Serum procalcitonin has the potential to identify Staphylococcus aureus endocarditis.

The role of procalcitonin (PCT) in the diagnosis of infective endocarditis (IE) remains unclear. The aim of our study was to test the accuracy of PCT in the early diagnosis of IE and analyse if the accuracy of PCT is dependent on the type of pathogen causing IE. We carried out a prospective analysis of hospitalised patients referred for transthoracic echocardiography to search for an IE. The plasma PCT value was measured at the time of echocardiography. The diagnosis of IE was made using the modified Duke criteria. A total of 77 patients were included. IE was confirmed in 15 patients. The mean PCT values were 6.9 (+/-21.6) ug/l in patients without IE and 6.4 (+/-11.7) ug/l in patients with confirmed IE (p=0.92). IE patients with Staphylococcus aureus bacteraemia (n=7) had significantly higher PCT values compared to IE patients with other types of bacteraemia (n=8) (13.1 vs. 0.435, p=0.0299). This study demonstrates that PCT levels markedly differ at the time when IE is diagnosed. While PCT values are very high in patients with S. aureus bacteraemia, they are surprisingly low in patients with Streptococcus viridans bacteraemia, which are common offenders of endocarditis. We conclude that serum PCT has the potential to be used in the early diagnosis of S. aureus endocarditis.

Concentric visual field restriction under vigabatrin therapy: extent depends on the duration of drug intake.

Vigabatrin (VGB) is a novel antiepileptic drug which inhibits GABA-transaminase (GABA-T) and thus increases the level of GABA in the CNS and in its neurons. In the last few years, evidence has been presented that VGB intake may be associated with concentric visual field restrictions. The aim of this study was to estimate the prevalence of visual field constrictions and to determine if, and to what extent, they depend on the duration of VGB treatment. Visual fields of 15 patients who were taking VGB, and 12 matched control patients who had never been exposed to VGB, were investigated using a kinetic Goldmann perimeter. One of the 12 matched control patients had a slightly restricted visual field whereas nine of the 15 VGB patients (60%) showed a moderate to severe concentric visual field restriction. The extent of the outer isopters (V4, I4, I3, I2) depended on the duration of VGB intake. VGB treatment was clearly associated with a high prevalence of concentric visual field restriction. Moreover, the degree of visual field restriction depended on the duration of VGB intake. Further work, including longitudinal studies, is needed to clarify whether these lesions are reversible or not.