Salvage Treatment of Refractory HSV Oral Lesions with Pritelivir in Allogeneic Hematopoietic Cell Transplant Recipients.

We present two allogeneic hematopoietic cell transplantation recipients (HCTr) treated with pritelivir for acyclovir-resistant/refractory (r/r) HSV infection based on the expanded access program of the pritelivir manufacturer. Outpatient treatment with pritelivir was administered, with partial response by week 1 of treatment and complete response by week 4 of treatment in both patients. No adverse events were noted. Pritelivir appears to be an effective and safe option for the management of acyclovir-r/r HSV infections in highly immunocompromised patients in an outpatient setting.

[Lactate and acute mesenteric ischemia: diagnostic value]. / Lactate et ischémie mésentérique aiguë†: utilité diagnostique.

Acute mesenteric ischemia is a rare diagnosis with a very high mortality rate. It is often suspected in case of severe abdominal pain, disproportional to the findings of physical examination. The definite diagnosis is confirmed by CT-angiography and surgical exploration, but the measurement of blood L-lactate often takes place during the diagnostic work-up when this pathology is suspected. This review shows that there is no biological marker with sufficient sensitivity and specificity to confirm or rule out acute mesenteric ischemia. L-lactate measurement is easy to perform, but its diagnostic performance is insufficient to avoid a CT-angiography, whatever the pre-test clinical probability of acute mesenteric ischemia. These conclusions are supported by the current recommendations of the World Society of Emergency Surgery.

L'ischémie mésentérique aiguë est un diagnostic rare au taux de mortalité très élevé. Elle est souvent suspectée en cas de douleurs abdominales sévères et disproportionnelles aux résultats de l'examen physique. Le diagnostic définitif s'obtient par angio-CT et exploration chirurgicale, mais le dosage du L-lactate intervient fréquemment lors de la stratégie diagnostique au moment de la suspicion clinique. Cet article met en évidence qu'il n'existe pas de marqueur biologique unique suffisamment sensible et spécifique pour confirmer ou exclure une ischémie mésentérique aiguë. Le dosage du L-lactate est rapide, mais sa performance diagnostique ne permet pas de surseoir à l'angio-CT, et ce quelle que soit la probabilité clinique prétest d'ischémie mésentérique. Ces conclusions sont soutenues par les recommandations des sociétés de chirurgie.

Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment.

BACKGROUND: Influenza infections have been associated with high morbidity. The aims were to determine predictors of mortality among patients with influenza infections and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS: All adult patients with influenza infection at the Hospital of Jura, Switzerland during four influenza seasons (2014/15 to 2017/18) were included. Cepheid Xpert Xpress Flu/RSV was used during the first three influenza seasons and Cobas Influenza A/B and RSV during the 2017/18 season. RESULTS: Among 1684 influenza virus tests performed, 441 patients with influenza infections were included (238 for influenza A virus and 203 for B). The majority of infections were community onset (369; 83.7%). Thirty-day mortality was 6.0% (25 patients). Multivariate analysis revealed that infection due to A virus (P 0.035; OR 7.1; 95% CI 1.1-43.8), malnutrition (P < 0.001; OR 25.0; 95% CI 4.5-138.8), hospital-acquired infection (P 0.003; OR 12.2; 95% CI 2.3-65.1), respiratory insufficiency (PaO2/FiO2 < 300) (P < 0.001; OR 125.8; 95% CI 9.6-1648.7) and pulmonary infiltrate on X-ray (P 0.020; OR 6.0; 95% CI 1.3-27.0) were identified as predictors of mortality. qSOFA showed a very good accuracy (0.89) equivalent to other more specific and burdensome scores such as CURB-65 and Pneumonia Severity Index (PSI). CONCLUSION: qSOFA performed similarly to specific severity scores (PSI, CURB-65) in predicting mortality. Infection by influenza A virus, respiratory insufficiency and malnutrition were associated with worse prognosis.