Neurosyphilis in a young Indian expatriate

Neurosyphilis is the infection of the central nervous system with treponema pallidum species, and true to its reputation as the old mimic, can present with a multitude of clinical scenarios, one of which is stroke in the young. Rare in developed countries, except for an at-risk population of drug abusers and HIV infected patients; it is still common in the rest of the world. We describe the case of a young Indian male, his presentation, diagnosis and treatment, and remarkable recovery on aqueous penicillin G therapy following his presentation with a stroke

Combined Brucella Melitensis and Streptococcal Viridans Endocarditis

Infectious endocarditis is a potentially lethal inflammation of the hearts' inner lining invaded by microorganisms. The mortality from this illness increases as the number of infective organisms rises to 2, due to involvement of the left side of the heart. These microorganisms usually arise from the patient's own flora but can be acquired from the environment. Fever and heart murmurs are the principal clinical manifestations followed by a plethora of peripheral signs due to dissemination of microorganisms via the bloodstream. Echocardiographic imaging and sensitive culture techniques form the cornerstone of diagnosis. We report a patient with rheumatic heart disease who had combined brucella melitensis and streptococcus viridans endocarditis complicated by heart failure and an aortic root abscess. He was diagnosed on the basis of a history of prolonged fever and occupational risk as a shepherd, the presence of heart murmurs, positive blood cultures and echocardiographic evidence of aortic vegetations. He had an excellent response to intravenous antibiotic therapy combined with aortic valve replacement, which nowadays is regarded as the safest therapeutic approach for aortic valve endocarditis

Traumatic fat embolism syndrome

Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. Diagnosis is aided further by the presence of hematological and biochemical abnormalities including anemia, thrombocytopenia, an elevated erythrocyte sedimentation rate and fat macroglobulinemia. Imaging by chest radiograph, computed tomography or magnetic resonance of the brain is used to confirm the extent of the respective organ involvement and to exclude alternative pathologies. The release of free fatty acids into the circulation and their subsequent effects is the key pathological event. Treatment is based on supportive care and high-dose corticosteroid therapy. We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate