Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis.

Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

[Infectious disease doctors also contract travellers' diarrhoea].

INTRODUCTION: Acute infectious diarrhoea is common in travellers. The aim of this study was to examine the incidence of travellers' diarrhoea in a group of Danish doctors and to identify exposures that may confer protective benefits. METHODS: A total of 19 Danish infectious disease doctors, pediatricians and clinical microbiologists received a questionnaire regarding symptoms of infectious diarrhoea after a journey to Myanmar. The association between exposure and outcome was calculated as a relative risk. RESULTS: The occurence of travellers' diarrhoea was independent of medical specialty and age. Doxycycline prophylaxis was a significant protective factor and high intake of yogurt seemed also to confer protection, albeit not significantly. No protective benefits were found from avoidance of ice cubes, raw salad or the use of hand sanitizer. Self-medication with antibiotics was associated with female sex, high age, previous travel experience, employment in the eastern part of Denmark and medical specialty other than infectious diseases, although not significant. DISCUSSION: Infectious disease doctors have a similar incidence of travellers' diarrhoea as others. Only a few intended to use common travel advice regarding food and drinks and no effect was shown. The reduced risk conferred by yogurt can be caused by the effect of live probiotics on diarrhoea pathogenesis. The reasons why the use of antibiotics was associated with sex, employment region and medical specialty are unaccounted for and should be interpreted with caution because of lack of statistical significance. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Tetanus can still be found in Denmark]. / Tetanus ses stadig i Danmark.

Tetanus (lockjaw) is caused by toxins produced by Clostridium tetani, usually transmitted through contaminated wounds. We describe a case of tetanus in an unvaccinated, previously healthy 78-year-old woman. Twelve days after minor trauma to the right palm, initially treated with tetanus vaccination without immunoglobulins, she developed hoarseness, dyspnoea and difficulties swallowing and opening her mouth. She got severe, painful muscle cramps of especially the truncal muscles requiring large doses of sedatives and complicating respiratory insufficiency. She was treated in intensive care for 33 days, but recovered completely.