[Abnormal ultrasonographic findings of the kidneys obtained with a portable echosonographic device in the patients with infectious diseases--a five-year study].

BACKGROUND/AIM: Ultrasonographic kidney changes might be a part of the clinical picture, or consequence of the various infections diseases. The aim of this study was to establish ultrasonographic findings obtained by portable devices, the frequency of abnormal findings of the kidneys in the non-selected group of the patients with infections diseases. METHODS: Over a five-year period (January 1, 2000-December 31, 2004), the kidneys were examined by ultrasonography in 2,718 patients, 1,452 males and 1,266 females, mean age 47.52 +/- 17 years, (16-92 years). The examination included the measurement of the size of the kidneys, evaluation of the condition of parenchyma and pyelo-calix, detection of simple cysts, calculi and tumor. The conventional portable ultrasonographic devices ALOKA SSD-500 and SSD-1000 (B-mode) with a convex 3.5 and 5 MHz sonde were used. RESULTS: The size of kidneys was normal in 95% of the patients, while they were enlarged in 1.3% and reduced in 1.5% of the patients. A normal ultrasonographic recording was noted in 68.9% of the patients, double pelvis in 0.1%, while hydronephrosis was revealed in 0.9% of the patients. A reduced renal parenchyma was observed in 16.1% of the patients. Nephrolithiasis was found in 10.9% of the patients, and simple cysts of kidneys in 8.9% of the patients. The finding of polycystic kidneys was seen in 0.5% of the patients. An ultrasonographic recording of angiomyolipoma was noted in 0.4% of the patients, and the finding of other tumors in 0.1% of the patients. Adrenal tumors were found in 0.1% of the patients. CONCLUSION: Portable ultrasonographic units may be highly useful for the standard morphological diagnostics of renal changes during infections, as well as in clinical-epidemiological studies and screening of hereditary and the acquired diseases of this organ.

[Streptococcus suis infection--clinical manifestations].

INTRODUCTION: Streptococcus suis is a bacterium causing a disease in pigs and rarely in humans. This zoonosis is mostly found as a sporadic disease in individuals that were in contact with the affected or infected pigs: farmers, veterinarians and workers engaged in fresh pork processing. It is assumed that the bacterium enters the body through a cut abrasion in the skin. Initially, the condition resembles a flu, followed by signs of bacteriemia and sepsis. The most frequent clinical manifestation of Streptococcus suis infection is meningitis, leading to hearing loss in over 75% of patients, and subsequent arthritis, endophtalmitis, endocarditis and pneumonia. Toxic shock syndrome with hemorhagic manifestations rarely develops. MATERIAL AND METHODS: This study included five male patients aged 22 to 63 years treated in the Intensive Care Unit of the Institute of Infectious and Tropical Diseases in Belgrade, due to Streptococcus suis infection. The aim of this study was to point to the existence of this bacteria in our environment, to describe clinical manifestations of the disease and to point out the importance of its prevention. RESULTS: All patients had epidemiological evidence of being in contact with pork meat. There were no data about diseased pigs. The estimated incubation period was 4 to 8 days. All patients had meningeal signs. Clinical symptoms included shivering, fever, vomiting, headache, malaise, vertigo and tinitus. Three patients presented with alerterd level of awarrness. Four patients developed very severe bilateral hearing impairment, whereas one endophtalmtis and one developed endocarditis. The cerebrospinal fluid (CSF) was opalescent in four patients, and only one patient presented with clear CSF. CSF examination showed typical changes characteristic for bacterial meningitis. Streptoccocus suis was isolated in CSF in all patients, and in one patient the bacteria was isolated in blood as well. All patients underwent treatement with II and III generation cephalosporins and one with one aminoglycosides. All patients were cured, but 4 of them developed sequelae like permanent sensorineural deafness and mild ataxia. CONCLUSIONS: Streptococcus suis infection is present as a zoonosis in pigs, while humans are contracted occasionaly, most frequently related to occupational risk. In cases with bacterial meningitis with sepsis and hearing loss, Streptococcus suis infections must be suspected. Effective prevention requires collaboration between epidemiologists, veterinarians and human medicine physicians.

[Endocranial bacterial infections originating in the otorhinolaryngologic area]. / Bakterijske infekcije endokranijuma s ishodistem u "otorinolaringoloskoj regiji".

The study reviewed 60 patients with various endocranial infections complicated by previous ORL infections. The mean age of patients was 41 years. Significantly more patients were males (70%). The majority of patients (55%) had previous chronic otitis media, 25% had tonsillopharyngitis and 20% had sinusitis. The majority of patients (68%) presented with meningitis. In addition to meningitis, 13% of the affected patients manifested signs of cerebritis. Cerebritis was found in 13% of patients. Three simultaneous complications were seen in two patients: meningitis, cerebritis and subdural empyema. Brain abscess developed two patients during the treatment. Aetiologic diagnosis of neuroinfections was made in 25% of cases. The most common cause was S. pneumoniae (66%), followed by E. coli, S. aureus, S. alpha haemolyticus and Acinetobacter spp. In two patients the same microorganisms were obtained by culture of cerebrospinal fluid and purulent content from the ear (S. pneumoniae and Acinetobacter spp.). Among patients with meningitis brain CT findings were mostly within normal limits, and mild diffuse oedema was found in patients with meningoencephalitis, while the patients with focal inflammatory brain diseases (cerebritis, abscessus and empyema) had solitary changes located mostly at the side of chronic otitis and near inflamming sinusitis. Following the treatment in our institution, 20% of patients underwent surgical treatment of chronical otitis or endocranial complications (empyema and abscessus). The mortality rate of patients was 35%.