Cryptococcus neoformans meningoencephalitis in a patient with idiopathic CD4+ T lymphocytopenia.

Cryptococcus neoformans is a leading cause of invasive cryptoccocal infections which include meningitis/meningoencephalitis, cerebral cryptococcoma, invasive pulmonary and mediastinal infection. Invasive infection is mainly diagnosed in immunocompromised patients, especially in HIV-infected individuals. There is a rising number of patients with invasive cryptococcal infections in immunocompromised patients who are HIV-negative. Among several primary immunodeficiency syndromes, considered as possible reasons for these invasive infections, idiopathic CD4+ T lymphocytopenia (ICL) is most frequently diagnosed. The pathogenesis of this rare syndrome is still unknown, while its clinical spectrum ranges from an asymptomatic laboratory abnormality to life-threatening opportunistic infections. Here we present an HIV-negative young man suffering from cryptococcal meningoencephalitis in whom ICL was diagnosed.

First clinical experiences about the neurotoxic envenomings inflicted by lowland populations of the Balkan adder, Vipera berus bosniensis.

The first overall clinical description of envenomings by the lowland populations of the Balkan adder (Vipera berus bosniensis) is provided by this study. Fifty-four incidents have been collected retrospectively from the south-western Hungarian and the northern Croatian distribution area of the taxon. There were five (9%) asymptomatic, 24 (44%) mild, 12 (22%) moderate, 12 (22%) severe, and one fatal (2%) case according to the Poisoning Severity Score. The single death is a 60-year-old Hungarian case that was caused by V.b. bosniensis. Average hospitalisation was 2.75 days. The most common systemic symptoms were gastrointestinal disorders, ECG changes, persisting hypotension and neurological disorders. The initial phase of neurotoxic manifestations was always expressed in cranial nerve disturbances: ptosis, external ophthalmoplegia, diplopia, reduced focusing capability and blurred vision. Neuromuscular paralysis progressed to dyspnoea and lower limb paralysis in the most severe cases. Unusual symptoms were fluctuating arterial hypertension, drowsiness, and hypokalaemia. Laboratory results reveal leucocytosis, while deviation in the other laboratory values is not common. Envenomings by V.b. bosniensis significantly differ from those by the European adder (Vipera berus berus) in lower manifestation rate of extensive oedema, anaemia, CNS depression, and haematuria but the development of neuromuscular paralysis is high (20%). Their bites rather resulted in mild and moderate local symptoms in envenomed patients than those inflicted by the nominate form. This study presents the evidence of the frequent neurotoxic manifestations in Balkan adder-bitten patients for the first time, which strongly suggests that the venom of the lowland populations of V.b. bosniensis has neurotoxic activity.

Marked improvement in survival among adult Croatian AIDS patients after the introduction of highly active antiretroviral treatment.

We compared the survival of patients following the first AIDS event in Croatia from the period 1986-1996 to the period 1997-2000. A total of 72 (81.8%) out of 88 patients from 1986-1996 and 18 (32.1%) out of 56 from 1997-2000 died. Survival following the first AIDS-defining illness markedly improved in the period 1997-2000 compared to the period 1986-1996 (adjusted Hazard Ratio (HR) for patients surviving more than 6 months: 0.11, 95% confidence interval (95% CI) = 0.04-0.29). A CD4+ cell count of < 100 x 10(6)/L was an independent risk factor for patients surviving up to 2 years (adjusted HR = 1.96, 95% CI = 1.1-3.43, p = 0.02). Patients with tuberculosis or fungal infections had a longer survival when compared to other diagnosis (adjusted HR = 0.53, 95% CI = 0.32-0.90, p = 0.01). However, despite dramatic survival benefit of combination antiretroviral therapy, mortality at six months following the first AIDS event was similar in the two study periods and the one-year probability of death was still substantial (27.2%) in the period 1997-2000.

[Sepsis caused by Fusobacterium necrophorum (Lemierre syndrome): a rare complication of acute pharyngotonsilitis]. / Sepsa uzrokovana bakterijom Fusobacterium necrophorum (Lemierreov sindrom): rijetka komplikacija akutnog tonzilofaringitisa.

Lemierre syndrome is defined as an acute pharyngotonsillar infection that has spread into the lateral pharyngeal space causing thrombophlebitis of the internal jugular vein with consecutive metastatic emboli. The syndrome is most often caused by Fusobacterium (F.) necrophorum and usually involves young, previously healthy people. We present a healthy 20-year-old man who suddenly developed with high fever and sore throat followed by dyspnea, tachypnea and cough on the third day of illness. His condition worsened despite outpatient intramuscular penicillin therapy (1600 000 IU/day). He was admitted to Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Zagreb, on the sixth day of his illness with clinical signs of sepsis. Chest radiograph showed bilateral multiple infiltrates. F. necrophorum was isolated from blood culture. Swelling of the neck was also observed on the fourteenth day of illness, however, thrombophlebitis of the jugular vein was not diagnosed on ultrasound examination. The patient was treated with clindamycin for five weeks and recovered completely.