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ABSTRACT: The authors describe 3 histologically confirmed cases of temporal arteritis occurring in three siblings aged 62–72years old,
diagnosed from 1999 to 2005. Chapel Hill publication surrogate parameters combined with the American College of Rheumatology
criteria for vasculitis were used in the diagnostic procedure. The diagnosis of temporal vasculitis was confirmed by right
occipital artery excision and demonstration of relevant histopathology. Although genetic linkage studies have demonstrated
a potential genetic predisposition to temporal arteritis, this is one of the rare multiple occurrences of temporal arteritis
in a family reported in the literature.
Clinical Rheumatology 04/2012; 26(11):1997-1998. · 2.00 Impact Factor
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ABSTRACT: Adult-onset Still's disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece. The aims of the study were: (1) to study the incidence of AOSD and (2) to retrospectively apply different classifications to the data of these patients in search of a more efficient way of diagnosing these patients in the future. The annual incidence of AOSD was estimated at two new cases per 10(5). The clinical manifestations of the patients are discussed, with an emphasis on specific manifestations being considered as criteria by Yamaguchi and Fautrel classifications. Four patients exhibited markedly increased serum D: -dimers, a finding of which the potential pathophysiologic implications are discussed. Serum ferritin levels have additive values, both for diagnostic and cost-reduction purposes in cases presenting as FUO; serum ferritin values are not included in any diagnostic set of criteria at present. The finding of high levels of D-dimers in AOSD needs further studies.
Clinical Rheumatology 05/2011; 31(1):49-53. · 2.00 Impact Factor
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ABSTRACT: The cardiac effects imposed by the novel H1N1 influenza strain have not been elucidated until now. Electrocardiographic (ECG) abnormalities were evaluated in a series of 50 patients with confirmed novel H1N1 influenza infection. Epidemiologic and clinical characteristics, laboratory correlations, and the effect ECG abnormalities may exert on disease outcomes were prospectively studied. Of the 50 patients, 14 (28%) exhibited ECG changes on admission. Nine patients presented with T-wave inversions, while ST-segment depression was observed on the electrocardiograms of 6 patients. The presence of ECG changes did not correlate with age, gender, co-morbidities, the laboratory profiles of the patients, or the coexistence of lower respiratory tract involvement. None of the patients exhibited alterations in cardiac-specific biochemistry or cardiac ultrasonography. All ECG changes were transient and reversed during disease regression. Two patients with ECG changes and 1 with normal ECG findings required intensive care, the former 2 eventually dying. Among the remainder, the duration of hospitalization did not exhibit a significant difference between the 2 groups, although there was a trend toward fewer days of hospitalization in the patients with ECG changes. In conclusion, ECG abnormalities are frequently encountered during novel H1N1 influenza infection, but their presence does not indicate a direct pathogen effect to the myocardium; these alterations may necessitate admission in the first place but are transient and not correlated with preexisting patient characteristics or with outcomes.
The American journal of cardiology 11/2010; 106(10):1517-9. · 3.58 Impact Factor
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ABSTRACT: To describe the first documented case of subacute (De Quervain) thyroiditis in the course of novel H1N1 influenza infection. This is a case report of a patient diagnosed at the General Hospital "G. Hatzikosta" of Ioannina, Greece. A 55-year-old previously healthy male developed an influenza-like syndrome that was accompanied by severe neck pain, palpitations, weight loss, and disproportionately increased erythrocyte sedimentation rate. Polymerase chain reaction assay of pharyngeal swabs confirmed the diagnosis of novel H1N1 influenza infection. Serum thyroid-stimulating hormone was suppressed to zero and levels of free thyroxine and particularly triiodothyronine were increased. Technetium-99m-pertechnetate scintigraphy showed diffuse and inhomogeneous very low technetium trapping. The patient was treated with non-steroidal anti-inflammatory drugs and thyroid function gradually normalized without evolving to a hypothyroid phase. This is the first case of subacute thyroiditis associated with novel H1N1 influenza infection. Furthermore, this is the first case to definitely demonstrate active influenza infection of any type concurrent with thyroiditis, and one of the very rare similar cases for any active viral disease etiologically implicated in the pathogenesis of subacute thyroiditis.
Endocrine 06/2010; 37(3):440-1. · 1.42 Impact Factor
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The Lancet 04/2009; 373(9666):836. · 38.28 Impact Factor
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ABSTRACT: Existing classifications of potential biological weapons, acknowledge only limited important parameters of biological weapon potential. Certain pathogen factors would further influence the outcome of a potential attack in context with social and political aspects of the time and space of the attack. The importance of these factors was investigated through various attack scenarios that have been developed by the authors, and an individual score for each of these factors was calculated, based on the overall effect their variation had in the scenario outcome. A new classification score for potential biological weapons was subsequently developed, one, which drastically alters the perception of risk for certain pathogens, such as filoviruses and anthrax. This frame further allows for more accurate evaluation of the bioweapon potential of agents such as avian flu. Recognition of intervening factors and proper assessment of the actual risk might augment in proper distribution of interest and funds on relevant medical research.
