[Automatic platelets numbering with citrate as anticoagulant: is the result valid?]. / Numération automatique des plaquettes sur citrate de sodium : le résultat est-il exact ?

Platelets count is usually realised on EDTA anticoagulant. This one is sometimes able to generate platelets agregats. That is the reason why the first thing to do encountering thrombopenia is to check for agregats on blood thin smear. In case of positive result, a control can be asked using another anticoagulant. The most used is sodium citrate. A correction has to be applied to the automat result because blood is diluted in anticoagulant. But no one says those haematological automats are exact on citrate as they are on EDTA. That's what we wanted to check.

[Apport de l'immunocapture-Elisa au diagnostic de l'infection à virus grippal A(H1N1)pdm09 : une alternative à la RT-PCR ?] / Apport de l'immunocapture-Elisa au diagnostic de l'infection à virus grippal A(H1N1)pdm09 : une alternative à la RT-PCR ?

AIM OF THE STUDY: To evaluate immunocapture-Elisa (ICE) sensitivity versus RT-PCR in diagnosis of influenza A(H1N1)pdm09 virus infection. METHODS: Sixty-seven RT-PCR-negative and 282 RT-PCR-positive nasopharyngeal swabs collected during winter 2009-2010 have been analyzed using ICE. RESULTS: Among all the samples tested, a sensitivity of 31.3% was found for ICE. The sensitivity of ICE was directly correlated to the virus load determined through the number of cycling reactions necessary to reach detection by RT-PCR. CONCLUSION: ICE can be a suitable method compared to RT-PCR when RT-PCR cannot be used for economical or epidemiological reasons. Its sensitivity is largely dependent of the nasopharyngeal sampling quality.

Splenic infarction during Plasmodium ovale acute malaria: first case reported.

The splenic complications of acute malaria include two different prognostic and treatment entities: splenic infarction and splenic rupture. This is the first case of splenic infarction during an acute malaria due to Plasmodium ovale in a 34-year-old man. As in the majority other described cases of splenic infarction, the course was spontaneously favourable, suggesting that this complication was relatively benign compared to splenic rupture, which is life-threatening and usually necessitating surgery.

Clinical evaluation of a new quantitative enzyme-linked immunosorbent assay for detection of double-stranded DNA autoantibodies.

The measurement of autoantibodies specific for double-stranded DNA (anti-dsDNA) is a useful tool for the diagnosis and the prognosis of systemic lupus erythematosus (SLE). A new quantitative enzyme-linked immunosorbent assay (ELISA), ORG anti-dsDNA, is recently available for the determination of anti-dsDNA antibodies. The aim of this study was to evaluate the clinical performance of this new assay in a cohort of SLE patients. Seventy-five sera from SLE patients were tested by two methods for anti-dsDNA determination, ORG anti-dsDNA, and EliA anti-dsDNA. Normal controls were 60 sera from healthy subjects. Moreover, 37 sera from patients with non-SLE connective tissue diseases were tested in parallel. The levels of complement components (C3, C4, CH50) were measured by nephelometry. From SLE patients, 91% were positive against 9% in non-SLE patients and 2% in healthy subjects. The sensitivity, specificity, and Youden test for SLE were 90%, 98%, and 88%, respectively. The Yule test (1%) indicated a close association with the disease. The comparison with EliA anti-dsDNA showed a moderate concordance between the two tests in the group of SLE (kappa = 0.51) and a good concordance in the non-SLE group (kappa = 0.89). A significant inverse correlation was found with complement components levels, biological markers associated with disease activity. Our results show this new assay as sensitive and specific for the diagnosis of SLE. Moreover, the correlation with markers associated with disease activity makes it promising for clinical use.

Ibuprofen can induce syndrome of inappropriate diuresis in healthy young patients.

A 30-year-old caucasian woman, without past medical history or known drug use, was admitted to the emergency department for persistent fever and arthralgias. The laboratory analysis showed moderate hypoosmolar hyponatremia (Na: 132 mmol/L, osmolality: 239 mOsm/L), normal sodium excretion (<20 mmol/L), and a high urinary osmolality (415 mOsm/L). Later, she deteriorated with seizures and deeper hyponatremia (Na: 113 mmol/L) and so was moved to the critical care unit. At first, no obvious aetiology was found, the patient was euvolemic, as she was well hydrated and lacked concerning findings of heart failure, renal disease, or liver cirrhosis. A syndrome of inappropriate diuresis (SIAD) was proposed, and corrective measures were started immediately to reduce her hyponatremia, including restriction of fluid intake. The administration of intravenous hypertonic saline solution permitted normal neurological status to be restored and corrected the sodium concentration but induced reversible acute renal failure. Further investigation revealed that the patient had ingested 8 g ibuprofen two days before admission. After other aetiologies were ruled out, drug-induced SIAD due to ibuprofen was the most likely diagnosis for this patient. SIAD-associated hyponatremia and acute renal failure are rare side effects of nonsteroidal anti-inflammatory drugs, particularly in young people. Therefore, this case may represent a unique case of NSAID-induced SIAD and highlight the need to obtain thorough medication histories and exclude all other potential causes in hyponatremic patients.

Three related cases of cutaneous anthrax in France: clinical and laboratory aspects.

Anthrax is an acute bacterial infection caused by Bacillus anthracis. The infection is cutaneous in about 95% of human cases and respiratory in about 5%. Approximately 2000 cases of cutaneous anthrax are reported annually worldwide. This disease became exceptional in Europe thanks to strict veterinarian monitoring. The last human cases of anthrax indicated in France were in 1997. We report 3 new related cases of naturally acquired cutaneous anthrax that occurred in France in 2008. The unique features of these cases include the atypical clinical presentation and the contribution of the rapid and specific diagnosis techniques by polymerase chain reaction.In cutaneous forms of anthrax, although the local course is not influenced by the treatment, antibiotic therapy is necessary to control any bacterial distribution. A case of exposure similar to that of a confirmed human case or an exposure identified by epidemiologic inquiry should usually result in chemoprophylaxis. Chemoprophylaxis for the close relations of a patient or for health workers is unnecessary since person-to-person transmission has not been reported.