Major amputation of lower extremity: prognostic value of positive bone biopsy cultures.

BACKGROUND: To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated. MATERIALS AND METHODS: We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009. RESULTS: Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03). CONCLUSION: Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event. LEVEL OF EVIDENCE: Study level IV: retrospective observationnal study.

Incidence of and risk factors for severe liver toxicity in HIV-infected patients on anti-tuberculosis treatment.

OBJECTIVE: To assess the incidence and risk factors for severe liver toxicity in human immunodeficiency virus (HIV) infected patients on anti-tuberculosis treatment and the impact of patients' characteristics and concomitant medications instituted during the first week of antituberculosis treatment. METHODS: HIV-infected patients referred to six French hospitals between 1 January 1992 and 31 December 2004, with confirmed or 'presumptive' tuberculosis (TB). Liver toxicity was studied during the first 2 months of TB treatment. RESULTS: During the 12 years of the study period, 144 patients were enrolled. Severe liver toxicity developed in 15 (10.7%). The median time to development of liver toxicity was 14 days. In the univariate analysis, high baseline bilirubin levels (P = 0.004), CD4 cell counts between 50 and 100 cells/mm3 (P = 0.022) and the use of fluconazole (P = 0.0005) were associated with liver toxicity. In the multivariate analysis, independent risk factors were abnormal baseline alanine aminotransferase (ALT) (P = 0.028) and bilirubin levels (P = 0.033) and the use of fluconazole (P = 0.008). CONCLUSION: Severe liver toxicity is frequent, and occurs early in the course of anti-tuberculosis treatment. ALT and bilirubin levels should be closely monitored during the first month of treatment, especially in patients with high baseline ALT or bilirubin levels. We suggest caution when prescribing fluconazole and anti-tuberculosis drugs concomitantly, although this needs to be confirmed and further investigated.

[Surveillance of animal and human rabies in Lithuania from 1991 to 2001]. / Surveillance de la rage animale et humaine en Lituanie de 1991 à 2001.

OBJECTIVE: The objective of this study was to assess the epidemiology of rabies in Lithuania from 1991 to 2000. MATERIALS AND METHODS: Data available from the reports of the Lithuanian State Food and Veterinary Service, of the Public Health centers, of the Veterinary Laboratories of counties, districts and cities, and from the reports of the Lithuanian Ministry of Agriculture and the Environment Protection Department were used to assess rabies both in domestic animals and wildlife. The situation of human rabies from 1991 to 2000 was evaluated using the medical records of patients with a diagnosis of rabies and the epidemiological follow-up of people receiving post-exposure treatment. RESULTS: From 1991 to 2000, 2,148 laboratories confirmed cases of rabies were diagnosed in animals in Lithuania. Domestic animals accounted for 44% of all cases whereas wild animals accounted for 56% of the cases. During the 10-year period of investigation, 5 human cases were reported and 44,710 bitten persons received post-exposure treatment. COMMENTS: A high incidence of rabies in wild animals in Lithuania had a direct influence on the increase human rabies infection. It is necessary to improve preventive measures against rabies - vaccination of domestic and wild animals, and spread information on rabies to the general public.

Valacyclovir in the treatment of facial herpes simplex virus infection.

The objective of this multicenter, randomized, double-blind, noninferiority trial was to investigate valacyclovir as treatment for facial herpes simplex virus (HSV) outbreaks. In total, 308 otherwise healthy outpatients self-initiated therapy with valacyclovir, either 1000 mg twice daily for 1 day or 500 mg twice daily for 3 days, for treatment of one facial HSV episode. Aborted lesions were the primary end point. Secondary end points included episode and pain resolution and lesion healing. By regimen (1 or 3 days), aborted lesions occurred in 42.2% versus 46.7% of patients, treatment difference, -4.5% (95% confidence interval, -16.3% to 7.4%; P=.49). Subgroup findings showed that about half the episodes aborted when therapy started during the prodrome/macule stages or within 6 h of first symptoms. Episode and pain resolved rapidly, with results similar for both treatments. Adverse events were infrequent and similar for the two regimens.

Prevalence of tick-borne-encephalitis virus antibodies in Lithuania.

BACKGROUND: Clinical infections caused by tick-borne encephalitis virus (TBEV) are quite common in Lithuania and cause significant disease burden not only as acute cases but as chronic sequealeae as well. In order to evaluate the spread of the disease and risk factors, a population based seroprevalence study was done. MATERIAL AND METHODS: about 1488 serum samples collected from healthy people from different parts of the country during the year 2000 were studied by hemagglutination inhibition (HI) method. For risk factor analysis detailed information was collected by a questionnaire. RESULTS: 44 samples (2.96%) were positive. This indicates that at least 1500 infections occur in the country annually. Seropositivity did not increase with increasing age. In certain areas, seropositivity was clearly higher than the average. Other living conditions or outdoor habits correlated poorly with seropositivity. Certain groups of people such as farmers, cattle breeders, or those having a summer cottage or spending time in the nature daily had increased risk. Seropositivity was significantly linked with meningoencephalitis without laboratory confirmation for TBE in the anamnesis, and drinking of goat milk. CONCLUSION: The study suggests that TBEV is prevalent in Lithuania. The data also supports the view that an increase in the incidence has occurred in the 1990s. The correlation between seropositivity and presumed risk factors do not seem strong enough to warrant a selective vaccination policy based on risk factors.

Tick-borne encephalitis virus in Lithuania.

Tick-borne encephalitis (TBE) is a severe problem in Lithuania, indicated by the 171 to 645 serologically confirmed cases that occurred each year between 1993 and 1999. In the present report, the first isolation and partial genetic analysis of a Lithuanian TBE virus (TBEV) strain isolated from a patient's serum sample is described. The patient was bitten by a tick while visiting the Lazdijai district (Veisiejai forest) in the southernmost part of Lithuania, a geographical area where Ixodes ricinus but not Ixodes persulcatus ticks are known to be present. The E protein-encoding viral gene sequence (nt 74-1273) recovered from the TBEV isolate showed the closest similarity to previously characterized European strains of the Western TBEV subtype, including the prototype TBEV strain Neudoerfl and those from neighbouring Latvia. Accordingly, the Lithuanian isolate was placed within the Western genetic lineage of TBEV in phylogenetic trees.