Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study.

Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.

Masked hypertension unfavourably affects haemostasis parameters.

OBJECTIVE. Recent evidence demonstrates that masked hypertension (MH) is a significant predictor of cardiovascular disease. The aim of our study was to examine the impact of MH on haemostasis parameters and to compare the findings to those of healthy normotensives matched for age, sex, body mass index and the rest of risk factors. DESIGN AND METHOD. 130 (60 male, 70 female) healthy subjects mean age 45 ± 12 years who had clinic blood pressure < 140/90 mmHg were studied. The whole study population underwent 24-h ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (eight males, 16 females) had MH (daytime systolic blood pressure ≥ 135 mmHg or daytime diastolic blood pressure ≥ 85 mmHg - group A) and the remaining 106 subjects (52 males, 54 females) had normal ABPM recordings - group B. Fibrinogen, thrombomodulin ™, the antigens of plasminogen activator inhibitor 1 (PAI-1Ag) and tissue plasminogen activator (tPA-Ag) were determined in the two groups. Results. The PAI-1 Ag, tPA-Ag, fibrinogen and TM levels were significantly higher in the masked hypertensive group than to normotensive control group. CONCLUSIONS. Our findings suggest that subjects with MH have significantly higher fibrinogen, TM, PAI-1Ag and tPA-Ag plasma levels compared with normotensives. This observation may have prognostic significance for future cardiovascular events in subjects with MH and needs further investigation.

Association of resistin and adiponectin with different clinical blood pressure phenotypes.

We investigated whether the resistin (Res) and adiponectin (Adp) levels are associated with different clinical blood pressure (BP) phenotypes. Among 465 consecutive never-treated white subjects, we excluded those with diabetes mellitus; impaired glucose metabolism; history of any cardiovascular disease or other concurrent medical condition; secondary hypertension; ongoing vasoactive treatment. Three separate clinic BP measurements and ambulatory BP monitoring were implemented to divide 328 subjects (aged 48±6 years; 172 males) into hypertensives (n=105), masked hypertensives (n=41), white-coat hypertensives (n=52) and normotensives (n=130). Participants underwent echocardiography and oral glucose tolerance testing, whereas, from fasting venous blood samples metabolic profile, plasma Res and Adp levels were assessed. Hypertensives and masked hypertensives showed higher log(10)(Res) and lower log(10)(Adp) levels compared with normotensives, whereas white-coat hypertensives had similar levels of these adipokines compared with normotensives. Common correlates for both of the adipokines were 24-h systolic BP, standing/sitting difference of both diastolic BP and heart rate, and waist circumference. Hypertensive and masked hypertensive compared with normotensive phenotype were independently associated with log(10)(Res) with odds ratios of 1.24 (1.08-1.44), and 1.16 (1.09-1.34) and log(10)(Adp) with 0.74 (0.65-0.87), and 0.81 (0.67-0.95), respectively. Increased Res and decreased Adp plasma levels are associated with out-of-clinic hypertension, whereas they did not determine white-coat hypertension.

Panton-Valentine leukocidin-positive Staphylococcus aureus skin and soft tissue infections among children in an emergency department in Madrid, Spain.

Fifty-three children who attended the emergency department with community-associated (CA) Staphylococcus aureus skin and soft tissue infections (SSTIs) were enrolled in the study. Seven cases of infection (13.2%) were due to methicillin-resistant S. aureus (MRSA). Twelve of 46 available isolates (26.1%) were Panton-Valentine leukocidin (PVL)-positive. PVL-positive S. aureus SSTIs were more frequently associated with abscesses and cellulitis (75% vs. 38%, p 0.028), and more commonly required incision and drainage (75% vs. 21%, p 0.001). Most PVL-positive CA-MRSA isolates belonged to a single multilocus sequence type (ST8). In contrast, PVL-positive methicillin-susceptible S. aureus isolates belonged to four different sequence types (ST8, ST30, ST80, ST120).

Permanent unilateral blindness associated with peripartum cardiomyopathy.

Peripartum Cardiomyopathy (PPCM) is a rare and ominous disease manifested in the peripartum period of women with complications concerning different organic systems. We describe a case of peripartum cardiomyopathy which was complicated with acute permanent unilateral blindness, further documented embolic retinal artery occlusion as a consequence of PPCM. This is a quite unusual event with PPCM, since to our knowledge there is no previously reported case with PPCM as the sole associated factor. The purpose of our paper is to emphasize that thromboembolism of the central retinal artery, seems to be compatible with peripartum cardiomyopathy and that, peripartum blindness, may be attributed to the cardiomyopathy diagnosis.

Changes of metalloproteinases profile in patients with masked hypertension.

