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NECROTISING PNEUMONIA WITH STAPHYLOCOCCUS AUREUS CARRYING PANTON-VALENTINE LEUKOCIDIN GENES: AN UNDERESTIMATED GRAVITY?
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Results: Seventy-eight patients, 65.5 +/- 4.4 years old (age range: 31 to 84 years), with 34 women (43.6%) were included. 43 patients (55.1%) fulfilled diagnostic criteria of the syndrome. Increased waist/hip circumference ratio was observed in 38 patients (48.7%). Twenty-five patients fulfilled 3 diagnostic criteria (58.1%), 10 patients 4 diagnostic criteria (23.3%) and 8 patients fulfilled all the diagnostic criteria (18.6%). Prevalence of VRF: 43.6% for obesity (BMI > 30 Kg/m2), 68.4% arterial hypertension, 65.4% smoking, 58.9% elevated cholesterol levels, 53.8% sedentarism, 45.9% diabetes mellitus and 44.9% elevated triglycerides. MS was associated with the occurrence of an acute coronary syndrome (p < .01). Conclusions: Patients hospitalized for an acute coronary syndrome have an elevated prevalence of vascular risk factors and the metabolic syndrome. This syndrome, in spite of the discrepancies on its prognostic significance, is associated with an increased risk for an acute coronary syndrome. CERVICOFACIAL ACTINOMYCOSIS Victor Romero, Ramón Guitart, Ruben Blanco, Juan Agramonte, Victor Romero Nieves, Jorge Peraza. Miramar Polyclinic Palma de Mallorca, Spain Background: Actinomycosis is an uncommon, chronic bacterial infection caused by Actinomyces species, normal inhabitants in the oral cavity, respiratory and digestive tracts. This is characterized by suppuration, abscess formation, tissue fibrosis and granuloma formation. Actinomyces species are anaerobic bacteria that cannot penetrate healthy tissue. It has three main forms cervicofacial, pulmonary and abdominal. Actinomyces israelii is the most common pathogen. It is diagnosed by examining the exudates and infected tissue. Gram staining reveals gram positive long-branching filaments. The histologic and microscopic diagnoses are made by the finding of sulfur granules in the specimens; incisional biopsy is often undertaken to determine a diagnosis. Prolonged antimicrobial therapy with penicillin has typically been recommended. Case Report: We present the case of 50 years old, female, with personal history of Diabetes Mellitus type I, who was admitted to our hospital because fever of 38° C and painful right submaxilar mass, six weeks before admission the patient had suffered dental manipulation. At physical examination we found a painful, hard, red, and hot right sub maxilar mass of about 3 cms of diameter running to right lateral cervical region. Lab test shown severe leukocytosis, hyperglycaemia and raised ESR and CRP. Cervicofacial CT scanner shown bulky and heterogenic right laterocervical mass. Cytology and the culture of material obtained shown Actinomyces radingae. Incision and drainage of abscess, following of Penicillin G 24 millions U/d IV daily was the treatment with an excellent clinical response. ALCOHOL USE DISORDERS AND ITS DETECTION AMONG MEDICAL INPATIENTS IN EUROPE. THE ALCHIMIE STUDY. FIRST PHASE DATA Beatriz Rosón1, Jan Vaclavik2, Rudolf Stauber3, Ieva Ruza4, Pascal Perney5, José Barata6, Alexander Arutyunov7, and the ALCHIMIE STUDY GROUP. 1 Hospital Universitari De Bellvitge; 2University Hospital Olomouc; 3Medical University of Graz; 4Riga East Clinical University Hospital. Hospital Linezers; 5CH du Bassin de Thau; 6Hospital García Orta; 7City Clinical Hospital n°4 Background: This project aims to investigate the prevalence of alcohol use disorders (AUDs) in medical wards across Europe and to assess its recognition by physicians. Methods: Point-prevalence, multicentre study performed in 8 European countries. Patients were screened with the AUDIT-C and the SIAC questionnaires. Drinking patterns were determined using ICD-10 criteria. Medical records were reviewed to collect information about recording of alcohol use. Results: We interviewed 2123 (79%) inpatients [1114 (52%) men; mean age (SD) 67.9±17.3 years]. Reasons for admission were not alcohol-related in 2031 (95%) patients. Overall, 300 (14%) patients had current AUDs. Drinking patterns were: non-drinkers 984 (46%), low-risk 773 (36%), harzardous 163 (8%), harmful 63 (3%), dependent 74 (3%), former-dependent 47 (2%), and unknown pattern 19 (1%). There were significant differences in the prevalence of AUDs between countries with range of 22% for France and 8% for Estonia. We reviewed 2100 (98%) medical records. Alcohol consumption was recorded in 920 (44%) patients. Recording was more frequently performed in patients
