An audit of the (ab)use of thyroid function tests

Lyme disease and tick-borne encephalitis have similar principal epidemiological features chiefly associated with their basic carrier and determinants of human infection. The cases of Lyme disease, as evidenced by laboratory studies, indicate that there are active natural foci of this infection in the city, frequently combining with natural foci of tick-borne encephalitis. At the same time a great quantity of cases of tick-borne encephalitis and Lyme disease (mixed infection) is notified in Tomsk.     

Gerstmann's syndrome following an acute herpes simplex encephalitis

The authors present a rare clinical case of a woman who developed Gerstmann's syndrome following an acute Herpes simplex viral encephalitis. Clinical observation and laboratory evaluation were performed during the acute phase of the disease. After that the follow-up continued for one-year period. The localization of the pathologic process was determined by computerized tomography, conducted periodically. The characteristics of the clinical picture are interpreted in the context of the contemporary concepts of the topical diagnosis of Gerstmann's syndrome. The possibility of a sudden onset of acute Herpes simplex viral encephalitis without a preceding febrile-intoxication syndrome is worth noting. Conclusions are drawn stressing the need of an early etiologic treatment and the importance of the rehabilitation activities during the convalescence period.     

ACTH, beta-endorphin, substance P, and corticotrophin releasing hormone in plasma and follicular fluid in hormonally stimulated menstrual cycles for in-vitro fertilization in the human

The differential diagnosis of psychiatric symptoms in encephalitis, especially in the early phase of the disease may be very difficult. It is particularly hard to distinguish it from the classic psychosis. The diagnostic problems have been presented on the basis of analysis of two case reports of the acute encephalitis in young persons. The presence of fever and pathological changes in the CSF were the most important indicators that helped to establish the diagnosis of encephalitis during the phase of acute psychopathological disorders.     

Immunomodulatory activity of thunberginol A and related compounds isolated from Hydrangeae Dulcis Folium on splenocyte proliferation activated by mitogens

We have prospectively studied 27 adult patients attending the Department of Infectious Diseases, G?teborg, Sweden, between October 1992 and October 1996 with a diagnosis of acute viral encephalitis. In addition to cerebrospinal fluid (CSF) virus isolations and antibody analyses against herpes simplex virus, cytomegalovirus, varicella zoster virus, Epstein-Barr virus (EBV), enterovirus, adenovirus, tick-borne encephalitis virus, and mycoplasma, polymerase chain reaction test (PCR) to 5 viruses from the family of human herpes viridae, and to adenovirus as well as to enterovirus were analysed in CSF. 10 patients had herpes simplex virus type-1 (HSV-1), 1 had varicella zoster virus, 1 had tick-borne encephalitis, and 2 had Influenza A infections. In 13 patients the aetiology remained unclear. Eight patients with HSV-1 encephalitis and clinical symptoms for 2-11 d before admission were PCR-positive, while 2 patients with a < or = 2 d history of disease were negative for HSV-1 DNA on admission. These 2 patients became positive for HSV-1 DNA in CSF samples taken 4 d later in 1 case and 7 d later in the other. In 4 patients with HSV-1 encephalitis, in 1 patient with Influenza A complicated by encephalitis, and in 1 patient with encephalitis of unknown origin EBV DNA was found in CSF samples during the study. The clinical significance of these findings is unclear. The study shows that HSV-1 was the most common etiological agent in patients with viral encephalitis in the G?teborg area. In spite of improved diagnostic procedures, a large proportion of patients with symptoms and laboratory findings compatible with viral encephalitis still have an unclear aetiology.     

Sensitivity of radionuclide isotope brain scan in cerebral melioidosis: case report

Melioidosis, an unusual infectious disease formerly confined to the Orient, is being seen with increasing frequency in the United States. We present a report of a patient who had recently traveled in the Far East and subsequently developed pulmonary melioidosis complicated by a fatal encephalitis. Although the radionuclide brain scan was markedly abnormal, computed tomographic studies were minimally abnormal on one occasion and within normal limits on another. The radionuclide brain scan appears to have greater sensitivity in diagnosis of early encephalitis and, therefore, may be the more valuable of the two studies in the diagnosis of this disorder.     

Bickerstaff encephalitis. Clinical and magnetic resonance follow-up studies

We present a patient with Bickerstaff's brainstem encephalitis in whom MR imaging correlated with the clinical findings during the course of the disease. T2-weighted MR imaging showed increased signal intensity in the medulla oblongata, upper pons, pendunculi cerebelli and the cerebellum. In the course of the disease the lesions on MRI tended to descend more caudally. No anti-GQ1b antibody titers could be detected in the acute phase of the illness. Our findings suggest that MRI is the most valuable diagnostic tool in supporting the clinical diagnosis of Bickerstaff's brainstem encephalitis and may be helpful in the distinction between Miller Fisher syndrome and Bickerstaff's brainstem encephalitis.     

