Predisposing Factors Responsible for the Occurrence of Bacterial Purulent Meningoencephalitis

Bacterial purulent meningoencephalitis (BPME) is a life-threatening infectious disease caused by various pyogenic bacteria. The disease is defined as the inflammatory process of leptomeninges (visceral layer, pia mater and arachnoid membrane) and brain parenchyma with exudates in the subarachnoid space and surrounding brain structures. The aim of the study was to define the predisposing factors responsible for the occurrence of BPME, as well as the possible correlation between the presence of predisposing factors and patient demographic characteristics, etiology and outcome of the disease. This retrospective-prospective study included 90 patients with BPME confirmed by clinical, neuroradiological and laboratory findings. Multivariate logistic regression models were fitted to analyze the impact of the predisposing factors on the disease outcomes. Predisposing factors that were related to BPME were found in 61% of patients. Cranial trauma as the leading factor was recorded in 23.3% of patients, followed by previous neurological disease in 14.4% of patients, while 13 patients were exposed to previous chemotherapy or long-term corticosteroid therapy. Cardiovascular diseases were reported in 12.2% and diabetes in 7.8% of patients. The existence of cardiovascular diseases significantly influenced unfavorable outcome of the disease, i.e. "deceased" in comparison to "cured" (OR=8.418; 95% CI=1.007-76.270), independently of age and gender. None of the examined predisposing factors was significantly related to the "recovered with sequels" outcome as compared with "cured" outcome. Older age and presence of cardiovascular disease as a predisposing factor significantly increased the odds of the BPME unfavorable outcome "deceased" as compared to "cured" outcome.

Fever of unknown origin: Most frequent causes in adults patients.

BACKGROUND/AIM: The differential diagnosis of fever of unknown origin (FUO) includes more than 200 different diseases and conditions. The aim of this study was to identify the most frequent causes of FUO among adult patients according to gender and age. METHODS: The study included 74 patients examined from June 2010 to June 2013 at the Infectious Disease Clinic, Clinical Center Kragujevac in Serbia, according to the defined criteria for FUO. The patients were divided according to the diagnosis into four groups: infectious, malignant, rheumatic and "other diseases". A cause of febricity could not be estabilshed in a portion of subjects, and they comprised the group of undiagnosed cases. RESULTS: Infectious diseases were dominant in the study, followed by rheumatic diseases, which were most frequently found in women and the elderly. The diseases recognised as the most common causes of febricity were subacute thyroiditis, subacute endocarditis, Still's disease, rheumatic polymyalgia with or without temporal arteritis, and cytomegalovirus infection. In 44% of the patients, the final diagnosis was composed of only six clinical entities. CONCLUSION: The importance of establishing the diagnosis of rheumatic disease is especially emphasised, in line with other authors' research indicating the number of these diseases is on the rise. The diagnostic approach to FUO should always be directed to the known frequency of diseases.

Radiology Services Costs and Utilization Patterns Estimates in Southeastern Europe-A Retrospective Analysis from Serbia.

OBJECTIVE: Assessment of costs matrix and patterns of prescribing of radiology diagnostic, radiation therapy, nuclear medicine, and interventional radiology services. Another aim of the study was insight into drivers of inappropriate resource allocation. METHODS: An in-depth, retrospective bottom-up trend analysis of services consumption patterns and expenses was conducted from the perspective of third-party payer, for 205,576 inpatients of a large tertiary care university hospital in Serbia (1,293 beds) from 2007 to 2010. RESULTS: A total of 20,117 patients in 2007, 17,436 in 2008, 19,996 in 2009, and 17,579 in 2010 were radiologically examined, who consumed services valued at €2,713,573.99 in 2007, €4,529,387.36 in 2008, €5,388,585.15 in -2009, and €5,556,341.35 in 2010. CONCLUSIONS: The macroeconomic crisis worldwide and consecutive health policy measures caused a drop in health care services diversity offered in some areas in the period 2008 to 2009. In spite of this, in total it increased during the time span observed. The total cost of services increased because of a rise in overall consumption and population morbidity. An average radiologically examined patient got one frontal chest graph, each 7th patient got an abdomen ultrasound examination, each 19th patient got a computed tomography endocranium check, and each 25th patient got a head nuclear magnetic resonance. Findings confirm irrational prescribing of diagnostic procedures and necessities of cutting costs. The consumption patterns noticed should provide an important momentum for policymakers to intervene and ensure higher adherence to guidelines by clinicians.

[Myopericarditis during acute Epstein-Barr virus infection: a case report].

INTRODUCTION: Complications associated with infectious mononucleosis are rare, but occasionally they can occur involving hematological, neurological, cardiological and pulmological complications, as well as liver and spleen disorders, sometimes with lethal outcome. The most important cardiac complications are myocarditis and pericarditis. CASE REPORT: An 18-year-old male patient was admitted to the Departement of Infectious Diseasees with clinical picture of infectious mononucelosis, while symptoms appeared 7 days before admission. He was under observation and treatment for nineteen days when clinical, radiographic and echocardiographic findings revealed development of myopericarditis and he was transferred to the Cardiology Department. He was treated with non-steroidal antiinflammatory drugs, beta-blockers, antibiotics and other symptomatic therapy. He became afebrile 35 days after admission, and was discharged on the 50th day in good condition. DISCUSSION: Myocarditis may develop as a complication of an infectious disease, and is usually caused by a direct viral infection, as well as, toxic and autoimmune mechanisms. Myocarditis attributed to Epstein-Barr virus infection is probably caused by autoimmune mechanisms: autoantibodies activate the complement or cause cellular cytotoxicity. CONCLUSION: Myopericarditis is not a common complication of acute Epstein-Barr virus infection. Transvenous endomyocardial biopsy is an established method required for exact diagnosis. In this case it was not done, due to some technical reasons. Thus, there is a high probalitiy that this patient had myopericarditis.

[Pseudomembranous colitis during antibiotic therapy]. / Pseudomembranozni kolitis u toku antibiotske terapije.

INTRODUCTION: The use of antibiotics is commonly accompanied by diarrhea: idiopathic diarrhea with a benign process and diarrhea caused by Clostridium difficile and pseudomembranous colitis. Clostridium difficile colonizes the gastrointestinal tract and produces a toxin in cases when normal flora is suppressed by antibiotics. Pseudomembranous colitis most frequently appears after application of clindamycin, lincomycin, ampicillin, cephalosporins and other antibiotics. Diagnosis is established after rectoscopic findings of adherent pseudomembrane and pathohistological verification. The diagnosis is confirmed if there is evidence of Cl. difficile toxin in feces. CASE REPORT: We report about the clinical course of two patients with antibiotic-associated colitis. The diagnosis were made by clinical examinations, rectoscopy and pathohistologic verification of biopsy specimen of the intestinal mucosa. Neutralization test was not done due to technical reasons. Patients were treated with metronidazole. Unwanted side-effects of metronidazole therapy were not observed. DISCUSSION: Both our patients confirmed that they previously used different antibiotics. In the first case, diarrhea appeared during the antibiotic therapy, and in the second case, after finishing it. After antibiotic use, diarrhea appears in 5.30% cases, but fortunately pseudomembranous colitis is rare. However, taking into consideration that pseudomembranous colitis has a severe course and requires urgent treatment, one has to consider the possibility of pseudomembranous colitis when diarrhea appears during and after antibiotic use in order to initiate adequate therapy.