Sequential changes in hematologic and biochemical parameters in African tick bite fever.

OBJECTIVE: To evaluate the sequential changes and to estimate the frequencies of abnormalities in some commonly measured biological variables in patients with African tick bite fever (ATBF), an emerging spotted fever group (SFG) rickettsiosis in international travelers to rural sub-Saharan Africa. METHODS: A study was done of hemoglobin, total leukocyte count, absolute lymphocyte count, blood platelet count and serum levels of C-reactive protein (S-CRP), alanine aminotransferase (S-ALAT), aspartate aminotransferase, lactic dehydrogenase, gamma-glutamyl transferase, alkaline phosphatase, bilirubin, sodium and creatinine during the first two weeks of illness and prior to the institution of antirickettsial therapy in 108 patients with travel-associated ATBF. RESULTS: There were significant falls in mean total leukocyte count, mean absolute lymphocyte count, and mean platelet count, and significant increases in mean S-CRP and S-ALAT. During the first ten days of illness, elevated S-CRP, lymphopenia and elevated S-ALAT were detected in 91.7%, 73.3% and 40.7% of patients, respectively. Most abnormalities were mild. For 55 patients who underwent both S-CRP and absolute lymphocyte count determination, at least one parameter was abnormal in 52 (94.5%) patients. CONCLUSIONS: The sequential changes in many biological parameters during the acute phase of ATBF mimic those reported in other SFG rickettsioses. Mild abnormalities are frequent, with increased S-CRP and lymphopenia being the two most consistent findings.

[Subcutaneous therapy of hairy cell leukemia with 2-chlorodeoxyadenosine]. / Subkutan behandling af hårcelleleukaemi med 2-klordeoxyadenosin.

The efficacy of subcutaneous 2-chlorodeoxyadenosine (2-CdA) was explored in eight patients with symptomatic hairy cell leukemia. This study is an interim report of a larger ongoing internordic multicentre clinical trial of subcutaneous 2-CdA in patients with hairy cell leukemia. The present results strongly indicate that subcutaneous therapy with 2-CdA induces an impressive therapeutic response which is fully comparable to the traditional continuous intravenous treatment with 2-CdA. The morbidity was acceptable, and the patient compliance to subcutaneous 2-CdA was excellent. In terms of the rate of complete remission (70-90%), therapy with 2-CdA in hairy cell leukemia is superior to any other drug. Consequently, 2-CdA is expected soon to displace both interferon alpha and deoxycoformycin as first line therapy in hairy cell leukemia. A long follow-up time is required, though, to decide whether 2-CdA is capable of curing patients with hairy cell leukemia.

[Malignant lymphoma of the heart]. / Malignt lymfom i hjertet.

A case of malignant lymphoma in the heart is presented. A 75-year-old man was admitted to hospital for dyspnea. Echocardiography revealed a right atrial tumour and enlargement of the right ventricular wall. Myxoma was suspected clinically. The patient died from rapidly progressing congestive heart failure. Autopsy revealed massive infiltration of the myocardium in the right atrium, right ventricle and the tricuspid valves by a high grade malignant non-Hodgkin lymphoma of B-cell type. Malignant lymphoma was found at no other sites except for a five mm tumour in the thyroid gland and a larger six by five by four cm mediastinal tumour.

[Purulent meningitis among adults in the county of Frederiksborg. Therapeutic results in the period 1 January 1980--31 December 1990]. / Purulent meningitis hos voksne i Frederiksborg Amt. Opgørelse af behandlingsresultater i perioden 1.1.1980-31.12.1990.

A review of 158 cases of bacterial meningitis and meningococcal sepsis in adults is presented. The patients were admitted during a 11-year period, from 1980-1990. The incidence was 5.5/100,000 adults per year, which is high. The area had epidemics of meningococcal disease in the years 1987 and 1989. The bacterial agent was meningococci in 40.5%, pneumococci in 21.5% and unknown in 27.2%. The overall lethality was 13.9%, highest (26%) in patients who were infected by pneumococci. The meningococcal relative lethality was 14%. In the period of high meningococcal incidence 1986-1989, we found a relative lethality of 17%. The overall local hospital lethality was 18.3%, which has to be compared with 11.2% among patients primarily admitted to the County hospital. The lethality among patients who underwent emergency transfer from one of the local hospitals to the County hospital was 20%, which is as high as in the group of patients treated locally. Neither of these trends lethality are statistically significant at the level of 5%, tested by chi square tests.

[Hypertrophic obstructive cardiomyopathy complicated with bacterial endocarditis]. / Hypertrofisk obstruktiv kardiomyopati kompliceret med bakteriel endocarditis.

A patient with hypertrophic obstructive cardiomyopathy (HOCM) and Staphylococcus aureus mitral valve endocarditis is reported. Bacterial endocarditis occurs with increased frequency and the prognosis is worse in these patients. All patients with HOCM should therefore be given antibiotic treatment every time they undergo invasive procedures to prevent potentially fatal bacteraemia.