For the first 3 months of COVID-19 pandemic, COVID-19 was expected to be an immunizing non-relapsing disease. We report a national case series of 11 virologically-confirmed COVID-19 patients having ...experienced a second clinically- and virologically-confirmed acute COVID-19 episode. According to the clinical history, we discuss either re-infection or reactivation hypothesis. Larger studies including further virological, immunological and epidemiologic data are needed to understand the mechanisms of these recurrences.
Background: Identification of underlying diseases is crucial for secondary hyperhidrosis management, but data are lacking to guide appropriate investigation.
Objective: To describe aetiologies of ...recurrent sweating in a hospital setting and the diagnostic performance parameters of their respective clinical/biological features.
Patients and Methods: We performed a monocentric evaluative study in a tertiary care centre. Patients with recurrent generalised sweating were selected via the Clinical Data Warehouse (CDW) by screening all electronic hospital documents from the year 2018 using a keyword-based algorithm. All in and out-patients aged ≥ 18 years having reported recurrent sweating for at least 2 weeks in 2018 were included, with a minimum one-year follow-up after symptoms' onset.
Results: A total of 420 patients were included. Over 130 different aetiologies were identified; 70 patients (16.7%) remained without diagnosis. Solid organ cancers (14.3% with 13 lung cancers), haematologic malignancies (14.0% with 35 non-Hodgkin's lymphomas) and Infectious Diseases (10.5% including 13 tuberculosis) were the most frequent diagnoses. Other aetiologies were gathered into inflammatory (16.9%) and non-inflammatory (27.6%) conditions. To distinguish non-inflammatory and undiagnosed hyperhidrosis from other causes, fever had a specificity of 94%, impaired general condition a sensitivity of 78%, and C-reactive protein (CRP) > 5.6 mg/l a positive predictive value of 0.86. Symptoms' duration over 1 year was in favour of non-infectious and non-malignant causes (94% specificity).
Conclusions: We identified fever, impaired general condition, duration, and CRP as helpful orientation parameters to assess the need for complementary explorations for hyperhidrosis. The study provides a diagnostic algorithm for the investigation of recurrent sweating.
KEY MESSAGES
In a hospital setting, malignancies and infections are the most frequently associated diseases, but 1/5 remain without diagnosis.
Fever is a specific but not sensitive sign to distinguish inflammatory conditions.
Over 1 year duration of symptoms significantly reduce the probability of malignancy or infection as the underlying diagnosis.
Ureaplasma parvum is usually part of the normal genital flora. Rarely can it cause invasive infections such as genitourinary infections, septic arthritis, or meningitis. Given the high prevalence of ...U. parvum colonisation, this diagnosis should remain a diagnosis of exclusion. However, because of the difficulty in detecting this microorganism, it should be considered in unexplained subacute urethritis or arthritis, including reactive arthritis, especially in immunosuppressed patients. Real-time PCR positivity in the absence of a differential diagnosis should not be overlooked.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The incidence of pyogenic vertebral osteomyelitis (PVO) has increased over the past two decades. One possible cause of this increase is the aging of the population, which results in more ...comorbidities in high income countries.
To better characterize the clinical presentation and outcome of PVO in the elderly.
We conducted a post-hoc analysis of a previously published trial that studied treatment duration in PVO and compared the presentation and outcomes according to age.
Our analysis included 351 patients among whom 85 (24%) were 75-years-old or more.
There were no significant differences in the socio-demographics of the patients. Neoplasia and chronic inflammatory diseases were more common in the older group: 34% vs. 19% (p = 0.021) and 9% versus 1% (p = 0.004), respectively. There were no significant differences in clinical and radiological presentations between the groups in terms of back pain (337/351, 97%), fever (182/351, 52%), PVO localization, neurological signs and epidural abscess. Associated infective endocarditis (IE) was more frequent in the older group (37% vs. 14%, p<0.001). Streptococci were more frequently involved in infections of older patients (29% vs. 14%, p = 0.003) in contrast to Staphylococcus aureus (31% vs. 45%, p = 0.03). Older patients displayed higher mortality rates at 1 year (21% vs. 3%, p<0.001) and more adverse events related to cardiorespiratory failure (10.6% vs. 3.8%, p = 0.025), but had similar quality of life among the survivors.
