Journal of Clinical Medicine

Research

13 pages, 717 KiB

Open AccessArticle

The Diagnostic Accuracy of Procalcitonin, Soluble Urokinase-Type Plasminogen Activator Receptors, and C-Reactive Protein in Diagnosing Urinary Tract Infections in the Emergency Department—A Diagnostic Accuracy Study

by Mathias Amdi Hertz, Isik Somuncu Johansen, Flemming S. Rosenvinge, Claus Lohman Brasen, Eline Sandvig Andersen, Anne Heltborg, Thor Aage Skovsted, Eva Rabing Brix Petersen, Mariana Bichuette Cartuliares, Stig Lønberg Nielsen, Christian Backer Mogensen and Helene Skjøt-Arkil

J. Clin. Med. 2024, 13(6), 1776; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13061776 - 20 Mar 2024

Viewed by 586

Abstract

Background: Urinary tract infections (UTIs) are a leading bacterial infection in the emergency department (ED). Diagnosing UTIs in the ED can be challenging due to the heterogeneous presentation; therefore, fast and precise tests are needed. We aimed to evaluate the diagnostic precision [...] Read more.

Background: Urinary tract infections (UTIs) are a leading bacterial infection in the emergency department (ED). Diagnosing UTIs in the ED can be challenging due to the heterogeneous presentation; therefore, fast and precise tests are needed. We aimed to evaluate the diagnostic precision of procalcitonin (PCT), soluble urokinase plasminogen activator receptors (suPARs), and C-reactive protein (CRP) in diagnosing UTIs, grading the severity of UTIs, and ruling out bacteremia. Methods: We recruited adults admitted to three Danish EDs with suspected UTIs. PCT, suPAR, and CRP were used in index tests, while blood cultures, expert panel diagnosis, and severity grading were used in the reference tests. Logistic regression and area under the receiver operator characteristic curves (AUROCs) were utilized to evaluate the models and determine the optimal cut-offs. Results: We enrolled 229 patients. PCT diagnosed UTI with an AUROC of 0.612, detected severe disease with an AUROC of 0.712, and ruled out bacteremia with an AUROC of 0.777. SuPAR had AUROCs of 0.480, 0.638, and 0.605, while CRP had AUROCs of 0.599, 0.778, and 0.646. Conclusions: The diagnostic performance of PCT, suPAR, or CRP for UTIs or to rule out severe disease was poor. However, PCT can safely rule out bacteremia in clinically relevant numbers in ED patients suspected of UTI. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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20 pages, 1597 KiB

Open AccessArticle

Intraspinal and Intracranial Neurotuberculosis, Clinical and Imaging Characteristics and Outcomes in Hospitalized Patients: A Cohort Study (2000–2022)

by Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, María Guadalupe Miranda-Novales, David Nava-Jiménez, Juan Antonio Delgado-Vázquez, Rafael Bustos-Mora, Aldo Guadalupe Cisneros-Aréchiga, José Francisco Aguayo-Villaseñor, Martha Rocio Hernández-Preciado and Mario Alberto Mireles-Ramírez

J. Clin. Med. 2023, 12(13), 4533; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12134533 - 6 Jul 2023

Viewed by 1127

Abstract

Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000–2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was [...] Read more.

Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000–2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was designed through clinical, laboratory and imaging findings. Variables included: demographic data, history of tuberculosis, neurological complications, comorbidities and outcomes. Morbi-mortality risk factors were identified by univariate analysis. The cohort included: 103 patients with intraspinal and 82 with intracranial neuroTB. During the study period, in-hospital mortality of 3% for intraspinal and 29.6% for intracranial neuroTB was estimated. Motor deficit was found in all patients with intraspinal neuroTB. Risk factors for the unfavorable outcome of patients with intraspinal neuroTB were: age ≥ 40 years, diabetes mellitus (DM), diagnostic delay, kyphosis and spondylodiscitis ≥ 3 levels of involvement. Among the patients with intracranial neuroTB, 79/82 (96.3%) had meningitis and 22 patients had HIV infection (10 of them died). Risk factors for mortality from intracranial neuroTB were: HIV infection, hydrocephalus, stroke, lymphopenia and disseminated and gastrointestinal TB. Patients with intraspinal neuroTB had a significant number of destroyed vertebrae that determined their neurological deficit status. The mortality burden in intracranial neuroTB was conditioned by HIV infection and renal transplantation patients. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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Review

