Giant anterior sacral meningocele presenting as bacterial meningitis in a previously healthy adult.

Meningocele may be asymptomatic and incidentally discovered. Presenting as a retrorectal mass, sacral meningocele may produce urinary, rectal, and menstrual pain. Anterior sacral meningocele may be the cause of tethered cord syndrome. This article presents a case of a previously healthy 39-year-old man with large meningeal herniation that occupied the entire pelvis who developed symptoms of bacterial meningitis. A 39-year-old man was admitted with fever, chills, headache and photophobia. Escherichia coli was isolated from cerebrospinal fluid culture. Moderate improvement regarding meningeal symptoms was noted due to intravenous antibiotic therapy, but intense pain in the lower back associated with constipation, fecal and urinary incontinence, and saddle anesthesia developed. Abdominal ultrasound was negative. Plain radiographs and computed tomography demonstrated sacral bone defect and retrorectal expansive mass. MRI confirmed anterior sacral meningocele with cord tethering. After posterior laminectomy and dural opening, communication between meningocele and intrathecal compartment was obliterated. Computed tomography-guided percutaneous drainage through the ischiorectal fossa was performed to treat residual presacral cyst. Delayed diagnosis in our patient was related to misleading signs of bacterial meningitis without symptoms of intrapelvic expansion until the second week of illness. In our patient, surgical treatment was unavoidable due to resistive meningitis, acute back pain, and symptoms of space-occupying pelvic lesion. Neurosurgical approach was successful in treatment of meningitis and neurological disorders. Computed tomography-guided evacuation of the residual retrorectal cyst was less invasive than laparotomy, resulting in normalization of defecation and miction despite incomplete evacuation. Further follow-up studies may provide insight into the most effective treatment of such conditions.

Low sero-prevalence of Lyme borreliosis in the forested mountainous area of Gorski Kotar, Croatia.

AIM: Clinical forms of Lyme disease in Gorski Kotar have occurred only sporadically, in contrast to the northwestern Croatia and the neighboring areas of Slovenia, which are well-known Lyme borreliosis endemic regions. Our aim was to assess the level of sero-prevalence of Borrelia burgdorferi sensu lato in a high-risk population of forestry workers in the mountainous region of Gorski Kotar, Croatia, and compare it with the sero-prevalence in the residents of that area and the neighboring littoral region. METHODS: A sero-epidemiological study was conducted on 520 healthy subjects, divided in 3 groups: the first group included 234 forestry workers, residents of Gorski Kotar, the second 100 residents of various professions in the same region, and the third 186 subjects of various professions from the neighboring littoral region. The sera were collected during the winters of two successive years, 1997 and 1998. Lyme borreliosis serology was performed by indirect immunofluorescence assay. Sera from 10 hunting dogs from Gorski Kotar were also analyzed. RESULTS: The IgG antibodies to B. burgdorferi sensu lato were found in 11 examinees (4.7%) from the group of forestry workers, in 3 (3%) from the second group, and in 5 (2.7%) from the third group. Four out of 10 dogs (40%) had IgG antibodies against B. burgdorferi. CONCLUSION: Our results show that the forest and mountainous area of Gorski Kotar, Croatia, has the characteristics of a low sero-prevalence area, in contrast to the endemic neighboring areas.

Occupational histamine poisoning by fish flour: a case report.

Histamine poisoning due to inhalation and skin contact with fish products is rarely described in the literature. This study presents a case of occupational histamine poisoning by spoiled fish flour via inhalation, skin and eye contact. Shipments of fish flour transported in black or blue bags, depending on the source, were handled by 20 harbour workers. Ten workers handling blue bags developed allergy-like skin, eye, gastrointestinal, respiratory and cardiac symptoms within 30 min. Workers handling black bags were symptom-free, except for minimal eye irritation. After consultation with the Poison Control Centre histamine poisoning was suspected. The histamine content, as determined by thin-layer chromatography, was 10-fold higher in samples from the blue than from the black bags (510 mg/100 g flour compared with 50 mg/100 g flour, respectively). Part of the shipment was labelled as hazardous for human health with permission for further usage only under specific personal protective measures. It is suggested that the highest permissible levels of histamine in fish flour and similar products should be set and legally adopted.

Malaria, a travel health problem in the maritime community.

BACKGROUND: Three to five hundred million cases of malaria occur annually, causing over one to two million deaths. Malaria is one of the leading causes of fever, resulting from travel in tropical or subtropical countries. That risk is very high, especially for sailors. By the nature of their job they cannot avoid malarial regions and generally suffer from the lack of medical help aboard, insufficient knowledge of preventive measures, and lack of up-to-date information about chloroquine resistant areas. METHODS: Retrospective analysis embraced all cases of malaria among seafarers employed in the years 1990-1993 by the Croatian sea carrier Losinjska Plovidba, and cases treated at the Clinic for Infectious Diseases, Rijeka, in the same period. RESULTS: In that period, among seafarers treated in our Port Health Office there were registered 23 cases of malaria; 19 cases among sailors and 4 among tourists, all of them aboard merchant ships. Among seafarers treated in the Clinic for Infectious Diseases from 1990-1993 there were 13 malaria patients, 12 of them sailors and 1 tourist. CONCLUSION: The aim of this work is to study the morbidity of malaria on board ships owned by the Croatian shipping company Losinjska Plovidba in the 4-year period 1990-1993 and point to the lack of a health system for their health protection. It can be concluded that the severity of malaria, the number of complications, the period of disablement for work, permanent health damage in a marked number of young persons on duty abroad, all clearly demonstrate the individual and social costs of this disease in Croatia and the maritime community worldwide.