Nederlands tijdschrift voor geneeskunde
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Better use of current antibiotics is warranted to curb increasing antimicrobial resistance rates. Procalcitonin guidance can safely reduce antibiotic usage when used to initiate or discontinue antibiotics in adult patients with a respiratory tract infection. However, the claimed reductions in antibiotic usage are mainly achieved in patients with acute bronchitis and exacerbations of COPD, conditions for which guidelines already discourage antibiotic treatment. ⋯ Determination of the aetiology of community-acquired pneumonia is an important clinical problem. Host gene expression pattern assays are promising for diagnosis of the aetiology of acute respiratory illness. This might be helpful to guide antibiotic therapy.
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Antibiotic resistance is considered a major threat to healthcare. The Dutch government recently announced additional measures to contain this threat, one of these being the creation of regional care networks dedicated to control antibiotic resistance. ⋯ Although scientific data do not support that claim, it is nevertheless likely that the planned investigations will identify yet unknown clusters of ESBL-carriers, necessitating infection control measures. Given the absence of an acute problem and the consequences for nursing home management, staff and clients of point-prevalence surveillance studies, a staged approach for investigating antibiotic resistance in nursing homes should be considered.
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Pyomyositis is a rare bacterial infection of striated muscle, usually caused by Staphylococcus aureus. ⋯ This specific type of pyomyositis in the hip is rare, especially in children. Being able to localise the pain with one finger is a typical characteristic of this condition. MRI is the investigation of first choice to confirm this diagnosis.
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Case Reports
[A pregnant patient with spontaneous haemothorax: hereditary haemorrhagic telangiectasia in pregnancy].
The incidence of hereditary haemorrhagic telangiectasia (HHT - Osler-Weber-Rendu disease) in the Netherlands is 1:5000 but approximately 1:1300 in people from the Antilles. The disease is characterised by the development of telangiectasia and arteriovenous malformations (AVMs) that may result in serious morbidity and mortality. ⋯ Pregnant patients with HHT are at risk of serious morbidity, especially if they are not screened for AVMs. A multidisciplinary approach for such patients, with consideration of various scenarios, is highly recommended.
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Case Reports
[No hair loss, but colitis or pneumonitis: unique side effects of immune checkpoint inhibitors for cancer].
Immunotherapy with checkpoint inhibitors is an effective strategy for several cancers. In some patients long-term remissions are seen. However, enhancement of the immune response can be accompanied by immune-related adverse events (irAEs). ⋯ Early diagnosis and adequate team management can improve the course of irAEs without compromising the cancer treatment. Here, we present two cases: a melanoma patient with an ipilimumab-induced colitis and a lung cancer patient with pneumonitis after anti-PD-1. We then summarise the most common toxicities of checkpoint inhibitors, emphasising the need to familiarise the practitioner with irAEs of approved and emerging immunotherapies.