The co-infection of malaria, dengue fever, and COVID-19 is rarely described in Sub-Saharan Africa, yet the overlapping clinical and biological features of these diseases pose a significant diagnostic challenge in endemic areas. We report the case of a 36-year-old woman requiring admission to the intensive care unit in Burkina Faso with acute respiratory distress. She presented with a triple co-infection of Plasmodium falciparum malaria, dengue fever (DEN3 serotype), and COVID-19, complicated by sepsis and multiple organ dysfunction. The patient exhibited severe hypoxemia, hepatic dysfunction (cytolysis and cholestasis), and a SOFA score of 7. Initial diagnosis focused on malaria and dengue, leading to a 10-day delay in the diagnosis of COVID-19. This case underscores the diagnostic complexity of triple co-infection in Sub-Saharan Africa. The diagnosis of COVID-19 was delayed due to the overlapping signs of malaria and dengue fever. Each disease should be assessed systematically in the context of any infectious presentation in this region, especially during the rainy season, as symptoms and biological parameters are not discriminatory. We advocate for the systematic use of multiplex PCR testing to ensure early and accurate diagnosis.
Background: Acute myocarditis is an inflammatory disorder of the myocardium that can lead to severe cardiac dysfunction, arising from a broad spectrum of infectious and noninfec-tious etiologies. Ankylosing spondylitis, which primarily affects the axial skeleton, can involve the heart due to its systemic inflammatory nature, occasionally resulting in severe complications such as myocarditis. Case Presentation: We report an unusual case of acute myocarditis in a 49year-old male with an-kylosing spondylitis presenting with chest pain and systemic inflammatory symptoms. Diagnostic workup using the 2018 Lake Louise Criteria among cardiac MRI confirmed myocarditis in the absence of coronary artery disease or infectious etiology. The patient also demonstrated extra-articular manifestations with pulmonary and ocular involvement, consistent with an active anky-losing spondylitis flare. Management combined beta blockers, physical activity restriction, and re-introduction of anti-TNF alpha therapy, leading to both clinical and biological improvement. Conclusion: Acute myocarditis represents a rare yet severe cardiac manifestation of ankylosing spondylitis, requiring a high clinical suspicion to prevent heart failure and dilated cardiomyopathy.
Rheumatoid arthritis (RA) is commonly treated with Janus kinase inhibitors (JAKis) and anti-tumor necrosis factor-α (anti-TNFα), but the cardiovascular safety profiles of these drugs remain unclear. The aim of this study was to describe the individual case safety reports of major adverse cardiac events (MACE) or stroke and to determine whether there was a difference in the frequency of reporting of cardiovascular events between JAKis and anti-TNFα used in RA. A case/non-case study was conducted using the WHO VigiBase® database. Descriptive analysis was performed, the time to onset (TTO) of MACE was calculated, and the reporting odds ratio (ROR) was used to estimate the frequency of MACE reports associated with JAKis versus anti-TNFα in RA. A total of 18,099 cases of MACE were identified, of which 2543 (14
Multiplex polymerase chain reaction (mPCR) testing has the potential to rapidly and accurately identify causative microorganisms in patients with community-acquired pneumonia (CAP). Its use in a management strategy, along with biomarkers, may reduce antibiotic exposure and improve clinical outcomes. The MULTI-CAP trial was a multicenter (n = 20), parallel-group, superiority, open-label, randomized trial. Subjects were non-immunocompromised adult patients (≥ 18 years) admitted to the intensive care unit (ICU) for CAP and randomly assigned in a 1:1 ratio. In the intervention group, the microbiological diagnosis combined a broad-spectrum respiratory mPCR and conventional microbiological investigations. An algorithm for early discontinuation or de-escalation of antibiotics was applied, based on mPCR results and serum procalcitonin. In the control group, only conventional microbiological investigations were performed. In both groups, antibiotic discontinuation was considered on Day 3 and day after day until Day 7, based on procalcitonin values and kinetics. The primary endpoint was defined as the number of days alive without any antibiotic from the time of enrollment to Day 28. From October 4, 2018, to March 3, 2022, 406 patients were randomized, and 385 were evaluable in the intention-to-treat analysis. The median number of days alive without antibiotics on Day 28 was 19.0 (0.0; 24.0) days in the intervention group and 19.0 (7.0; 22.0) days in the control group (difference, 0.0 (95
BACKGROUND:Preliminary reports suggest interim positron emission tomography (PET) could drive treatment duration in limited-stage diffuse large B-cell lymphoma (DLBCL). This phase III randomized study in first-line therapy for DLBCL patients with adjusted-age international prognostic index (aaIPI) risk = 0, evaluates an experimental PET-response adapted approach using PET response after two cycles of R-CHOP to de-escalate treatment duration. PATIENTS AND METHODS:LNH2009-1B study is a two-arm, open-label, multicenter, prospective, randomized phase III noninferiority trial, evaluating treatment de-escalation based on PET after two cycles of R-CHOP in previously untreated DLBCL patients aged 18-80 years, with aaIPI = 0. In the experimental PET-adapted arm, patients with a negative PET after two cycles received four cycles in total of R-CHOP, whereas those with a positive PET after two cycles received a total of six cycles. In the standard arm, treatment was six cycles regardless of PET results after two cycles. No radiotherapy was planned. The primary endpoint was 3 years progression-free survival (PFS). The primary analysis was carried out in the intention-to-treat population. The trial is registered with ClinicalTrial.gov, NCT01285765, recruitment is completed. RESULTS:A total of 650 patients were enrolled, of whom 319 were randomly assigned to the PET-adapted arm and 331 to the standard arm. In the PET-adapted arm, 77.7% of patients had a negative PET scan after two cycles and received a total of four cycles of R-CHOP. The 3-year PFS in PET-adapted and standard arms were 92.0% [95% confidence interval (CI) 88.3% to 94.5%] and 89.2% (95% CI 85.3% to 92.2%), respectively (P value = 0.070). The noninferiority of the experimental PET-adapted arm was demonstrated (hazard ratio 0.72, 95% CI 0.47-1.12, P value < 0.0001). Patients in the PET-adapted arm had fewer adverse events of grades ≥3 (54.7% versus 62.7%, P = 0.046) and serious adverse events (9.5% versus 14.2%, P = 0.039). CONCLUSION:A risk-adapted approach using early PET after two cycles of R-CHOP was beneficial, minimizing toxicity without compromising efficacy in patients treated in first-line therapy for low-risk DLBCL.