with AUDs than in the other patients (58% vs 41%). Quantitative recording was performed in 119 (13%) with significant differences among countries ranging from 46% of medical records in Austria to 0% in Latvia. Conclusion: AUDs are frequent among European patients hospitalized for reasons not alcohol-related. They are frequently undetected during hospitalization. Adequate quantification of alcohol intake is rarely performed. We stress the need to implement measures to increase and improve the detection and recording of alcohol use among hospitalized patients. NECROTISING PNEUMONIA WITH STAPHYLOCOCCUS AUREUS CARRYING PANTON-VALENTINE LEUKOCIDIN GENES: AN UNDERESTIMATED GRAVITY? Xavier Roux1, Bruno Soullié1, Fabrice Camou2, Christophe Rapp3, Patrick Imbert3, Frédéric Mechaï3, Jean Louis Koeck1. 1Service de biologie clinique, Hôpital d’instruction des armées Robert Picqué; 2Service de réanimation, Hôpital St André / CHU de Bordeaux; 3Service de pathologies infectieuses et tropicales, Hôpital d’instruction des armées Begin Background: Panton Valentine Leukocidin (PVL) associated staphylococcal pneumonia is a distinct clinical entity affecting healthy young people. Its physiopathology is well known and its clinicical specifications were recently described. Our study aims to assess the clinical, biological and radiological features of S. aureus pneumonia due to PVL. Methods: Our study reports a serie of ten retrospective cases of PVLassociated staphylococcal pneumonia. We studied the clinical, biological and radiological features with a standardized questionnaire. We compared our data with a serie of ten S. aureus pneumonia without leucocidine by a statistical analysis. Results: We report on 8 men and 2 women without any immunodepression. Four of them had an influenza-like syndrom a few days before. The median age was 29,5 years for the PVL-positive patients and 64,2 years (59·2–81·4) for the others (p=0·001). No clinical difference was found beetween PVL positive and PVL negative pneumonia. A neutropenia (p=0,039) and a higher level of C reactive protein (p=0,012) was found in PVL positive pneumonia. SAPS2 (Simplified Acute Physiology Score) and PSI (pneumonia severity index) scores in PVL pneumonia were lower than in PVL negative pneumonia. Conclusions: PVL-producing S aureus causes rapidly progressive, haemorrhagic, necrotising pneumonia, mainly in healthy children and young adults. In 40% of the cases, the pneumonia is preceded by influenza-like symptoms. There is no clinical distinction in our study. A neutropenia must alarm the physician. In our study, the gravity scores seem to under-estimate the risk of unfavourable evolution in spite of a high letality rate. IDIOPATHIC VENOUS THROMBOEMBOLISM: RISK FACTORS OF RECURRENCE AND OPTIMAL DURATION OF ANTICOAGULANT THERAPY Pedro Ruiz-Artacho, Jose Maria Pedrajas-Navas, Angel Molino-Gonzalez, Vanesa Sendín-Martin, Nike Sanchez-Martinez, Belen Gonzalez-Casanova, Emilio Agrela-Rojas, Vanesa Lopez-Pelaez, Angeles Martin-Serrat, Isabel Jimenez, Ruth Velarde, Pedro Gonzalez-deLara. Hospital Clínico San Carlos Background: Unprovoked venous thromboembolism (VTE) has a high incidence of recurrence. The optimal duration of secondary prophylaxis is not established. Predictors for recurrent VTE in these patients are unknown. Our objectives were to identify factors involved to recurrence of thromboembolism and the optimal duration of anticoagulant therapy in patients with idiopathic venous thromboembolism (VTE) and to assess the cumulative probability of recurrence after 18 months. Methods: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. We determined independent predictive factors (clinical and analytics) for recurrent venous thromboembolism (VTE) after stopping anticoagulation, including duration of anticoagulation. Results: Between January 2001 and March 2010, 30949 were included in RIETE. 8939 (28,9%) were unprovoked venous thromboembolism. 2294 were followed after stopping anticoagulation for a median of 5,4 months (IR 2,512,0), and had been treated for a median of 6,2 months of anticoagulation (IR 4,1-8,5). Cumulative probability of recurrence, until 18 months of follow up, was 17,5%. There were no significant independent predictor factors for recurrent VTE, including duration of anticoagulation.
