Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19–11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age <65 years, but PCT lost its discrimination power for in-hospital mortality in patients with a bronchopulmonary infection site or a temperature ≥37.8°C and for ICU admission in patients with severe clinical presentations. PCT could be helpful in risk stratification, but several limitations must be considered, including being sometimes outperformed by a simple clinical examination.

Mesotelioma Intraparenquimatoso Difuso: Uma Apresentação Rara

Pleural mesothelioma is a disease associated with exposure to asbestos. Although rare, it is the most common malignant pleural neoplasm. It is difficult to diagnose and it has a poor prognosis. We report the case of a 62-year-old male patient with a history of prolonged occupational exposure to asbestos, with dyspnea for minor exertion and productive cough, for several months. Imaging studies revealed extensive interstitial involvement with marked thickening of the interlobular and centrilobular septa and tenuous pleural involvement. Several differential diagnoses were considered such as, asbestosis, cryptogenic organizing pneumonia, desquamative interstitial pneumonia, pleuropulmonary metastases, and/or bronchopulmonary infection, but the histological and immunohistochemical results were compatible with pleural mesothelioma - a rare malignant neoplasm, with pleural origin, with a high mortality rate.

Mycobacterium abscessus WhiB7 Regulates a Species-Specific Repertoire of Genes To Confer Extreme Antibiotic Resistance

ABSTRACT Mycobacterium abscessus causes acute and chronic bronchopulmonary infection in patients with chronic lung damage, of which cystic fibrosis (CF) patients are particularly vulnerable. The major threat posed by this organism is its high intrinsic antibiotic resistance. A typical treatment regimen involves a 6- to 12-month-long combination therapy of clarithromycin and amikacin, with cure rates below 50% and multiple side effects, especially due to amikacin. In the present work, we show that M. abscessus whiB7, a homologue of Mycobacterium tuberculosis and Mycobacterium smegmatis whiB7 with previously demonstrated effects on intrinsic antibiotic resistance, is strongly induced when exposed to clinically relevant antibiotics that target the ribosome: erythromycin, clarithromycin, amikacin, tetracycline, and spectinomycin. The deletion of M. abscessus whiB7 results in sensitivity to all of the above-mentioned antibiotics. Further, we have defined and compared the whiB7 regulon of M. abscessus with the closely related nontuberculous mycobacterium (NTM) M. smegmatis to demonstrate the induction of a species-specific repertoire of genes. Finally, we show that one such gene, eis2, is specifically induced in M. abscessus by whiB7 and contributes to its higher levels of intrinsic amikacin resistance. This species-specific pattern of gene induction might account for the differences in drug susceptibilities to other antibiotics and between different mycobacterial species.

Vojislav Arnovljevic described "Sézary syndrome" ten years before Sézary and Bouvrain

In 1938 Sezary and Bouvrain reported on a patient with a set of symptoms which later began to carry an eponymous designation ?Sezary syndrome.? Ten years previously, Vojislav Arnovljevic had described a patient with exactly the same set of symptoms, as well as physical, laboratory, autopsy, and histopathology findings. Unfortunately, his contribution remained unnoticed, not only by the international but Serbian audience as well. In 1928, in the Serbian Archives of Medicine, in Serbian, Vojislav Arnovljevic published an article titled ?The chronic lymphoid leukaemia with skin lymphomatosis,? in which he described a 43-year-old man with a two-year history of progressive development of a diffuse erythroderma with itching and hair loss over the entire torso, leukemia of 240,000/mm3, 91% of which lymphocytes and 5% eosinophils, who soon after admission developed a bronchopulmonary infection and died. The autopsy showed a pronounced lymphadenopathy in axillae, chest, and abdomen, enlarged liver and spleen with multiple infiltrates and thick skin. The histology confirmed a profound lymphocyte infiltration of axillar, mediastinal and abdominal lymph nodes, as well as liver, spleen and skin, while ?the reaction of the other parts of the lymph and blood systems was relatively weak.? There is more than enough clinical, laboratory, autopsy and histological evidence to support that the patient Arnovljevic described in 1928 had a syndrome that ten years later was described by Sezary and Bouvrain, which now bears the eponymous designation of Sezary syndrome.