Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?

BACKGROUND/AIMS: Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. METHODS: Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. RESULTS: Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. CONCLUSIONS: Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care.

Erectile dysfunction in patients with nonalcoholic fatty liver disease

Background and study aims: There is a lack of studies on erectile dysfunction [ED] in patients diagnosed with nonalcoholic fatty liver disease [NAFLD]. The present study aimed to estimate the prevalence of ED in patients with NAFLD and to determine the independent predictors of ED in these patients

Patients and methods: We conducted a prospective, hospital-based study of 192 consecutive male patients with NAFLD. All patients underwent clinical evaluation; abdominal ultrasonography; test for viral hepatitis markers; and estimation of liver chemistry panel, complete blood count, prothrombin time, serum lipids panel, serum testosterone, and fasting serum levels of glucose, insulin, and C-peptide

Results: The mean age of the study population was 42.4 +/- 7.7 years [79.1% >/= 40 years]. Of the 192 patients with NAFLD, 88 [45.8%] had ED, 28 [14.6%] had metabolic syndrome, 25 [13%] had type-2 diabetes mellitus [DM], and 131 [68.2%] had insulin resistance [IR]. The mean level of serum testosterone was 3.17 +/- 2.94 ng/mL, while the mean insulin resistance index was 2.9 +/- 1.7. Mild ED [38.6%] was the most frequent grade of ED. Age >/= 40 years [odds ratio [OR] 6.4; 95% confidence interval [CI] 1.7-24.1; p- 0.006], IR [OR 5.9; 95% CI 1.7-20.6; p- 0.005], and low serum testosterone [OR 5.1; 95% CI 1.5-17.1; p- 0.009] were the predictors of ED

Conclusions: ED is a common disorder in male patients with NAFLD; both IR and low serum testosterone contribute to its development. Treatment of IR may carry a dual benefit of improving erectile function and decreasing the grade of hepatic steatosis

Hookworm infection among patients with pulmonary tuberculosis: Impact of co-infection on the therapeutic failure of pulmonary tuberculosis

Objective/background: The aim of this study is to determine the rate of hookworm infection among patients with pulmonary tuberculosis [TB] and to find out if there is a relation between hookworm infection and the therapeutic failure of pulmonary TB

Methods: We carried out a prospective, hospital-based study. The study included 231 naive patients with pulmonary TB, consecutively. Patients were evaluated at the 4th month of therapy for persistence of Mycobacterium tuberculosis infection. All patients had clinical evaluation, laboratory investigations [including sputum culture and stool microscopic examination], and imaging studies [abdominal ultrasonography and chest radiography]

Results: The study population mean age was 42.7 +/- 13.9 years old with 26.8% of them 40 years old or more. Out of 231 patients, 133 [57.6%] were men. Therapeutic failure rate of pulmonary TB was 29.4%. Hookworm infection was diagnosed among 16.5% of patients and 27.7% had diabetes mellitus [DM]. Using multivariate analysis, it was found that age of 40 years or more [odds ratio [OR] 8.4; 95% confidence interval [CI] 1.7-41.3; p = .009], hookworm infection [OR 7.6; 95% CI 1.2-49.9; p = .034], and DM [OR 5.9; 1.2-28; p = .027] were independently associated with therapeutic failure of pulmonary TB among the study population with pulmonary TB

Conclusion: In conclusion, the rate of therapeutic failure of pulmonary TB is high. Besides older age and DM, hookworm infection can reduce the therapeutic response of pulmonary TB. Screening for and control of DM and hookworm infection among patients with pulmonary TB may improve their therapeutic response

Evaluation of infections related to the different types of dialysis accesses in patients with end stage renal disease

Introduction: Infection is considered a common life threating complication of vascular access and causing morbidity, access failure, and it is the second leading cause of death after cardiovascular event. It accounts approximately 15% to 36% of morbidity and mortality [Jacob, 2011]. Peritonitis, subcutaneous tunnel and exit site infection are the most common complication in Continuous Ambulatory Peritoneal Dialysis [CAPD] patients and accounts for 18% of mortality [Johnson DW, 2009]

Aim of the work:1. To identify the most common pathogenic microorganisms in different types of dialysis accesses in suspected patients in hemodialysis and patients screened for Tenckhoff catheter infection in CA PD. 2. Common risk factors responsible for infection, 3. Most common sensitive antibiotic, and,.4. Strategy for management and prevention of infection in the dialysis units of Assiut governorate, Egypt

Material and methods: A total 88 patients with End Stage Renal Disease on regular dialysis. Divided into two main groups: Group [A]: 63 patients on hemodialysis with suspected infected vascular accesses. They were sub-divided into: 27 patients with Permanent accesses including [15 patients with AV fistula and 12 patients with tunneled catheters], and 36 patients with suspected infected temporary catheters including 12 patients for each of jugular, subclavian and femoral catheters in the dialysis unit in Assiut university hospital. Group [B]: 25 patients on Continuous Ambulatory Peritoneal Dialysis [CA PD] screened for Tenckhoff catheter infection in dialysis unit of Alexandria Students Hospital

Results: the positive cultures form colonized permanent accesses were 100% in AV fistula and 58.3% :n tunneled, regarding to CVCs, positive cultures were 75% in suhclavian, 83.3% in jugular and 100% in femoral so femoral vein catheters were the highest frequency of colonization, while in CAPD patients, the frequency of colonization were 12%.the most frequent organisms in the colonized permanent accesses and temporary non tunneled catheters were mixed infections [53.3% in AV fistuIa,.57.1% in tunneled, 60% in jugular and 75% in femoral, while the most common organism in subclavian was non- pathogenic staphylococci by 55.6%, and in CAPD patients, 100% of positive cultures were staphylococcus aureus. Our results demonstrate that, Vancomycin was the most sensitive antibiotic by 93.3% in arterio-venous fistula, 100% in tunneled, 75% in subclavian, 93.8% in Jugular and 87.5% in femoral catheter infections

Conclusion: Mixed infection with non- pathogenic staphylococci and candida were the most frequent pathogens in our centers, most sensitive antibiotics were Vancomcin, Amikacin, Niturofurantoin, and this should be combined with systemic antifungal

Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion

Noninvasive diagnosis of pleural tuberculosis [TB] remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis [MTB]-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information. Evaluation of pleural fluid interferon [INF]-gamma levels vs Quantiferon -TB Gold In tube assay [QFT- IT] in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB. Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-gamma assays. Ex vivo pleural fluid INF-gamma levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy. The final clinical diagnosis was TB in 20 [53%], malignancy in 10 [26%], and effusion due to other causes in eight patients [21%]. Ex vivo pleural fluid INF-gamma levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid [70 and 78% sensitivity, with 60 and 83% specificity, respectively]. QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay. The ex vivo pleural fluid INF-gamma level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-gamma in the diagnosis of pleural TB