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Results: Seventy-eight patients, 65.5 +/- 4.4 years old (age range: 31 to 84 years), with 34 women (43.6%) were included. 43 patients (55.1%) fulfilled diagnostic criteria of the syndrome. Increased waist/hip circumference ratio was observed in 38 patients (48.7%). Twenty-five patients fulfilled 3 diagnostic criteria (58.1%), 10 patients 4 diagnostic criteria (23.3%) and 8 patients fulfilled all the diagnostic criteria (18.6%). Prevalence of VRF: 43.6% for obesity (BMI > 30 Kg/m2), 68.4% arterial hypertension, 65.4% smoking, 58.9% elevated cholesterol levels, 53.8% sedentarism, 45.9% diabetes mellitus and 44.9% elevated triglycerides. MS was associated with the occurrence of an acute coronary syndrome (p < .01). Conclusions: Patients hospitalized for an acute coronary syndrome have an elevated prevalence of vascular risk factors and the metabolic syndrome. This syndrome, in spite of the discrepancies on its prognostic significance, is associated with an increased risk for an acute coronary syndrome. CERVICOFACIAL ACTINOMYCOSIS Victor Romero, Ramón Guitart, Ruben Blanco, Juan Agramonte, Victor Romero Nieves, Jorge Peraza. Miramar Polyclinic Palma de Mallorca, Spain Background: Actinomycosis is an uncommon, chronic bacterial infection caused by Actinomyces species, normal inhabitants in the oral cavity, respiratory and digestive tracts. This is characterized by suppuration, abscess formation, tissue fibrosis and granuloma formation. Actinomyces species are anaerobic bacteria that cannot penetrate healthy tissue. It has three main forms cervicofacial, pulmonary and abdominal. Actinomyces israelii is the most common pathogen. It is diagnosed by examining the exudates and infected tissue. Gram staining reveals gram positive long-branching filaments. The histologic and microscopic diagnoses are made by the finding of sulfur granules in the specimens; incisional biopsy is often undertaken to determine a diagnosis. Prolonged antimicrobial therapy with penicillin has typically been recommended. Case Report: We present the case of 50 years old, female, with personal history of Diabetes Mellitus type I, who was admitted to our hospital because fever of 38° C and painful right submaxilar mass, six weeks before admission the patient had suffered dental manipulation. At physical examination we found a painful, hard, red, and hot right sub maxilar mass of about 3 cms of diameter running to right lateral cervical region. Lab test shown severe leukocytosis, hyperglycaemia and raised ESR and CRP. Cervicofacial CT scanner shown bulky and heterogenic right laterocervical mass. Cytology and the culture of material obtained shown Actinomyces radingae. Incision and drainage of abscess, following of Penicillin G 24 millions U/d IV daily was the treatment with an excellent clinical response. ALCOHOL USE DISORDERS AND ITS DETECTION AMONG MEDICAL INPATIENTS IN EUROPE. THE ALCHIMIE STUDY. FIRST PHASE DATA Beatriz Rosón1, Jan Vaclavik2, Rudolf Stauber3, Ieva Ruza4, Pascal Perney5, José Barata6, Alexander Arutyunov7, and the ALCHIMIE STUDY GROUP. 1 Hospital Universitari De Bellvitge; 2University Hospital Olomouc; 3Medical University of Graz; 4Riga East Clinical University Hospital. Hospital Linezers; 5CH du Bassin de Thau; 6Hospital García Orta; 7City Clinical Hospital n°4 Background: This project aims to investigate the prevalence of alcohol use disorders (AUDs) in medical wards across Europe and to assess its recognition by physicians. Methods: Point-prevalence, multicentre study performed in 8 European countries. Patients were screened with the AUDIT-C and the SIAC questionnaires. Drinking patterns were determined using ICD-10 criteria. Medical records were reviewed to collect information about recording of alcohol use. Results: We interviewed 2123 (79%) inpatients [1114 (52%) men; mean age (SD) 67.9±17.3 years]. Reasons for admission were not alcohol-related in 2031 (95%) patients. Overall, 300 (14%) patients had current AUDs. Drinking patterns were: non-drinkers 984 (46%), low-risk 773 (36%), harzardous 163 (8%), harmful 63 (3%), dependent 74 (3%), former-dependent 47 (2%), and unknown pattern 19 (1%). There were significant differences in the prevalence of AUDs between countries with range of 22% for France and 8% for Estonia. We reviewed 2100 (98%) medical records. Alcohol consumption was recorded in 920 (44%) patients. Recording was more frequently performed in patients