Jump to: Research, Other

34 pages, 494 KiB

Open AccessReview

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

by Francisco Javier Candel, Miguel Salavert, Miren Basaras, Marcio Borges, Rafael Cantón, Emilia Cercenado, Catian Cilloniz, Ángel Estella, Juan M. García-Lechuz, José Garnacho Montero, Federico Gordo, Agustín Julián-Jiménez, Francisco Javier Martín-Sánchez, Emilio Maseda, Mayra Matesanz, Rosario Menéndez, Manuel Mirón-Rubio, Raúl Ortiz de Lejarazu, Eva Polverino, Pilar Retamar-Gentil, Luis Alberto Ruiz-Iturriaga, Susana Sancho and Leyre Serrano Show full author list Hide full author list

J. Clin. Med. 2023, 12(21), 6864; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12216864 - 30 Oct 2023

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Abstract

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its [...] Read more.

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

30 pages, 891 KiB

Open AccessReview

Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review

by Francisco Javier Candel, Miguel Salavert, Angel Estella, Miquel Ferrer, Ricard Ferrer, Julio Javier Gamazo, Carolina García-Vidal, Juan González del Castillo, Víctor José González-Ramallo, Federico Gordo, Manuel Mirón-Rubio, Javier Pérez-Pallarés, Cristina Pitart, José Luís del Pozo, Paula Ramírez, Pedro Rascado, Soledad Reyes, Patricia Ruiz-Garbajosa, Borja Suberviola, Pablo Vidal and Rafael Zaragoza Show full author list Hide full author list

J. Clin. Med. 2023, 12(20), 6526; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12206526 - 14 Oct 2023

Cited by 2 | Viewed by 3855

Abstract

Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the [...] Read more.

Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the approach to this infection model are widely implemented in international health systems and clinical teams, information continually emerges that generates debate or requires updating in its management. This scientific manuscript, written by a multidisciplinary team of specialists, reviews the most important issues in the approach to this important infectious respiratory syndrome, and it updates various topics, such as a renewed etiological perspective for updating the use of new molecular platforms or imaging techniques, including the microbiological diagnostic stewardship in different clinical settings and using appropriate rapid techniques on invasive respiratory specimens. It also reviews both Intensive Care Unit admission criteria and those of clinical stability to discharge, as well as those of therapeutic failure and rescue treatment options. An update on antibiotic therapy in the context of bacterial multiresistance, in aerosol inhaled treatment options, oxygen therapy, or ventilatory support, is presented. It also analyzes the out-of-hospital management of nosocomial pneumonia requiring complete antibiotic therapy externally on an outpatient basis, as well as the main factors for readmission and an approach to management in the emergency department. Finally, the main strategies for prevention and prophylactic measures, many of them still controversial, on fragile and vulnerable hosts are reviewed. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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17 pages, 983 KiB

Open AccessReview

Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

by Małgorzata Satora, Arkadiusz Grunwald, Bartłomiej Zaremba, Karolina Frankowska, Klaudia Żak, Rafał Tarkowski and Krzysztof Kułak

J. Clin. Med. 2023, 12(16), 5376; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12165376 - 18 Aug 2023

Cited by 4 | Viewed by 2959

Abstract

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations [...] Read more.

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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32 pages, 7502 KiB

Open AccessReview

Interleukins (Cytokines) as Biomarkers in Colorectal Cancer: Progression, Detection, and Monitoring

by Sajida Maryam, Katarzyna Krukiewicz, Ihtisham Ul Haq, Awal Ayaz Khan, Galal Yahya and Simona Cavalu

J. Clin. Med. 2023, 12(9), 3127; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12093127 - 25 Apr 2023

Cited by 5 | Viewed by 3386

Abstract

Cancer is the primary cause of death in economically developed countries and the second leading cause in developing countries. Colorectal cancer (CRC) is the third most common cause of cancer-related deaths worldwide. Risk factors for CRC include obesity, a diet low in fruits [...] Read more.

