A series of 22 patients with adult-onset Still's disease presenting with fever of unknown origin. A difficult diagnosis?

Adult-onset Still's disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece.

Electrocardiographic abnormalities in patients with novel H1N1 influenza virus infection.

The cardiac effects imposed by the novel H1N1 influenza strain have not been elucidated until now. Electrocardiographic (ECG) abnormalities were evaluated in a series of 50 patients with confirmed novel H1N1 influenza infection. Epidemiologic and clinical characteristics, laboratory correlations, and the effect ECG abnormalities may exert on disease outcomes were prospectively studied.

Subacute thyroiditis in the course of novel H1N1 influenza infection.

To describe the first documented case of subacute (De Quervain) thyroiditis in the course of novel H1N1 influenza infection. This is a case report of a patient diagnosed at the General Hospital "G. Hatzikosta" of Ioannina, Greece.

Reclassifying bioterrorism risk: are we preparing for the proper pathogens?

Existing classifications of potential biological weapons, acknowledge only limited important parameters of biological weapon potential. Certain pathogen factors would further influence the outcome of a potential attack in context with social and political aspects of the time and space of the attack. The importance of these factors was investigated through various attack scenarios that have been developed by the authors, and an individual score for each of these factors was calculated, based on the overall effect their variation had in the scenario outcome.

The globalization of leptospirosis: worldwide incidence trends.

Objectives: Leptospirosis continues to be a significant zoonosis of the developing world. Globalization, in the context of international travel, particularly for recreational activities and military expeditions, has led to increased exposure of individuals from the developed world to the disease, as recent outbreaks show.

Methods: We evaluated the trends in annual leptospirosis incidence for individual countries worldwide through reports from national and international organizations, the published medical literature on the subject, and web searches with the terms 'leptospirosis' and the individual country names.

Treatment of neurobrucellosis: what is known and what remains to be answered.

Neurological involvement is one of the most perplexing and diverse presentation complications of brucellosis, a worldwide prevalent zoonosis. This review presents the current knowledge available from medical literature and discusses the shortcomings of the existing data. A proposed regimen should include doxycycline and rifampicin and, with the benefit of doubt, ceftriaxone, since its high concentration in the cerebrospinal fluid may offer significant efficacy against the pathogen.

The liver in brucellosis.

Background & Aims: Brucellosis involves the liver in varying ways, ranging from benign subclinical increases in serum aminotransferase levels to ominous chronic suppurative disease. Data on histopathology of the liver in brucellosis are scarce and contradictory. We sought to determine the liver histologic patterns present in a series of brucellosis patients and review the existing knowledge about liver involvement in this worldwide, prevalent zoonotic infection.

Horton's three sisters: familial clustering of temporal arteritis.

The authors describe 3 histologically confirmed cases of temporal arteritis occurring in three siblings aged 62-72 years old, diagnosed from 1999 to 2005. Chapel Hill publication surrogate parameters combined with the American College of Rheumatology criteria for vasculitis were used in the diagnostic procedure. The diagnosis of temporal vasculitis was confirmed by right occipital artery excision and demonstration of relevant histopathology.

Diltiazem-induced eosinophilic pleural effusion.

A 68-year-old woman developed eosinophilic pleural effusion and systemic eosinophilia 2 months after starting antihypertensive therapy with diltiazem. Several drugs are known to cause this disorder; however, the only other drug the patient had been taking was clonidine, which she had taken for the past 3-4 years. She was evaluated for all other possible causes of eosinophilia and eosinophilic pleural effusion, including malignancy, infection, and autoimmune disorders.

Future trends in human brucellosis treatment.

The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior.

Use of ceftriaxone in patients with severe leptospirosis.

The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease.

Jaundice of unknown origin: Remember zoonoses!

Zoonotic diseases are randomly remembered in the differential diagnosis of jaundice of unknown origin. We present four characteristic cases of jaundice attributed to brucellosis and Coxiella burnetii infection and discuss the various pathogenetic pathways implicated in each case. We present a brief review of the relevant literature and, in an era of increasing subspecialization, underline the importance of viewing the "whole picture".

Health literacy in the field of infectious diseases: the paradigm of brucellosis.

Objectives: Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome.

Methods: We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis.

The new global map of human brucellosis.

The epidemiology of human brucellosis, the commonest zoonotic infection worldwide, has drastically changed over the past decade because of various sanitary, socioeconomic, and political reasons, together with the evolution of international travel. Several areas traditionally considered to be endemic--eg, France, Israel, and most of Latin America--have achieved control of the disease. On the other hand, new foci of human brucellosis have emerged, particularly in central Asia, while the situation in certain countries of the Near East (eg, Syria) is rapidly worsening.

Acute pancreatitis associated with brucellosis.

Context: Acute pancreatitis can be caused by a variety of infectious agents but it is regarded as an extremely rare complication of brucellosis.

Case Report: We briefly describe a 56-year-old man who presented with acute pancreatitis, fever, myalgia, and other clinical symptoms. Brucella melitensis was cultured from his blood.

CT evaluation of renal artery embolism with ectopic artery.

We present an 80-year-old woman, with a history of well-controlled hypertension and atrial fibrillation, who suffered from back pain and elevated blood pressure for 2 weeks prior to admission. At physical examination, a low-pitched systolic heart murmur was heard in the tricuspid area and there was mild tenderness in the left lower quadrant. Laboratory studies revealed an elevated hematocrit, lactate dehydrogenase, and liver aminotransferase.

New approaches to the antibiotic treatment of brucellosis.

The global burden of human brucellosis remains enormous, yet its optimal treatment remains based on traditional combinations of doxycycline with either rifampicin or streptomycin. Of the currently existing alternative regimens, only the combination of doxycycline with gentamicin can be considered therapeutically adequate and cost effective, the latter factor being a major obstacle in the utilisation of quinolones for brucellosis. Newer antibiotics, most notably tigecycline, may help in achieving monotherapy or shorter treatment duration.