INTRODUCTION: The aim of our study was to investigate whether collagen degradation is altered in participants with masked hypertension and whether this alteration could be related to disturbances in the matrix metalloproteinases plasma concentration and to compare the findings with those participants with normal blood pressure levels matched for age, sex, and body mass index. METHODS: Twenty-four (11 men, 13 women) participants with masked hypertension [mean age 46 +/- 7 years and body mass index 25.9 +/- 2.1 kg/m(2) (group A)] and 106 healthy normotensives (49 men, 57 women) with normal blood pressure [mean age 44 +/- 6 years and body mass index 25.5 +/- 2.4 kg/m(2) (group B)]. RESULTS: The plasma levels of matrix metalloproteinase-9 were significantly higher, while the levels of tissue inhibitors of metalloproteinases-1 and -4 were significantly lower in group A compared with group B (matrix metalloproteinase-9: 569 +/- 135 vs. 282 +/- 117 ng/mL, TIMP-1: 169 +/- 42 vs. 230 +/- 37 ng/mL, P < .01, and TIMP-4: 2.1 +/- 1.3 vs. 4.2 +/- 1.98 ng/mL, P < .04, respectively). CONCLUSIONS: Patients with masked hypertension had significantly increased matrix metalloproteinase-9 plasma levels and significantly decreased plasma levels of tissue inhibitors of metalloproteinases-1 and -4 compared with participants with normal blood pressure. These findings need further investigation.

Adiponectin--insulin and resistin plasma levels in young healthy offspring of patients with essential hypertension.

BACKGROUND: Accumulating epidemiological studies have shown that healthy offspring of hypertensive patients exhibit some metabolic disturbances such as hyperinsulinemia, insulin resistance, lipid disorders, elevated plasma leptin levels and reduced insulin receptor number, features that may be predictors of future cardiovascular events. The aim of this study was to determine insulin, adiponectin and resistin plasma levels in young healthy offspring of patients with essential hypertension, and to compare the findings to those of young healthy offspring of healthy normotensives matched for age, sex and body mass index (BMI). METHODS: Forty-six (24 male/22 female) healthy offspring of patients with essential hypertension-positive family history (FH+), mean age 18+/-3 years and BMI 22.4+/-1.4 kg/m2 (group A) and 50 (28 male/22 female) healthy offspring of healthy normotensives-negative family history (FH-) mean age 18+/-3.2 years and BMI 22.6+/-1.7 kg/m2 (group B) were studied. The two groups were matched for age, sex and BMI. Systolic and diastolic blood pressure (SBP and DBP) measurements, resting heart rate (HR), plasma insulin (RIA method), adiponectin and resistin plasma levels (ELISA) were determined in the whole study population. RESULTS: Mean SBP, DBP and resting HR were significantly higher in group A compared with group B (121+/-13 vs 110+/-10 mmHg, 78+/-6 vs 73+/-8 mmHg, 76+/-4 vs 72+/-6 beats/min, p<0.01, p<0.05 and p<0.01 respectively). Insulin and resistin plasma levels were significantly higher, while adiponectin levels were significantly lower. In group A compared with group B (21+/-7 vs 15+/-6 pIU/ml, 10+/-5 vs 6+/-3 ng/ml, 20+/-5 vs 29+/-8 microg/ml, p<0.01, p<0.01, p<0.01, respectively). CONCLUSION: Our findings suggest that increased SBP, DBP and resting HR as well as increased insulin and resistin plasma levels and decreased adiponectin plasma levels pre-exist in young healthy offspring with positive family history for essential hypertension. Further studies are needed to determine the clinical significance of these observations in attempt to classify these young healthy individuals for future cardiovascular risk.

Antiendothelial cell antibody levels in patients with masked hypertension.

UNLABELLED: Recent evidence demonstrate that masked hypertension (MH) is a significant predictor of cardiovascular disease, while, elevated levels of circulating antibodies against endothelial cell surface antigens (antiendothelial cell antibodies - AECA) seem to play an important role at the early stages of atherosclerosis process and of borderline hypertension as well. Aim of this study was to investigate the presence of AECA in patients (pts) with MH and to compare the AECA title among pts with MH and healthy normotensives (HN), matched for age, sex and body mass index. METHODS: One hundred-thirty (60 M, 70 F) healthy subjects mean age 45+/-12 yrs who had clinic blood pressure <140/90 mm Hg were studied. The whole study population underwent 24 hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 M, 16 F) had MH (daytime systolic blood pressure >/=135 mm Hg or daytime diastolic blood pressure >/=85 mm Hg - group A) and the remainder 106 subjects (52 M, 54 F) had normal ABPM recordings, group B. IgG and IgM AECA levels were determined by ELISA method. AECA levels were expressed as mean value+/-SD. None of the study population had a history of connective tissue disease or any metabolic disorder. RESULTS: Significantly increased titles of AECA class IgG were found in 8/24 pts of group A (30%) vs. 5/106 (4.6%) of group B (p<0,001). Significantly increased titles of AECA class IgM were also found in 6/24 pts of group A (25%) vs. 3/80 (3.8%) of group B (p<0,001). CONCLUSIONS: Our results suggest that patients with MH have significantly higher AECA levels of both classes (IgG, IgM) compared to healthy normotensives. These findings may indicate a possible explanation of the increased cardiovascular risk in MH. The possibility that high AECA levels may be a driving mechanism for the development of MH needs further investigation.