Surinfection bactérienne chez les patients hospitalisés pour COVID-19

Introduction

La surinfection bactérienne associée au COVID-19 est peu décrite et concerne principalement les patients de soins intensifs. L’objectif de cette étude est de décrire les aspects épidémio-cliniques et thérapeutiques de la surinfection bactérienne chez les patients hospitalisés pour COVID-19.

Matériels et méthodes

Il s’agit d’une étude rétrospective incluant les patients hospitalisés dans un service de maladies infectieuses, pour une infection COVID-19 confirmée et compliquée d’une surinfection bactérienne, durant la période du 2 novembre 2020 au 18 janvier 2021.

Résultats

Parmi 236 patients hospitalisés pour une infection COVID-19, 58 (24,6 %) présentaient une surinfection bactérienne présumée. L’âge médian de la population inclue était de 70,4 [38 ; 88], avec prédominance masculine (31 cas ; 53,4 %). Les comorbidités étaient dominées par le diabète (33 cas ; 56,9 %) et l’hypertension artérielle (30 cas ; 51,7 %). La surinfection bactérienne était communautaire dans 55 cas (94,8 %). Les signes cliniques les plus fréquents étaient la dyspnée (51 cas ; 87,9 %), la fièvre (32 cas ; 55,2 %) et la toux (31 cas ; 53,4 %). Cliniquement, l’infection COVID-19 était sévère dans 25 cas (43,1 %), modérée dans 32 cas (55,2 %) et légère dans 1 cas (1,7 %). Les signes biologiques prédominants étaient l’élévation de la CRP (41 cas ; 70,7 %) et l’hyperleucocytose (26 cas ; 44,8 %). Le scanner thoracique, réalisé chez tous les patients, objectivait un aspect en verre dépoli associé à une condensation parenchymateuse dans 49 cas (84,5 %) et une condensation parenchymateuse isolée dans 9 cas (15,5 %). Le diagnostic de la surinfection bactérienne était présumé sur les données cliniques (expectorations purulentes, fièvre élevée, augmentation des besoins en oxygène [22 cas ; 37,9 %]), biologiques (syndrome inflammatoire biologique), radiologiques et évolutives (amélioration clinique sous antibiothérapie). L’antibiothérapie instaurée était à base de céphalosporine de 3^e génération (C3G) en monothérapie dans 52 cas (89,6 %), C3G associée à la doxycycline dans 3 cas (5,2 %) et C3G associée à la lévofloxacine dans 3 cas (5,2 %). L’évolution était favorable dans 46 cas (79,3 %), alors que 7 patients (12,1 %) étaient transférés en réanimation et 5 patients (8,6 %) étaient décédés.

Conclusion

L’infection COVID-19 peut se compliquer d’une surinfection bactérienne qu’il faut traiter à temps. Le diagnostic de la surinfection doit se reposer sur un faisceau d’arguments et doit être de préférence documenté pour éviter le recours inutile à l’antibiothérapie et l’émergence de résistance.

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period

BACKGROUND

Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends.

METHODS

We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants.

RESULTS

We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001).

CONCLUSION

In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

Magnetic and magnetocaloric properties of La0.55Bi0.05Sr0.4CoO3 and their implementation in critical behaviour study and spontaneous magnetization estimation

In this work, we present the results of the magnetic, critical, and magnetocaloric properties of the rhombohedral-structured La_0.55Bi_0.05Sr_0.4CoO₃ cobaltite. Based on the modified Arrott plot, Kouvel–Fisher, and critical isotherm analyses, we obtained the values of critical exponents (β, γ, and δ) as well as Curie temperature (T_C) for the investigated compound. These components were consistent with their corresponding values and they were validated by the Widom scaling law and scaling theory. The obtained critical exponents were close to the theoretical prediction of the mean-field model values, revealing the characteristic of long-range ferromagnetic interactions. The magnetic entropy, heat capacity, and local exponent n(T, μ₀H) of the La_0.55Bi_0.05Sr_0.4CoO₃ compound collapsed to a single universal curve, confirming its universal behaviour. The estimated spontaneous magnetization value extracted through the analysis of the magnetic entropy change was consistent with that deduced through the classical extrapolation of the Arrott curves. Thus, the magnetic entropy change is a valid and useful approach to estimate the spontaneous magnetization of La_0.55Bi_0.05Sr_0.4CoO₃.

