[Critical illness polyneuropathy--report of two cases]. / Critical illness polyneuropathia--esetismertetés.

The authors describe the cases of two mechanically ventilated septic patients, in whom developed during their illness with the signs of severe tetraparesis critical illness neuropathy. In both cases the first sign of the neuropathy was the respirator dependency despite the improving neurological status. The severe general condition of the patients and the administered sedatives obscured the neurological signs for a long time, and only the development of a severe tetraparesis raised the suspicion of the critical illness neuropathy. In the first case the diagnosis was made by exclusion, but in the second case it was proved with the help of EMG and the histological examination of the m. biceps brachii. The authors discuss the clinical relevance, neurological and electrophysiological signs and the problems of the differential diagnosis of this disease, which is quite common among the critically ill, septic patients.

[Flesh-eating bacteria infection of an immunocompromised patient]. / Húsevó baktérium fertózés immunszupprimált betegnél.

After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. The reason for this impressive change in the epidemiology and clinical manifestation of group A streptococcal infections remains unknown. The possible etiological factor is changing in virulence factor or the lack of protective immunity of the population (immunocompromise) against the invasive strains. We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.