Brucellosis: a retrospective evaluation of 99 cases and review of brucellosis treatment

This retrospective study was performed in two university hospitals between January 2002 and 2006. Ninety-nine brucellosis patients were included in the study. These patients were classified as acute (91), chronic (4) and relapse (4) according to their clinical presentations and serological tests. Brucella bacteria were isolated in the blood of 17 (17.2%) cases. The most frequent symptom and clinical sign was fever. The osteoarticular complications were found in 17 patients (17.2%). Four of them were complicated with epidural abscess the same time. Two (2.2%) had meningitis, two (2.2%) had epididymoorchitis, three (3.3%) had skin rashes and one (1.1%) had hepatitis. Three of the acute brucellosis patients were pregnant. Rifampin and doxycycline combination therapy had been administered to most of the patients with acute and relapse brucellosis. However, complicated and chronic brucellosis cases were given different treatment combinations. This study reviews brucellosis therapy choices.     

Brucellosis: a lymphoma-like presentation

Brucellosis is one of the most common zoonotic infections worldwide caused by gram negative bacilli of the genus Brucella. It is transmitted to humans by contact with infected animals or derived food products such as unpasteurized milk. Brucellosis' clinical presentation varies widely from multi-systemic involvement to asymptomatic infection. We present the case of a 52-year-old Lebanese male who was admitted to our hospital with a 3-week history of fever(up to 40 °C), chills, night sweats and abdominal pain. Abdominal CT scan revealed the presence of several mesenteric lymphadenopathies and some retroperitoneal lymphadenopathies. Blood cultures came back positive for Brucella melitensis, and a follow-up CT of the abdomen done after treatment revealed complete resolution of the lymphadenopathies. To our knowledge, this is the first case in the literature of brucellosis presenting as retroperitoneal and mesenteric lymphadenopathies. In endemic areas, the diagnosis of brucellosis should always be raised in front of any long duration fever even in the absence of a typical clinical presentation.     

Computerized tomographic colonography: performance evaluation in a retrospective multicenter setting

BACKGROUND & AIMS: No multicenter study has been reported evaluating the performance and interobserver variability of computerized tomographic colonography. The aim of this study was to assess the accuracy of computerized tomographic colonography for detecting clinically important colorectal neoplasia (polyps >or=10 mm in diameter) in a multi-institutional study. METHODS: A retrospective study was developed from 341 patients who had computerized tomographic colonography and colonoscopy among 8 medical centers. Colonoscopy and pathology reports provided the standard. A random sample of 117 patients, stratified by criterion standard, was requested. Ninety-three patients were included (47% with polyps >or=10 mm; mean age, 62 years; 56% men; 84% white; 40% reported colorectal symptoms; 74% at increased risk for colorectal cancer). Eighteen radiologists blinded to the criterion standard interpreted computerized tomography colonography examinations, each using 2 of 3 different software display platforms. RESULTS: The average area under the receiver operating characteristic curve for identifying patients with at least 1 lesion >or=10 mm was 0.80 (95% lower confidence bound, 0.74). The average sensitivity and specificity were 75% (95% lower confidence bound, 68%) and 73% (95% lower confidence bound, 66%), respectively. Per-polyp sensitivity was 75%. A trend was observed for better performance with more observer experience. There was no difference in performance across software display platforms. CONCLUSIONS: Computerized tomographic colonography performance compared favorably with reported performance of fecal occult blood testing, flexible sigmoidoscopy, and barium enema. A prospective study evaluating the performance of computerized tomography colonography in a screening population is indicated.     

Amoebic liver abscess: a retrospective clinical evaluation of twenty-seven cases

Twenty-seven patients with Amobebic Liver Abscess were observed during the last two years and were analysed retrospectively with respect to diagnostic procedures and therapeutic strategies. Seven of the 27 patients had surgery and were subsequently referred to our hospital. Those patients with surgery had a longer duration of illness and hospitalization (3.3 months) compared to the other 20 patients with chemotherapy alone (2 months). Most important diagnostic parameters for extraintestinal amoebiasis were: typical clinical findings, time spent in tropical or subtropical countries, strongly positive Latex agglutination against Entamoeba histolytica antigen, and isotope and/or ultrasound scanning to confirm abscess formation in the liver. The vast majority of abscesses were found in the right liver lobe. Response to treatment with complete cure was seen in all patients, regardless of whether Metronidazole alone or combinations of Metronidazole with Chloroquine and Metronidazole and Dehydroemetine or Chloroquine and Dehydroemetine were used. There is a need for prospective therapeutic studies to compare the different drug regimen concerning side-effects, toxicity, costs, application, and duration of hospitalization. From the retrospective data it seems that surgery is not beneficial for the patients.     

