Good clinical outcome in a case of Listeria-associated multiple liver abscesses and clinical hepatitis.

This case report describes a patient with the rare phenomenon of multiple liver abscesses and signs of hepatitis, secondary to disseminated listeriosis. All signs and symptoms resolved with antibiotic treatment only, contradicting current literature. This suggests that the development of multiple liver abscesses following infection with Listeria monocytogenes does not necessarily yield a poor prognosis, even without drainage.

Chronic Q fever-related complications and mortality: data from a nationwide cohort.

OBJECTIVES: Chronic infection with Coxiella burnetii (chronic Q fever) can cause life-threatening conditions such as endocarditis, infected vascular prostheses, and infected arterial aneurysms. We aimed to assess prognosis of chronic Q fever patients in terms of complications and mortality. METHODS: A large cohort of chronic Q fever patients was assessed to describe complications, overall mortality and chronic Q fever-related mortality. Chronic Q fever-related mortality was expressed as a case fatality rate (number of chronic Q fever-related deaths/number of chronic Q fever patients). RESULTS: Complications occurred in 166 of 439 (38%) chronic Q fever patients: in 61% of proven (153/249), 15% of probable (11/74), and 2% of possible chronic Q fever patients (2/116). Most frequently observed complications were acute aneurysms (14%), heart failure (13%), and non-cardiac abscesses (10%). Overall mortality was 38% (94/249) for proven chronic Q fever patients (median follow-up 3.6 years) and 22% (16/74) for probable chronic Q fever patients (median follow-up 4.7 years). The case fatality rate was 25% for proven (63/249) chronic Q fever patients and 4% for probable (3/74) chronic Q fever patients. Overall survival was significantly lower in patients with complications, compared to those without complications (p <0.001). CONCLUSIONS: In chronic Q fever patients, complications occur frequently and contribute to the mortality rate. Patients with proven chronic Q fever have the highest risk of complications and chronic Q fever-related mortality. Prognosis for patients with possible chronic Q fever is favourable in terms of complications and mortality.

Outbreak of group A streptococci in a burn center: use of pheno- and genotypic procedures for strain tracking.

In a burn center, an outbreak of group A streptococci (GAS) colonizations involving 13 patients and two staff members occurred. Adverse events due to GAS, loss of skin graft after initial take (secondary loss) and partial take, occurred in patients who underwent surgery before the colonization was detected. GAS isolates from nine patients and one staff member were stored and subsequently pheno- and genotyped by T serotyping, gas chromatography, M genotyping, and random amplified polymorphic DNA typing. The outbreak was caused by two types of GAS, identified as T4/28-M48 and T13-M77 by T serotyping and M genotyping. Random amplified polymorphic DNA typing and gas chromatography distinguished both clusters accurately. One subcluster indicated by gas chromatography could be linked to the acquisition of GAS from a roommate. The T13-M77 cluster was characterized by rapid spread through the center compared with the T4/28-M48 cluster. One patient contracted the T13-M77 strain while in protective isolation, indicating a role for staff members in the transmission. Our standard GAS control policy, consisting of twice weekly screening of all burned patients and immediate isolation and treatment, proved efficacious in preventing further spread of GAS. Reporting by staff members of signs and symptoms compatible with GAS infection was reenforced.

[Health complaints in relation to quality of swimming water in participants of a triathlon]. / Gezondheidsklachten in verband met de zwemwaterkwaliteit bij deelnemers aan een triathlon.

Participants in a triathlon in Alphen aan den Rijn, the Netherlands, reported gastrointestinal symptoms to the local health authority. A study was performed to establish the number of complaints and the relation with the microbiological water quality at the surface water swimming site, which met current standards. An epidemiological survey was carried out with a questionnaire among 629 participants, with non-participating relatives as controls. Faecal samples of patients and water samples were investigated by conventional methods. 439 participants and 217 controls completed the questionnaire. 140 participants had at least one gastro-intestinal symptom and 28 (6.4%) had highly credible gastroenteritis. Participants had an odds ratio for gastro-enteritis of 14.7 (95% CI: 2.39-604.45). Electron microscopic examination in six of 12 patients showed viruses able to cause such symptoms. Water samples showed considerable faecal pollution at the time of the triathlon (geometric mean counts: thermotolerant coliforms 725/100 ml; faecal streptococci 23/100 ml). The most likely source is the effluent discharge of the nearby waste water treatment plant. A surface water swimming site meeting current standards does not exclude health complaints among tri-athletes.

Artificial ventilatory management in a severe, pregnant asthmatic--a case report.

A 33-year-old pregnant atopic woman, who had never suffered from asthma or atopic-related disorder, was admitted on three occasions during her fifth pregnancy with severe asthma. On her last admission she required more intensive monitoring and artificial ventilation. We report this patient and discuss the pathogenesis of asthma during pregnancy. Asthma in pregnancy is not uncommon and it may take a severe course in some pregnancies. In one prospective study 42% of the patients required aggressive management, but none required artificial ventilation. However, there was no difference in the outcome of pregnancies between asthmatic and control subjects. Here we describe a patient with severe asthma who required artificial ventilation with a successful outcome.

Influence of high and low sodium dialysis on blood volume preservation.

Haemodialysis has a profound effect on fluid balance. Since fluid is initially withdrawn from the intravascular compartment, hypovolaemia is a frequent complication. A fluid shift from the overhydrated interstitium towards the intravascular compartment can counteract hypovolaemia. However, a fast decline in extracellular osmolality may cause an increase in the intracellular volume, reducing the available amount of fluid to compensate for the hypovolaemia. To overcome this problem, the use of alternating high and low sodium dialysate is advocated. In this study six patients were studied during standard haemodialysis (HD) and during dialysis with alternating high and low sodium dialysate (HLSD). Changes in intracellular fluid volume (IFV) and extracellular fluid volume (EFV) of tissue and blood were measured by means of a non-invasive electrical conductivity method. Changes in blood volume (BV) were studied by serial erythrocyte counts. Plasma sodium concentration was determined at regular intervals. The distribution volume of sodium during the high and low sodium episodes of HLSD was calculated according to a mathematical model. HLSD led to fluctations in plasma sodium concentration that induced changes in red cell volume, but not in IFV. Distribution of sodium was largely confined to blood. BV was better preserved during HLSD than during HD, probably due to a higher mean plasma sodium concentration. Postdialysis sodium concentration however, was not significantly different between HLSD and HD. These data suggest that the better BV preservation during HLSD results from an induced osmotic gradient across the capillary wall, rather than from an osmotic gradient across the cell membrane.