Chlamydiae as agents of human and animal diseases

A brief review is given of the properties, occurrence, and public health significance of chlamydiae in man and animals and of the diagnosis and control of chlamydial infections. Chlamydiae occur naturally in a large number of avian and mammalian species. Man is the primary host of chlamydiae causing trachoma, inclusion conjunctivitis, genito-urinary tract infection, and lymphogranuloma venereum. In animals chlamydial infections have been recognized as a cause of pneumonia, encephalitis, abortion, arthritis, diarrhoea, and conjunctivitis. Chlamydial infections have been recognized in a wide range of avian hosts. Sporadic psittacosis/ornithosis in man is associated with close exposure to birds and may occur as an occupational disease. Transmission studies suggest that mammalian chlamydial strains are not very host-specific and that diseases and even chains of infection may develop in secondary hosts. There are a few well-documented cases of human infection with chlamydiae of mammalian origin. Although various chlamydial isolates have specific antigenic components, no routine test for identifying different serotypes has been generally accepted. Further investigation of the host range of chlamydiae and of their antigenic properties is essential for a more accurate assessment of the potential danger of chlamydia-infected animals to human health. The frequent occurrence of inapparent or latent infections makes it imperative to establish adequate laboratory facilities for the effective surveillance and control of chlamydial infections.     

Pott's puffy tumor. A case report

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. This common condition is usually not diagnosed initially and is easily confused with neoplasms, skin and soft-tissue infection, and infected haematoma. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis, complicated by frontal brain abscess, and a subdural empyema. It was successfully treated with abscess drainage and prolonged use of antibiotics. To the best of our knowledge, only 13 cases of Pott's puffy tumor have been previously reported in adults. Particularities of this disease are reported here.     

Human subcutaneous dirofilariasis: a report of three cases manifesting as breast or axillary nodules

Human subcutaneous dirofilariasis is a rare infection caused by filarial worms of the genus Dirofilaria. The parasites are transmitted to man by zooanthropophilic bloodsucking insects and the infection is manifested as subcutaneous nodules. Excisional biopsy is both diagnostic and therapeutic. We herein report three cases of human subcutaneous dirofilariasis diagnosed, over a period of ten years (1991-2000), in North East Greece. The patients, two women and one man, were all adults between 32 and 67 years of age. In two cases the infection was manifested as breast nodules, while in the third case as a painful nodule in the axillary region. The excisional biopsy showed the presence of an adult Dirofilaria, identified as Dirofilaria (Nochtiella) repens. It is emphasised that both clinicians and pathologists should have an increased awareness of this clinicopathologic entity and include dirofilariasis in the differential diagnosis in patients presenting with breast or subcutaneous nodules.     

Serological typing of mycobacteria for tracing possible sources of avian mycobacterial infections in man

Avian mycobacteria represent a potential danger to the human population in areas where effective control of tuberculosis has been achieved, but where tuberculosis is still present in poultry. During the period 1957-67, a total of 44 cases of pulmonary and non-pulmonary disease in man caused by avian mycobacteria were recorded in Czechoslovakia. The source of infection was reliably established in only a small number of cases.     

Lyme Borreliosis

The epidemiology of Lyme borreliosis is described with stress laid on the relations between ticks as vectors and the animals which are the reservoir of borrelia infecting man. Other discussed problems include the possibility of infection of man, the seasonal character of new cases, the worldwide presence of Ixodes ticks and their species in various continents, the incidence of Lyme borreliosis in various countries.     

Transmission of the virus of foot and mouth disease between animals and man

The virus of foot and mouth disease causes severe epizootics in animals and infrequently evokes painful, but transient, clinical signs in man. Adults in certain occupational groups and young children are particularly exposed to risk. Infected persons may disseminate virus for up to about 14 days. The virus can be transmitted from animals to animals, from animals to man, from man to animals and, probably, from man to man. Evidence for transfer of the disease between human and animal populations is reviewed in detail and modern methods of diagnosis are described. Predisposing factors play an important role in the development of overt foot and mouth disease in man. Subclinical infection occurs. The possibility of aerial transfer of the virus between man and domestic livestock constitutes a hazard, especially to the latter. Attention is directed to the need for sophisticated diagnostic techniques, to requirements for adequate precautions in the handling and disposal of affected animals, and to hygienic measures for disease control.     