The natural history of incidentally discovered adrenocortical adenomas: a retrospective evaluation

Adrenal adenoma is the most frequent lesion among adrenal incidentalomas. The present retrospective study was undertaken to investigate medium-term evolution of supposed or ascertained adrenocortical adenomas in a group of 53 subjects (16 males and 37 females, aged 31-83 yr), with bilateral (no.=8) or monolateral (no.=45) incidentally discovered adrenal masses (size 10-50 mm, median 25 mm), who were followed-up for 6-78 months (median 24 months). Diagnosis of adenoma was based on size and morphovolumetric aspect of the lesion at computed tomography (CT), scintigraphic pattern using NP59 as a tracer, and it was histologically confirmed in 7 patients. After an extensive hormonal investigation including morning (no.=53) and midnight (no.=28) serum cortisol, plasma ACTH (no.=50), serum DHEAS (no.=51), daily urinary free cortisol excretion (no.=52), post-dexamethasone (1 mg) cortisol (no.=42) and ACTH stimulation test for 17-hydroxyprogesterone (17-OHP) response (no.=48) at the time of diagnosis, patients were periodically re-evaluated for hormonal function and radiological aspect of the lesion(s) by CT. Seven patients underwent surgery 6-42 months after incidentaloma demonstration, with histological diagnosis of adrenal adenoma. During follow-up an increase in the size of the lesion was demonstrated in 22 patients (41.5%); the increase was greater than 10 mm in 8 cases. In 3 patients with unilateral mass, a contralateral lesion appeared 10-52 months after first demonstration. Six patients (11.3%) showed reduction or disappearance of the lesions. On the basis of the hormonal evaluation 3 patients were considered to have subclinical Cushing's syndrome and 10 patients exhibited 17-OHP hyperresponse to ACTH test consistent with partial 21 -hydroxylase deficiency. A significant difference in the size of the lesions was observed between patients with or without 17-OHP hyperresponse to ACTH test (31.1 1.9 vs 24.1 +/- 1.2 mm; p<0.01). No significant changes in the hormonal parameters were observed in the patients, when retested. In conclusion, although none of the patients of the present series exhibited evolution to hypersecretion or to aberrant growth, in more than 40% of patients an increase in the size of the mass was observed, even after a long period of "quiescence". This suggests that a radiological re-evaluation of lesions should be periodically undertaken.     

Case report: Brucellosis: a re-emerging disease in Thailand

Brucellosis is a zoonotic disease prevalent in many countries, but it has been reported only once in Thailand, 36 years ago. We describe here two consecutive cases of brucellosis in Bangkok, Thailand. Both cases presented with prolonged fever and weight loss. Blood cultures taken from 2 patients yielded Brucella melitensis. The slide agglutination test of blood samples were also positive, with a titer of 1:64 for antibodies to Brucella. The first patient responded to a combination of doxycycline, gentamicin, and ciprofloxacin; the other responded to doxycycline and rifampicin. Brucellosis is a potential public health threat, therefore, preventive measures should be actively implemented. This clinical syndrome should be included in the differential diagnosis of patients presenting with prolonged fever, particularly those with contact to animals which could serve as reservoirs.     

Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes

Introduction: Acute pancreatitis (AP) incidence in the elderly population has increased in the last years. However, the role of age as influencing factor on the AP clinical course is still debated.

Methods: We reviewed clinical records of consecutive patients admitted with diagnosis of AP. Patients were divided in elderly (≥65 years) and non-elderly (<65 years). Primary endpoint was comparison of overall mortality. Secondary endpoint included ICU admission, in-hospital length of stay (LOS) and surgical procedures.

Results: We enrolled 352 elderly and 532 non-elderly patients. A higher mortality rate (7.4% vs 1.9%; p?<?.001), ICU admission rate (18.9% vs 6.3%; p?<?.001) and prolonged length of hospital stay (9 (6–14) vs 7 (5–11.7) days; p?=?.01) were registered in the ≥65 years group. Multivariate analysis identified age (OR: 3.5; 95% CI:1.645–7.555; p?=?.001), a higher Ranson score at admission (OR: 5.52; 95% CI:1.11–27.41; p<.001) and necrotic pancreatitis (OR: 8.6; 95% CI:2.46–30.27; p?=?.001) as independent predictors of mortality. Conversely age and necrotic pancreatitis were independent risk factors for higher LOS and ICU admission.

Conclusions: Patients with AP and age ≥65 years have a higher mortality, ICU admission and prolonged LOS. Early recognition and prompt treatment are key elements to improve outcomes in this population.     

Brucellosis

Brucellosis is an old disease, revisited because of its past use in biological warfare programs and its potential use in bioterrorism. Early recognition and management of this systemic disease in its acute or chronic form is vital to current antibioterrorism defense programs. This article focuses on the causative organism, as well as the clinical presentation, diagnosis, and therapeutic challenges of Brucellosis.     