In this work, we present the results of the magnetic, critical, and magnetocaloric properties of the rhombohedral-structured La_0.55Bi_0.05Sr_0.4CoO₃ cobaltite.

A new combined predicting model using a non-invasive score for the assessment of liver fibrosis in patients presenting with chronic hepatitis B virus infection

OBJECTIVES

Several non-invasive markers have recently been proposed to predict liver fibrosis without percutaneous liver biopsy (PLB). We aimed to evaluate the performance of non-invasive scores and to highlight the value of a new combined score in the prediction of liver fibrosis in chronic hepatitis B (CHB) patients.

PATIENTS AND METHODS

We performed a retrospective study of patients presenting with CHB who underwent PLB between 2008 and 2016. We calculated ASAT/Platelet Ratio Index (APRI), Fibrosis-4 Score (FIB4), GGT-to-platelet ratio (GPR), and ASAT/ALAT Ratio (AAR). Then, we combined APRI and FIB-4 scores into a new combined score. We assessed their performance in predicting liver fibrosis according to the Metavir score.

RESULTS

A total of 179 patients presenting with CHB were included. Multivariate analysis showed that the APRI score was the only independent factor of significant fibrosis (OR=3.78; P=0.02), whereas the FIB-4 score was the only independent factor for severe fibrosis (OR=2.85; P<0.001) and cirrhosis (OR=2.5; P=0.001). At a threshold of severe fibrosis, APRI had the best specificity (75%) and FIB-4 had the greatest sensitivity (74%). Using the combined score, we improved the diagnostic performance of APRI and FIB-4 scores at the three thresholds of liver fibrosis. With this combined score, maximum 25.1% of patients presenting with CHB would undergo PLB.

CONCLUSION

APRI, FIB-4, and GPR scores were well performing to predict liver fibrosis during CHB. The new combined score using APRI and FIB-4 was more accurate at the three-fibrosis thresholds.

[Ocular tuberculosis : A case series]

OBJECTIVES

Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis.

METHODS

We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay.

RESULTS

The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae.

CONCLUSION

Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

[Symmetrical peripheral gangrene: 4 cases]

BACKGROUND

Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases.

PATIENTS AND METHODS

We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction.

RESULTS

Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes.

CONCLUSION

SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.

Role of lanthanum vacancy on the structural, magnetic and magnetocaloric properties in the lacunar perovskite manganites La0.8−x□xNa0.2MnO3 (0 ≤ x ≤ 0.15)

Lacunar La_0.8−x□_xNa_0.2MnO₃ (0 ≤ x ≤ 0.15) ceramics where □ is a lanthanum deficiency were synthesized via a sol–gel method.

Critical behavior study near the paramagnetic to ferromagnetic phase transition temperature in Pr0.6−xErxCa0.1Sr0.3MnO3 (x = 0, 0.02 and 0.06) manganites

The aim of the present work is to study the critical behavior of Pr_0.6−xEr_xCa_0.1Sr_0.3MnO₃ (x = 0, 0.02 and 0.06) manganites, synthetized by the conventional solid-state reaction method, around the paramagnetic (PM)–ferromagnetic (FM) phase transition.

Critical behavior and magnetocaloric study in La0.6Sr0.4CoO3 cobaltite prepared by a sol–gel process

The structure, magnetic properties, critical exponents and magnetocaloric effect (MCE) of La_0.6Sr_0.4CoO₃ cobaltite are studied.

A microfluidic electrochemical biosensor based on multiwall carbon nanotube/ferrocene for genomic DNA detection of Mycobacterium tuberculosis in clinical isolates

Herein we present a microfluidic-multiplexed platform that integrates electrochemical sensors based on carbon nanotubes associated with ferrocene as redox marker (carbon nanotube (CNT)/ferrocene) for direct detection of pathogenic viral DNA from Hepatitis C and genomic DNA from Mycobacterium tuberculosis in clinical isolates. By operating the fluidic device under high flow (150 μl/min), the formation of a very thin depletion layer at the sensor surface (δS = 230 nm) enhances the capture rate up to one DNA strand per second. By comparison, this capture rate is only 0.02 molecule/s in a static regime without flow. This fluidic protocol allows thus enhancing the limit of detection of the electrochemical biosensor from picomolar in bulk solution to femtomolar with a large dynamic range from 0.1 fM to 1 pM. Kinetics analysis also demonstrates an enhancement of the rate constant of electron transfer (kS) of the electrochemical process from 1 s(-1) up to 6 s(-1) thanks to the geometry of the miniaturized fluidic electrochemical cell. This microfluidic device working under high flow allows selective direct detection of a Mycobacterium tuberculosis (H37Rv) rpoB allele from clinical isolate extracted DNA. We envision that a microfluidic approach under high flow associated with a multiwall CNT/ferrocene sensor could find useful applications as the point-of-care for multi-target diagnostics of biomarkers in real samples.