Human infections with Angiostrongylus cantonensis

Angiostrongylus cantonensis is a parasite that causes eosinophilic meningitis and has been reported to be present on most Pacific islands. Rats are the principal host and several species of land snails the intermediate host. Important paratenic hosts are fresh water shrimp and fish. Modes of transmission include ingestion by man of raw fish, snails and fresh leafy vegetables contaminated by snail slime trails containing larvae. The parasitic worms are neurotropic in man, and the diagnosis should be considered in any adult or child, who presents, in endemic areas or areas with suitable intermediate hosts, with severe unrelenting headache, paresthesias, or a cranial nerve palsy. Eosinophils in the cerebral spinal fluid suggest the diagnosis. Simple analgesia is sufficient for mild cases. Treatment of those with severe symptoms remains controversial. Glucocorticoids, lumbar puncture to reduce intercranial pressure and antihelminthic agents have been used.     

Comments on present-day spread and epidemiology of BSE and prion diseases

Prion diseases of animals and man are neurological diseases with amyloidal deposition of the respective proteins. As to prion disease, the cellular prion protein is in its abnormal isoform(s) an essential component of prion protein aggregates found in affected tissue. In contrast to all neurodegenerative diseases like Morbus Alzheimer or Huntington's disease, prion diseases are transmissible. Therefore, prion diseases were designated Transmissible Spongiform Encephalopathies (TSE). The diseases have been well known for decades. Scrapie was first described around 1750, a BSE case was reported in the 1850-ties most likely a misdiagnosis, and in 1920/1930 the human Creutzfeldt-Jakob disease (CJD) had been described. Transmission of CJD i. e. Kuru had been suspected in the early 1950 s and was erroneously classified as slow virus disease. The CJD transmission posed a problem to humans when transplants from CJD cases were used for treatment. Fortunately, these iatrogenic transmissions remained limited. But with the advent of BSE and appearance of variant CJD cases in the UK and some places in Europe scientists suspected that transmission from cattle to man could have happened. From animal models we know of successful transmission via several routes. Species barriers do not completely prevent transmission. Rather, transmission barriers might exist controlling individual susceptibility against prions. Modes of transmission, susceptibility to transmission, identification of receptor molecules as well as molecular mechanisms of the transmission process are being investigated with great intensity. Current knowledge leads us to assume that inapparent stages of prion infection wrongly suggest a (non-existent) species barrier. This inapparent infection precedes overt disease, and, hence, most research focuses on the development of highly sensitive assay systems for detection of minute amounts of pathological prion protein in suspected cases. Inapparence also should warn us to underestimate BSE or human vCJD cases; at present, approx. 145 cases occurred in Europe and one probable case in Hong Kong (June 2003). Whether BSE had spread to other parts of the world by animal nutrition components or meat can neither be excluded nor confirmed at this time. New data on transmission and consequences of BSE for the human population are summarised in this review.     

Pentastomiasis and cancer of the colon

The case is described of a 50-year-old man, admitted to a small mission hospital in Zaire, where a preliminary diagnosis of cancer was made. On referral to a bigger hospital he was found to be infected with Entamoeba histolytica and biopsy of the peritoneal tumour revealed a pentastomid nymph, probably of Armillifer armillatus, the most common pentastomid infecting man in Zaire. X-ray subsequently revealed numerous calcified nymphs. Surgical and anti-parasitic treatment are described and the possible association between pentastomid infection and cancer is discussed.As Self, Hopps & Williams (1975) admit, our knowledge of pentastomiasis in Africa is incomplete and it must be assumed that its occurrence is much more widespread than published reports indicate. It may, therefore, exist throughout much of sub-Saharan Africa, as does liver cancer.Nymphal pentastomiasis in man caused by Armillifer armillatus is generally discovered during surgical intervention or at necropsy. Pathological complications caused by the nymphs are very rare. However, Fain (1975) has drawn attention to the possibility of a carcinogenic action of pentastomids and, although the arguments for this association may be weak, it is an interesting hypothesis bearing in mind the association between clonorchiasis and cancer of the bile-ducts and schistosomiasis and cancer of the urinary bladder. We describe below a case of cancer of the colon accompanied by pentastomiasis.     

