F. Smaoui

Elevated Neutrophil-to-Lymphocyte Ratio is an Effective Prognosis Indicator In Extra-Pulmonary Tuberculosis

Abstract Background Extra-pulmonary tuberculosis (EPT) may lead to serious outcomes in the absence of an adequate treatment. Factors related to poor prognosis (PP) are still insufficiently understood. The peripheral blood neutrophil to lymphocyte ratio (NLR) has been reported to correlate with the prognosis of many acute or chronic infectious diseases. In this perspective, we aimed to investigate the prognostic relevance of NLR in EPT patients. Methods Data were collected from EPT patients, diagnosed between 1990 and 2014. We defined a PP by the occurrence of clinical complications during the hospital-stay or the follow-up. We evaluated the performance of NLR in identifying PP. The Kaplan-Meier method was used to generate complication-free survival curves which were compared by Log rank test according to NLR categories. Cox proportional hazard regression analysis was used to reveal the independent prognostic factors. Results We included 265 patients with EPT among them 68 cases (25.7%) had a PP. The mean age was 42 ± 19.2 years. Sex ratio was 0.8. EPT incriminated lymph node in 95 cases (35.8%), neuromeningeal sites in 50 cases (19%) and bones in 42 cases (15.8%). Mean value of NLR was significantly higher in the PP group (4.5 ± 3 vs. 3.2 ± 2.5; P = 0.01). NLR had an Area Under the Receiving Operating Curve (AUROC) of 0.63 in predicting PP (P = 0.004). At an optimal cutoff of 2.7, sensitivity and specificity were of 60%. There were 128 cases (48.3%) with a high NLR (≥ 2.7). Positive predictive value of NLR was 67.2% while negative predictive value achieved 80%. Overall, the median complication-free survival was 33 days (CI95% 19.2–46.7). When stratified by NLR cutoff, survival curve analysis showed that the one-month complication-free survival rate was lower in patients with high NLR (45% vs. 55%; P = 0.042). In multivariate Cox regression analysis, high NLR was an independent risk factor of predicting PP in EPT patients (HR=1.7; CI95% 1.1–2.9; P = 0.048). Conclusion In this study, NLR was a useful prognostic factor to predict complications in patients with EPT and may be applied in clinical management of EPT in association with other prognostic indicators in order to identify high-risk patients. Disclosures All authors: No reported disclosures.

APRI Score as a Predictor of Significant Liver Fibrosis in Chronic Hepatitis B

Abstract Background Chronic hepatitis B (CHB) is a global public health problem. Histologic staging of liver fibrosis is crucial to identify patients who need antiviral treatment. As an alternative to percutaneous liver biopsy (PLB), Aminotransferase Platelet Ratio index (APRI) score was recently validated by the WHO. We aimed to evaluate the performance of APRI score in predicting significant fibrosis (SF) in patients with CHB. Methods We conducted a retrospective study including 179 patients aged ≥ 15 years with documented CHB and who underwent a PLB during the period 2008-2016. A SF was defined according to Metavir score (≥ F2). ROC curves assessed the performance of APRI score in predicting SF. We estimated PLB cost of 60 Dollars in our institution. Results Mean age of patients was 37.6 ± 10 years and sex ratio was 1.48. There were 93 patients with SF (52%) who had a high level of aspartate aminotransferase (ASAT) (71.4 ± 38 vs. 34 ± 16 IU/L; P < 0.001) but a low level of platelet count (195 ± 53 vs. 208 ± 52 G/L; P = 0.04). APRI score was significantly higher in patients with SF (1.1 ± 0.7 vs. 0.48 ± 0.26; P < 0.001). Multivariate analysis using logistic regression showed that only APRI score was independently predictive of a SF (HR = 3.78, CI95% 1.23-11.6; P = 0.02). APRI predicted accurately SF with an Area Under the Receiving Operating Curve (AUROC) of 0.7 (CI 95% 0.62–0.77; P < 0.001). At a threshold of 0.5, APRI had a sensitivity of 62%, a specificity of 68%, a positive predictive value of 64.4% and a negative predictive value of 60.7%. The number of avoided PLB with APRI score was 112 PLB with a diagnostic accuracy of 62.5%. Subsequently, the saved cost was estimated to be around 6720 Dollars. Conclusion APRI score was well performing in predicting SF in patients with CHB. This could be of paramount importance particularly in developing countries given that this non-invasive score may help to assess liver fibrosis in CHB. Larger scale and analytic prospective studies are required in order to strengthen the accuracy of this score. Disclosures All authors: No reported disclosures.

