Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions.

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively. Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay. The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 microg x L(-1). The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.

Pleural fluid myeloperoxidase as a marker of infectious pleural effusions.

Background: The aim of this study was to establish the diagnostic accuracy of neutrophil markers (elastase, lysozyme, myeloperoxidase) found in pleural fluid in differentiating between infectious and non-infectious pleural effusions (PE). Methods: We studied 184 patients over 18 years of age with PE, classified as either infectious (34 complicated parapneumonic, 32 non-complicated parapneumonic, 45 tuberculous) or non-infectious (31 neoplasms and 42 undiagnosed exudates). Polymorphonuclear elastase (PMN-E) was determined using an immunoactivation method and lysozyme using a turbidimetric method. Myeloperoxidase (MPO) was measured by double antibody competitive radioimmunoassay. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy. Results: Pleural fluid MPO was the biochemical marker that best differentiated between infectious and non-infectious PE. The ROC area under the curve (AUC) for myeloperoxidase was 0.86. MPO values over 550 &mgr;g/l diagnosed infectious PE with a specificity of 90.4% and a sensitivity of 77.4%. After excluding purulent parapneumonic PE, the sensitivity of a pleural MPO value >/=550 &mgr;g/l was 72.6%. Conclusions: Pleural fluid MPO was the marker that best differentiated between infectious and non-infectious PE.

Interleukin-8 and markers of neutrophil degranulation in pleural effusions.

In order to know the degree of interleukin-8 (IL-8) production in the pleural space and its relationship to neutrophil activation, IL-8, neutrophil elastase (NE), and myeloperoxidase (MPO) were assessed in blood and pleural fluid (PF) of 219 patients with pleural effusions. Correlations between blood and PF IL-8, NE, and MPO were either absent or weak, except for IL-8 in transudates (r = 0.6745, p < 0.001). PF IL-8, NE, and MPO concentrations in cases of empyema were higher than in cases of effusion of other causes (p < 0.001). No significant differences in inflammatory markers were observed between parapneumonic and tuberculous fluids. IL-8, NE, and MPO levels in malignant, nonspecific, and transudative effusions were lower than in those due to infection, the lowest levels corresponding to transudates. No significant correlation was observed between PF IL-8 and neutrophil count in any group; in contrast, IL-8 was associated with NE and MPO in empyema (r = 0.7545, and r = 0.7283; p < 0.001), tuberculosis (r = 0.4016, p = 0.008 and r = 0.6545, p < 0.001), and nonspecific effusions (r = 0.3748, p = 0.007 and r = 0.3085, p = 0.028). Our results indicate that local production of markers of the nonspecific inflammatory response is high in both chronic and acute pleural infection, and suggest a role for IL-8 in the release of NE and MPO.

[Study of 86 cases of Mediterranean boutonneuse fever hospitalized at a university hospital]. / Estudio de 86 casos de fiebre botonosa mediterránea que ingresaron en un hospital universitario.

OBJECTIVES: To study the clinical manifestations of 86 patients with Mediterranean Boutonneuse Fever who were admitted in a University General Hospital. PATIENTS AND METHODS: Between 1986 and 1994 we studied retrospectively the clinical manifestations, evolution and complications of 86 patients with Mediterranean Boutonneuse Fever. Diagnosis was based on clinical and serological findings. RESULTS: We studied a total of 86 patients (64 males; 22 females) with a mean age of 55 years. 88% of cases were diagnosed between June and September, and 89% of them had contact with dogs. 53% of patients had an underlying disease. All patients presented with fever and a generalized erythematous rash. 60% of patients had a initial lesion (tache noire) especially in legs. All patients were treated with doxicycline during one week. 22% of patients had complications such as renal failure, respiratory failure, gastrointestinal bleeding and stroke. Old patients and those with underlying disease had severe complications with a higher significant frequency. No patients died. CONCLUSIONS: 22% of patients with Mediterranean Boutonneuse Fever, especially those with advanced age or underlying disease, who were admitted in the Hospital had severe complications.

[Cutaneous vasculitis during primary myelofibrosis]. / Vasculitis cutánea en el curso de una mielofibrosis primaria.

A leukocytoclastic cutaneous vasculitis in the course of an idiopathic myelofibrosis is reported. The cutaneous lesions that might appear in this hematological disease are discussed, including cutaneous infections, myeloid metaplasia and cutaneous infiltration due to the myeloproliferative process. We point out the rarity of cutaneous vasculitis during the course of primary myelofibrosis.

[Esophageal candidiasis in patients without cellular immunity changes. Report of 7 cases]. / Candidiasis esofágica en pacientes sin alteraciones en la inmunidad celular. A propósito de siete casos.

OBJECTIVE: To study the clinical and immunological features of esophageal candidiasis in patients with no changes in cellular immunity. PATIENTS AND METHODS: Seven patients with the endoscopic diagnosis of esophageal candidiasis were studied and in no patient were changes in cellular immunity detected. An investigation was carried out of the presence of antibodies to the human immunodeficiency virus antigen, lymphocyte populations, complement, and immunoglobulins. RESULTS: Seven male patients with a mean age of 57 years (range: 43-67 years) and no underlying diseases were studied. The symptom at presentation in all cases was dysphagia and odynophagia of several days; two patients had also retro-sternal pain and one of them upper digestive hemorrhage. The digestive endoscopy showed white confluent patches highly suggestive of esophageal candidiasis. Therapy with intravenous fluconazole was started and both the clinical course and endoscopic lesions had a favorable outcome. Antibodies and antigen of human immunodeficiency virus were negative. Lymphocyte populations, complement, and immunoglobulins were normal in all patients but one, in whom a severe IgG hypogammaglobulinemia was detected. COMMENT: Esophageal candidiasis, though rare, is an entity to be considered in immunocompetent patients or with no changes in cellular immunity.

[Severe weight loss at the beginning of mesenteric panniculitis]. / Severa pérdida de peso en el debut de una paniculitis mesentérica.

We report a case of mesenteric panniculitis that presented with a severe lost of weight. We stress the difficulty that entails the diagnosis of this unusual entity, and also the excellent response to corticoid therapy in our patient. The clinical, pathological and therapeutic features of mesenteric panniculitis are reviewed.