Small bowel obstruction secondary to intestinal schistosomiasis

Intestinal obstruction caused by chronic schistosomiasis infection is rare, with only 12 previously recorded cases in the literature. We report the first recorded case presenting to a European hospital. A 36-year-old Caucasian man, who was born and lived in the UK, presented with small bowel obstruction. He had visited China and Indonesia 8 years previously. At laparotomy, there was an obstructing inflammatory mass close to the ileocaecal junction and several small bowel strictures. Initially he was thought to have Crohn's disease. However, subsequent histology diagnosed intestinal schistosomiasis.     

Campylobacter enteritis-an in-patient study

During the first eight months of 1978, 26 patients were admitted to the Communicable Diseases Unit at King's Cross Hospital, Dundee with a diagnosis of campylobacter enteritis. The variety of clinical features encountered is described. Although diarrhoea occurred in all cases, it was preceded or accompanied by abdominal pain in the majority of cases and by fever in over half of the patients. The article emphasises the need to consider campylobacter infection in patients presenting with bloody diarrhoea, acute abdominal pain or pyrexias of unknown origin.     

Common variable immunodeficiency: a 7 cases reported

BACKGROUND: Common variable immunodeficiency (CVID) is an immune defect characterized by primary hypogammaglobulinemia. The most clinical manifestations are recurrent infection of respiratory tract. AIM: We reported seven cases of DICV which showed METHODS: We reported seven cases of CVID between 1994 and 2004, included six women and one man. RESULTS: The mean age at the first clinical symptoms is 23 years and the mean age at diagnosis is 38. Six patients presented recurrent bacterial infection particularly of the upper and the lower respiratory tract, these infections can lead to chronic diseases such as bronchiectasis. Two patients had chronic diarrhea caused by nodular lymphoid hyperplasia, we showed two cases of granulomatous: spleen tuberculosis and pulmonary sarcoidosis. The diagnostic was confirmed by protein electrophoresis and serum levels of immunoglobulin. All patients received treatment with intravenous immunoglobulin, with a decrease in frequency and severity of infection episodes. CONCLUSIONS: Protein electrophoresis must be done in a young adult with recurrent low respiratory tract infections and/or diffuse bronchectasis.     

The spread of Rift Valley fever and approaches to its control

Rift Valley fever (RVF) is primarily a disease of sheep, cattle, other domestic animals, and man; it was believed to be relatively benign for man until 1977 when it spread to Egypt. There it caused enormous losses of sheep and cattle, and thousands of human cases occurred, with nearly 600 reported deaths. Although mosquitos are known to transmit RVF virus in epizootics and epidemics, the reservoir and means of inter-epizootic maintenance are not known. RVF epizootics can be recognized by a combination of observations: abortions and neonatal death in sheep and cattle at times when mosquitos are abundant, accompanied by cases of fever in man, which are complicated in a minority of patients by haemorrhagic fever, encephalitis, and retinitis with blindness. Vaccination of livestock with available killed or live attenuated vaccines should prevent transmission to both human subjects and animals. Although routine quarantine of animals is not deemed a practical measure, movement of animals should be restricted when an epizootic is in progress. Since it is possible that RVF may spread from Africa in the future, serological surveillance in man and animals is recommended in potentially receptive countries of the Mediterranean Basin and South-West Asia to establish baseline data and to familiarize staff with the methods of RVF diagnosis.     

