Septic sacroiliitis with iliacus muscle abscess – a case report

Prikazali smo slučaj 26 godina starog, prethodno zdravog muškarca s radiološki verificiranim septičkim sakroileitisom i apscesom lijevog ilijačnog mišića u tijeku stafilokokne sepse. Bolest se prezentirala naglim nastupom visokog febriliteta praćenog zimicama i tresavicama te bolovima u donjem dijelu leđa i lijevom kuku. Standardnom laboratorijskom obradom kod prijama nađena je lagano ubrzana SE 26 mm/1 h (uz porast na 60 mm/1 h trećeg dana), povišene vrijednosti CRP 123 mg/L, blaža leukocitoza 11,1 s neutrofilijom 78 % u DKS, blaža hipoproteinemija 61 g/L i hipoalbuminemija 33 g/L uz povišene vrijednosti frakcije alfa 1 (6,8 %) i alfa 2 (11,2 %) globulina u elektroforezi bjelančevina i fibrinogena 7,74 g/L te uredne ostale rutinske laboratorijske nalaze. Izolacija Staphylococcus aureusa iz hemokulture omogućila je ranu etiološku terapiju, a scintigrafijom skeleta i potom ciljanom radiografskom snimkom i kompjuteriziranom tomografijom (u daljnjem tekstu CT) sakroilijačnog zgloba locirano je mjesto upalnog procesa. Primijenjena antimikrobna terapija (vankomicin i ciprofloksacin parenteralno 2 tjedna, cefazolin parenteralno 4 tjedna, cefaleksin peroralno 3 tjedna) rezultirala je potpunim kliničkim oporavkom uz gotovo potpunu regresiju promjena na kontrolnim radiološkim snimkama. Septički sakroileitis izrazito je rijetka komplikacija u tijeku stafilokokne bakterijemije te smo iz toga razloga željeli prikazati bolesnika koji je uspješno liječen konzervativnom terapijom.We present a case of a 26-year-old previously healthy young male with radiologically confirmed septic sacroiliitis and left iliacus muscle abscess during staphylococcal sepsis. The disease onset was sudden with high fever, chills and shivering accompanied by pain in the lower back and left hip. Standard laboratory analysis on admission revealed moderately increased sedimentation rate 26 mm/1h (increasing up to 60 mm/1 h on the third day), elevated CRP 123 mg/L, mild leukocytosis 11.1 with neutrophilia 78 % in differential blood count, mild hypoproteinemia 61 g/L and hypoalbuminemia 33 g/L with elevated alpha-1 (6.8 %) and alpha-2 (11.2 %) globulins in protein electrophoresis and fibrinogen 7.74 g/L. Other routine laboratory tests were normal. The isolation of Staphylococcus aureus from blood culture has enabled early etiological therapy. Skeletal scintigraphy and targeted radiographic imaging as well as computed tomography of the sacroiliac joint revealed the location of the inflammatory process. Administered antimicrobial therapy (vancomycin and ciprofloxacin parenterally for 2 weeks, cefazolin parenterally for 4 weeks, cephalexin perorally for 3 weeks) resulted in full clinical recovery with almost complete regression of the changes observed on radiological images taken during follow-up visit. Septic sacroiliitis is an extremely rare complication during staphylococcal bacteremia and for this reason we decided to report a case that was successfully treated with conservative therapy

Evaluation of tuberculous meningoencephalitis by computerized tomography: a case report

Prikazali smo slučaj trogodišnje djevojčice s laboratorijski potvrđenim tuberkuloznim meningoencefalitisom i neurološkim komplikacijama koje su se razvile u kliničkom tijeku bolesti unatoč primjeni antituberkulozne terapije. Prikazana je CT evaluacija tuberkuloznog meningoencefalitisa koja je u početku bolesti pokazivala samo edem mozga, a u daljnjem tijeku i znakove meningitisa s hiperdenznim subarahnoidalnim bazalnim prostorima. U subakutnoj fazi CT-om su se verificirali ishemijski infarktni procesi bazalnih ganglija te znaci cerebritisa i ventrikulitisa. Neurokirurška intervencija pridonijela je regresiji hidrocefalusa, koji postaje normotenzijski uz razvoj frontalnih efuzija. Evaluacija tuberkuloznog meningoencefalitisa kompjuteriziranom tomografijom u Hrvatskoj je relativno rijetka te želimo kliničare podsjetiti na mogućnosti aplikacije CT-a i njegovu vrijednost u sličnim slučajevima.We present a case of a three-year-old girl with laboratory confirmed tuberculous meningoencephalitis and neurological complications that developed during the clinical course of disease despite antituberculous therapy. Computerized tomography evaluation of tuberculous meningoencephalitis is shown. Brain edem was the initial process. In addition, characteristic CT signs of meningitis with hyperdense basal subarachnoid spaces occurred. In the subacute phase ischemic infarcts in basal ganglions and the signs of cerebritis and vasculitis were visualised. Neurosurgical interventions improved the regression of hydrocephalus that became normotensive with the development of frontal effusions. The evaluation of tuberculous meningoencephalitis with CT scans in Croatia is rare and we want to remind the clinicians on the possibilities of CT application and its value in such cases

Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa

Background: South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. Methods: We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk ( 30%). Results: Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44-60) of the patients were stratified to very low risk ( 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. Conclusions: Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation

