RESUMEN
Acute hepatitis B is a serious cause of fulminant hepatic failure and subsequent mortality. No established guidelines are currently present for the treatment of this life threatening entity. Several therapeutic options were reported in the literature including the use of lamivudine as well as the more novel nucleoside analogue entecavir. We report an unfortunate case of fulminant hepatitis B that passed away despite intensive care unit management and treatment with entecavir in combination with steroids. Extensive review of the literature about various therapeutic approaches to manage fulminant hepatitis B was conducted. The aim of this report is to emphasize the need for larger more structured studies in order to improve the outcome of the treatment of this entity
RESUMEN
Nontuberculous mycobacteria are rare causes of skin, soft tissue, and musculoskeletal infections. Mycobacterium marinum remains one of the most commonly encountered mycobacterial species in humans, causing superficial cutaneous as well as deep infections. We are reporting a case of M. marinum osteomyelitis involving two primary noncontiguous sites in an immunocompetent host, which was success- fully treated with surgical drainage and antibiotic therapy
RESUMEN
Background: CD11b, an alpha subunit of the beta2 integrin adhesion molecule, and CD64, the high affinity Fc-gamma receptor I, are specific neutrophil-surface antigens activated in response to systemic inflammation and, hence, they might potentially help identifying neonatal infections
Objective: We sought to evaluate the time course of expression and diagnostic and prognostic utility of CD11b and CD64 in early-onset sepsis in the suspected newborn
Methods: Sixty newborn infants [28-40 weeks gestation] with antenatal risk factors for sepsis were enrolled and subjected to sepsis work-up including complete blood count, quantification of serum C reactive protein [CRP] and flow cytometric analysis of CD11b and CD64 in cord blood [0 h]. These tests were repeated at 8, 24 and 48 h postnatally. Neonates were defined, retrospectively, in two groups: sepsis and no infection, on basis of clinical observation over their first five postnatal days and sepsis work-up results
Results: A significant enhancement of neutrophil CD11b and CD64 expression was demonstrated in the sepsis group as compared to the non-infected group. CD11b over-expression had an onset at 0 h. Its mean value approached two-fold mean level of non-infected neonates by 8-24 h, and declined thereafter. CD64 rising onset was detectable at 8 h and its mean percentage reached four-fold mean value of the non-infected group at 24 h. At 24 h, an optimal cut-off value for CD11b expression of 35% [sensitivity 80%, and specificity 100%], and for CD64 expression of 17% [sensitivity 88%, and specificity 90.3%] had the best performance for prediction of sepsis. Combined use of both markers at 24 h yielded 90% sensitivity and 95% specificity for sepsis prediction. Sepsis survivors showed significantly lower mean expression for CD11b and CD64 as compared to those with fatal outcome. At 24 h, a cut-off value of 88% expression for CD11b and 50% expression for CD64 predicted mortality with sensitivity and specificity of 100%
Conclusion: Enhanced expression of neutrophil-surface antigens CD11b and CD64 could be a promising tool for prediction and therapeutic decision-making in early-onset sepsis indicating the necessity of initiation of antimicrobial therapy and reduction of its unnecessary use in non-infected neonates even before definitive microbiologic identification