During PVO, the clinical and radiological findings are similar in older patients. Global mortality rates are higher in older patients compared to younger patients, which could be explained by the increased frequency of neoplasia at diagnosis and higher prevalence of associated IE in the elderly.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Microsporidiosis is a fungal infection that generally causes digestive disorders, especially in immunocompromised hosts. Over a 4-day period in January 2018, 3 patients with hematologic malignancies ...who were admitted to the hematology unit of a hospital in France received diagnoses of Enterocytozoon bieneusi microsporidiosis. This unusually high incidence was investigated by sequence analysis at the internal transcribed spacer rDNA locus and then by 3 microsatellites and 1 minisatellite for multilocus genotyping. The 3 isolates had many sequence similarities and belonged to a new genotype closely related to genotype C. In addition, multilocus genotyping showed high genetic distances with all the other strains collected from epidemiologically unrelated persons; none of these strains belonged to the new genotype. These data confirm the epidemiologic link among the 3 patients and support a common source of infection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Tularemia, caused by the bacterium
is an infrequent zoonotic infection, well known in immunocompetent (but poorly described in immunocompromised) patients. Although there is no clear literature data ...about the specific characteristics of this disease in immunocompromised patients, clinical reports seem to describe a different presentation of tularemia in these patients. Moreover, atypical clinical presentations added to the fastidiousness of pathogen identification seem to be responsible for a delayed diagnosis, leading to a" loss of chance" for immunocompromised patients. In this article, we first provide an overview of the host immune responses to
infections and discuss how immunosuppressive therapies or diseases can lead to a higher susceptibility to tularemia. Then, we describe the particular clinical patterns of tularemia in immunocompromised patients from the literature. We also provide hints of an alternative diagnostic strategy regarding these patients. In conclusion, tularemia should be considered in immunocompromised patients presenting pulmonary symptoms or unexplained fever. Molecular techniques on pathological tissues might improve diagnosis with faster results.
Our case reports a 52-year-old woman who presented with Purpureocillium lilacinum skin infection after a renal transplantation. The diagnosis was difficult and this species exhibits many resistances ...to antifungal agents. The clinical history was marked by a relapse caused by foreign body. Our case suggests that posaconazole may be an alternative to cure P. lilacinum infection, and that the surgical debridement, the identification and removal of a foreign body may improve the prognosis.
•Acute kidney injury (AKI) occurred in 52.7% of patients with infective endocarditis.•Staphylococcus aureus was the most common species and was associated with AKI.•An infectious disease consultation ...appeared to be a protective factor for AKI.•Exploration of AKI needs to be systematic to conclude on its aetiologies.•Among the 69% patients who survived at one year, 32% had chronic kidney disease.
The incidence of acute kidney injury (AKI) in infective endocarditis (IE), its risk factors and consequences on patient and renal survival remain debated.
Patients hospitalized for a first episode of IE (possible or definite according to modified Duke criteria) between 2013 and 2016 were included. The primary endpoint was to determine risk factors for early AKI (E-AKI) during the first week of management of IE.
A total of 276 patients were included: 220 (79.7%) had definite IE and 56 (20.3%) had possible IE. E-AKI occurred in 150 patients (53%). IE due to Staphylococcus aureus (OR 3.41; 95% CI 1.83–6.39; p<0.01), history of diabetes (OR 2.34; 95% CI 1.25–4.37; p<0.01), peripheral arterial disease (OR 2.59; 95% CI 1.07–6.23; p<0.05), immunological manifestations (OR 3.11; 95% CI 1.31–7.39; p=0.01), and use of norepinephrine (OR 3.44; 95% CI 1.72–7.02; p<0.01) were associated with E-AKI. In subgroup analysis, infectious disease consultation was associated with a lower risk of AKI at day 7 (OR 0.41; 95% CI 0.16–0.88; p=0.04). E-AKI was associated with 1-year mortality (OR 1.65; 95% CI 1.03–2.64; p=0.04) and chronic kidney disease progression (OR 2.23; 95% CI 1.30–3.82; p<0.01).
E-AKI is common in IE and often associated with non-modifiable variables. Multidisciplinary management should be mandatory, and awareness of AKI diagnosis and etiological explorations should be raised.
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