with CMV disease, defined as the presence of clinical signs and Ag-pp65 in the nuclei of more than two cells. After extraction, viral DNA was quantified in each sample using the Q-PCR CMV R-gene kit according to the manufacturer's instructions. Immediately after blood was drawn, the Ag-pp65 test had been performed in 32 samples using CINAkit (Argene). RESULTS: The 16 samples positive by the Ag-pp65 test were also positive by PCR; six samples negative by the Ag-pp65 test were positive by PCR; and the remaining 10 samples were negative by both techniques. During treatment, the two markers' kinetics were similar. CONCLUSION: The CMV R-gene test has a predictive value as good as that of the Ag-pp65 test but is fast and easier to use. A prospective study with a greater number of patients is needed to define the prediction threshold for CMV disease.
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Sistemas de Computación , Infecciones por Citomegalovirus/virología , Citomegalovirus/aislamiento & purificación , ADN Viral/sangre , Reacción en Cadena de la Polimerasa/métodos , Juego de Reactivos para Diagnóstico , Carga Viral , Viremia/virología , Conservación de la Sangre , Criopreservación , Citomegalovirus/genética , Citomegalovirus/inmunología , Citomegalovirus/fisiología , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Diagnóstico Precoz , Infecciones por VIH/complicaciones , Humanos , Huésped Inmunocomprometido , Fosfoproteínas/sangre , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Proteínas de la Matriz Viral/sangre , Activación ViralRESUMEN
Kikuchi-Fujimoto disease is characterized by painful cervical lymphadenopathy and constitutional symptoms. Microscopical study of lymph nodes shows focal areas of non-suppurative necrosis with histiocytic and plasmacytoid cell infiltrates. The course is usually benign. Often primitive, necrotising histiocytic lymphadenopathy may be associated with autoimmune disorders. We describe the case of a 30-year-old female patient with two 15-day courses of Kikuchi-Fujimoto disease flares within a period of 3 months, occurring in association with mixed connective tissue disease.
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Linfadenitis Necrotizante Histiocítica/patología , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Enfermedad Mixta del Tejido Conjuntivo/patología , Adulto , Biopsia con Aguja , Estudios de Seguimiento , Linfadenitis Necrotizante Histiocítica/complicaciones , Linfadenitis Necrotizante Histiocítica/diagnóstico , Humanos , Inmunohistoquímica , Masculino , Enfermedad Mixta del Tejido Conjuntivo/diagnóstico , Remisión Espontánea , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Castleman's disease (CD) is a polyclonal lymphoplasmacytic and vascular proliferation prominent in lymphoid tissues, associated to Human Herpesvirus 8 (HHV-8) in Human Immunodeficiency Virus (HIV)-infected patients. The presence of autoimmune stigmates is frequent. EXEGESIS: We report two cases of neutropenia secondary to IgG neutrophil autoantibodies, indeterminate specificity, occurring in two HIV-infected patients with CD HHV-8+, treated by vinblastine since several years. The neutropenia was associated to other biologic stigmates of autoimmunity and the evolution has been complicated by several infections. Granulocyte-colony stimulating factor (G-CSF) and polyvalent immunoglobulin permitted a transient and low increase of neutrophila in one case. CONCLUSION: Auto-immune neutropenia in CD is rare and difficult to treat in our cases. This evolution is independent of relapse of CD. The immunoglobulin and G-CSF may be transitory effective.