Septic sacroiliitis with iliacus muscle abscess – a case report

Prikazali smo slučaj 26 godina starog, prethodno zdravog muškarca s radiološki verificiranim septičkim sakroileitisom i apscesom lijevog ilijačnog mišića u tijeku stafilokokne sepse. Bolest se prezentirala naglim nastupom visokog febriliteta praćenog zimicama i tresavicama te bolovima u donjem dijelu leđa i lijevom kuku. Standardnom laboratorijskom obradom kod prijama nađena je lagano ubrzana SE 26 mm/1 h (uz porast na 60 mm/1 h trećeg dana), povišene vrijednosti CRP 123 mg/L, blaža leukocitoza 11,1 s neutrofilijom 78 % u DKS, blaža hipoproteinemija 61 g/L i hipoalbuminemija 33 g/L uz povišene vrijednosti frakcije alfa 1 (6,8 %) i alfa 2 (11,2 %) globulina u elektroforezi bjelančevina i fibrinogena 7,74 g/L te uredne ostale rutinske laboratorijske nalaze. Izolacija Staphylococcus aureusa iz hemokulture omogućila je ranu etiološku terapiju, a scintigrafijom skeleta i potom ciljanom radiografskom snimkom i kompjuteriziranom tomografijom (u daljnjem tekstu CT) sakroilijačnog zgloba locirano je mjesto upalnog procesa. Primijenjena antimikrobna terapija (vankomicin i ciprofloksacin parenteralno 2 tjedna, cefazolin parenteralno 4 tjedna, cefaleksin peroralno 3 tjedna) rezultirala je potpunim kliničkim oporavkom uz gotovo potpunu regresiju promjena na kontrolnim radiološkim snimkama. Septički sakroileitis izrazito je rijetka komplikacija u tijeku stafilokokne bakterijemije te smo iz toga razloga željeli prikazati bolesnika koji je uspješno liječen konzervativnom terapijom.We present a case of a 26-year-old previously healthy young male with radiologically confirmed septic sacroiliitis and left iliacus muscle abscess during staphylococcal sepsis. The disease onset was sudden with high fever, chills and shivering accompanied by pain in the lower back and left hip. Standard laboratory analysis on admission revealed moderately increased sedimentation rate 26 mm/1h (increasing up to 60 mm/1 h on the third day), elevated CRP 123 mg/L, mild leukocytosis 11.1 with neutrophilia 78 % in differential blood count, mild hypoproteinemia 61 g/L and hypoalbuminemia 33 g/L with elevated alpha-1 (6.8 %) and alpha-2 (11.2 %) globulins in protein electrophoresis and fibrinogen 7.74 g/L. Other routine laboratory tests were normal. The isolation of Staphylococcus aureus from blood culture has enabled early etiological therapy. Skeletal scintigraphy and targeted radiographic imaging as well as computed tomography of the sacroiliac joint revealed the location of the inflammatory process. Administered antimicrobial therapy (vancomycin and ciprofloxacin parenterally for 2 weeks, cefazolin parenterally for 4 weeks, cephalexin perorally for 3 weeks) resulted in full clinical recovery with almost complete regression of the changes observed on radiological images taken during follow-up visit. Septic sacroiliitis is an extremely rare complication during staphylococcal bacteremia and for this reason we decided to report a case that was successfully treated with conservative therapy

Ultrasound measurements of carotid intima-media thickness and plaque in HIV-infected patients on the Mediterranean diet

Aim To evaluate the influence of food habits, specifically adherence to the Mediterranean diet, on carotid intimamedia thickness (CIMT) and the presence of plaques in HIV-infected patients taking antiretroviral therapy (ART) and non-HIV-infected participants and to determine if HIV infection contributes independently to subclinical atherosclerosis. Methods We conducted a cross-sectional study of 110 HIV-infected patients on ART and 131 non-HIV-infected participants at the University Hospital for Infectious Diseases in Zagreb, Croatia, from 2009-2011. CIMT measurement and determination of carotid plaque presence was detected by ultrasound. Adherence to the Mediterranean diet was assessed by a 14-point food-item questionnaire. Subclinical atherosclerosis was defined by CIMT≥0.9 mm or ≥1 carotid plaque. Results In HIV-infected patients, subclinical atherosclerosis was associated with older age (P < 0.001; Mann-Whitney test), higher body mass index (P = 0.051; Mann-Whitney test), hypertension (P < 0.001; χ2 test), and a lower Mediterranean diet score (P = 0.035; Mann-Whitney test), and in non-HIV-infected participants with older age (P < 0.001; Mann-Whitney test) and hypertension (P = 0.006; χ2 test). Multivariate analysis showed that decreased adherence to the Mediterranean diet was associated with higher odds of subclinical atherosclerosis (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.10-4.72, P = 0.027) as was current smoking (OR 2.86, 95% CI 1.28-6.40), hypertension (OR 3.04, 95% CI 1.41-6.57), and male sex (OR 2.35, 95% CI 0.97- 5.70). There was a significant interaction of age and HIV status, suggesting that older HIV-infected patients had higher odds of subclinical atherosclerosis than controls (OR 3.28, 95% CI 1.24-8.71, P = 0.017 at the age of 60 years). Conclusion We confirmed the association between lower adherence to the Mediterranean diet and increased risk of subclinical atherosclerosis and found that treated HIV infection was a risk factor for subclinical atherosclerosis in older individuals