Cancer is the primary cause of death in economically developed countries and the second leading cause in developing countries. Colorectal cancer (CRC) is the third most common cause of cancer-related deaths worldwide. Risk factors for CRC include obesity, a diet low in fruits and vegetables, physical inactivity, and smoking. CRC has a poor prognosis, and there is a critical need for new diagnostic and prognostic biomarkers to reduce related deaths. Recently, studies have focused more on molecular testing to guide targeted treatments for CRC patients. The most crucial feature of activated immune cells is the production and release of growth factors and cytokines that modulate the inflammatory conditions in tumor tissues. The cytokine network is valuable for the prognosis and pathogenesis of colorectal cancer as they can aid in the cost-effective and non-invasive detection of cancer. A large number of interleukins (IL) released by the immune system at various stages of CRC can act as “biomarkers”. They play diverse functions in colorectal cancer, and include IL-4, IL-6, IL-8, IL-11, IL-17A, IL-22, IL-23, IL-33, TNF, TGF-β, and vascular endothelial growth factor (VEGF), which are pro-tumorigenic genes. However, there are an inadequate number of studies in this area considering its correlation with cytokine profiles that are clinically useful in diagnosing cancer. A better understanding of cytokine levels to establish diagnostic pathways entails an understanding of cytokine interactions and the regulation of their various biochemical signaling pathways in healthy individuals. This review provides a comprehensive summary of some interleukins as immunological biomarkers of CRC. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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Other

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9 pages, 1048 KiB

Open AccessBrief Report

Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection

by Raquel Nahra, Shahrzad Darvish, Snehal Gandhi, Suzanne Gould, Diane Floyd, Kathy Devine, Henry Fraimow, John E. Dibato and Jean-Sebastien Rachoin

J. Clin. Med. 2024, 13(9), 2647; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13092647 - 30 Apr 2024

Viewed by 312

Abstract

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial [...] Read more.

Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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6 pages, 185 KiB

Open AccessCase Report

Encephalitis in the Course of HHV-7 Infection in an Infant

by Justyna Moppert, Eliza Łężyk-Ciemniak and Małgorzata Pawłowska

J. Clin. Med. 2024, 13(2), 418; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13020418 - 12 Jan 2024

Viewed by 668

Abstract

Most cases of acute infections caused by human herpesvirus 7 (HHV-7) are asymptomatic or very mild. Clinical symptoms disappear spontaneously; however, the infection becomes latent and persists for life with periodic asymptomatic reactivation. Little is known about the virus’s ability to cross the [...] Read more.

Most cases of acute infections caused by human herpesvirus 7 (HHV-7) are asymptomatic or very mild. Clinical symptoms disappear spontaneously; however, the infection becomes latent and persists for life with periodic asymptomatic reactivation. Little is known about the virus’s ability to cross the blood–brain barrier. Our case of an immunocompetent infant indicates that HHV-7 infection should be considered a cause of neuroinfection, not only in immunocompromised patients but also in the youngest immunocompetent patients. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

11 pages, 15626 KiB

Open AccessCase Report

Complicated Clinical Course of a Patient with Multivisceral Cystic Echinococcosis Requiring Extensive Surgical and Medical Treatment

by Gabriela Loredana Popa, Alexandru Cosmin Popa, Bogdan Mastalier, Carmen Michaela Crețu and Mircea Ioan Popa

J. Clin. Med. 2023, 12(17), 5596; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12175596 - 27 Aug 2023

Cited by 2 | Viewed by 1041

Abstract

Cystic echinococcosis is an often-overlooked condition that otherwise negatively impacts both the individual and the community, prompting major public health concerns. Early diagnosis and treatment, as well as collaboration between specialties including surgery and parasitology, are essential for avoiding complications and disease relapse. [...] Read more.

Cystic echinococcosis is an often-overlooked condition that otherwise negatively impacts both the individual and the community, prompting major public health concerns. Early diagnosis and treatment, as well as collaboration between specialties including surgery and parasitology, are essential for avoiding complications and disease relapse. To better illustrate this, we present the case of an elderly person with a rare localization of the disease at the muscular level. The patient underwent numerous surgical interventions, and received multiple courses of antiparasitic treatment over the course of 40 years as a result of the multivisceral dissemination of the parasite. Full article

(This article belongs to the Special Issue Clinical Aspects of Infectious Diseases)

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