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BACKGROUND: Known also as Osler's triad, Austrian syndrome is a complex pathology which consists of pneumonia, meningitis and endocarditis, all caused by the haematogenous dissemination of Streptococcus pneumoniae. The multivalvular lesions are responsible for a severe and potential lethal outcome. CASE REPORT: The case of a 51-year-old female patient, with a past medical history of splenectomy, is presented. She developed bronchopneumonia, acute meningitis and infective endocarditis as a result of Streptococcus pneumoniae infection and subsequently developed multiple organ dysfunction syndromes which led to a fatal outcome. Bacteriological tests did not reveal the etiological agent. The histopathological examination showed a severe multivalvular endocarditis, while a PCR based molecular analysis from formalin fixed valvular tissue identified Streptococcus pneumoniae as the etiologic agent. CONCLUSIONS: The presented case shows a rare syndrome with a high risk of morbidity and mortality. Following the broad-spectrum treatment and intensive therapeutic support, the patient made unfavourable progress which raised differential diagnosis problems. In this case, the post-mortem diagnosis demonstrated multiple valvular lesions occurred as a result of endocarditis.
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INTRODUCTION: The aim of the study was to assess the safety and efficacy of darunavir (Prezista(®)) used in subtype F human immunodeficiency virus - type 1 (HIV-1) infected, antiretroviral therapy (ART)-experienced patients in Romania in routine clinical practice. METHODS: This was a post-authorization, open-label, one-cohort, non-interventional, prospective study conducted at multiple sites in Romania to assess efficacy (CD4 cell count, viral load, and treatment compliance) and safety ([serious] adverse events, clinical laboratory evaluation, and vital signs) of darunavir in combination with low-dose ritonavir (DRV/r) and other antiretroviral (ARV) medications in subtype F HIV-1 infected subjects in naturalistic settings. Seventy-eight subjects were recruited by 9 investigational sites and received 600/100 mg DRV/r twice daily. RESULTS: Treatment with DRV/r administered with other ARV medications resulted in the expected, statistically relevant improvement of CD4 cell count and viral load in subjects eligible for such treatment. In addition, adherence to treatment was high and the treatment-emergent safety profile observed during this study was consistent with the established safety profile of darunavir. CONCLUSION: DRV/r administered in combination with other ARV medications in subtype F HIV-1 infected subjects in naturalistic settings proved to be an effective and safe treatment in Romania. TRIAL REGISTRATION: NCT01253967.
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INTRODUCTION: Listeria monocytogenes is an important opportunistic pathogen affecting patients with immunosuppression and shows a high tropism for the central nervous system. The clinical manifestations of central nervous system listerial infections are variable and represent a diagnostic challenge. CASE REPORT: The authors report the case of a 59-year-old woman who was admitted for confusion, agitation, and right-lower extremity weakness. The patient was treated for 3 months with fludarabine and 2 months with corticosteroids for chronic lymphocytic leukemia and hemolytic anemia, respectively. At the time of admission, the neurological examination revealed grade 4 right-lower extremity weakness with reflex asymmetry and right-sided Babinski sign; no signs of meningeal irritation were detectable. Physical examination was notable for grade 1 obesity and subfebrility. The cerebral computed tomography scan demonstrated a hypodense lesion in the left frontal lobe. Cerebral magnetic resonance imaging revealed a hyperintense lesion in the left frontal lobe with extension toward the basal ganglia (T2 and Fluid-Attenuated Inversion Recovery [FLAIR] sequences), and small nodular enhancing lesions after gadolinium infusion in the affected territory. Blood analyses revealed pancytopenia and elevated liver enzymes. During the second day after admission, the patient developed fever and neurological examination revealed signs of meningeal irritation. The cerebrospinal fluid (CSF) analyses revealed: red blood cells 24 cells/mm(3); white blood cells 829 cells/mm(3) (76% lymphocytes, 22% neutrophils, 2% monocytes); protein level 111.2 mg/dL; glucose level 10.2 mg/dL. Empiric anti-infection treatment was started with intravenous ceftriaxone, ciprofloxacine, aciclovir, and fluconasole. Both blood cultures and CSF cultures were positive for L. monocytogenes. The antimicrobial regimen was changed to ampicillin. The clinical and imaging outcome was excellent. CONCLUSION: The supratentorial focal lesions secondary to Listeria meningoencephalitis are rare. The cases with focal neurological signs without fever at onset can resemble stroke.
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Enteroviral encephalitis is a rare neuroinfection more often diagnosed in children within the context of enteroviral epidemic outbreaks. It has pleomorphic clinical features, variable severity and a definite potential to cause neuropsychological sequelae especially in infants. Some subtypes are extremely severe with a mortality rate of up to 25% by affecting the brain stem. These subtypes usually come with highly specific findings on neuroimaging. We present a paediatric case of diffuse encephalitis most likely enteroviral in nature, with some particular features concerning the severe clinical form, the neuroimaging aspects and the neuropsychological sequelae due to the rarely described evolution towards encephalomalacia.
