Sepsis represents a severe pathology that requires both rapid and precise positive and differential diagnosis to identify patients who need immediate antimicrobial therapy. Monitoring septic patients’ outcome leads to prolonged hospitalisation and antibacterial therapy, often accompanied by substantial side effects, complications and a high mortality risk.Septic patients present with complex pathophysiological and immunological disorders and with a predominance of pro-inflammatory or anti-inflammatory mediators which are heterogeneous with respect to the infectious focus, the aetiology of sepsis or patients’ immune status or comorbidities. Previous studies performed have analysed inflammatory biomarkers, but a test or combinations of tests that can quickly and precisely establish a diagnosis or prognosis of septic patients has yet to be discovered. Recent research has focused on re-analysing older accessible parameters found in the complete blood count to determine the sensitivity, specificity, positive and negative predictive values for the diagnosis and prognosis of sepsis.The neutrophil/lymphocyte count ratio (NLCR), mean platelet volume (MPV) and red blood cells distribution width (RDW) are haemogram indicators which have been evaluated and which are of proven use in septic patients’ management.
IntroductionStreptococcal infection can be responsible for multiple complications, such as toxic, septic or allergic disorders. Toxin-mediated complications (TMC) can appear during the acute phase of disease and can involve any organ, causing carditis, arthritis, nephritis, hepatitis etc.Case presentationThe case of a young woman without a history of recurrent streptococcal tonsillitis, admitted to “Matei Balş” National Institute for Infectious Diseases, Bucharest, Romania, presenting with fever, sore throat and exudative tonsillitis, is detailed. The initial test for Streptococcus pyogenes was negative. The patient had leukopenia with severe neutropenia, high values of inflammatory biomarkers and electrocardiographic (ECG) changes with inverted T waves in leads V1-4 and flattened T waves in V5-6. There were no other cardiac signs or symptoms. The patient received cefuroxime for two days. On admission, the patient was prescribed Penicillin G and dexamethasone which resulted in a rapid recovery. The leucocytes count returned to normal as did the ECG abnormalities. At the time of discharge, the antistreptolysin O titre was high.ConclusionsThe case highlights the toxin-mediated complications (TMC) of streptococcal infection which occur from the outset of the disease.
There are limited data available on the regression of fibrosis in hepatitis C virus (HCV) patients who have achieved sustained virologic response (SVR) after interferon-free treatments. Moreover, a perfect method for assessing liver fibrosis and its dynamics has not been established yet. The main objective of this study was to evaluate the dynamics of aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores in patients with HCV who registered SVR. We performed ROC curve analysis to evaluate the diagnostic performance of APRI and FIB-4 scores in determining the presence of cirrhosis in comparison to FibroTest. In total 251 patients were enrolled: 164 cirrhotic and 83 non-cirrhotic patients, and they were evaluated at baseline, at 6 and at 12 months post-end of treatment (EOT). In the cirrhotic group, at baseline, there was a weak but statistically significant correlation between APRI and FibroTest (τ= 0.173, P=0.001), as well as between FIB-4 and FibroTest (τ= 0.265, P<0.001). At the 6-month follow-up, APRI no longer correlated with FibroTest (τ= 0.144, P= 0.057), while FIB-4 was correlated (τ= 0.256, P= 0.001). The same pattern was shown at 12 months post-EOT. Between baseline and the 6-month evaluation, there was a significant decrease in APRI (P<0.001) and FIB-4 (P<0.001) scores, but for the next follow-up period, there was no reduction. In the non-cirrhotic group, APRI and FIB-4 did not correlate with the FibroTest value at any of the evaluation times. There was a significant difference between baseline and the 6-month visit for APRI (P=0.01) and for FIB-4 (P= 0.014). The areas under the receiver operating characteristics curve (AUROCs) for the presence of cirrhosis compared with FibroTest for APRI and FIB-4 were 0.682 [95% confidence interval (CI), 0.613-0.752] and 0.693 (95% CI 0.625-0.76). Both APRI and FIB-4 prove to be easy, quick and inexpensive tools for screening HCV cirrhosis, with moderate diagnostic accuracy and FIB-4 can be useful for monitoring patients post-EOT.
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