[Discussion on classification and diagnostic nomenclature of burn infection].

Infection is the most common complication after burn injury and one of the leading causes of death in burn patients. Thus, how to effectively prevent the occurrence and development of infection is an important task in treating burns. Till now, there are still many controversies in the clinical definition, diagnosis, and treatment of infection, especially burn infection. The authors of this article put forward their opinions and views on this subject, hoping to deepen the readers' understanding of burn infection.

Protothecosis in four dogs in New Zealand.

CASE HISTORIES: Medical records of four dogs diagnosed with protothecosis in New Zealand were reviewed. The dogs were aged between 4 and 9 years and three of the four dogs were female. Breeds were one Labrador, one Miniature Schnauzer and two crossbreeds. The reasons for initial veterinary evaluation were a cough and opaque appearance of the right eye (Case 1), diarrhoea (Cases 2 and 3), and cutaneous disease (Case 4). CLINICAL FINDINGS: The ocular signs were characterised by panuveitis, retinal detachment and secondary glaucoma. Gastrointestinal signs included chronic haemorrhagic diarrhoea due to colitis. Three cases had disseminated infection and developed both bilateral, blinding, ocular disease and chronic gastrointestinal disease. Cutaneous signs consisted of draining fistulae over the olecranon, multifocal cutaneous nodules, and ulceration and tracts of the foot pads. Disseminated protothecosis was confirmed by histopathology of biopsied ocular tissues in Cases 1 and 2 and by gastrointestinal biopsies in Case 3. Prototheca spp. were also identified in cytological specimens from Cases 1 and 4 and recovered by culture in Cases 2 and 4. Cutaneous protothecosis was diagnosed in Case 4 initially by cytology and histopathology of skin lesions, and Prototheca zopfii was confirmed by PCR of cultured organisms. TREATMENT AND OUTCOME: Prior to diagnosis of protothecosis, a variety of treatments were prescribed to treat the gastrointestinal and ocular signs. After diagnosis, only Cases 2 and 4 received medication aimed at treating the protothecal infection, which was itraconazole in both cases. Following the progression of clinical signs and concerns about quality of life, all four dogs were euthanised. DIAGNOSIS: Disseminated protothecosis in three dogs, cutaneous protothecosis in one dog. CLINICAL RELEVANCE: Canine protothecosis is rarely reported, despite the ubiquity of the causal algae, and the disease usually carries an extremely grave prognosis when infection is generalised. In New Zealand, protothecosis should be considered as a differential diagnosis in dogs with panuveitis, chorioretinitis or retinal detachment, colitis, or nodular, ulcerative or fistulating cutaneous lesions.

Current Concepts of Fracture-Related Infection.

Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.

Disseminated Protothecosis Due to Prototheca zopfii and Literature Review.

ABSTRACT: Prototheca species are achlorophyllic algae that are a rare cause of infection in humans. It most commonly causes localized cutaneous disease and rarely disseminated infection. Immunocompromised patients have the highest risk of disseminated protothecosis, with a higher mortality rate than localized cutaneous infections. At the species level, infections caused by Prototheca zopfii are reported less frequently than those caused by Prototheca wickerhamii. The diagnosis can be made using histopathology, culture, and molecular testing. There is no definitive evidence for an effective treatment, which currently consists of antifungals (primarily amphotericin B). With only a handful of cases of disseminated protothecosis reported worldwide that are caused by P. zopfii , we herein present an additional case of a postbone marrow transplant patient in the Midwest of the United States.

Serum procalcitonin improves diagnosis of infectious complications after CRS/HIPEC.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of selected patients with peritoneal metastasis. A major cause of treatment-related morbidity after CRS/HIPEC is infection and sepsis. HIPEC alters the diagnostic sensitivity and specificity of blood and serum markers and therefore has an impact on early diagnosis of postoperative complications. This study aimed to assess the sensitivity and specificity of blood and serum markers after CRS/HIPEC. METHODS: Patients from two centers, operated between 2009 and 2017, were enrolled in this study. Perioperative blood samples were analyzed for white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT); postoperative complications were graded according to Clavien-Dindo and infectious complications according to CDC criteria. RESULTS: Overall, n=248 patients were included with peritoneal metastasis from different primary tumors treated by CRS/HIPEC. Depending on the applied HIPEC protocol, patients presented a suppressed WBC response to infection. In addition, a secondary and unspecific CRP elevation in absence of an underlining infection, and pronounced after prolonged perfusion for more than 60 min. PCT was identified as a highly specific - although less sensitive - marker to diagnose infectious complications after CRS/HIPEC. DISCUSSION/CONCLUSION: Sensitivity and specificity of WBC counts and CRP values to diagnose postoperative infection are limited in the context of HIPEC. PCT is helpful to specify suspected infection. Overall, diagnosis of postoperative complications remains a clinical diagnosis, requiring surgical expertise and experience.

