[Infectious diseases-past, present, future]. / Fertözö betegségek, infektológia-tegnap, ma, holnap.

The complex interactions between microorganisms and humans include the well-known, traditional infectious diseases and also the symbiotic relationship with the human endogenous normal flora. Forty years ago everybody was convinced that medicine would soon be able to eradicate most of the infectious diseases. Perception of victory over infectious diseases has been blunted in recent years by nosocomial infections and by the new and re-emerging diseases. The spectrum of infectious diseases is expanding and many of those once thought conquered are increasing in numbers. Moreover, the problems of infection are present in all aspects of medicine and with the field turning more and more complex its challenge for practitioners has become increasingly demanding. It is now clear, that at the dawn of the new millennium infectious disease remains the number one killer in the world.

[Chlamydia trachomatis infections]. / Chlamydia trachomatis infekciók.

Chlamydia trachomatis is the most common bacterial cause of sexually transmitted disease in the developed countries. The most important implications of genital chlamydia infections involve the reproductive health sequalae of upper genital tract infections in women: pelvic inflammatory disease, ectopic pregnancy, and infertility, infection by this organism is insidious, symptoms are absent or minor among most infected women and many man. This large group of asymptomatic and infectious persons sustains transmission within a community. This review discusses the epidemiology, of sexually transmitted chlamydial infections, the spectrum of clinical manifestations and their sequelae, the laboratory diagnosis of genital chlamydiasis, antibiotic treatment and prevention.

[Successful meropenem therapy of recurrent multiple brain abscess]. / Recidiváló multiplex agytályog sikeres kezelése meropenemmel.

Authors describe the history of a 37-year-old man suffering from multiple purulent brain abscess. The multiple brain abscess evolved primarily from a gluteal abscess to the lung, and secondarily from the lung to the brain by hematogenous spreading of the bacteria. The identification of the pathogene/s was unsuccessful despite numerous bacteriological examination. Despite many regimens of empiric antibacterial therapy the brain abscesses progressed, neurologic state of the patient deteriorated. At long last, the patient was given chloramphenicol. After that, he had no more fever, his consciousness cleared, no more epileptic convulsion occurred and the cell number of the cerebrospinal fluid became normal. The patient was thought to be cured and was sent home. Two months later fever occurred again and it was accompanied by excrutiating headache, increasing disorientation, so the patient was admitted to the hospital. The occurrence of a new brain abscess and purulent meningitis indicated the relapse of the disease. It was again unsuccessful to identify the pathogene/s therefore the authors treated the patient with many empiric antibiotic regimen, all of which-including chloramphenicol too--proved to be uneffective. As all the therapeutic regimens usually used in the treatment of purulent brain abscess were uneffective--including the combinations which have the widest antibacterial spectrum, authors gave meropenem as ultimum refugium. Some days later the fever came to an end, his consciousness cleared, the brain pressure and the cerebrospinal fluid became normal. The patient had no serious complaints in the course of the four years follow up, his residual neurologic symptoms regressed. On the base of this case history, authors suppose that meropenem--which has already proved to have a very wide antibacterial spectrum and to be very effective in the therapy of many kinds of serious bacterial infections--could also become a promising new therapeutic alternative in the treatment of purulent brain abscess.

Prevalence of Chlamydia pneumoniae antibodies in Hungary.

Investigation of Chlamydia pneumoniae (TWAR) antibodies in paired sera of 120 patients with various respiratory diseases revealed a prevalence of 4.2% of IgG seroconversion. IgG antibody without seroconversion was found in 83.3%. Sera of ten patients showed titers as high as 512-1024 or above. Children with no respiratory disease and blood donors in Budapest had specific IgG in 46.5% and 75.2% respectively. Prevalence of IgG antibody in children from the rural areas of Hungary was about 50% lower than in children in the capital. The high prevalence of persistent IgG, indicating earlier infection, suggests that Chlamydia pneumoniae infection may be endemic in Budapest. The small number of the serologically confirmed acute infections in hospitalized patients with pneumonia leads to the conclusion that the majority of patients with chlamydial pneumonia responds to the therapeutic regimen administered by the general practitioner and referral to hospital rarely becomes necessary.

[Opportunistic systemic mycoses]. / Opportunista szisztémás mycosisok.

Systemic fungal infections can be primary or opportunistic. The mycoses caused by opportunistic pathogens become increasingly more important. These infections are mainly caused by Candida species, Aspergillus species, Cryptococcus neoformans, Mucor etc. The predisposing factors to these diseases are numerous: neutropenia, organ transplantation, use of steroids, broad spectrum antibiotics, antineoplastic chemotherapy, parenteral nutrition, prolonged intravenous infusions, extensive surgery etc. Mortality is high because many fungal infection are difficult to diagnose, especially in their early, more treatable stages. Considerable progress in treating these infections has been achieved. Systemic fungal infections, however, continue to present major problems, including clinical resistance, microbial resistance, emergence of new pathogens and involvement of more susceptible patients. The purpose of this paper is to review the recent progress and current problems in diagnosis, treatment and prevention of opportunistic systemic fungal infections.

[Hypereosinophilia syndrome of unknown origin]. / Az ismerethen eredetü hypereosinophiliás syndroma.

The authors describe the case of a 19-year-old man with hypereosinophilic syndrome. At first the clinical picture suggested a localized eosinophilic gastrointestinal disease which rapidly progressed to the fatal disseminated form. The spectrum of hypereosinophilic syndrome is discussed and current thoughts on diagnosis, pathology and treatment presented.

[Isolation of Corynebacterium JK from the blood of neutropenic patients with septic diseases]. / Corynebacterium JK isolálása neutropéniás szeptikus betegek véréböl.

The authors report on the isolation of Corynebacterium JK from the blood of two neutropenic patients with hematological malignancy. In Hungary this paper is the first to discuss the microbiology of the organism and clinical manifestations of the group JK Coryneform infection. The clinical significance of this organism in the nosocomial infections of compromised patients and the association of the infection with the use of plastic devices has been emphasized. The sensitivity of the multiresistant coryneform bacterium to vancomycin may help to make the microbiological diagnosis and to select the drug for therapy.

Use of Eryc capsule in adult patients.

Ninety adult patients were treated with Eryc capsule, 1-2 capsules (250-500 mg) were given every 6 hours one hour before meals. The treatment was continued for 4-14 days, in cases of upper and lower respiratory tract infections, cutaneous and soft part infections, borreliosis and enteritis caused by Campylobacter jejuni. Of the 90 patients 85 recovered, 2 improved, in 3 cases failure was recorded. Side-effect necessitating the discontinuance of therapy was observed only in one case.

Ceftriaxone versus cefotaxime in the treatment of septicemia in adults.

Two potent third-generation cephalosporins with similar antibacterial spectra but different pharmacokinetics were compared in patients suffering from septicemia due to different organismus. Sixty patients with a variety of underlying diseases were included in the study. They received either 2-4 g ceftriaxone (active ingredient of Rocephin) once a day or 2 g cefotaxime every 8 h for 10-15 days. Our data confirm that a single dose of 2 g ceftriaxone should be sufficient to treat septicemia.

Diagnostic experience in two cases of legionellosis.

Sera of 30 patients with atypical pneumonia were tested for antibodies against the representative strains of Legionella pneumophila 1-6 serogroups and 4 species of legionella-like organisms. Investigations were carried out with indirect immunofluorescence assay. The sera of 2 patients gave a titre of 2048 and 1024 with serogroup 5 and 4, respectively. The high antilegionella IgM titres were indicative of recent infections. Legionellae were not detected in transtracheal aspirate and in autopsy material.