Modic changes (MCs) have attracted great interest in recent years. The complex process of MC development and progression seems to involve interplay between mechanical, infective, inflammatory, and ...degenerative processes that cannot be clearly differentiated. Based on signal intensity on T1- and T2-weighted MRI scans, MCs can be divided three types: Type 1, Type 2, and Type 3. Predominantly Type 1 MCs are commonly associated with chronic low back pain that is unresponsive to classic treatment options. Infection with low-virulent anaerobic microorganisms, most commonly Propionibacterium acnes, has been implicated in MC development following a disc herniation when a tear enables bacteria to enter the disc. Recent studies in patients with chronic low back pain following a lumbar disc herniation associated with Type 1 MCs have reported promising results following prolonged systemic antibiotic treatment with amoxicillin-clavulanate. Hyperbaric oxygen therapy, as primary or adjuvant treatment in association combination with systemic antibiotics or anti-inflammatory therapy, could offer important advantages in treating patients with suspected low-virulent disc infections due to anaerobic microorganisms associated with Type 1 MCs. We believe that hyperbaric oxygenation could contribute to faster resolution of Type 1 MCs and associated pain through multiple effects—including direct antimicrobial effects through formation of reactive oxygen species (ROS), altering the favorable low oxygen tension milieu such that it becomes unfavorable for bacterial growth and survival, and anti-biofilm effects. Additionally, hyperbaric oxygenation could contribute to faster pain resolution via direct and indirect anti-inflammatory effects. As an adjuvant treatment administered in combination with systemic antibiotics, HBOT could increase the sensitivity of Propionibacterium acnes to antimicrobial drugs under hyperoxic conditions, resulting in faster MC resolution. Overall, the faster infection resolution, diminished bacterial load, and anti-inflammatory effects due to reduced cytokine expression and levels of infectious by-products could lead to faster pain resolution following HBOT, and a significant improvement of quality of life in these patients.
Lajmska borelioza i krpeljni meningoencefalitis (KME) najčešće su bolesti prenosive krpeljima u Republici Hrvatskoj. Isti vektor, krpelj roda Ixodes ricinus, odgovoran je i za prijenos humane ...granulocitne anaplazmoze (HGA) koja se u našoj zemlji rijetko dokazuje, a prvi slučajevi su potvrđeni 1998. godine u Koprivničko-križevačkoj županiji. HGA se najčešće klinički prezentira vrućicom s leukopenijom, trombocitopenijom, povišenim aminotransferazama i CRP-om, a potvrđuje se serološki, pri čemu se povremeno dokaže koinfekcija s virusom KME i/ili bakterijom Borrelia burgdorferi.
Prikazujemo slučaj 44-godišnje bolesnice koja je ambulantno liječena u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka zbog vrućice s bicitopenijom (leukopenija, trombocitopenija) i akutnog perikarditisa. Serološkom je obradom dokazana akutna koinfekcija uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi. Liječenje je provedeno doksiciklinom i nesteroidnim antireumaticima, čime je postignut povoljan klinički odgovor.
Cilj: Prikazati slučaj bolesnika s atipičnom kliničkom slikom toksokaroze, koja se manifestirala izoliranom afekcijom središnjeg živčanog sustava. Prikaz slučaja: Bolesnik u dobi od 55 godina liječen ...je u Klinici za infektivne bolesti KBC-a Rijeka zbog cerebralne toksokaroze koja se prezentirala inicijalno aneozinofilnim aseptičnim meningitisom. Klinički tijek bolesti u početku nije ukazivao na parazitarnu infekciju, već je dijagnoza postavljena nakon ponavljajućih citološko-biokemijskih i seroloških analiza cerebrospinalnog likvora i seruma. Zaključci: Cerebralna toksokaroza je rijetka bolest, a može se prezentirati i kao teški meningitis, encefalitis ili mijelitis. Prikaz slučaja bolesnika s dokazanom cerebralnom toksokarozom koja se inicijalno prezentirala kao aneozinofilni aseptični meningitis ukazuje na važnost uključivanja neurotoksokaroze u diferencijalnu dijagnozu sindroma aseptičnog meningitisa bez drugog dokazanog uzročnika.
Aim: To present a case of a patient with an atypical clinical course of toxocariasis, which was manifested by isolated affection of the central nervous system. Case report: A 55-year-old patient was hospitalized at the Clinic for Infectious Diseases of the University Hospital Center Rijeka due to cerebral toxocariasis, which was initially presented as aneosinophilic aseptic meningitis. Since the clinical course of the disease did not initially indicate a parasitic infection, the diagnosis was established after repeated cytological-biochemical and serological analyzes of the cerebrospinal fluid and serum. Conclusions: Cerebral toxocariasis is a rare disease and can also present as severe meningitis, encephalitis, or myelitis. This case report of a patient with proven cerebral toxocariasis initially presented as aneosinophilic aseptic meningitis indicates the importance of including neurotoxocariasis in the differential diagnosis of aseptic meningitis syndrome with no other proven causative agent.
Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine ...šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.
Tuberculous meningoencephalitis (TBM) is a rare and serious, often fatal presentation of active tuberculosis and account for about 1% of cases. Early diagnosis and prompt treatment of TBM is ...essential to reduce morbidity and mortality. Here, we report a case of TBM in 60-year-old man. TBM was considered on the basis of clinical presentation, laboratory findings (hyponatraemia), cerebrospinal fluid studies, radiological findings (hydrocephalus on multi-slice computed tomography), and history of orchiepididymitis of unknown origin one year earlier, together with information that the patient originated from Kosovo where incidence of tuberculosis is still high. Mycobacterium tuberculosis was cultured from cerebrospinal fluid on Lowenstein-Jensen medium confirming diagnosis of TBM. Subsequently, acid-fast bacilli (AFB) staining on samples obtained after orchiectomy a year ago was performed, revealing AFB. Anti-tuberculosis therapy is still in course. This is the second case of tuberculous meningoencephalitis with the same disease pattern (i.e. tuberculous orchiepididymitis - meningoencephalitis) in our Department, and this fact was crucial for the presumptive diagnosis and urgent treatment of TBM. The former case was described five years ago.
Pyostomatitis vegetans (PV) is a rare, chronic mucocutaneous disorder associated with inflammatory bowel disease (IBD). Oral lesions of PV are distinct and present as multiple white or yellow ...pustules with an erythematous base that coalesce and undergo necrosis to form a typical "snail tracks" appearance. Two cases of PV associated with IBD--one with Crohn's disease (CD) and the other with ulcerative colitis (UC) are reported. In the first case, adalimumab therapy brought the oral and gastrointestinal manifestations to complete remission. In the second case, the remission was achieved with systemic steroid therapy, but the disease relapsed after therapy discontinuation. Azathioprine was added leading to sustained remission of PV. Because of persistent active intestinal manifestation of UC, in spite of immunosuppressive therapy, infliximab was introduced. With the therapy remission of intestinal manifestation of UC was achieved as well. Our cases confirm previously reported good experience with immunomodulators and biologics in the treatment of PV. But, before using them we have to exclude an infectious etiology of oral lesions.
Splenic rupture is rare but life threatening complication of mononucleosis syndrome. It has been suggested that subcapsular splenic hematoma formation precedes rupture. The case of 44-year-old, ...previously healthy, male with splenic hematoma occurring after rising of heavy cargo is reported. Mononucleosis syndrome was suggested based on routine laboratory tests (elevated white blood cell count with predominance of lymphocytes and raised serum transaminases) and CMV infection was confirmed by serological test. Nonoperative management was used since the patient was hemodynamically stable with no further signs of splenic rupture. The same approach has been used in growing number of cases of patients with spontaneous splenic rupture in mononucleosis syndrome. Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent patient.
Bolest mačjeg ogreba (BMO) infekcija je uzrokovana Gram negativnom, fakultativno intracelularnom bakterijom Bartonella henselae. Glavni rezervoar infekcije je mačka i oko 75% bolesnika ima podatak o ...ogrebu ili ugrizu mačke u anamnezi. Rjeđe se infekcija javlja u kontaktu s psom, posredovano mačjom buhom ili neizravnim kontaktom oštećene kože ili sluznice s površinom kontaminiranom mačjom slinom. Infekcija može proći asimptomatski, ali se i prezentirati spektrom kliničkih manifestacija. U 85-90 % bolesnika radi se o klasičnoj BMO s kožnom lezijom i samoograničavajućim, regionalnim limfadenitisom dok ostale, rjeđe kliničke manifestacije, mogu zahvatiti gotovo svaki organ i organski sustav. Prikazujemo četiri bolesnika s BMO liječenih u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka te raspravljamo o dijagnostičkim i terapijskim izazovima ove bolesti.
Tuberculous meningoencephalitis (TBM) is a rare and serious, often fatal presentation of active tuberculosis and
account for about 1% of cases. Early diagnosis and prompt treatment of TBM is ...essential to reduce morbidity and mortality.
Here, we report a case of TBM in 60-year-old man. TBM was considered on the basis of clinical presentation, laboratory
findings (hyponatraemia), cerebrospinal fluid studies, radiological findings (hydrocephalus on multi-slice computed
tomography), and history of orchiepididymitis of unknown origin one year earlier, together with information that
the patient originated from Kosovo where incidence of tuberculosis is still high. Mycobacterium tuberculosis was cultured
from cerebrospinal fluid on Lowenstein-Jensen medium confirming diagnosis of TBM. Subsequently, acid-fast bacilli
(AFB) staining on samples obtained after orchiectomy a year ago was performed, revealing AFB. Anti-tuberculosis
therapy is still in course. This is the second case of tuberculous meningoencephalitis with the same disease pattern (i.e.
tuberculous orchiepididymitis – meningoencephalitis) in our Department, and this fact was crucial for the presumptive
diagnosis and urgent treatment of TBM. The former case was described five years ago.
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