Une cause inhabituelle de céphalées

A 64 year old woman presented to the emergency department with a history of sudden onset severe generalised headache after waking, associated with nausea. She had no medical history. On examination, the pain had not eased but she appeared alert with no other discernible features. She underwent a computed tomography scan of the head (fig 1). What is the diagnosis, and are further investigations warranted?

H-07: Les formes neurologiques de la rickettsiose

Introduction – objectifs Les formes severes de la rickettsiose representent 6 a 10 % avec une mortalite de 32 %. L’atteinte neurologique constitue 28 % des formes graves avec un pronostic reserve. Le but etait d’evaluer la frequence des formes neurologiques de la rickettsiose et decrire leurs aspects cliniques et therapeutiques. Materiels et methodes Etude retrospective realisee entre 1990 et 2013. Les patients inclus avaient une atteinte neurologique et une rickettsiose confirmee serologiquement. Resultats Parmi 403 cas de rickettsiose, 26 avaient une atteinte neurologique (6 %) avec un âge median de 51,5 ans. Le delai moyen de consultation etait de 8,3 jours. La fievre (100 %) et les cephalees (69 %) etaient les principaux signes fonctionnels. A l’examen, le syndrome meninge etait predominant (76 %) suivi de confusion (30 %) et autres signes psychiatriques (15 %). Une eruption caracteristique etait presente dans 61 %. L’escarre d’inoculation etait trouvee chez 2 patients. L’atteinte neurologique se resumait a une meningite (11 cas), une meningo-encephalite (8 cas), une encephalite isolee (4 cas), une cerebellite (1 cas), une atteinte du nerf VIII (1 cas) et une hemorragie meningee (1 cas). Une meningite lymphocytaire normoglycorachique et normoproteinorachique etait l’anomalie la plus frequente du LCR. La serologie de Rickettsia conorii etait positive dans 76 %. Le traitement de premiere intention etait une fluoroquinolone (61 %) et des phenicoles (34 %). La duree moyenne de traitement etait 17 jours. L’evolution etait favorable sans sequelles (19 cas), avec des sequelles psychiques (2 cas) et fatale (5 cas). Conclusion Les formes neurologiques de la rickettsiose sont de plus en plus frequentes. Leur tableau clinique est polymorphe. Elles sont graves et meritent une attention particuliere pour leur prise en charge clinique et therapeutique.

L-19: L’hydatidose osseuse extra vertébrale

Introduction – objectifs Le kyste hydatique constitue un probleme de sante public dans les zones endemiques. L’echinococcose osseuse est rare et ne represente que 0,9 a 2,5 % des localisations. Le but de notre travail etait de preciser les caracteristiques cliniques, therapeutiques et evolutives de l’hydatidose osseuse. Materiels et methodes Etude retrospective realise dans le service des Maladies Infectieuses entre 2002 et 2013. Le diagnostic positif reposait sur un faisceau d’arguments epidemiologiques, cliniques, biologiques et radiologiques. Resultats Il s’agissait de 4 femmes d’origine rurale et d’âge moyen de 35 ans. Le delai moyen du diagnostic etait 10 mois. Une patiente avait des antecedents d’hydatidose hepatique operee. Les plaintes fonctionnelles etait des douleurs osseuses (2 cas), myalgie (1 cas) et sciatalgie (1 cas). La serologie hydatique etait positive dans tous les cas. L’os atteint etait les cotes (2 cas), l’aile iliaque (1 cas) et le femur (1 cas). La radiologie (scanner ou imagerie par resonnance magnetique) montrait des masses kystiques (4 cas), une lyse osseuse (3 cas), un decollement de la corticale (1 cas) et un envahissement musculaire (2 cas). Des kystes extra osseux ont ete trouves au niveau pulmonaire (1 cas) et hepatique (1 cas). Une chirurgie etait realisee chez trois patientes suivie avec des cures d’albendazole. Aucune recidive n’a ete observee. Conclusion L’hydatidose osseuse est une affection rare qui pose des problemes therapeutiques en raison de la latence clinique et de la gravite de son pronostic lie au risque de recidive. L’exploration radiologique est essentielle au diagnostic. Le traitement est base sur l’association chirurgie-albendazole.