Journal of infection and public health. 01/2009; 2(2):55-61.
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ABSTRACT: Leptospirosis continues to be a significant zoonosis of the developing world. Globalization, in the context of international travel, particularly for recreational activities and military expeditions, has led to increased exposure of individuals from the developed world to the disease, as recent outbreaks show.
We evaluated the trends in annual leptospirosis incidence for individual countries worldwide through reports from national and international organizations, the published medical literature on the subject, and web searches with the terms 'leptospirosis' and the individual country names. Inter-country variations in leptospirosis incidence, when relevant official data were available, were also analyzed.
The Caribbean and Latin America, the Indian subcontinent, Southeast Asia, Oceania, and to a lesser extent Eastern Europe, are the most significant foci of the disease, including areas that are popular travel destinations.
Leptospirosis is a re-emerging zoonosis of global importance and unique environmental and social correlations. Attempts at global co-ordination and recognition of the true burden of an infectious disease with significant mortality should be encouraged.
International Journal of Infectious Diseases 08/2008; 12(4):351-7. · 1.94 Impact Factor
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Journal of Clinical Oncology 01/2008; 25(34):5523-4. · 18.37 Impact Factor
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ABSTRACT: Neurological involvement is one of the most perplexing and diverse presentation complications of brucellosis, a worldwide prevalent zoonosis. This review presents the current knowledge available from medical literature and discusses the shortcomings of the existing data. A proposed regimen should include doxycycline and rifampicin and, with the benefit of doubt, ceftriaxone, since its high concentration in the cerebrospinal fluid may offer significant efficacy against the pathogen. Corticosteroids have been used in specialized situations. The use of streptomycin is discouraged owing to its questionable ability to penetrate into the cerebrospinal fluid and its potential neurotoxicity that may perplex the clinical presentation. Treatment duration should be individualized in the absence of an adequate cut-off index.
Expert Review of Anticancer Therapy 01/2008; 5(6):983-90. · 3.28 Impact Factor
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ABSTRACT: The authors describe 3 histologically confirmed cases of temporal arteritis occurring in three siblings aged 62-72 years old, diagnosed from 1999 to 2005. Chapel Hill publication surrogate parameters combined with the American College of Rheumatology criteria for vasculitis were used in the diagnostic procedure. The diagnosis of temporal vasculitis was confirmed by right occipital artery excision and demonstration of relevant histopathology. Although genetic linkage studies have demonstrated a potential genetic predisposition to temporal arteritis, this is one of the rare multiple occurrences of temporal arteritis in a family reported in the literature.
Clinical Rheumatology 12/2007; 26(11):1997-8. · 2.00 Impact Factor
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ABSTRACT: Brucellosis involves the liver in varying ways, ranging from benign subclinical increases in serum aminotransferase levels to ominous chronic suppurative disease. Data on histopathology of the liver in brucellosis are scarce and contradictory. We sought to determine the liver histologic patterns present in a series of brucellosis patients and review the existing knowledge about liver involvement in this worldwide, prevalent zoonotic infection.
Fourteen patients from 2 referral centers were retrospectively studied. They had brucellosis caused by Brucella melitensis and had undergone liver biopsy at the time of diagnosis.
All patients exhibited granuloma formation in the liver parenchyma and in the majority in portal spaces. Varying degrees of cellular infiltration of parenchymal tissue and portal spaces, giant cells in granulomas, parenchymal necroses, and Kupffer's cell hyperplasia were also noted. No significant epidemiological or clinical correlations with liver involvement were exhibited. Thus, liver involvement was not increased in men vs women, young vs old patients, or complicated vs uncomplicated disease.
The liver is involved in Brucella melitensis infection contrary to past beliefs. Different histologic patterns can be observed in liver involvement in brucellosis, the most common being granuloma formation. The pathogenetic role of brucellosis in development of liver fibrosis and cirrhosis remains limited and understudied.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 09/2007; 5(9):1109-12. · 5.64 Impact Factor
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ABSTRACT: A 68-year-old woman developed eosinophilic pleural effusion and systemic eosinophilia 2 months after starting antihypertensive therapy with diltiazem. Several drugs are known to cause this disorder; however, the only other drug the patient had been taking was clonidine, which she had taken for the past 3-4 years. She was evaluated for all other possible causes of eosinophilia and eosinophilic pleural effusion, including malignancy, infection, and autoimmune disorders. Her symptoms resolved after diltiazem was discontinued, and no recurrence was noted on follow-up. To our knowledge, this is the first case report of eosinophilic pleural effusion caused by diltiazem. According to the Naranjo adverse drug reaction probability scale, a probable relationship existed between diltiazem and the patient's eosinophilia and pleural effusion. Although numerous drugs have been associated with eosinophilia and eosinophilic pleural effusion, the spectrum may actually be wider than is commonly thought and may include such unrecognized agents as diltiazem.