Ultrasound-assisted green solvent extraction of high-added value compounds from microalgae Nannochloropsis spp

The aim of this work was to investigate ultrasound (US)-assisted green solvent extraction of valuable compounds from the microalgae Nannochloropsis spp. Individual green solvents (water, ethanol (EtOH), dimethyl sulfoxide (DMSO)) and binary mixture of solvents (water-DMSO and water-EtOH) were used for the extraction procedures. Maximum total phenolic compounds yield (Yp ≈ 0.33) was obtained after US pre-treatment (W=400 W, 15 min), being almost 5-folds higher compared to that found for the untreated samples and aqueous extraction (Yp ≈ 0.06). The highest yield of total chlorophylls (Yc ≈ 0.043) was obtained after US (W=400 W, 7.5 min), being more than 9-folds higher than those obtained for the untreated samples and aqueous extraction (Yc ≈ 0.004). The recovery efficiency decreased as DMSO>EtOH>H2O. The optimal conditions to recover phenolic compounds and chlorophylls from microalgae were obtained after US pre-treatment (400 W, 5 min), binary mixtures of solvents (water-DMSO and water-EtOH) at 25-30%, and microalgae concentration of 10%.

[Acute osteomyelitis of the clavicle in the newborn infant: a case report]

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Coracoid fracture combined with distal clavicle fracture without coracoclavicular ligament rupture: A case report

Distal clavicle fracture accompanied by coracoid process one is a rare injury. Surgical and/or conservative treatments are proposed. We report the case of a 49-year-old woman presenting a distal clavicle fracture associated with a coracoid process one due to a fall on the left shoulder. Both injuries are treated surgically. Per operatively, and through an anterior "strap" approach, the coracoclavicular ligament was seen intact. The distal clavicle fracture was fixed with K-wires and cerclage and the coracoid process was secured by a screw. Active-assisted rehabilitation of the shoulder was initiated 3 weeks after surgery. At the last follow-up of twelve months, the patient had painless full shoulder functions and X-rays show bony union. Early recovery to normal life is possible with surgical treatment in patients with distal clavicle fracture combined with coracoid fracture.

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report

Obturator dislocation of the hip associated with ipsilateral femoral neck fracture is an unusual injury. We report a case of a 40-year-old man with such a combination of injuries which was treated with an open reduction and internal fixation. He has a good follow-up result. There was no evidence of avascular necrosis on radiographs after 3 years.

Posterior interosseous nerve syndrome due to intramuscular lipoma

Lipomas are extremely common benign soft tissue tumors that are usually subcutaneous and asymptomatic. However, an intramuscular lipoma, occurring adjacent to the proximal radius, may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. In this report, we describe an unusual case of a 48-year-old-woman with a posterior interosseous nerve syndrome due to an intramuscular lipoma. The patient had good recovery after surgery and rehabilitation physiotherapy.

[Idiopathic ulnar nerve entrapment at the elbow: report of 20 cases]

We report a retrospective study of 20 patients treated for idiopathic cubital tunnel syndrome in a period of 10 years (2002-2011). The average age was 46 years. A profession at risk was present in the majority of cases. The treatment was surgical in all the cases. The indication for surgery was related to the importance of sensory-motor deficit, the long duration of symptoms, and the failure of conservative treatment. Two surgical techniques were used in this work: isolated neurolysis and neurolysis with anterior transposition of the ulnar nerve. There were no complications or recurrence of symptoms. After a mean follow-up of 12 months, our results evaluated thanks to the classification of Bishop were considered as excellent or good in 85% of cases and fair in 15% of cases. Prognosis factors were advanced age (more than 60 years), severity of the disease, and duration of symptoms (more than one year). The management of this affection must go through a better knowledge of the disease, for early diagnosis and appropriate treatment, only guarantees for a good result.