Performance of serum procalcitonin as a biochemical predictor of death in hematology patients with febrile neutropenia.

INTRODUCTION: Historically, the measurement of serum procalcitonin (PCT) levels in patients with leukopenia has been rejected without sufficient prospective evidence to justify this argument. On the other hand, the accumulated use of broad spectrum antibiotics in these patients and their consequences make the use of PCT attractive in an effort to reduce its use. PATIENTS AND METHODS: We conducted a prospective study between 2016 and 2018, recruiting newly diagnosed FN patients, evaluating them with PCT levels during the first 24 h. After this we evaluate them with overall survival throughout the follow-up. RESULTS: A total of 81 episodes of FN in 72 patients were included. We report a mortality of 27.2% in our cohort. The mean serum PCT in these patients was 4.01 ng/mL compared to 0.42 ng/mL in the survivors group (p < 0.01). Using ROC curves, we determined a cut-off point to predict septic shock/death at 0.46 ng/mL. Patients with a procalcitonin >0.46 ng/mL had an increased risk of death, with a HR of 4.43, (p = 0.048). CONCLUSION: In conclusion, in our trial a single PCT on admission at a cut-off value of 0.46 ng/mL was able to predict the occurrence of septic shock and death in FN patients.

A tick beat in the electrocardiogram: Persistent third degree block as only manifestation of Lyme disease.

Lyme disease is the most common tick-borne illness in North America. A 23-year-old female presented to our emergency department with a chief complaint of sudden dyspnea and chest pain. An electrocardiogram revealed a third degree heart block. She was a resident of the Northeast region of Mexico and referred a recent travel to an endemic area for Borrelia burgdorferi in the center of Mexico in the past weeks. Lyme carditis was diagnosed after enzyme linked immunosorbent assay for IgM antibodies against B. burgdorferi was reported positive and corroborated by a confirmatory immunoblot analysis. Persistent AV block was the only manifestation in our patient, a presentation scarcely reported in literature.

Septic Pulmonary Emboli and Renal Abscess Caused by Staphylococcus aureus in an HIV-Infected Patient.

Staphylococcus aureus is a common cause of bacteremia in the general population and can lead to serious metastatic infection particularly in immunocompromised persons. However, prompt diagnosis and management can result in favorable outcomes. In the following case report, the clinical course of an HIV-infected man is presented; he developed bloodstream infection (BSI) and associated complications: septic pulmonary embolism, right renal abscess, and ipsilateral renal vein thrombosis. Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the cause of sepsis and successfully treated with surgery and antimicrobials. Intravenous vancomycin was the primary therapy, followed by oral linezolid after resolution of bacteremia.