Jean-Baptiste Giot

Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients.

Objectives: To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. Design: Single-center, prospective, randomized controlled study. Setting: Five intensive care units from a tertiary teaching hospital. Patients: All consecutive adult patients hospitalized for > 48 hrs in the intensive care unit during a 9-month period. Interventions: Procalcitonin serum level was obtained for all consecutive patients suspected of developing infection either on admission or during intensive care unit stay. The use of antibiotics was more or less strongly discouraged or recommended according to the Muller classification. Patients were randomized into two groups: one using the procalcitonin results (procalcitonin group) and one being blinded to the procalcitonin results (control group). The primary end point was the reduction of antibiotic use expressed as a proportion of treatment days and of daily defined dose per 100 intensive care unit days using a procalcitonin-guided approach. Secondary end points included: a posteriori assessment of the accuracy of the infectious diagnosis when using procalcitonin in the intensive care unit and of the diagnostic concordance between the intensive care unit physician and the infectious-disease specialist. Measurements and Main Results: There were 258 patients in the procalcitonin group and 251 patients in the control group. A significantly higher amount of withheld treatment was observed in the procalcitonin group of patients classified by the intensive care unit clinicians as having possible infection. This, however, did not result in a reduction of antibiotic consumption. The treatment days represented 62.6 ± 34.4% and 57.7 ± 34.4% of the intensive care unit stays in the procalcitonin and control groups, respectively (p = .11). According to the infectious-disease specialist, 33.8% of the cases in which no infection was confirmed, had a procalcitonin value >1µg/L and 14.9% of the cases with confirmed infection had procalcitonin levels <0.25 µg/L. The ability of procalcitonin to differentiate between certain or probable infection and possible or no infection, upon initiation of antibiotic treatment was low, as confirmed by the receiving operating curve analysis (area under the curve = 0.69). Finally, procalcitonin did not help improve concordance between the diagnostic confidence of the infectious-disease specialist and the ICU physician. Conclusions: Procalcitonin measuring for the initiation of antimicrobials did not appear to be helpful in a strategy aiming at decreasing the antibiotic consumption in intensive care unit patients.

Fatal Alveolar Echinococcosis of the Lumbar Spine

ABSTRACT For the last 10 years, the southern part of Belgium has been recognized as a low-risk area of endemicity for alveolar echinococcosis. This infection, caused by Echinococcus multilocularis, usually induces a severe liver condition and can sometimes spread to other organs. However, alveolar echinococcosis involving bones has been described only very rarely. Here, a fatal case of spondylodiscitis due to E. multilocularis contracted in southern Belgium is reported.

A pauci-symptomatic case of documented Hantavirus (Puumala) infection in a patient under anti-TNF treatment

We describe the case of an 18-yr-old male under anti-TNF treatment for Crohns disease for more than 8 months. He developed fever and biological inflammatory syndrome without absolutely no accompanying sign or symptom or paraclinical abnormality despite extensive work-up performed in the context of his immunocompromised state. Symptoms disappeared after 10 days and a diagnosis of Puumala infection was made retrospectively on a serological basis. The case illustrates that anti-TNF treatment does not worsen the course of Puumala infection and could even be associated with a milder clinical picture.

Autoimmune Angioneurotic Edema in a Patient with Helicobacter pylori Infection

Association of acquired autoimmune angioneurotic edema with other diseases is increasing. However, the precise mechanism by which antibodies to C1‐esterase inhibitor (C1‐INH) are produced, is not elucidated. We describe a patient with IgA antibodies against C1‐INH without other autoimmune markers. Our patient had gastritis and Helicobacter pylori infection, proven by biopsy. This case suggests that H. pylori infection can act as triggering factor for acquired autoimmune angioneurotic edema.

Factors associated with late presentation for HIV care in a single Belgian reference center: 2006–2017

Late presentation for HIV care is a major issue and the cause of higher morbidity, mortality and transmission. In this regard, we analyzed the characteristics of patients presenting for care at our center from January 2006 to July 2017 (n = 687). The majority of the studied population was of African origin (54.3%) with heterosexual women representing the main group (n = 292; 42.5%). 44% of the patients were late presenters (LP) (presenting for care with CD4 T cells <350/mm3 or an AIDS defining event) and 24% were late presenters with advanced disease (LP-AD) (presenting for care with CD4 T cells <200/mm3 or an AIDS defining event). A very high risk of being LP and LP-AD was associated with Sub-Saharan origin (OR 3.4 and 2.6 respectively). Other factors independently associated with LP or LP-AD were age (OR 1.3), male gender (OR 2.0 and 1.5 respectively) and heterosexual route of transmission (OR 2.4 and 2.3 respectively). A significant increase in HIV screening without forgetting those groups would contribute to earlier HIV diagnosis, a key element to end the HIV epidemic. To achieve this goal, addressing the specific hurdles to HIV testing in the migrant population is critical.

