Spectrum of neuropsychiatric complications in 791 cases of typhoid fever

Summary Over a 6-year period, we studied 791 patients with multidrug-resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo-encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo-encephalitis are associated with significant morbidity but very low mortality (0.5%).     

Osteoarticular complications of brucellosis: a study of 169 cases

Of 452 patients with brucellosis, 169 (111 male and 58 female) had osteoarticular complications. Brucella melitensis was isolated from the blood in 7.7% of the cases. Fever, chills, arthralgia, backache, high levels of C-reactive protein, positive rheumatoid factor, and splenomegaly were more frequent in osteoarticular brucellosis than in nonosteoarticular disease. Arthritis occurred in the hip joint in 90 cases (53%), knees in 61 (36%), sacroiliacs in 33 (20%), ankles in 25 (15%), elbows in nine (5.3%), shoulders in eight (5%), wrists in six (3.5%), and sternoclavicular arthritis occurred in three cases (1.8%). Spondylitis occurred in 10 cases (6%), osteomyelitis in four (2.4%), and tendinitis or bursitis in two (1.2%). Treatment with tetracycline or trimethoprim-sulfamethoxazole (TMP-SMZ) alone (four to eight weeks) or in combination with streptomycin (two to four weeks) resulted in a relapse rate of 16.6%. No relapses occurred in seven patients treated with repeated four- to six-weeks courses of rifampin plus tetracycline or TMP-SMZ plus streptomycin.     

麻疹145例临床分析

我院 1994- 0 1～ 1999- 12共诊治麻疹 35 4例 ,其中住院病人 145例 ,全部住院病人均有并发症 ,大部分病人有麻疹疫苗接种史。现将临床资料报道如下。1　临床资料1.1　一般资料　 145例病例中年龄最小 13天 ,最大 30岁 ,其中 8个月以内 12例 ,8个月以上至 3岁 43例 ,3岁以上至7岁 38例 ,7岁以上至 14岁 2 1例 ,14岁以上 31例。 145例患者中 ,男性 85例 ,女性 6 0例 ,男女之比为 1 4∶1,按年份季度发病情况见表 1。其中以 1998年第 4季度及 1999年第 1季度为多 ,两个季度共 10 0例。表 1　麻疹各年度四季发病情况1～ 3月 4～ 6月 7～ 9月 10…     

Hemoglobin sickle cell disease complications: a clinical study of 179 cases

Background

Hemoglobin sickle cell disease is one of the most frequent hemoglobinopathies. Surprisingly, few studies have been dedicated to this disease, currently considered to be a mild variant of homozygous sickle cell disease. The aim of this study was to update our knowledge about hemoglobin sickle cell disease.

Design and Methods

The study involved a single center series of 179 patients. Clinical and biological data were collected with special attention to the assessment of pulmonary arterial hypertension and nephropathy.

Results

Hemoglobin sickle cell diagnosis was delayed and performed in adulthood in 29% of cases. Prevalence of hospitalized painful vasoocclusive crisis, acute chest syndrome and priapism was 36%, 20% and 20%, respectively. The most common chronic organ complications were retinopathy and sensorineural otological disorders in 70% and 29% of cases. Indeed, prevalence of complications reported in homozygous sickle cell disease, such as nephropathy, suspicion of pulmonary hypertension, strokes and leg ulcers was rather low (13%, 4% and 1%, respectively). Phlebotomy performed in 36% of this population (baseline hemoglobin 11.5 g/dL) prevented recurrence of acute events in 71% of cases.

Conclusions

Our data suggest that hemoglobin sickle cell disease should not be considered as a mild form of sickle cell anemia but as a separate disease with a special emphasis on viscosity-associated otological and ophthalmological disorders, and with a low prevalence of vasculopathy (strokes, pulmonary hypertension, ulcers and nephropathy). Phlebotomy was useful in reducing acute events and a wider use of this procedure should be further investigated.     

Pulmonary complications in adult measles]

The clinical features of pulmonary complications were evaluated in 15 patients with adult measles diagnosed by clinical and serologic investigations. Of those 15 patients, 12 were admitted because of high fever, sever anorexia and dyspnea. Almost all patients were found to have thrombocytopenia, elevations of LDH and aminotransferase. Pulmonary infiltrates were present in only 2 of the 12 patients (16.7%) on whom chest roentgenograms were performed, but hypoxemia (PaO2 < 70 Torr) were present in 8 of the 12 patients (66.7%). Pulmonary function tests in 8 patients showed mild decrease in VC, moderate decrease in FEV1 and severe decrease in V25. These findings suggest that hypoxemia in patients with normal chest radiographs may be largely caused by bronchiolitis. The observations of sequential peak flow rate measurement showed that severe pulmonary dysfunction continued for 4-5 days after the onset of the rash. To avoid the development of respiratory failure, patients with measles should be carefully monitored for bacterial superinfections of the respiratory tract especially within several days after the appearance of the rash.     

Implementation of a mass measles campaign in central Afghanistan,December 2001 to May 2002

In Afghanistan health services have been disrupted by 23 years of conflict and 1 of 4 children die before age 5 years. Measles accounts for an estimated 35,000 deaths annually. Surveillance data show a high proportion of measles cases (38%) among those >/=5 years old. In areas with complex emergencies, measles vaccination is recommended for those aged 6 months to 12-15 years. From December 2001 to May 2002, Afghan authorities and national and international organizations targeted 1,748,829 children aged 6 months to 12 years in five provinces in central Afghanistan for measles vaccinations. Two provinces reported coverage of >90% and two >80%. Coverage in Kabul city was 62%. A subsequent cluster survey in the city found 91% coverage (95% confidence interval [CI], 0.85-0.91) among children 6-59 months and 88% (95% CI, 0.87-0.95) among those 5-12 years old. Thus, this campaign achieved acceptable coverage despite considerable obstacles.     

Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households

An outbreak of measles among a predominantly unvaccinated and susceptible Amish population in Lebanon County, Pennsylvania, offered the opportunity to test the hypothesis that secondary cases in households are more severe than primary cases because the former have more intense exposure and receive a greater virus inoculum. Of 130 measles cases reported between April and June 1988, 119 (92%) constituted a study of disease severity. Severity was assessed by determining frequency and duration of symptoms, length of any hospitalization, and number of days in bed. In a univariate analysis, fewer secondary cases had conjunctivitis (relative risk [RR], 0.67; 95% confidence interval [CI], 0.48-0.96) and headache (RR, 0.37; CI, 0.15-0.86), but more had earache (RR, 9.69; CI, 1.8-202.9) compared with primary cases. Secondary cases had a shorter mean duration of coryza (4.0 vs. 5.0 days, Student's t test, P = .08). However, a logistic regression model that matched by family and controlled for age and sex indicated that there were no significant differences in measles severity among primary and secondary cases in households.     

Spectrum of tricuspid atresia--a study of 23 cases.

The present report describes the clinical and angio-cardiographic features of 23 cases of tricuspid atresia. Nineteen patients had type I anatomy, 2 patients had type II anatomy and 2 patients had type III anatomy. In addition to the standard features, there were some uncommon associations observed. These included double outlet right ventricle, double outlet left ventricle, single coronary artery, complete heart block, right axis deviation, ostium primum atrial septal defect and coarctation of the aorta.     

33例麻疹临床分析

目的探讨局部麻疹流行的临床表现及流行病学的特点。方法采用回顾性临床病例资料,分别对2005年3-6月我院收治33例麻疹患者的发病年龄、季节、症状、体征、预防接种史、实验室检查及器械检查进行归纳分析。结果33例麻疹中,10￣30岁之间高发,多发生在4-6月份,多数病例具有典型麻疹的临床表现,少数在发热2、3d后或5、6d后出疹,自觉症状重,50%以上患者出现呼吸系统并发症,少数肝肾功能损害,特异性IgM抗体阳性,大多数有麻疹疫苗接种史。结论麻疹发病年龄后移,临床症状相对较重。现行的麻疹疫苗接种程序,不能从根本上消灭麻疹的局部流行。     

123例麻疹特点分析

目的 分析2004-2005年麻疹流行病学、临床特点,为进一步预防、控制麻疹提供依据.方法 采用流行病学方法对2004年6月-2005年9月收治的123例麻疹患者进行分析.结果 发病时间以3～5月份最多(62.6%),18～30岁是发病的高峰年龄(38.2%).结论 加强对流动人口监测工作,高危成年人群应强化免疫.     

麻疹138例临床特点分析

目的分析泸州地区麻疹患者临床特点。方法收集2002—07／2005—06住院麻疹患者138例临床资料，从患者性别、年龄分布、发病地区、是否接种疫苗、发病季节、临床特征及主要并发症等方面进行分析。结果138例麻疹患者在性别、发病地区、接种疫苗等方面均有差异；高发季节为春季，共92例（66．67％），其次为夏季32例（23．19％）；高发年龄组为9个月～6岁，患儿共77例（55．80％）；其次为8个月以内的婴儿组和成年人组，分别为28例（20．29％）和19例（13．77％）；临床表现多数趋于典型；有并发症者98例（71．01％）。结论麻疹流行季节有向春末夏初推移的趋势；成年人和婴儿麻疹有增多趋势；为控制和消除麻疹，应加强麻疹防治工作。     

Representativeness of suspected measles cases reported in a southern district of Nigeria

ObjectiveTo compare the characteristics of suspected measles cases at the health facilities and to determine the representativeness of the data.MethodsWe visited 25 hospitals in the Aniocha Local Government Area (LGA) of Delta State, Nigeria, from which information on reportable diseases was collected. In particular, the suspected measles cases in their registries between January 1, 2007, and June 30, 2008, were reviewed. We compared the characteristics, including age, sex, location, and month of reporting, of the suspected cases with the LGA surveillance records.ResultsIn the LGA records, 10% cases involved individuals older than 14 years, compared with 20% in the same age group in the health facility records. Based on geographic location, 53% of the measles cases among the hospital records came from a single location, in contrast to only 30% of the cases among the LGA records. An analysis considering time revealed that 30% of the cases in the LGA records occurred in August 2007, whereas 20% of hospital cases were reported in February and May 2008 combined.ConclusionsThe two record types differed considerably in all of the characteristics used in this comparison.     

Local complications associated with indwelling Swan-Ganz catheters: Autopsy study of 36 cases

Thirty-six hearts of patients who died with indwelling Swan-Ganz catheters in place were prospectively examined to assess the incidence and extent of localized lesions in the right side of the heart. Bland mural thrombosis in the superior vena cava, the right atrium and the pulmonary artery was found in 22 of 36 cases (61 %). Patients with catheter periods > 2 days had a greater incidence and extent of bland mural thrombosis (79%) than patients with short-term catheterization (41%, p < 0.01). Anticoagulation had no influence on bland mural thrombosis. Valvular hemorrhage occurred in 31% and aseptic valvular vegetations in 8% of the hearts. No case of infective endocarditis was found. Four of 36 cases (11%) had evidence of pulmonary infarction that appeared to be unrelated to the lesions in the right side of the heart. Endocardial lesions were common complications of indwelling Swan-Ganz catheters but had no significant impact on the clinical courses of the patients.