Epidemiology, diagnostic delay and outcome of tuberculosis in North Jutland, Denmark.

INTRODUCTION: The objective of this study was to evaluate the clinical outcome of tuberculosis (TB) with regards to epidemiology, symptoms, delay, diagnostics, use of HIV-test, treatment, treatment outcome and mortality in the North Jutland Region from 2000 through 2008. MATERIAL AND METHODS: The present study is a retrospective study of all new TB cases in the 2000-2008 period. RESULTS: The period saw a total of 251 TB patients (an average of 28 per year). Almost 60% of the patients were not Danish-born, being mostly from Somalia and Greenland. The mean age was 43 years. 31% were alcohol abusers. 2% had AIDS. Cough was the most frequent symptom followed by weight loss, fever and fatigue. In 78.5% of the cases, it was possible to retrieve a positive culture, 53% had a positive sputum smear. However, in 8% of all patients, it was not possible to isolate Mycobacterium tuberculosis and these cases were diagnosed in accordance with the clinical signs. Almost all patients received the standard treatment comprising four antibiotics. 83% were treated successfully, while 5% ended their treatment prematurely. At the end of the study, 14% were dead. In all, 55% of all patients were HIV-tested. Two tested positive before their TB diagnosis and three after. CONCLUSION: The incidence of TB did not seem to decrease over the course of the study period as seen in the rest of Europe. The relatively high rate of alcohol abusers as compared with earlier Danish literature seems to be due to previous underreporting. A treatment success of 83% is high. This first study of HIV testing in Danish TB patients revealed that it was an acceptable result compared with other studies in this field, but the result was not satisfactory because we may miss patients with HIV/TB co-infection when only half of the patients are tested.

[Cerebral manifestations of influenza A (H1N1)v]. / Cerebrale manifestationer ved influenza A (H1N1)v.

We describe two patients with cerebral manifestations of influenza A (H1N1)v. A 13-year-old boy developed severe cerebral oedema and increased intracranial pressure despite medical treatment and external drainage of cerebrospinal fluid. He was treated with bifrontal decompressive craniectomy with good result. A 25-year-old man with a previous kidney transplant developed encephalopathy and convulsions. Magnetic resonance imaging showed encephalitis. The patient fully recovered. The cases demonstrate that influenza A (H1N1)v can cause seriously and potentially life-threatening neurological complications.

[Legionella pneumonia in patients treated with infliximab]. / Legionella pneumoni hos patienter, der er i behandling med infliximab.

Therapy with tumour necrosis factor-alfa inhibitors is widely used in various inflammatory disorders, but adverse events from severe infections with intracellular pathogens may occur. We describe two cases of severe pulmonary legionellosis in patients treated with infliximab for Crohn's disease and psoriasis, respectively. We conclude that legionella infections are probably more frequent in patients receiving immunosuppressive therapy with tumour necrosis factor-alfa inhibitors than in the background population.

[Neuroborreliosis in North Jutland]. / Neuroborreliose i Nordjylland.

INTRODUCTION: Infection with Borrelia sp. is common in Denmark, and dissemination to the central nervous system (neuroborreliosis) may develop in a minority of cases with varying symptoms. We here present a population-based review of neuroborreliosis in Northern Denmark. MATERIAL AND METHODS: We identified 84 patients with neuroborreliosis from North Jutland County in the period 1998-2006 based on the demonstration of intrathecal antibody production to B. burgdorferi, and we reviewed the medical records for symptoms, diagnosis, treatment and outcome. RESULTS: Paresis of the facialis nerve and fever were more common among children than among adults, whereas radiculitis and sensory symptoms were more frequent among adults than among children. Eight of 84 patients (10%) reported only nonneurological symptoms. All patients were treated with antibiotics for at least ten days. Information on outcome was available for 76 patients (90%) of whom 16 (19%) had persistent sequelae after six months. Patients with persistent sequelae had a lower cell count in the cerebrospinal fluid than patients without sequelae. Patients with a diagnostic delay of less than 28 days had less sequelae than patients with a delay longer than 28 days. CONCLUSION: Symptoms in neuroborreliosis are heterogeneous, although some symptoms are common in children while others are predominant in adults. Early diagnosis of neuroborreliosis potentially improves the outcome.