[Laboratory findings in patients with hemorrhagic fever with renal syndrome]. / Analiza laboratorijskih nalaza u bolesnika s hemoragijskom vrucicom s bubreznim sindromom.

AIM: To examine the frequency and distribution of hematologic and biochemical laboratory findings in 94 patients with hemorrhagic fever with renal syndrome (HFRS) in the epidemic year 2002. PATIENTS AND METHODS: The following laboratory findings were retrospectively analyzed: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, hematocrit, leukocyte count and differential percentage (segmented neutrophils, band neutrophils, atypical lymphocytes), platelet count, coagulation tests, blood urea nitrogen (BUN), creatinine, urine, potassium, bilirubin (BIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GT), alkaline phosphatase (ALP), and serum protein electrophoresis. The study included 94 HFRS patients treated at the Dr Fran Mihaljevic University Hospital for Infectious Diseases in Zagreb during 2002. RESULTS: ESR increase, mostly mild to moderate, was found in 86.2% of study patients. Increased CRP was recorded in 98.9% of study patients, however, one-fourth had CRP higher than 100 mg/L. Leukocytosis was recorded in 38.3% (10.1 +/- 4.2 x 10(9)/L), thrombocytopenia in 89.4% patients (68.2 +/- 48.3 x 10(9)/L), and severe thrombocytopenia (x 10(9)/L) in six patients. Three patients had abnormal coagulation tests. Increased values of BUN and creatinine were recorded in more than a half of patients, while only four patients had mild hyperkalemia. Only three patinets required hemodialysis. Mildly to moderately increased values of aminotransferases (AST, ALT, GT) were observed in more than 2/3; hypoalbuminaemia in nearly 1/3, and elevated alpha-2 fraction in more than 2/3 of patients. The majority of patients had pathologic urine findings. First laboratory abnormalities were usually found between day 5 and 7 of the disease (increased CRP level, thrombocytopenia, leukocytosis, and elevation of hemoglobin and hematocrit). Biochemical abnormalities(elevation of cratinine and urea, increased levels of aminotransferases) usually occurred at the beginning of the second week, and ESR increase in the second week of disease. CONCLUSION: The majority of our patients had laboratory findings characteristic of HFRS. Thrombocytopenia and increased level of CRP were the most common laboratory findings during the first week of the disease. Renal and liver impairment occurred at the beginning of the second week of the disease.

[Polymicrobial sepsis and perityphlic abscess: case report and review of literature]. / Polimikrobna sepsa i peritifliticki apsces: prikaz bolesnika i pregled literature.

AIM: To evaluate the safety and efficacy of conservative therapy of polymicrobial anaerobic sepsis and appendiceal mass. CASE REPORT: We report on an 18-year-old patient admitted for fever (38.8 degrees C), abdominal pain and vomiting. Leukocytosis with left shift maturation, and diarrhea were noted during hospital stay. A Fusobacterium species and Bacteroides ovatus were isolated from blood culture specimens. Radiologic examination with barium enema showed normal ileocecal region, while colonoscopy indicated terminal ileitis. Abdominal ultrasound and computed tomography showed appendiceal mass sized 6.5x5.5 cm in the right lower quadrant. The patient was treated with intravenous antibiotic therapy consisting of amoxicillin + clavulanic acid and metronidazole for 21 days. He was discharged from the hospital when control ultrasound indicated disappearance of the appendiceal mass. DISCUSSION: Acute appendicitis is the most common cause of urgent surgery in children. Bacterial enteritis limited to the ileocecal region appears to be responsible for an appreciable number of unnecessary appendectomies. On the other hand, diagnostic errors in appendicitis may delay early appendectomy and result in the formation of appendiceal mass. The advent of high-resolution real-time scanners and graded compression sonography has enabled not only an accurate diagnosis of acute appendicitis but also a reliable diagnosis of other diseases of the ileocecal region. Acute terminal ileitis has similar clinical and laboratory manifestations as acute appendicitis, thus presenting a common diagnostic problem in daily practice. Perforation occurs in 20% to 30% of children with acute appendicitis. Perforation may be difficult to diagnose by sonography. The most common complications are peritonitis and intraperitoneal abscesses. The management of appendiceal mass remains controversial, such as interval appendectomy after nonoperative treatment. CONCLUSION: Successful conservative treatment for polymicrobial anaerobic sepsis and appendiceal mass in an 18-year-old patient is described. The case report is followed by review of the literature on the appendiceal mass management.

Electrocardiographic changes in patients with haemorrhagic fever with renal syndrome.

The purpose of the study was to assess the incidence, type and dynamics of electrocardiography (ECG) alterations in patients with haemorrhagic fever with renal syndrome (HFRS) according to different stages of the disease. 79 patients hospitalized at the University Hospital for Infectious Diseases in Zagreb during the large HFRS outbreak in Croatia in 2002 were retrospectively analysed. HFRS diagnosis was confirmed by enzyme-linked immunosorbent assay. A 12-lead resting ECG was obtained. 30 (38%) patients had abnormal ECG findings, most frequently in the oliguric stage. Increased levels of urea and creatinine were observed in all patients with abnormal ECG, along with abnormal chest X-ray in nearly 50% of cases. Sinus tachycardia was the most frequent ECG disorder in the febrile stage, and bradycardia in the oliguric stage. During the course of disease, some other ECG disorders were recorded: bundle branch conduction defects, non-specific ventricular repolarization disturbances, supraventricular and ventricular extrasystoles, prolonged QT interval, low voltage of the QRS complexes in standard limb leads, atrioventricular block first-degree, and atrial fibrillation. Myocarditis was present in 3 patients. In conclusion, abnormal ECG was found in more than one-third of HFRS patients with the most common findings during the oliguric stage. All ECG changes were transient.