ABSTRACT
The prognosis of rheumatoid arthritis (RA) has recently been improved, resulting in longer survival of patients. The incidence of oral diseases increases with age, particularly for periodontal disease and those involving tooth decay, even in normal healthy individuals. Patients with RA display increased incidence of oral diseases, and the use of steroids or methotrexate to treat RA increases susceptibility to infections, sometimes causing serious infections. We present here two cases of cervical abscesses in RA patients who underwent emergency surgery to treat oral infections due to the possibility of mediastinal inflammation.
ABSTRACT
Six patients unexpectedly presented with Japanese encephalitis (JE) from early August to mid-September 2002 in the Chugoku district of Japan. The mean age was 67.5 years (range 42 - 89 years); the onset period in two patients shifted to the middle of September. The JE virus was isolated from the cerebrospinal fluid samples from two patients, and the strain isolated in the one was identified as genotype III. Neurologically, consciousness impairment, meningeal signs, rigidity, hemiparesis, tetraparesis, and convulsive seizures were commonly observed. Magnetic resonance imaging uniformly revealed high signal intensities in the bilateral thalami, brainstem (substantia nigra), hippocampi, and brain cortices. In all patients, acyclovir was used, due to the unexpected outbreak of JE. Five patients, except for one without sequelae, had a severe outcome, including one death. This report indicates that JE in Japan is still a threat to adults and the elderly with decreased or absent immunity to the JE virus.
