Aim: To investigate whether the serum levels of interleukin‐1β, 6, 8, tumour necrosis factor‐α and the soluble receptor of IL‐2 are useful in the diagnosis of neonatal sepsis, and whether their diagnostic power is increased when in combination with classical markers such as C‐reactive protein and white blood cell count. Methods: Blood samples were collected at admission from 40 neonates with suspected infection. Patients were included in different groups according to the bacteriological and laboratory results: Group I consisted of 20 newborns with positive blood cultures and other biological tests suggestive of infection. Group II included 20 neonates with negative blood cultures and biological tests not suggestive of infection. The control group included 20 healthy neonates with no clinical or biological data of infection. Results: Mean values of C‐reactive protein were significantly higher in Group I. No differences were found between the groups for white blood cell count, with the exception of the presence of leucocytosis in Group II. Levels of interleukin‐1β, 6, 8, tumour necrosis factor‐α, soluble receptor of interleukin‐2, and C‐reactive protein were significantly higher in infected neonates than in the control groups. Detection sensitivity and specificity were 80 and 92% for C‐reactive protein, 60 and 87% for interleukin‐1β, 61 and 80% for interleukin‐6, 62 and 96% for interleukin‐8, 54 and 92% for tumour necrosis factor‐α and 63 and 94% for soluble receptor of interleukin‐2. The discriminant analysis showed that the best combination for sepsis diagnosis was C‐reactive protein + interleukin‐8 + soluble receptor of interleukin‐2, with a sensitivity of 85% and a specificity of 97.1%. Conclusion: Our study suggests that no individual test can on its own identify infected neonates, and that although the combination of C‐reactive protein, interleukin‐8 and the soluble receptor of interleukin‐2 exhibits a high specificity, its sensitivity is limited.
An epidemiological, multicenter, noninterventional, observational case-control study was conducted to describe the performance of serum beta-d-glucan (BDG) and Candida PCR in blood, serum, and sterile samples for the diagnosis of invasive candidiasis (IC) in very-low-birth-weight (VLBW) preterm neonates and to compare these techniques with culture of samples from blood and other sterile sites. Seventeen centers participated in the study, and the number of episodes analyzed was 159. A total of 9 episodes of IC from 9 patients (7 confirmed and 2 probable) and 150 episodes of suspected sepsis from 117 controls were identified. The prevalence of IC was 5.7% (95% confidence interval [95% CI], 2.1 to 9.3). The mortality was significantly higher in episodes of IC (44.4%) than in the non-IC episodes (11.1%, P < 0.01). The sensitivity and specificity of the PCR performed on blood/serum samples were 87.5% and 81.6%, respectively. The sensitivity and specificity of the BDG results were lower (75.0% and 64.6%). For cases with negative culture results, the PCR and the BDG results were positive in 27 (17.4%) and 52 (33.5%) episodes, respectively. The presence of multiorgan failure, improvement with empirical antifungal therapy, thrombocytopenia, and Candida colonization were significantly associated (P < 0.01) with PCR or BDG positivity regardless of the results of the cultures. Serum BDG analysis and Candida PCR could be used as complementary diagnostic techniques to detect IC in VLBW neonates.
Congenital leukemia is a rare disease with particular biological and clinical characteristics which differs from those of older children and adults. Here, we describe two cases of congenital acute lymphoblastic leukemia in two newborns with different clinical presentations (leukemia cutis vs. splenomegaly and respiratory distress) and fatal outcome. Both cases shared the expression of myeloid antigens (CD65) and cytogenetic disorders involving the MLL gene (location 11q23) which are associated to extremely poor prognosis.
AMALE TERM NEWBORN OF A 22-YEAR-OLD primiparous woman, born after an uneventful pregnancy via normal vaginal delivery (Apgar scores of 9 and 10 at 1 and 5 minutes), birth weight of 3220 g, was admitted to the Neonatology Unit because of a generalized cutaneous eruption and leukocytosis with left shift during the first few hours of life. Other concurrent systemic symptoms were not detected. A hemogram showed 20.4 ϫ 10 3 leukocytes/µL (60% of neutrophils). Findings from conventional biochemistry, thorax irradiation, blood cultures, and cerebral spinal fluid culture were normal. Alterations of the placenta and the umbilical cord were not recorded. After taking samples for hemocultures, the patient was empirically treated with cefotaxime sodium (150 mg intravenously for 12 hours) and vancomycin hydrochloride (30 mg intravenously for 8 hours), which were discontinued because of negative results. Physical examination revealed a healthy newborn with an erythematous cutaneous rash on the trunk (Figure 1), scalp, and extremities, with palmoplantar involvement and showing a number of vesicles and disseminated pustules, as well as desquamation (Figure 2).Mucosal involvement was not observed. Two weeks after the rash disappeared, the infant developed ungual lesions in all of the fingers of both hands, which consisted of yellow-brownish-colored proximal and medial dystrophic lesions with mild paronychia (Figure 3). The mother had a history of frequent recurrent vulvovaginitis, although postdelivery gynecological exploration findings were normal. Skin biopsy of one of the lesions was performed and samples were collected from pustules for a Gram stain, potassium hydroxide test, and culture.
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