[Rat bite fever in children]. / Rattenbeetziekte bij kinderen.

BACKGROUND: Worldwide, disease in children due to exposure to rats is increasing, also in the Netherlands. Not only the generally known pathogen Leptospira should be considered, also S. moniliformis, Yersinia pestis, Lymphocytic choriomeningitis virus, Hantavirus, Francisella tularensis and Pasteurella multocida are also known rat-associated zoonosis. CASE DESCRIPTION: An 12-year-old boy visited the pediatrician with fever, headache and nausea, followed by generalized erythema and arthritis. The boy had a pet rat. The patient's blood culture was positive for S. moniliformis. The patient was treated with antibiotics and made a full recovery. CONCLUSION: Just like many rat-associated diseases have 'rat-bite fever' caused by S. moniliformis an nonspecific clinical presentation. It is not necessary to have had a rat bite, to develop rat-bite fever. Better awareness and knowledge about rat related diseases should contribute to earlier diagnosis and treatment. Which is of great importance because of increased morbidity and mortality associated to rat related diseases.

[An outbreak of respiratory tract infections in an institution: combating Mycoplasma pneumoniae in mentally disabled persons]. / Een uitbraak van Mycoplasma pneumoniae in een instelling voor mensen met een verstandelijke beperking.

BACKGROUND: In October 2013, the Municipal Health Service, Rotterdam, the Netherlands, was notified of an outbreak of Mycoplasma pneumoniae infections in an institution for mentally disabled persons. CASE DESCRIPTION: A total of 58 potential infections were identified, of which 12 were confirmed in the laboratory, 5 with PCR testing on throat swabs, 3 by an increased IgM value in the serum, 2 via IgM seroconversion and 2 with an increased IgG titer in consecutive serum samples. To combat the outbreak, measures were taken in collaboration with the municipal health service. Every patient who coughed with fever or malaise was considered to be potentially infected and immediately treated with antibiotics, with as much cohort nursing as possible. The staff made every effort to explain the more stringent hand and cough hygiene measures to the residents. CONCLUSION: An outbreak of Mycoplasma pneumonia in an institution for mentally disabled persons was controlled through active disease surveillance, treatment of potential cases and hygiene measures.

A positive family history for premature cardiovascular disease identifies patients prone to recurrent arterial thrombotic events.

BACKGROUND: Cardiovascular disease (CVD) is characterized by slow progressive atherosclerosis and arterial thrombotic events, leading to occlusions. Whether either of these presentations is more likely in patients with a genetic predisposition for CVD is still unknown. We suggest that a genetic predisposition for CVD is related to recurrent events of the same nature. METHODS: We retrospectively investigated 275 patients with premature CVD and divided them in two groups according to their first event: an arterial thrombotic event or stable atherosclerosis. We used a Cox proportional-hazards model to estimate the effect of a positive family history for CVD on recurrent events of the same nature. This was tested in the entire cohort and in patients with coronary artery disease only. RESULTS: Patients with a first arterial thrombotic event and a positive family history had a threefold increased risk for a recurrent event of the same nature, compared to patients with a negative family history (hazard ratio 3.00, 95% confidence interval 1.32-6.81); p < 0.05). In contrast, a positive family history was not associated with an increased risk for a recurrent stable atherosclerosis (hazard ratio 0.98 (95% confidence interval 0.59-1.63). These findings were similar analysing the patients with coronary artery disease only. Additional adjustments for other risk factors did not change these associations. CONCLUSIONS: Patients with a first premature arterial thrombotic event and a positive family history for CVD have an increased risk for a second event of the same nature. This might be due to unknown hereditary mechanisms leading to recurrent acute events.

Patients with premature cardiovascular disease and a positive family history for cardiovascular disease are prone to recurrent events.

BACKGROUND: Premature cardiovascular disease (CVD) is treated in the same way as CVD of advanced age. However, in patients with premature CVD and a family history of CVD, different -possibly genetic- mechanisms may underlie this disease, which current medical treatment is not targeted to. This suggests that subjects with a genetic predisposition to CVD are more likely to have recurrent cardiovascular events. METHODS: We retrospectively investigated 291 patients with premature CVD and assessed the amount of recurrent events according to family history in a follow-up period of 31 years. Premature CVD was defined as an event <51 years for men or <56 for women. We used a Cox proportional hazards model to estimate the relationship between a positive family history and recurrence of cardiovascular events. RESULTS: Patients with recurrent events had more often a positive family history (60.0% vs. 47.1%; p<0.05), were more often smokers (85.2% vs. 70.7%; p<0.05), had more often hypertension (36.3% vs. 23.6%; p<0.05) and had a longer follow-up period (10.0 years vs. 5.4 years; p<0.001) than patients without recurrent events. After adjusting for these differences and modelling time to events, a positive family history was independently associated with recurrent events (Hazard ratio 1.31 (95% confidence intervals (CI) 1.01-1.72; p<0.05)). CONCLUSIONS: Patients with a genetic predisposition for CVD are at risk for recurrent events, after adjusting for risk factors and other confounders. This might imply that in subjects with a genetic predisposition for CVD different pathophysiological mechanisms are active, leading to recurrent events.