D-dimer may aid in the diagnosis of pediatric musculoskeletal infections: a prospective study.

Musculoskeletal infections, including septic arthritis, osteomyelitis, and soft tissue infections, are critical morbidity factors for children and adolescents. This study investigated the role of D-dimer levels for diagnosing childhood musculoskeletal infections. This single-center prospective study was initiated in April 2020 following approval from the local ethics committee. The study included 54 children, divided into the infection group ( n = 21), comprising patients who underwent surgical treatment for childhood musculoskeletal infections and had macroscopically visible purulent discharge during surgery, and the control group ( n = 33), comprising healthy children. In the infection group, the mean values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasma D-dimer, and white blood cell (WBC) were 39.42 ± 27.00 mm/h, 101.50 ± 76.90 mg/l, 2.34 ± 2.59 mg/l, and 15.55 ± 6.86 × 10 9 /l, respectively. On comparison, the infection group showed higher levels of WBC, CRP, ESR, D-dimer, and neutrophil-to-lymphocyte ratio than the control group. When the D-dimer cutoff value of 0.43 mg/l was taken, it was observed that it had 95.2% sensitivity and 81.8% specificity. The area under curve (AUC) of the above-mentioned parameters calculated via receiver operating characteristic curves showed CRP levels as the optimum predictor of childhood musculoskeletal infections, followed by the ESR, plasma D-dimer, and WBC levels in descending order (AUC: 0.999, 0.997, 0.986, and 0.935, respectively). D-dimer is another test, which in combination with other conventional established tests (CRP and ESR) can be helpful in diagnosis of pediatric infection. We recommend the addition of D-Dimer to ESR, CRP, and WBC as a first-line investigation in cases with suspected pediatric musculoskeletal infections.

Sífilis mimetizando lúpus eritematoso sistêmico: um relato de caso / Syphilis mimicking systemic lupus erythematosus: a case report / Sífilis que simula lupus eritematoso sistémico: informe de un caso

O Lúpus Eritematoso Sistêmico (LES) é uma patologia crônica, de origem autoimune e inflamatória. As diversas manifestações clínicas existentes em pacientes acometidos pelo LES, sejam elas sistêmicas ou órgãos-alvo, possibilitam variados diagnósticos diferenciais. Dentre as manifestações clínicas que possibilitam estes diagnósticos está o acometimento cutâneo, com vasta variabilidade de apresentação. Da mesma forma, a sífilis também possui apresentação cutânea, tornando possível o diferencial de diagnóstico com outras patologias, inclusive o próprio LES. O presente estudo tem como objetivo relatar um caso de sífilis mimetizando lúpus eritematoso sistêmico, descrever o quadro clínico apresentado pelo paciente, bem como as ferramentas utilizadas para diagnóstico, e a posterior abordagem terapêutica. O caso relatado refere-se a um paciente de 29 anos, do sexo masculino, procedente de Campos Novos (SC), que apresentou um quadro clínico e laboratorial de lúpus-like induzido por uma infecção aguda de sífilis. A resolução completa de critérios inflamatórios de LES ocorreu após tratamento correto da doença infecciosa, com total melhora clínica e sorológica.

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease. The various clinical manifestations in SLE patients, both systemic and in target organs, allow for various differential diagnoses. Among the clinical manifestations that aid in diagnosis are the cutaneous injuries, which have a wide range of presentations. Syphilis also has cutaneous manifestations, which aid in the differential diagnosis from other pathologies, including SLE. The present study aims to report a case of syphilis mimicking SLE, describe the clinical condition presented by the patient, the tools used for diagnosis, and the therapeutic approach. The case reported refers to a 29- year-old male patient from Campos Novos (SC), who showed a clinical and laboratory lupus-like condition induced by an acute syphilis infection. The full resolution of SLE inflammatory criteria occurred following appropriate treatment for the infectious disease, with complete clinical and serological improvement.

