Respiratory syncytial virus in critically ill adult patients with community-acquired respiratory failure: a prospective observational study.

The incidence of respiratory syncytial virus (RSV) and influenza virus infection was determined during three RSV seasons in 158 adult patients consecutively admitted to the intensive care unit with community-acquired respiratory failure. Nasopharyngeal swabs were tested for the presence of RSV and influenza virus by real-time polymerase chain reaction. Six patients (4%) were positive for RSV and all recovered. This finding was in sharp contrast to influenza (23 (15%) patients, 4 (17%) deaths). In conclusion, even in the midst of the RSV season, RSV is an infrequent cause of respiratory failure in adults admitted to the intensive care unit.

Oral myiasis in a child by the reindeer warble fly larva Hypoderma tarandi.

We describe a case of human oral myiasis by a first-stage larva of the reindeer warble fly, Hypoderma (Oedemagena) tarandi (L.) (Diptera: Oestridae), in a 12-year-old girl. In September the patient complained of erythema, swelling and conjunctivitis of the right eyelid. Symptoms subsided spontaneously but re-occurred in October. In December she presented with acute swelling of the right corner of the mouth. Later that day a living larva protruded from this swelling. The patient had been on vacation in Norway during the previous summer months.

[Subcutaneous nodules with malignant presentation, but caused by infection]. / Een subcutane zwelling met een maligne presentatie, maar met een infectieuze oorzaak.

Three patients, a woman aged 32, a boy aged 6.5 and a man aged 56 years, presented with a subcutaneous mass suggesting a malignancy: respectively a rubbery swelling, painful to the touch below the left scapula, a partly massive, partly soft swelling on the inside of the left upper leg, and a non-fluctuating mass near the right eighth rib, parasternally. Additional diagnostic investigation revealed an infectious cause: respectively Mycobacterium tuberculosis, Bartonella henselae and Salmonella typhi. Antimicrobial therapy was successful. Subcutaneous masses suspected of being a benign or malignant tumour are sometimes caused by an infection. The differential diagnosis is extensive. Sometimes the travel anamnesis yields helpful information. It is concluded that besides histopathological examination, microbiological investigation can play a major role in the evaluation of subcutaneous masses.

[Persistent fever of unknown origin in two young infants caused by the atypical form of Kawasaki disease]. / Aanhoudend onbegrepen koorts bij twee zuigelingen door de atypische vorm van de ziekte van Kawasaki.

Two previously healthy infants, a boy and a girl aged 3 and 4 months, respectively, were admitted for fever of unknown origin with laboratory results indicating an inflammation. The boy presented with vomiting, pyuria, anaemia, and thrombocytosis. The girl presented with irritability, erythema and diarrhoea. All viral and bacterial cultures remained negative and supplementary radiology was unable to detect a focus of infection. The fever had persisted for at least 12 days in both cases before the diagnosis 'atypical Kawasaki disease' was considered. Cardiac echograms showed dilatation of the coronary arteries in both patients and confirmed the diagnosis. Immediate therapy with intravenous immunoglobulins and acetylsalicylic acid was given, whereupon the fever subsided within 24 hours; the further clinical course was uneventful. These cases illustrate the fact that atypical Kawasaki disease is often a late consideration, especially when the symptoms of the classical form are absent. This condition should be considered in every infant presenting with long-lasting unexplained fever.