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Encefalitis Viral/complicaciones , Encefalitis Viral/diagnóstico , Encefalomalacia/diagnóstico , Encefalomalacia/virología , Infecciones por Enterovirus/complicaciones , Infecciones por Enterovirus/diagnóstico , Enfermedad Aguda , Aciclovir/uso terapéutico , Ansiolíticos/uso terapéutico , Antibacterianos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Preescolar , Diuréticos/uso terapéutico , Quimioterapia Combinada , Electroencefalografía , Encefalitis Viral/tratamiento farmacológico , Encefalitis Viral/virología , Encefalomalacia/tratamiento farmacológico , Infecciones por Enterovirus/tratamiento farmacológico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Imagen por Resonancia Magnética , Índice de Severidad de la Enfermedad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Lung carcinoma represents the first cause of mortality by cancer in men of all industrialized countries. Distribution of lung carcinoma cases in function of histological type is variable from a region to another. Especially in the United States and Western Europe, there is a remarkable decrease in the incidence of squamous cell and small cell carcinoma, simultaneously with a significant increase in the incidence of adenocarcinoma. A comparative study in Strasbourg and Iasi demonstrates that the main histological type of lung cancer still remains squamous cell carcinoma. But in Strasbourg, adenocarcinoma has an important percentage, being found on the first place in women's mortality by cancer. It's likely that in the near future, lung adenocarcinoma will become the predominant histological type in France.
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Adenocarcinoma/epidemiología , Carcinoma de Células Escamosas/epidemiología , Neoplasias Pulmonares/epidemiología , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Carcinoma de Células Pequeñas/epidemiología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Femenino , Francia/epidemiología , Humanos , Incidencia , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Estudios Retrospectivos , Rumanía/epidemiología , Tasa de SupervivenciaRESUMEN
On an average of 6-18 months, actual survival in lung carcinoma (only 20% patients live over 1-2 years) is very modest, in spite of remarkable diagnostic and therapeutic efforts. In a research performed on 304 patients (244 men and 60 women), diagnosed between January 1st 2000 and December 31st 2001, we have studied the survival in function of disease extension over 10 months. A comparison of the survival of the patients diagnosed in the IV-th stage and the other stages respectively I-st, II-nd and III-rd has been realised by a statistical study with the help of test chi2. The percentages in the clinical stages I and IV was of 1.64% and respectively of 48.68% and it demonstrates a very modest survival for the patients diagnosed in the stage IV; disease extension represents a decisive factor in the determinism of this disease. Women survival (of 53.33%) better than that of men (of only 48.36%) can be explained by a more reduced smoking (only 63% at women comparative with 87% at men) and by a more reduced exposure to professional carcinogen agents. Statistical analysis of clinical stages I, II and III in comparison with the clinical stage IV by the help of the test X2, demonstrates that there are significant statistical differences between the clinical stage IV and the other clinical stages.
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Carcinoma/mortalidad , Neoplasias Pulmonares/mortalidad , Carcinoma/diagnóstico , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Cómputos Matemáticos , Estadificación de Neoplasias , Estudios Retrospectivos , Factores de Riesgo , Rumanía/epidemiología , Tasa de SupervivenciaRESUMEN
Besides smoking, the occupational exposure to carcinogens could be an important etiological factor responsible in almost 15% of lung cancer cases. In a retrospective study carried out on 304 patients (244 men and 60 females; mean age 63.4 years and median 64.6 years), diagnosed between 1st January 2000 and 31st December 2001, we looked for the percent of patients sent for consultation in Occupational Pathology department, the number of those who had a declaration of their cancer as occupation related and the carcinogens responsible. Sixty patients (19.7%) had a consultation in Occupational Pathology department and an occupational disease declaration was done on 27 of them. Among the patients non consulted in the Occupational Pathology department, an occupational exposure could have been suspected in 37 (12.2%) for the reason of the nature of their jobs. The principal carcinogens found were: asbestos, polycyclic aromatic hydrocarbons, welding smoke, crystalline silica and metallic powders. It seems necessary to try to search, by taking a detailed work history, for an exposure to a possible carcinogen during occupational life of the patients having diagnosed with a lung cancer.
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Contaminantes Ocupacionales del Aire/efectos adversos , Neoplasias Pulmonares/etiología , Enfermedades Profesionales/etiología , Amianto/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Fumar/efectos adversosRESUMEN
Lung cancer mortality is a major public health problem. Smoking, the most important aetiological factor, is responsible in almost 85% of lung cancer cases. Tobacco smoking is associated with almost all histological types of lung cancer. In a retrospective study, carried out on 304 patients (244 men and 60 females; average age 63.4 years), diagnosed between January 1st, 2000, and December 31st, 2001, we investigated the importance of smoking, the age of beginning of smoking and the association of different histological types of lung cancer with smoking. Twenty-one patients were non-smokers, 123 ex-smokers and 160 current smokers, with an average number of PY of 43 (2-120). Age at the start of smoking was between 10-19 years for the most important number of patients. In concordance with others studies, squamous cell carcinoma was on the first place in men (47.1%) and in smokers (43.81%), while in the women and non-smokers it was an adenocarcinoma (33.3%) and (52.38%). The squamous cell carcinoma remains the most frequently found in our study; the increase in adenocarcinoma is associated with changes in the composition and consumption of cigarettes.