Two cases of pyrexia of unknown origin are described in which no cause was found despite exhaustive inpatient investigation until occult dental infection was detected: extraction of the teeth involved was followed by resolution of the pyrexia. Dental infection should be considered as an unusual but eminently treatable cause of pyrexia of unknown origin.

Fever of Unknown Origin↗

PubMed1982

Extradural empyema complicating frontal sinusitis.

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Adult↗

PubMed1982

Brucellosis of the spine. A report of 3 cases.

Three cases of spinal osteomyelitis due to brucellosis are reported, all in women. Radiological confirmation was delayed for at least three months after the first clinical manifestation, while in one patient a bone scan was positive at an early stage. In two of the three cases the diagnosis was delayed because of insufficient awareness of the disease. Spinal osteomyelitis caused by Brucella is indistinguishable radiologically from that caused by other micro-organisms and needle aspiration or exploration is frequently performed to establish the correct diagnosis. Increased awareness of brucellosis and the carrying out of appropriate blood cultures and serological tests may make these procedures unnecessary.

Adult↗

PubMed1980

[Determination of optimal diphenylhydantoin dosage by monitoring serum concentrations].

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Aged↗

PubMedDate not supplied

Brucellosis: difficulties in diagnosis and a report on 38 cases.

We have reviewed 38 patients with brucellosis who were admitted to the Chaim Sheba Medical Center between 1955 and 1977, i.e. during a 23-year period. The clinical manifestations varied greatly. Diagnosis was easy when brucellosis was suspected, as in cases presenting with fever of unknown origin. In nine of the 38 cases diagnosis was difficult and delayed for several weeks since brucellosis was not suspected. Some of these cases will be described in detail. The diagnosis was established in 16 patients by isolating Brucella melitensis and in the other 22 by serological tests. There were no relapses in the 26 patients treated with a combination of streptomycin and tetracycline; two of the 12 patients treated with tetracycline alone relapsed. Brucellosis should be considered when clinical manifestations are puzzling.

Adolescent↗

PubMedDate not supplied

Murine typhus and spotted fever in Israel in the eighties: retrospective analysis.

One hundred and twenty-one cases of murine typhus and spotted fever in Israel between 1976 and 1985 in the Chaim Sheba Medical Center are reviewed. Clinical manifestations of murine typhus were similar to those described previously, but those of spotted fever were different from classical Mediterranean spotted fever: rash was present in 87% but eschar was noted in only two out of 38 patients. The occurrence of relapse in eight of the 16 patients treated with chloramphenicol (seven cases of murine typhus and one case of spotted fever) was striking, particularly since none occurred in 86 patients treated with tetracycline hydrochloride (p less than 0.01). Relapses were milder than the primary illness, except for one which did not receive specific therapy and was fatal.

Chloramphenicol↗

PubMedDate not supplied

Q fever meningoencephalitis associated with bilateral abducens nerve paralysis, bilateral optic neuritis and abnormal cerebrospinal fluid findings.

Q fever is an zoonosis caused by Coxiella burnetti, the clinical features of which are often nonspecific and self-limited. Involvement of the central nervous system is rare and is usually seen as a complication of endocarditis caused by this rickettsial organism in the chronic disease. Specific neurological manifestations in the course of the acute illness aseptic meningitis, encephalitis, toxic confusional states, extrapyramidal signs, dementia and behavioral disturbances. We describe a patient who developed reversible bilateral abducens nerve paralysis and bilateral optic neuritis in the course of acute Q fever meningoencephalitis.

Abducens Nerve↗

PubMedDate not supplied

Immediate immunosuppression caused by acute HIV-1 infection: a fulminant multisystemic disease 2 days post infection.

A healthy 19-year-old woman had vaginal intercourse on a single occasion with an HIV-1 positive male from Gambia. Two days later she developed an acute HIV infection presenting as a fulminant multisystem disease that lasted for 35 hospital days and included: immediate immunosuppression with extreme CD4+ lymphocytopenia and combined with CD8+ lymphocytosis, neutropenia and hypogammaglobulinemia; intermittent spiking fever; pneumonitis; hepatitis; changing skin rashes; peripheral neuropathy with myopathy, and panencephalitis. P24 antigen was detected by Western blot on day 23 and seroconversion was detected by ELISA on day 25. Cultured lymphocytes from peripheral blood and cerebrospinal fluid grew HIV-1.

Adult↗

PubMedDate not supplied

Nontyphoid salmonellosis in renal transplant recipients: report of five cases and review of the literature.

Five cases of nontyphoid salmonella infection among renal transplant recipients are reported, and 32 cases from the literature are reviewed. Contrary to the nontyphoid salmonella infection in normal hosts, such infection in renal transplant recipients manifested as bacteremia (62%) and in extraintestinal foci (35%). Asymptomatic bacteriuria, at times prolonged, was common, whereas gastrointestinal symptoms were noted in only 19%. The course of infection may be prolonged, with relapse occurring in 43.2% and death in 5.4%. Extraintestinal manifestations were located at very unusual sites, such as testes, maxillary sinus, axillary vein thrombus, and hemodialysis fistula. Because relapses were so frequent, the suggestion is made that every effort be made to find silent foci of infection after clinical recovery and to eradicate such foci with prolonged antibiotic therapy and with surgical measures, if necessary. Stool and urine should be screened for nontyphoid Salmonella before and after transplantation.

Adult↗

PubMedDate not supplied

Nontyphoid salmonellosis in patients with total hip replacement: report of four cases and review of the literature.

Five episodes of nontyphoid salmonella infection following total hip replacement in four patients were studied. In three patients the infection occurred in the immediate postoperative period while prophylactic antibiotics were being administered. The fourth patient had bilateral total hip replacements five years apart with two nontyphoid salmonella infections, one immediately after the first operation (during antibiotic prophylaxis) and the second four years after the second operation. In addition to local infection, clinical manifestations included fever (all patients), diarrhea (three patients), deep prosthetic infection (two patients), and shock with disseminated intravascular coagulation and acute renal failure (one patient). In addition to antibiotic therapy, removal of the prosthesis was necessary for cure in three patients. All patients recovered. Hematogenous spread was thought likely in all cases. Four of five salmonella isolates were resistant to ampicillin and chloramphenicol. A review of the English-language literature yielded information on five additional cases of nontyhpoid salmonella infection after total hip replacement in four patients.

Adult↗