Alveolar echinococcosis in southern Belgium: retrospective experience of a tertiary center.

Dear Editor, Alveolar Echinococcosis (EA) is a zoonosis due to the larval stage of the fox tapeworm Echinococcus multilocuris. Humans are dead-end hosts and are exposed through sylvatic (fox) or domestic (cat and dog) cycles. Infection is acquired through the fecal-oral route. The metacestodes of E. multilocularis proliferate in the liver, inducing a Btumorlike^ lesion that can invade the neighboring organs or spread away from the primary lesion [1]. Until recently, Belgium was considered as a low-risk country for AE. However, in 2008, Hanosset et al. demonstrated by necropsies of red foxes (Vulpes vulpes), a prevalence of AE at up to 60% in some parts of Wallonia, the Southern part of Belgium [2]. The first indigenous Belgian human AE case was diagnosed in 1999 at the Centre Hospitalier Universitaire (CHU) of Liege, a tertiary university hospital in Wallonia [3]. Since this first case, other patients have been diagnosed with EA and managed by the different departments of the CHU Liege [4]. The aim of this study was to evaluate the overall experience and results of the different teams of the CHU Liege with AE and to better determine the number of indigenous AE cases to provide this information to authorities in charge of public health. After University Hospital Ethical committee approval, the authors retrospectively collecteddata from the laboratoryof clinical microbiology (for Echinococcus serologies and PCR), the hospital pharmacy in charge of supplying albendazole, and by searching through patient files from themedico-economic informationservice. Informationwascollectedfrom1999toFebruary 2018. Belgian regulations do not require patient informed consent for a purely retrospective review of medical files. Between 1999 and February 2018, a total of 22 human indigenous AE cases were recorded and their medical files were studied. In all cases, the diagnosis was established based on Echinococcus sp. serology (inhibition of hemagglutination (Fumouze, France), ELISA specific for E. granulosus (Rbiopharm, Germany) and E. multilocularis (Bordier, Suisse) respectively and Western Blot), clinical imaging, histopathology and in some cases an E. multilocularis specific PCR assay on tissue [5]. According to the criteria of Brunetti et al. [1], 11 possible and 11 confirmed cases were diagnosed. The mean age of the patients at the time of diagnosis was 69 years (ranges: 34–85 years). Sixty-four percent of the patients were male. Some degree of immunosuppression could be identified in 36% of cases (solid or hematologic cancers, chronic inflammatory disease, diabetes, and chronic alcoholism). At least one of the risk factors described by Conraths et al. [6] (owning a dog and/or a cat, living in a rural zone, working as farmer, or forestry worker) was identified in all patients but one (data are missing). Patients lived in rural * Audrey Cambier au.cambier@gmail.com

Campylobacter coli meningitis in a 57-year-old patient

Abstract Campylobacter coli is a major pathogen rarely responsible for extra-intestinal infections. We report a case of Campylobacter coli bacteremia and meningitis in a 57-year-old immunocompetent Belgian man. The strain, isolated from cerebrospinal fluid, belonged to the unusual sequence type 8418 (ST8418). The patient fully recovered after meropenem treatment.

Hepatic alveolar echinococcosis.

Olivier Detry, Nicolas Meurisse, Jean Delwaide, Jean-Baptiste Giot, Philippe Leonard, Bertrand Losson, Marie-Pierre Hayette, Noella Bletard, Paul Meunier and Pierre Honor e Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium; Multidisciplinary Unit for Echinococcosis Management and Research of the University of Liege (Echino-Liege), University of Liege, Liege, Belgium; Department of Hepatogastroenterology, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium; Department of Infectious diseases, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium; Laboratory of Parasitology and Pathology of Parasitic Diseases, Faculty of Veterinary Medicine, University of Liege (ULg), Liege, Belgium; Department of Microbiology, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium; Department of Pathology, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium; Department of Radiology, CHU Liege, University of Liege (CHU-ULg), Liege, Belgium