El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria autoinmune crónica. Las diversas manifestaciones clínicas de los pacientes con LES, tanto sistémicas como en órganos diana, permiten realizar varios diagnósticos diferenciales. Entre las manifestaciones clínicas que ayudan al diagnóstico se encuentran las lesiones cutáneas, que tienen una amplia gama de presentaciones. La sífilis también tiene manifestaciones cutáneas, que ayudan al diagnóstico diferencial con otras patologías, incluido el LES. El presente estudio tiene como objetivo comunicar un caso de sífilis que simula un LES, describir el cuadro clínico presentado por la paciente, las herramientas utilizadas para el diagnóstico y el abordaje terapéutico. El caso relatado se refiere a un paciente masculino de 29 años, natural de Campos Novos (SC), que presentó un cuadro clínico y de laboratorio semejante al lupus, inducido por una infección aguda por sífilis. La resolución completa de los criterios inflamatorios del LES ocurrió tras el tratamiento adecuado de la enfermedad infecciosa, con mejoría clínica y serológica completa.

Point-of-care C-reactive protein test results in acute infections in children in primary care: an observational study.

BACKGROUND: Acute infections are a common reason for children to consult primary care. Serious infections are rare but differentiating them from self-limiting illnesses remains challenging. This can lead to inappropriate antibiotic prescribing. Point-of-care C-reactive protein testing is used to guide antibiotic prescribing in adults. However, in children its use remains unclear. The purpose of this study was to assess point-of-care CRP test levels with respect to patients' characteristics, care setting, preliminary diagnosis, and management. METHODS: A prospective observational study was performed in children with an acute infection presenting to ambulatory care in Belgium. RESULTS: In this study 8280 cases were analysed, of which 6552 had a point-of-care CRP value available. A total of 276 physicians participated. The median patient age was 1.98 years (IQR 0.97 to 4.17), 37% of children presented to a general practitioner, 33% to a paediatric out-patient clinic, and 30% to the emergency department. A total of 131 different preliminary diagnoses were found, with acute upper airway infection as the most frequent. In 6% (n = 513) patients were diagnosed with a serious infection. The most common serious infection was pneumonia. Antibiotics were prescribed in 28% (n = 2030) of all episodes. The median CRP over all infectious episodes was 10 mg/L (IQR < 5-29). Children below 5 years of age and those presenting to a paediatrician had a higher median CRP. Median CRP in patients with serious infections was 21 mg/L (IQR 6 to 63.5). Pneumonia had a median CRP of 48 mg/L (IQR 13-113). In the episodes with antibiotics prescription, median CRP level was 29 mg/L (IQR 10-58) compared to 7 mg/L (IQR < 5-19) when they were not prescribed. CONCLUSION: A low POC CRP as a standalone tool did not seem to be sufficient to rule out serious infections, but its potential in assessing serious infections could increase when integrated in a clinical decision rule. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02024282 (registered on 31/12/2013).

Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space.

This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = -0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.

Nuevos modelos predictivos de bacteriemia en el servicio de urgencias: un paso adelante / New predictive models of bacteremia in the emergency department: a step forward

La atención de pacientes con sospecha de un proceso infeccioso en los servicios de urgencias hospitalarios(SUH) se haincrementado en la última década hasta suponer alrededor del15-20% de todas las atenciones diarias. En la valoración inicialde estos enfermos se toman muestras para los distintos estudios microbiológicos en un 45% de los casos, donde predomina la obtención de hemocultivos (HC), en el 14,6% de todosellos. La rentabilidad diagnóstica de estos HC es muy variable(2-20%). Los focos o procesos infecciosos más frecuentes sospechados o confirmados de las bacteriemias verdaderas(BV) enlos SUH son la infección del tracto urinario (45%) y la infecciónrespiratoria (25%). Por todo ello, la sospecha y confirmaciónde la BV tiene un relevante significado diagnóstico, pronósticoy obliga a cambiar algunas de las decisiones más importantesa tomar en el SUH. Entre otras, indicar el alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz.La intención de esta revisión es poner de manifiesto las evidencias científicas publicadas en los últimos cinco años, aclararlas controversias existentes actuales y comparar la capacidadpara predecir bacteriemia de los últimos modelos predictivospublicados desde el año 2017 con los ya existentes en esa fecha, año en el que se publicó una revisión que dejaba abierta lapropuesta de seguir buscando un modelo con un rendimientoadecuado para los SUH. Y así, a partir de ella, generar distintasrecomendaciones que ayuden a definir el papel que pueden tener estos modelos o escalas en la mejora de la indicación deobtención de los HC, así como en la toma inmediata de otrasdecisiones diagnóstico-terapéuticas (administración precozy adecuada del tratamiento antibiótico, solicitud de estudios complementarios y otras muestras microbiológicas, intensidaddel soporte hemodinámico, necesidad de ingreso, etc.) (AU)

