Granulomatosis with polyangiitis according to geographic origin and ethnicity: clinical-biological presentation and outcome in a French population.

Objectives: Granulomatosis with polyangiitis (GPA) mainly affects white Europeans, but rarely GPA may also affect non-Europeans. This study aimed to describe GPA clinical-biological presentation and outcome in black sub-Saharan Africans and Afro-Caribbeans and in North Africans. Methods: Among 914 GPA patients included in the French Vasculitis Study Group database, geographic origin and ethnicity were known for 760. Clinical-biological presentations and outcomes of white Europeans vs black sub-Saharans and Afro-Caribbeans and vs North Africans were analysed. Results: Among the 760 patients, 689 (91%) were white Europeans, 33 (4.3%) were North Africans and 22 (2.9%) were sub-Saharans (n = 8) or Afro-Caribbeans (French West Indies, n = 14). Black sub-Saharans and Afro-Caribbeans, compared with white Europeans, were significantly younger at GPA diagnosis (P = 0.003), had more frequent central nervous system involvement (P = 0.02), subglottic stenosis (P = 0.002) and pachymeningitis (P = 0.009), and tended to have more frequent chondritis and retroorbital tumour. Median serum creatinine levels and Birmingham Vasculitis Activity Score were significantly lower in sub-Saharans and Afro-Caribbeans (P = 0.002 and P = 0.003, respectively). In contrast, in comparison with white Europeans, North Africans had only less frequent arthralgias (P = 0.004). Time to relapse was shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans [adjusted HR = 1.96 (95% CI: 1.09, 3.51) (P = 0.02)], and did not differ for North Africans. In contrast, overall survival was not significantly different according to ethnicity. Conclusion: Our findings indicated different GPA clinical presentations in white Europeans and sub-Saharans and Afro-Caribbeans, with black patients having more frequent severe granulomatous manifestations. In addition, time to relapse was significantly shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans.

[Trends on the epidemics of acute meningitis and encephalitis among population under 18 years-old in Shijiazhuang city, 2007-2017].

Objective: To understand the trends on the epidemics of acute meningitis and encephalitis (AME) among children under 18 years-old in Shijiazhuang city, 2007-2017. Methods: Surveillance programs on acute meningitis and encephalitis (AMES) had been conducted in population less than 18 years-old, since 2007. Hospitals at county level or above in Shijiazhuang had been included to carry out the epidemiologic surveillance, including 6 on pathogens, regarding AMES. Qualitative description was performed to describe the epidemiologic patterns and pathogenic spectrums. Annual percent change (APC) was used to demonstrate the secular trends of AME. Results: In 2007-2017, 11 222 locally developed AME cases that younger than 18 years-old, were reported in Shijiazhuang, with the annual average incidence rate as 108.62/100 000 (1 021/939 974) and APC as 4.81%(95%CI: 3.90%-5.93%)(t=23.01, P<0.001). Age-specific incidence appeared the highest among 4-5 years-old (242.96 cases per 100 000 children per year). Significant differences were found among children of other aged years except aged 0- years (aged 1- years t=20.21, P=0.004; aged 2- years t=19.41, P=0.006; aged 3- years t=23.50, P<0.001; aged 4- years t=31.76, P<0.001; aged 5- years t=18.53, P=0.008; aged 10-17 years t=12.82, P=0.023). The ratio of male to female was 1.46 ∶ 1 (6 652/4 570). The ratio of urban to rural cases was 0.28 ∶ 1 (2 456/8 766). A total of 57.73% (6 478/11 222) of the cases were seen between June and September. The overall positive rate of pathogens was 20.07% (658/3 123) among these patients. The top five pathogens appeared as Enterovirus (44.68%, 264/658), Cryptococcus neoformans (9.12%, 60/658), Japanese encephalitis virus (8.66%, 57/658), Streptococcus pneumoniae (6.99%, 47/658) and Varicella-zoster virus (6.69%, 44/658). Conclusions: AME seriously harms the health of population under 18 years-old in Shijiazhuang city, with aged 3- years, aged 4- years in particular. Continued improvement on surveillance and expanded immunization are important to AME prevention and control.

U.S. emergency department visits for meningitis, 1993-2008.