Transfusion-associated babesiosis after heart transplant

We describe a 54-year-old spleen-intact man with transfusion-associated Babesia microti infection after a heart transplant. Adult respiratory distress syndrome developed in the patient, and he required mechanical ventilation. Our experiences with this patient suggest that babesiosis should be considered in the differential diagnosis of transplant patients who have fever and hemolytic anemia.     

Syncope as a probable side effect to combination antiretroviral therapy initiated during primary HIV-1 infection

A previously healthy young man experienced several episodes of syncope while being treated with tenofovir, emtricitabine and nevirapine initiated during primary HIV-1 infection. Symptoms disappeared after discontinuation of antiretroviral therapy and we suggest that syncope may be a side effect to one of the three antiretroviral drugs that has not been described previously.     

Endocarditis due to Pasteurella sp. Two cases

Human pasteurellosis is, in general, a locoregional infection due to contact with an animal. Systemic infections are rare and endocarditis is exceptionally described. The authors report two new cases of endocarditis due to Pasteurella spp, they then review 29 other published cases. Pasteurella spp. endocarditis presents as an acute form in 64% of cases and affects the aortic as often as the mitral valves. Contact with an animal is documented in 65% of cases. Pasteurella multocida is the most frequent species in this infection. The total death rate is 40% and can reach 57% of cases in case of immunodepression. The bad prognosis of this infection, justifies an early diagnosis and a rapid and adapted but not yet consensual medicosurgical treatment.     

An epidemiologic summary of the hepatitis C epidemic in Minnesota

Hepatitis C virus (HCV) infection has been described as a "silent epidemic" because the majority of HCV cases are clinically asymptomatic. This presents challenges in identification and diagnosis of HCV infection. Between 1990 and 2001, the Minnesota Department of Health received 16,913 reports of HCV enzyme immunoassay (EIA) positive cases, which represent the tip of the HCV prevalence iceberg. The most commonly identified risk factor associated with HCV infection is intravenous drug use (IDU). Among cases of HCV infection in Minnesota, 52% (2,760) of those who had reported risk-factor information reported history of IDU. Nationally, the number of new cases of acute infection is declining, but the number of persons with HCV infection is sizeable. Morbidity and mortality due to HCV-related liver disease is expected to increase greatly in the next decade. A coordinated effort between the public and private health systems will be necessary to address issues that affect the HCV-positive community.     

Bickerstaff's brainstem encephalitis: a case report

Bickerstaff's brainstem encephalitis (BBE) is a rare diagnosis different from meningoencephalitis with ophthalmoplegia, ataxia and confusion. Less than 100 cases have been described in the literature. We described the fatal case of a 69-year-old man who presented a severe consciousness disorders, distal weakness in the four limbs, and the BBE triad a few days after his admission for pneumonia.     

Human listeriosis in Britain, 1967-85, a summary of 722 cases. 1. Listeriosis during pregnancy and in the newborn

Clinical information was collected on 722 cases of Listeria monocytogenes infections in humans occurring in Britain between 1967 and 1985: 248 cases (34%) were associated with pregnancy (maternal, foetal, and neonatal), and comprised 9 cases (4%) of maternal bacteraemia without infection of the foetus; 42 cases (19%) of intra-uterine deaths; 118 cases (54%) of neonatal infection diagnosed within 2 days post-partum; and 50 cases (23%) of neonatal infection diagnosed as ill after 2 days post-partum. An overall mortality of 50% was recorded. The cases unassociated with pregnancy are described elsewhere (see accompanying paper).     

Osteitis pubis]

Lytic degeneration of the pubic symphysis is a relatively rare entity. The present study is dedicated to the fact that the disease causes numerous diagnostic problems. Authors based on their three cases describe the clinical features and review the literature. It is stated that both from the aspect of the diagnosis and the result of the treatment, operative intervention is beneficial. In contraversion to numerous papers it is found that the described disease is often infectious and can be consequence of an infection of the urinary tract.