An evaluation of phencyclidine (PCP) psychosis: a retrospective analysis at a state facility

It has been reported in the literature that phencyclidine (PCP) psychosis recovery may take up to 4-6 weeks. This retrospective review sought to determine whether patients with a new onset of PCP psychosis have a longer hospitalization than those patients with new onset functional psychosis. The PCP arm (N = 20) was found to have a significantly shorter hospitalization than those with a new onset functional psychosis (N = 20)-mean 4.8 days (range 1-9) versus 13.6 days (range 3-41), p < .05. In addition, patients with psychosis related to PCP use were treated more aggressively with conventional antipsychotics than patients with a new onset functional psychosis at this facility.     

Brucellosis in a renal transplant recipient

Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.     

Primary cardiac tumors: retrospective evaluation of 15 consecutive patients

During a decade (1975-1985) 15 patients have been treated for a primary cardiac tumor at the University Hospital of Ghent. Histological examination revealed both benign (n = 12) (myxoma, pseudomyxoma, myxoid degeneration) and malignant (n = 3) (angiosarcoma) tumors. Tumor diagnosis generally was made by echocardiographic and/or angiocardiographic examination of patients presenting with various constitutional and/or cardiac symptoms. In two patients however diagnosis became obvious by histological examination of the material removed during acute embolectomy. All tumors were surgically resected with the aid of extracorporeal circulation. Benign tumors have generally good prognoses, although rhythm or conduction disturbances, complete obstruction or embolization can entertain malignant consequences. Three of our patients died of such a complication. Therefore all cardiac tumors should be resected as soon as possible after diagnosis. One patient showed evidence of recurrence of the tumor. Malignant heart tumors have bad prognoses: all three of our patients died within two years.     

Efficacy of chemical and/or surgical therapy against condylomata acuminata: a retrospective evaluation

In order to estimate treatment resistance of condylomas, standardized records of 230 males aged 17-80 years (mean 27) attending at an STD clinic were analysed retrospectively. Anal warts occurred in 38 (17%) men; in 19 (50%) intranal warts were extensive enough to require further referral to the Department of Surgery. Urinary meatal warts occurred in 30 men; 9 of them (30%) were referred to the Department of Urology. The remaining 202 (88%) men were treated in the STD clinic with simple surgery and/or home-treatment with 0.5% podophyllotoxin-ethanol twice a day for one or more 3 day sessions. After a follow-up of at least one year, 46 (23%) patients still had condylomas. However, 77 (49%) of the remaining 156 men were cured after a single therapeutic session, and after 1-4 sessions the cumulative cure rate was 77%.     

California state Mosquito-Borne Virus Surveillance and Response Plan: a retrospective evaluation using conditional simulations

The California Mosquito-Borne Virus Surveillance and Response Plan recently was developed to provide a semi-quantitative means for assessing risk for western equine encephalomyelitis (WEE) or St. Louis encephalitis (SLE) viruses and to provide intervention guidelines for mosquito control and public health agencies during periods of heightened risk for human infection. West Nile virus recently has arrived in California, and the response plan also will provide a baseline for assessing the risk for human and equine infection with this virus. In the response plan, overall risk is calculated by averaging risk due to 1) environmental conditions, 2) adult mosquito vector abundance, 3) vector infection rates, 4) sentinel chicken seroconversion rates, 5) equine cases (for WEE), 6) human cases, and 7) the proximity of virus activity to populated areas. Overall risk is categorized into three levels: normal season, emergency planning, or epidemic conditions. We evaluated this response plan using historical data from years with no, enzootic, and epidemic activity of WEE and SLE in several areas of California to determine whether calculated risk levels approximated actual conditions. Multiple methods of risk calculation were considered for both viruses. Assessed risk based on cumulative temperature, rainfall, and runoff levels over the entire season provided more or equally accurate assessments than biweekly assessments based solely on the previous half-month. For WEE, during years with enzootic activity or early-season periods of years with WEE epidemic activity, combining horse and human cases as a single risk factor improved the model's ability to forecast pending WEE activity, but separating the two factors allowed a better indication of WEE activity during epidemics and periods with no activity. For SLE, assignment of higher risk to drier conditions as measured by rainfall and runoff yielded the most accurate representation of actual virus activity during all recent study periods.     

Brucellosis as a Cause of Severe Colitis

A 16-yr-old girl presented with osteomyelitis and massive rectal bleeding. Colonoscopy revealed severe nonspecific colitis. Multiple laboratory investigations failed to disclose the etiology of either the bone or colon infections. Empiric treatment with corticosteroids and sulfasalazine resulted in only transient improvement. One month after discharge, her original symptoms recurred. Blood and pus cultures at this time yielded Brucella melitensis. After tetracycline treatment, the patient recovered. At 1-yr follow-up, she was found completely asymptomatic. Although osteomyelitis is a well-known manifestation of brucellosis, colitis related to this agent has so far not been described.