OBJECTIVES: Large-scale epidemiologic studies of meningitis in the emergency department (ED) setting are lacking. Using a nationwide sample, the authors determined the frequency of meningitis visits and characterize management. METHODS: Using National Hospital Ambulatory Medical Care Survey (NHAMCS) data, 1993 through 2008, meningitis diagnoses were studied and national rates were estimated via standard weighting procedures. RESULTS: Meningitis was diagnosed at 1,048,000 visits (95% confidence interval [CI] = 893,000 to 1,203,000) during 1993 through 2008. This is 66,000 cases annually, or 62 per 100,000 visits, with no change over time (p = 0.20). ED diagnoses were unspecified (60%), viral (31%), bacterial (8%), and fungal (1%) meningitis. Median age was 24 years (interquartile range = 9 to 40 years). While 1.97 times as many adults were diagnosed with meningitis (95% CI = 1.83 to 2.13), meningitis accounted for a similar proportion of visits among children and adults (ratio = 1.33, 95% CI = 0.58 to 2.63). Per population, children were more likely to have a meningitis visit (31 vs. 21 per 100,000; ratio = 1.48, 95% CI =1.003 to 2.10); children aged younger than 3 years had the highest rate (98 per 100,000, 95% CI =63 to 133). Spring and summer visits were 1.25 times as numerous as fall a nd winter (95% CI= 1.15 to 1.36). Third-generation cephalosporins were administered in 42%, analgesics in 19%, and antiemetics in 15% of cases, and 66% were admitted to the hospital (95% CI= 58% to 73%). CONCLUSIONS: Meningitis is rare, diagnosed at 62 per 100,000 ED visits. Rates have been stable over time. Children are 1.48 times more likely to have a visit for meningitis, although adults make twice as many visits. Absence of consensus guidelines for patients suspected of having viral meningitis but being tested for bacterial meningitis may lead to variability in admission and prescribing decisions.

Isolated leptomeningeal carcinomatosis (carcinomatous meningitis) after taxane-induced major remission in patients with advanced breast cancer.

OBJECTIVES: To identify the incidence of leptomeningeal carcinomatosis (LMC), as the first site of systemic progression, in breast cancer patients after having obtained a major response (CR or near CR) to first-line taxane-based chemotherapy and compare these findings in retrospect with a matched-pair group of historical control patients from our database treated with nontaxane regimens. PATIENTS AND METHODS: Patients with histologically proven breast cancer having either metastatic disease or high-risk locoregional disease that were entered into treatment protocols with first-line taxane (paclitaxel or docetaxel) plus anthracyclines or mitoxantrone combinations and developed LMC as the first evidence of progression after major response (CR or >80% PR) were analyzed in the present study (n = 155), and compared, as regards the incidence of LMC, to a matched-pair retrospective group of 155 patients treated with nontaxane regimens in our unit. RESULTS: Seven patients with a median age of 54 years (range 40-70) developed LMC as their first evidence of progression after taxane-based regimens with a median interval of 6 months (range 2-18) from start of treatment to diagnosis of LMC. Five patients received intrathecal (i.t.) methotrexate treatment and whole brain radiotherapy (RT), while 1 patient received i.t. methotrexate and RT to the lumbar spine. Two patients responded to treatment for LMC, while 2 achieved stable disease and 3 progressed. Two patients had elevated cerebrospinal fluid tumor markers (more than serum marker levels) that proved useful in monitoring response to treatment. Median survival after LMC was 3.6 months (range 1-17+) and correlated positively to the interval from the initiation of taxane-based therapy to LMC (r = 0.84, p = 0.019). Seven out of 86 responders (8.13%) in the taxane group versus 1 out of 72 responders (1.4%) in the non-taxane-treated group developed LMC as the first sign of progression after a major response to first-line chemotherapy (p < 0.1). CONCLUSIONS: LMC after a major response to front-line taxane-based regimens represents a grave disease manifestation and its incidence appears increased, but not significantly so, when compared retrospectively to non-taxane-treated patients. Prospective evaluation of the incidence of LMC after taxane versus non-taxane-based treatment from large randomized multi-institutional trials is warranted and identification of potential prognostic factors might help to identify patients requiring appropriate prophylactic therapy.