The "other" parvovirus: first description of the minute virus of canines (Canine parvovirus type 1) in Germany

OBJECTIVE: We present seven cases of acute encephalitis following measles, which were diagnosed during the epidemic that occurred in Spain in 1986. PATIENTS AND METHODS: We studied seven patients diagnosed of encephalitis due to measles. The diagnosis of measles was a made by the presence of a characteristic morbiliform rash and the detection of specific IgM antibodies. The diagnosis of encephalitis was based on the symptoms and the routine examinations of blood, CSF, EEG, CT, ophthalmic exploration and the study of the audiovisual evoked potentials. RESULTS: The patients were between 5 and 9 years of age. None of them had been previously vaccinated for measles. The symptoms of encephalitis occurred 1 to 12 days after the appearance of the rash and the most frequent symptoms were drowsiness and vomiting. All of the patients had EEG abnormalities that returned to normal 1 to 18 months after the diagnosis. One patient presented CT abnormalities. CSF examination revealed an increase of the cell count in one case. The ophthalmic exploration was normal except in one of the patients which had optic neuritis. There were no abnormalities in the audiovisual evoked potentials. All of the cases showed good evolution. Five years later, all of the patients have had a normal development. CONCLUSIONS: The correct vaccination of measles can eradicate this disease.     

Inhibitory effect of dopamine treatment on Na+/K(+)-ATPase activity in preterm infants

A range of neural pathology, in particular meningitis with sporadic encephalitic extension, can develop in salmonids infected with Renibacterium salmoninarum, the agent of bacterial kidney disease (BKD). Tissues from 134 Atlantic salmon and 164 chinook salmon were selected on the basis of their having a positive diagnosis of BKD, with evidence of multi-tissue infection including the brain (214 fish), or brain involvement in the absence of systemic lesions attributable to BKD (58 fish). Although meningitis was a feature of BKD in both species, encephalitis was more common in the Atlantic salmon. Specifically, a higher portion of the Atlantic salmon had encephalitis accompanying meningitis (P = 0.0159), encephalitis in the absence of meningitis (P = 0.0756), and brain lesions (meningitis or encephalitis) in the apparent absence of systemic lesions (P = 0.0067). These findings suggest either that some aspects of the pathobiology of R salmoninarum are dictated by the host species, or that the farm management methods used to deal with BKD are sufficiently different for the two species of salmon that they affect the pathology of the disease.     

Profiles of subjective quality of life in schizophrenic in- and out-patient samples

The genus Enterovirus is a large group of viruses belonging to the family Picornaviridae. They have a worldwide distribution, cause a wide spectrum of disease, and are a common cause of central nervous system disease. Included among the sixty-six enterovirus serotypes known to infect humans are the three poliovirus (PV) serotypes, the cause of paralytic poliomyelitis (PPM). PPM has been controlled in many parts of the world by vaccination. Molecular and functional comparison of PV vaccine strain and wild neurovirulent PV strains has provided an insight into mechanisms of neurovirulence. Enteroviruses are also the most commonly implicated viral agents of aseptic meningitis. Less commonly they cause a more serious encephalitis. Specific antiviral treatment for enterovirus infections is not currently available. Virological diagnosis is nonetheless important to distinguish between enterovirus-induced meningitis or encephalitis and other treatable causes of disease with a similar clinical picture.     

Herpes varicella zoster encephalitis in immunocompromised patients

The authors describe specific MRI features that suggest the diagnosis of varicella zoster encephalitis. MRI initially revealed discrete, subcortical, nonenhancing lesions that coalesced and developed enhancement. Gray matter involvement was seen later. Autopsy revealed spherical lesions of demyelination and hemorrhagic cavitation confirmed as varicella zoster encephalitis. Characteristic MR features may suggest the diagnosis of varicella zoster encephalitis, enabling definitive diagnostic testing and early institution of antiviral treatment.     

Failure of acyclovir sodium therapy in herpes simplex encephalitis

Herpes simplex encephalitis is an important disease characterized by focal haemorrhagic necrosis of the temporal and frontal lobes of the brain. The mortality rate may be as high as 70% of untreated cases. Isolation of the virus from brain tissue is the most reliable means of diagnosis. Although some non-invasive diagnostic modalities have been investigated, none is as reliable as brain tissue sampling. Despite acceptance that acyclovir sodium is the most effective drug for treatment, there is not a consensus on the dosage and duration of the antiviral therapy because some patients fail to respond and sometimes there is recurrence following therapy. We report a case of encephalitis in a previously normal host who died after a 13-day course of acyclovir therapy with isolation of HSV-type 1 from the brain post mortem.     

