Abdominal bloating and distension: what is the role of the microbiota.

Most patients with irritable bowel syndrome complain of a sensation of an increase in pressure within their abdomen during the course of the day which is called bloating and, in approximately half of these individuals, this symptom is accompanied by an actual increase in abdominal girth, which is referred to as distension. The pathophysiology of these two phenomena is somewhat different and it is now recognised that a whole variety of overlapping mechanisms are involved. Some of these are potentially amenable to treatment by modification of the bacterial flora of the gut and this article reviews the evidence for this.

Coronary involvement in Mediterranean spotted fever.

Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, a maculo-papular rash and a black eschar at the site of the tick bite. We describe the case of a 3-year-old boy with MSF who developed a transient right coronary artery ectasia. The patient was brought to the hospital after four days of fever and mild myalgia of the legs. The suspicion of MSF arose due to the presence of a maculo-papular skin rash and treatment with oral clarithromycin was started. After four days fever persisted and the differential diagnosis of Kawasaki syndrome was considered. Echocardiography showed a dilated right coronary artery with hyperreflective walls. Treatment with intravenous immunoglobulin was initiated while clarithromycin was continued. After one day the fever disappeared. An immunofluorescent antibody test performed after four weeks confirmed a R. conorii infection. A follow-up echocardiography was normal six weeks and six months later. We suggest that ectasia of the coronary arteries may be a manifestation of rickettsial vasculitis. Prospective studies are needed to understand the frequency and the possible consequences of this phenomenon in the course of MSF.

Widened coronary arteries in a feverish child.

A 3-year-old girl with fever of unknown origin after a visit to Surinam was seen at our hospital. Signs and symptoms were indicative of either Kawasaki syndrome or an acute viral or (atypical) bacterial illness. No cardiac abnormalities were noted at echocardiography. She was treated with intravenous immunoglobulin and clarithromycin and made a quick recovery. Serologically, the diagnosis of murine typhus was made; a flea-borne rickettsiosis caused by Rickettsia typhi. A follow-up echocardiography 1 week later showed a dilated left coronary artery, which was normal again 4 weeks later. We suggest that this phenomenon was a manifestation of rickettsial vasculitis.

Actinomyces hyovaginalis associated with disseminated necrotic lung lesions in slaughter pigs.

Lungs from 26 slaughter pigs with a diagnosis of pyaemic lung lesions (disseminated necrotic lesions and abscesses), as determined at post-mortem meat inspection, were subjected to a thorough examination, including re-evaluation of gross pathology and histopathological and microbiological examination of samples from multiple lesions. The pulmonary lesions, which appeared identical on gross inspection, could be divided into three histopathological types, namely (1) abscesses, (2) circumscribed (contained) necrotic lesions, and (3) bronchiolar ectasias. Some characteristic relations between bacterial species and histopathological type were demonstrated. Thus, abscesses were dominated by Staphylococcus aureus infections, and circumscribed (contained) necrotic lesions were dominated by infections with an Actinomyces species, identified as Actinomyces hyovaginalis by 16S rRNA gene sequencing. Actinomyces hyovaginalis was demonstrated in 23% of all cases, pointing to this organism as an important agent of disseminated lung lesions of pigs. Furthermore, a characteristic pyogranulomatous reaction with a central area of necrosis was found to be associated with this infection.

MR imaging of acute coccidioidal meningitis.

BACKGROUND AND PURPOSE: Our purpose was to describe the MR imaging findings in patients with acute coccidioidal meningitis. METHODS: Fourteen patients (11 men, three women; 22-78 years old; mean age, 47 years) with coccidioidal meningitis underwent neuroimaging within 2 months of diagnosis. Thirteen patients had MR imaging and one had an initial CT study with a follow-up MR examination 5 months later. Initial and follow-up MR images were evaluated for the presence of ventricular dilatation, signal abnormalities, enhancement characteristics, sites of involvement, and evidence of white matter or cortical infarction. The patterns of enhancement were characterized as focal or diffuse. Pathologic specimens were reviewed in two patients. RESULTS: Ten of the 14 images obtained at the time of initial diagnosis showed evidence of meningitis. All of the initially abnormal studies showed enhancement in the basal cisterns, sylvian fissures, or pericallosal region. Subsequent studies, which were available for three of the four patients with normal findings initially, all eventually became abnormal, with focal enhancement seen on the initial abnormal examination. Other abnormalities seen at presentation included ventricular dilatation (six patients) and deep infarcts (four patients). Pathologic specimens in two patients showed focal collections of the organism corresponding to the areas of intense enhancement on MR images. CONCLUSION: Early in its disease course, coccidioidal meningitis may show areas of focal enhancement in the basal cisterns, which may progress to diffuse disease. Pathologically, the areas of enhancement represent focal collections of the organism. Deep infarcts and communicating hydrocephalus are associated findings.

Conjunctival injection, episcleral vessel dilation, and subconjunctival hemorrhage in patients with new tsutsugamushi disease.

Tsutsugamushi disease is found in two types: classical and new. There have been very few reports describing the ocular findings in patients with the new form. We have described four patients with this type, selected according to their clinical and laboratory findings, including immunofluorescent titers and polymerase chain reaction results. Eyes were examined by standard ophthalmic procedures. Patient 1 had bilateral conjunctival injection and subconjunctival hemorrhage; patients 2-4 had conjunctival injection and episcleral vessel dilation bilaterally. We believe that conjunctival injection is found in most eyes of patients with new tsutsugamushi disease.

[Papillary necrosis and formation of fungal balls in a patient with AIDS: a clinical case and brief review]. / Necrosis papilar y formación de pelotones de hongos en paciente afecto de SIDA: caso clínico y breve revisión.

An AIDS case, with a Candida urinary infection causing papillary necrosis and accompanied by occurrence of fungal lumps is reported. The paper remarks on the incidence and peculiarities of urinary affectation in these patients, emphasizing the usefulness of percutaneous nephrostomy as a diagnostic, and above all as a therapeutic procedure, in cases of expanded urinary tract.

Are the lesions of duct ectasia sterile?

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.

[Enteropathogenicity of E. coli strains isolated from calves]. / Enteropatogennost na shtamove E. coli, izolirani ot teleta.

By applying the technique of ligated intestinal segments, comparative studies were carried out on the enteropathogenic character of E. coli eliminated from calves. In was proved that the anatomic-topographic position of ligated intestinal segments, as well as the quantity of the innoculated bacterial suspension, exercise an influence on the intensity of intestinal reaction. The first 2.5 m and the last 4 m of the thin intestines are inappropriate for the investigation because of the spurious reactions that take place in them. In was proved that the intestinal reaction was more pronounced in the front ofa the thin intestines in comparison with that in the pack part. Canamicin and hyperimmune K 99 antiserum, applied intramuscularly and subcutaneously, did not exercise any special influence on the enteropathogenic activity of E. coli strains. It is recommended that the antibiotics and the serum should be applied orally for the neutralization of EEC in the digestive tract.