Pharmacotherapy 05/2007; 27(4):600-2. · 2.90 Impact Factor
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ABSTRACT: Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome.
We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis. Patients were assessed by interviewing at the time of diagnosis and during follow-up. Awareness and perception of the disease, willingness for epidemiologic surveillance, mode of referral, treatment preferences, and adherence were evaluated.
Although basic disease awareness is high, willingness to collaborate in epidemiologic surveillance is limited. Patient education may improve adherence to treatment and willingness to undergo surveillance, but may also result in many false referrals for relapse. Level of academic education does not influence the results. Convenience is the major factor when determining treatment preferences.
Improving health literacy may result in improved treatment outcome and improved control of disease incidence. There is a need for constant evaluation of the quality and quantity of information distributed in order to reduce transmission of misinformation and occurrences of public anxiety.
The Journal of infection 02/2007; 54(1):40-5. · 4.13 Impact Factor
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International Journal of Infectious Diseases 01/2007; 11(1):82-3. · 1.94 Impact Factor
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ABSTRACT: The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior. Current alternative approaches such as co-trimoxazole-containing regimens, should be widely evaluated as being more cost-effective. New methods of delivery such as gentamicin-loaded microparticles, neutralisation of the environment where Brucella resides and use of novel antibiotics such as tigecycline may be of importance in the future. The role of immunomodulation, widely but inconsistently applied in 'chronic' brucellosis, should be further evaluated in all disease stages to define if it is of any use. The development of a subcellular vaccine would be an important step forward although one has to take into account the multiple interactions between Brucella and the immune system, various technical problems and the lack of funds. Reviewing existing attempts at the development of such a vaccine, the authors conclude that a trivalent subcellular vaccine may be needed for adequate efficacy.
Expert Opinion on Investigational Drugs 10/2006; 15(10):1141-9. · 5.27 Impact Factor
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ABSTRACT: The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease. The adverse effect profile and the convenience of the regimen were superior to penicillin regimens reported in other clinical trials. Ceftriaxone may be a reasonable alternative in severe leptospirosis as an efficient, convenient and safe regimen. Large multicentre studies may further define the optimal interventions in severe leptospirosis as well as possible variations in the pathogenic and clinical parameters of respiratory leptospirosis.
International Journal of Antimicrobial Agents 10/2006; 28(3):259-61. · 4.13 Impact Factor
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Infectious Disease Clinics of North America 07/2006; 20(2):395-421, x. · 3.03 Impact Factor
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ABSTRACT: The epidemiology of human brucellosis, the commonest zoonotic infection worldwide, has drastically changed over the past decade because of various sanitary, socioeconomic, and political reasons, together with the evolution of international travel. Several areas traditionally considered to be endemic--eg, France, Israel, and most of Latin America--have achieved control of the disease. On the other hand, new foci of human brucellosis have emerged, particularly in central Asia, while the situation in certain countries of the Near East (eg, Syria) is rapidly worsening. Furthermore, the disease is still present, in varying trends, both in European countries and in the USA. Awareness of this new global map of human brucellosis will allow for proper interventions from international public-health organisations.
The Lancet Infectious Diseases 03/2006; 6(2):91-9. · 17.39 Impact Factor
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ABSTRACT: We present an 80-year-old woman, with a history of well-controlled hypertension and atrial fibrillation, who suffered from back pain and elevated blood pressure for 2 weeks prior to admission. At physical examination, a low-pitched systolic heart murmur was heard in the tricuspid area and there was mild tenderness in the left lower quadrant. Laboratory studies revealed an elevated hematocrit, lactate dehydrogenase, and liver aminotransferase. Macroscopic hematuria was present in urine and 20% eosinophils were detected with Hansel's stain method. Assuming a possible vascular embolic episode, angiography of the renal arteries was performed, which revealed an obstructive pattern in the presence of a left duplicate system.
European Journal of Internal Medicine 02/2006; 17(1):61-2. · 2.00 Impact Factor
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ABSTRACT: Acute pancreatitis can be caused by a variety of infectious agents but it is regarded as an extremely rare complication of brucellosis.
We briefly describe a 56-year-old man who presented with acute pancreatitis, fever, myalgia, and other clinical symptoms. Brucella melitensis was cultured from his blood. All clinical manifestations gradually resolved with the institution of intramuscular streptomycin and oral doxycycline therapy.
Acute pancreatitis may rarely be a complication of infection with B. melitensis. In areas where brucellosis is endemic, it should be kept in mind that acute pancreatitis may result from infection with brucella organisms.
JOP: Journal of the pancreas 02/2006; 7(1):62-5.