The care of patients with a suspected infectious processin hospital emergency department (ED) has increased in thelast decade to account for around 15-20% of all daily care.In the initial evaluation of these patients, samples are takenfor the different microbiological studies in 45% of the cases,where obtaining blood cultures (BC) predominates, in 14.6%of all of them. The diagnostic yield of these BC is highly variable (2-20%). The most frequent suspected or confirmed focior infectious processes of true bacteremia (TB) in the ED areurinary tract infection (45%) and respiratory infection (25%).For all these reasons, the suspicion and confirmation of TB hasa relevant diagnostic and prognostic significance and requireschanging some of the most important decisions to be made inthe ED. Among others, indicate discharge or admission, extractBC and administer the appropriate and early antimicrobial. Theintention of this review is to highlight the scientific evidencepublished in the last five years, clarify the current controversies and compare the ability to predict bacteremia of the latest predictive models published since 2017 with those alreadyexisting on that date, year in which a review was publishedthat left open the proposal to continue searching for a modelwith adequate performance for ED. And so, based on it, generate different recommendations that help define the role thatthese models or scales can have in improving the indicationfor obtaining BC, as well as in the immediate making of otherdiagnostic-therapeutic decisions (administration early andappropriate antibiotic treatment, request for complementary studies and other microbiological samples, intensity of hemodynamic support, need for admission, etc.) (AU)

Detection of SARS-CoV-2 in semen samples: a scoping review / Detecção de SARS-CoV-2 em amostras de sêmen: revisão de escopo

Background: many doubts about the infection of SARS-CoV-2 were raised, such as sexual transmission, sterility, and changes in fertility procedures; however, information is not clearly stated and organized. Purpose: to review and summarize scientific evidence on detection of SARS-CoV-2 in semen samples of Covid-19 patients. Methods:literature search in PubMed, Web of Science, Scopus, Medline and Embase databases, and followed Scoping Review protocol defined by Joanna Briggs Institute (JBI) after the guiding question "Is it possible to detect SARS-CoV-2 in the semen of adult patients with a confirmed diagnosis of Covid-19?" Results: 287 studies were identified, and, after discerning analysis, 9 studies published in the English language were selected. Three researchers analyzed the studies for SARS-CoV-2 presence in the seminal fluid, patients' severity, days since the onset of disease, diagnosis confirmation, semen collection method, viral analysis method, and sample numbers. Conclusions: it was not possible to find strong evidence to confirm the presence or absence of Covid-19 in the semen of adult patients. New studies on the subject should be better designed, taking into account the possible anatomical and functional conditions and changes of the male reproductive system during and after the infection by SARS-CoV-2 (AU)

Objetivo: Revisar e resumir as evidências científicas em pesquisas realizadas para detectar a presença de SARS-CoV-2 em amostras de sêmen de pacientes com COVID-19. Métodos: A pesquisa de literatura foi conduzida nas bases de dados PubMed, Web of Science, Scopus, Medline e Embase. Seguiu o protocolo de revisão de escopo definido por Joanna Briggs Institute (JBI) e baseou-se na pergunta norteadora "É possível detectar SARS-CoV-2 no sêmen de pacientes adultos com diagnóstico confirmado de Covid-19?". Resultados: 287 estudos foram identificados, 9 estudos publicados em língua inglesa foram selecionados após análise minuciosa. Três pesquisadores analisaram os estudos em busca de presença de SARS-CoV-2 no fluído seminal, gravidade do paciente, dias desde o início da doença, confirmação diagnóstica, método de coleta de sêmen, método de análise viral e número de amostras. Conclusões: Não foi possível identificar fortes evidências para confirmar a presença ou ausência de COVID-19 no sêmen de pacientes adultos. Novos estudos sobre o tema devem ser melhor projetados, levando-se em conta as possíveis condições anatômicas e funcionais e mudanças no sistema reprodutor masculino durante e após a infecção por SARS-CoV-2 (AU)