with AUDs than in the other patients (58% vs 41%). Quantitative recording was performed in 119 (13%) with significant differences among countries ranging from 46% of medical records in Austria to 0% in Latvia. Conclusion: AUDs are frequent among European patients hospitalized for reasons not alcohol-related. They are frequently undetected during hospitalization. Adequate quantification of alcohol intake is rarely performed. We stress the need to implement measures to increase and improve the detection and recording of alcohol use among hospitalized patients. NECROTISING PNEUMONIA WITH STAPHYLOCOCCUS AUREUS CARRYING PANTON-VALENTINE LEUKOCIDIN GENES: AN UNDERESTIMATED GRAVITY? Xavier Roux1, Bruno Soullié1, Fabrice Camou2, Christophe Rapp3, Patrick Imbert3, Frédéric Mechaï3, Jean Louis Koeck1. 1Service de biologie clinique, Hôpital d’instruction des armées Robert Picqué; 2Service de réanimation, Hôpital St André / CHU de Bordeaux; 3Service de pathologies infectieuses et tropicales, Hôpital d’instruction des armées Begin Background: Panton Valentine Leukocidin (PVL) associated staphylococcal pneumonia is a distinct clinical entity affecting healthy young people. Its physiopathology is well known and its clinicical specifications were recently described. Our study aims to assess the clinical, biological and radiological features of S. aureus pneumonia due to PVL. Methods: Our study reports a serie of ten retrospective cases of PVLassociated staphylococcal pneumonia. We studied the clinical, biological and radiological features with a standardized questionnaire. We compared our data with a serie of ten S. aureus pneumonia without leucocidine by a statistical analysis. Results: We report on 8 men and 2 women without any immunodepression. Four of them had an influenza-like syndrom a few days before. The median age was 29,5 years for the PVL-positive patients and 64,2 years (59·2–81·4) for the others (p=0·001). No clinical difference was found beetween PVL positive and PVL negative pneumonia. A neutropenia (p=0,039) and a higher level of C reactive protein (p=0,012) was found in PVL positive pneumonia. SAPS2 (Simplified Acute Physiology Score) and PSI (pneumonia severity index) scores in PVL pneumonia were lower than in PVL negative pneumonia. Conclusions: PVL-producing S aureus causes rapidly progressive, haemorrhagic, necrotising pneumonia, mainly in healthy children and young adults. In 40% of the cases, the pneumonia is preceded by influenza-like symptoms. There is no clinical distinction in our study. A neutropenia must alarm the physician. In our study, the gravity scores seem to under-estimate the risk of unfavourable evolution in spite of a high letality rate. IDIOPATHIC VENOUS THROMBOEMBOLISM: RISK FACTORS OF RECURRENCE AND OPTIMAL DURATION OF ANTICOAGULANT THERAPY Pedro Ruiz-Artacho, Jose Maria Pedrajas-Navas, Angel Molino-Gonzalez, Vanesa Sendín-Martin, Nike Sanchez-Martinez, Belen Gonzalez-Casanova, Emilio Agrela-Rojas, Vanesa Lopez-Pelaez, Angeles Martin-Serrat, Isabel Jimenez, Ruth Velarde, Pedro Gonzalez-deLara. Hospital Clínico San Carlos Background: Unprovoked venous thromboembolism (VTE) has a high incidence of recurrence. The optimal duration of secondary prophylaxis is not established. Predictors for recurrent VTE in these patients are unknown. Our objectives were to identify factors involved to recurrence of thromboembolism and the optimal duration of anticoagulant therapy in patients with idiopathic venous thromboembolism (VTE) and to assess the cumulative probability of recurrence after 18 months. Methods: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) is an ongoing, prospective registry of consecutively enrolled patients with objectively confirmed, symptomatic, acute VTE. We determined independent predictive factors (clinical and analytics) for recurrent venous thromboembolism (VTE) after stopping anticoagulation, including duration of anticoagulation. Results: Between January 2001 and March 2010, 30949 were included in RIETE. 8939 (28,9%) were unprovoked venous thromboembolism. 2294 were followed after stopping anticoagulation for a median of 5,4 months (IR 2,512,0), and had been treated for a median of 6,2 months of anticoagulation (IR 4,1-8,5). Cumulative probability of recurrence, until 18 months of follow up, was 17,5%. There were no significant independent predictor factors for recurrent VTE, including duration of anticoagulation.