ABSTRACT
Panton-Valentine leucocidin is a major virulence factor produced by some strains of Staphylococcus aureus (SA-PVL). The best-described invasive infection is a necrotizing haemorrhagic pneumonia. Pleural effusion is not uncommon but is always associated with a parenchymal lesion. Here, we report a case of haemorrhagic pleurisy attributable to isolated SA-PVL.
Subject(s)
Bacterial Toxins/metabolism , Exotoxins/metabolism , Hemorrhage/diagnosis , Leukocidins/metabolism , Pleurisy/diagnosis , Respiratory Tract Infections/diagnosis , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Adult , Bacterial Toxins/toxicity , Diagnosis, Differential , Exotoxins/toxicity , Female , Hemorrhage/complications , Hemorrhage/microbiology , Humans , Leukocidins/toxicity , Pleurisy/complications , Pleurisy/microbiology , Pneumonia, Staphylococcal/diagnosis , Radiography, Thoracic , Respiratory Tract Infections/complications , Respiratory Tract Infections/microbiology , Staphylococcal Infections/complications , Staphylococcus aureus/metabolism , Young AdultABSTRACT
INTRODUCTION: Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS: A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS: Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION: Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
Subject(s)
Nocardia Infections , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Coinfection , Female , France/epidemiology , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Immunocompromised Host , Lung Diseases/complications , Lung Diseases/drug therapy , Lung Diseases/epidemiology , Male , Middle Aged , Nocardia/isolation & purification , Nocardia Infections/diagnosis , Nocardia Infections/drug therapy , Nocardia Infections/epidemiology , Nocardia Infections/microbiology , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: The Doege-Potter syndrome is a rare paraneoplastic syndrome, first described by Doege and Potter in 1930, that usually involves solid fibrous pleural tumours. Hypoglycaemia is a rare complication of these tumours, due to secretion of insulin-like growth factors, and it can be the presenting symptom. The incidence of malignancy is low, about 12-15 %. CASE REPORT: An 81-year-old Caucasian man, operated on 20 years previously for a benign pleural fibroma, presented with several episodes of loss of consciousness due to profound hypoglycaemia and a history of increasing dyspnea. The chest X-ray revealed an intrathoracic mass. Following excision histological examination confirmed recurrence with malignant transformation to a high-grade sarcoma. CONCLUSION: The Doege-Potter syndrome is a rare condition but it should be suspected in episodes of hypoglycaemia associated with a history of dyspnea. These patients should be followed up postoperatively because of the risk of tumour recurrence.