Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
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Comparative Study
Procalcitonin, C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis.
The aim of this study was to evaluate procalcitonin (PCT), C-reactive protein (CRP), platelet count (PLT) and serum lactate dehydrogenase (LDH) as early markers for diagnosis of SIRS, bacterial sepsis and systemic candidiasis in intensive care unit (ICU) patients. Based on blood culture results, the patients were divided into a sepsis group (70 patients), a SIRS group (42 patients) and a systemic candidiasis group (33 patients). PCT, CRP, LDH and PLT levels were measured on day 0 and on day 2 from the sepsis symptom onset. ⋯ However, PCT was unable to discriminate between SIRS and systemic candidiasis groups (P=0.093 N. S.). In conclusion, PCT can be used as a preliminary marker in the event of clinical suspicion of systemic candidiasis; however, low PCT levels (<0.99 ng/mL) necessarily require the use of other specific markers of candidaemia to confirm the diagnosis, due to great uniformity of PCT levels in systemic candidiasis and SIRS groups.
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Multidrug-resistant gram-negative bacteria are an important issue in intensive care units worldwide. Colistin, one of the earliest polymyxin antibiotics, was once widely used for the treatment of gram-negative bacterial infections. However, its use is now limited due to concerns over nephrotoxicity. ⋯ The MICs of colistin against A. baumannii were 0.125-2.0 mcg/mL, and 0.25-2.0 mcg/mL against P. aeruginosa; all multidrug-resistant strains examined in this study were susceptible to colistin. Recently, colistin has re-emerged as an effective treatment for infections due to multidrug-resistant A. baumannii, P. aeruginosa, and Klebsiella pneumoniae. All isolates examined in this study were susceptible to colistin, suggesting it could be a viable alternative for the treatment of infections with multidrug-resistant strains.
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Pneumonia severity assessment systems, such as the pneumonia severity index (PSI) and CURB-65, were designed to guide physicians to admit the patients involved to appropriate wards of hospitals. This study evaluated concordance rate of decisions leading to patients' hospitalization in accordance with PSI and CURB-65 criteria and comparison of the two systems' P-values in evaluating mortality and the hospitalization period of the patients in question. A total of 134 hospitalized patients with community-acquired pneumonia (CAP) were evaluated. ⋯ However, there was no significant difference in the mortality between the two groups with and without admission indication according to the CURB-65 system. A considerable portion of our hospitalizations met the related criteria of the PSI/CURB-65. The two evaluation systems have near equal sensitivity and specificity for predicting mortality among hospitalized patients with CAP when the PSI class IV-V and CURB-65 score ≥ 2.
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Letter Case Reports
Long-term treatment of hepatocellular carcinoma with sorafenib.
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Tuberculosis is still one of the most prevalent and fatal infectious diseases in spite of considerable improvements in medical science. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. There are limited numbers of cases in which immune thrombocytopenia is associated with splenic tuberculosis. ⋯ The patient was successfully treated with apheresis platelets suspension, intravenous immunoglobulin and antituberculous therapy. In conclusion, splenic tuberculosis should be suspected in patients who have fever, abdominal lymphadenopathies and immune thrombocytopenic purpura. Histopathological examination is still an ideal method to confirm the diagnosis, suitably aided by microbiological examination.