Laboratory diagnosis of subacute and acute encephalitis probably of viral origin: seven years of experience

The results obtained in the laboratory diagnosis of 609 cases of acute or subacute encephalitis, studied during a period of time of even years, is briefly presented. Diagnostic methods included virus isolation from stools and cerebrospinal fluid (CSF); specific serology in serum; detection of intrathecal production of IgG antibody; and, in the last two years, detection of viral genome sequences in CSF by the polymerase chain reaction. Significant results were obtained in 196 cases (32.2%) and the alfa-herpesviruses were responsible for a major part of them (77.5%). Furthermore, 18 cases were likely to respond to dual infection by both herpes simplex and varicella-zoster viruses. Epstein-Barr virus and Human herpesvirus 6 were found in CSF from three immunocompetent patients. Besides the current vaccination program, measles virus is still responsible for an important part (22/196, 11.2%) of cases of viral encephalitis.     

Some forms of disease associated with impaired locomotion in sheep (author's transl)

A number of flock diseases in sheep associated with impaired locomotion, which are of importance or may assume importance in the Netherlands, are reviewed. Attention is paid to the following metabolic disorders and deficiencies: acetonaemia, hypocalcaemia, hypomagnesaemia, some forms of osteopathy, enzootic ataxia and cerebrocortical necrosis. The following forms of infectious diseases are described: listeric encephalitis, purulent meningitis following injury to the throat, scrapie, visna, Aujeszky's disease and border disease. Finally, a number of viral forms of encephalitis are discussed, which are of minor importance or negligible in the Netherlands, though they are of importance in neighbouring countries. No attempt was made exhaustively to describe the above diseases. The aetiology and pathogenesis usually were not discussed in greater detail than that required for the diagnosis, treatment and prevention of the disease. Efforts were made to be of some help to the veterinary practitioner in controlling some forms of ovine disease in cases in which this is necessary and possible.     

Evaluation of histological studies of brains in pigs

The aim of this study was to formulate guidelines to determine whether, on the basis of the anamnesis, the age of the animal at slaughter, and the post-mortem findings, histological examination of the brain is necessary to arrive at a reliable diagnosis. In total 3159 animals were examined at the laboratory of the Animal Health Service in Gouda over the period from 1 August 1988 to 1 August 1990. Histological examination is recommended for pigs that show nervous signs, motor disturbances, and poor appetite without a clear cause of death, and for fattening pigs in which the post-mortem examination fails to detect abnormalities severe enough to cause death. Histological examination is also recommended when the animal has an overfilled stomach and/or a hard colon content. The examination is not necessary for pigs with intestinal disturbances or for pigs with endocarditis, polyserositis, or visible abnormalities of the brain. The occurrence of meningitis and encephalitis add little to the diagnosis.     

Encephalitis. Identifying the specific cause is key to effective management

Acute viral encephalitis and postinfectious encephalomyelitis affect both children and adults. Enteroviruses, HSV types 1 and 2, and arboviruses are the most common causes of encephalitis in the United States; however, the differential diagnosis is broad. History taking and physical examination can provide clues to the cause, but the diagnosis is usually established on the basis of CSF analysis, viral culture, MRI, and serologic testing, when indicated. In the future, PCR techniques may enhance rapidity of diagnosis. Until the specific cause is identified, empirical therapy should be given. Because complications can be severe, all patients with encephalitis should be monitored in a facility capable of providing supportive intensive care. Long-term follow-up is important to detect sequelae, particularly in patients with eastern equine or HSV encephalitis.     

Current problems in the laboratory control of louse-borne typhus infection in Ukraine

Surveys designed to study spread of typhus infection (persistent form and Brill's disease), and state of laboratory diagnosis in Ukraine showed an important role the laboratory diagnosis plays in the system of epidemiological surveillance aimed at preventing epidemic typhus. Main trends of activities on perfection of the system of laboratory control of the infection under present-day conditions are outlined.     

Proton MR spectroscopy in inflammatory and infectious brain disorders

This article reviews the proton MR spectroscopy literature regarding brain infarction and inflammatory diseases. We examine the salient findings reported for bacterial abscesses, intracranial tuberculomas, Creutzfeldt-Jakob disease, herpes simplex encephalitis and HIV. These processes demonstrate specific metabolic profiles which may be useful in differential diagnosis. The results reported in the literature support the view that MR spectroscopy can be employed in longitudinal studies to monitor the response to therapy and therefore may lead to individual optimized treatment effectiveness.     

Herpes simplex virus

CNS infections caused by human herpesvirus 1 and human herpesvirus 2-herpes simplex virus type 1 and herpes simplex virus type 2--are reviewed. The major diseases associated with these viruses are meningitis and encephalitis. Two forms of encephalitis are known, neonatal encephalitis and encephalitis occurring after the neonatal period. Both diseases are associated with high mortality and morbidity and require prompt diagnosis and aggressive antiviral chemotherapy. Methods for the specific diagnosis of these infections are reviewed and the value of intrathecal antibody assay and nucleic acid amplification techniques are emphasised.