[Eosinophilic small vessel vasculites (EGPA) a hidden severe asthma comorbitity].

A 72-year-old woman presented to the emergency department due to worsening dyspnea. She had been diagnosed with asthma a year earlier. At arrival, her oxygen saturation was only 84%. During lung auscultation, wheezing was noted over all lung fields. A blood test showed a significant increase in eosinophils in peripheral blood, highest value of 1.4 x 10E9/L. Further investigations in the respiratory ward showed a positive MPO-ANCA, which, together with clinical features of asthma, chronic rhinosinusitis with polyps, mononeuritis multiplex and eosinophilia, led to the diagnosis of eosinophilic granulomatosis with polyangiitis, or what used to be called Churg-Strauss syndrome. Corticosteroid treatment was initiated and subsequently tapered down when treatment with mepolizumab was started, which is an IL-5 inhibitor. Her symptoms quickly became much better. Frequent exacerbations and pulmonary symptoms became things of the past.

[Dizziness in the emergency department - do we lack clinical judgment?]

OBJECTIVES: The aim of this study was to evaluate the extent and quality of work-up of dizzy patients at the Landspitali Emergency department. PATIENTS AND METHODS: All cases presenting to the emergency department with the main complaint of dizziness over a period of four months were analyzed retrospectively. Demographics, duration of symptoms, diagnosis and results from investigations and consultations were recorded from medical records. Investigations were categorized to blood tests, brain imaging and consultations to simplify interpretation of the results. RESULTS: One hundred sixty three cases were identified. 28% were diagnosed with inner ear problem and 32% were discharged without diagnosis. A serious central nervous system cause was found in 4% of cases. About one-third underwent investigations from all of the three investigation categories. An acute CT scan of the brain was obtained in 40% and MRI in 17% of all cases. Consultation was obtained from a neurologist for 28%, ENT for 26% and a cardiologist for 2% of cases. 11.6% (n=19) of the patients were admitted to the hospital, 53% to neurology, 42% to internal medicine and 5% to ENT. CONCLUSIONS: Dizziness is a common complaint in the emergency department and the cause is most often benign. Nevertheless, patients with dizziness routinely undergo extensive workup which often includes acute CT scan of the brain. Key words: vertigo, dizziness, CT, computed tomography, acute, emergency department. Correspondence: Arni Ornolfsson, arni.ornolfsson@skane.se.

Resistance in respiratory tract pathogens and antimicrobial use in Icelandic and Lithuanian children.

To assess resistance rates among respiratory tract pathogens and antimicrobial usage of children in Iceland and Lithuania, and to correlate usage patterns with resistance rates, nasopharyngeal swabs were taken from healthy children attending day-care centres in Reykjavik (n = 6) and Vilnius (n = 13), and cultured for pneumococci, Haemophilus influenzae and Moraxella catarrhalis. Information about recent antimicrobial use was obtained by a questionnaire. 50% and 51% carried pneumococci, 59% and 67% carried H. influenzae and 60% and 46% carried M. catarrhalis, in Reykjavik (n = 297) and Vilnius (n = 508), respectively. The prevalence of penicillin non-susceptible pneumococci was 11% in Reykjavik (mainly serotype 6B) and 5% in Vilnius (mainly 23F). At the time of sampling 3% of the children in Reykjavik and 8% in Vilnius were receiving antimicrobials. Children carrying penicillin non-susceptible pneumococci had used antimicrobials more frequently in the preceding month and this was significant for the Icelandic children (p < 0.0002). Antimicrobial use was more common in Vilnius than in Reykjavik, yet antimicrobial resistance was more common in Reykjavik. Resistance rates cannot be predicted only on the basis of recent antimicrobial use.

Listeriosis in Iceland, 1978-2000: a description of cases and molecular epidemiology.

The purpose of our study was to review all cases of listeriosis in Iceland during the period 1978-2000 and to analyse the genetic relatedness of their isolates. Case records of all patients in Iceland with listeriosis during the period were reviewed and the isolates compared using serotyping and pulsed-field gel electrophoresis (PFGE) using SmaI, AseI and ApaI restriction enzymes. Forty cases of listeriosis were diagnosed during the period, resulting in a mean annual incidence of 6.9 cases per million and a case fatality rate of 33%. In the first 5 y of the study only serotype 4b was observed; subsequently serotypes 1/2a and 1/2b appeared and serotype 4b declined in prevalence. PFGE yielded 24 different genotypes with 7 clusters of indistinguishable genotypes, each comprising 2-6 cases. During 1992-95 the annual incidence of listeriosis in Iceland rose to 15 cases per million. This was largely due to 2 clusters, 1 of 3 cases and the other of 6. No cases of listeriosis were diagnosed during 1998-2000. Our data show an increased number of cases within clusters in the latter half of the period. At the same time, food processing and distribution has become increasingly centralized in Iceland, suggesting an increased risk of listeriosis outbreaks.