History and electrocardiography as pathway to diagnosis of Brugada syndrome: a case report

Introduction: The major electrocardiographic feature of Brugada syndrome is a distinct ST-segment elevation in the right precordial leads. Patients with spontaneously emerging Brugada ECG have a high risk of sudden arrhythmic death secondary to ventricular tachycardia/fibrillation. The ECG manifestations of Brugada syndrome are often dynamic. Type 1 pattern is diagnostic of Brugada syndome and is characterized by a coved ST segment elevation ≥2 mm, followed by a negative T wave.1-3 Case report: 23-years-old male has been hospitalized due to piercing pain in the left hemithorax and chills and fever lasting for several hours. He experienced such complaints for the first time in his life. He does not use tobacco, alcohol or psychoactive substances. He plays football for recreation. He reported severe family history: his father died at age of 36, and two paternal uncles died before their age of 25. At admission, he is conscious, oriented, mildly dyspneic, febrile (39.8˚C); BP 115/70 mmHg. Laboratory: WBC 13.9 x 109/L, neutrophils 85%, CRP 87; urine culture showed Escherichia coli >100.000/ mL. He has been treated with antipyretic/paracetamol, antibiotic according to antibiogramme, and rehydration therapy. The initial ECG showed type 1 Brugada sign: cove ST elevation in V1-3 with negative T waves; RBBB (Figure 1). After a 12 hours of hospitalization, the ECG showed type 2 Brugada sign: saddle-shaped elevation of ST-segment and J point in V2 (Figure 2). After 24 hours of hospitalization, the ECG showed type 3 Brugada sign (Figure 3). At discharge 7 days later, type 1 Brugada sign develops again – a cove ST elevation in V1-2 and a saddle ST elevation in V3 (Figure 4). Ajmaline test has been performed according to protocol. During administration of a maximum dose of 70 mg, a >2 mm ST elevation was detected in V2-3, making the test positive. Electrophysiological study involved right femo-ral vein access with quadripolar catheter to the right ventricle. Programmed stimulation did not induce ventricular tachycardia/ fibrillation. The patient was not indicated for ICD for prevention of sudden cardiac death. Conclusion: Family history and electrocardiography are the cornerstones of diagnosis of Brugada syndrome even today. Hyperthermia helped damask typical type 1 Brugada sign that showed dynamic changes. Our patient did not meet the criteria for implantation of ICD device

An update of the Culicoides (Diptera: Ceratopogonidae) checklist for the Balkans

International audienceBackground: The prime significance of species belonging to the genus Culicoides Latreille, 1809 (Diptera: Ceratopogonidae) is their ability to transmit viruses such as bluetongue virus (BTV) to wild and domestic ruminants. Prior to 1998, BTV was considered exotic in Europe, but according to recent history of its outbreaks, it has become endemic in southern and eastern European countries circulating beyond its expected historical limits, into the Balkan region. The wind-borne long-distance dispersal of Culicoides spp. over water bodies and local spreading between farms emphasize the necessity of filling in the information gaps regarding vector species distribution. In most Balkan countries, data on Culicoides fauna and species distribution are lacking, or information is old and scarce.Results: During this study, 8586 specimens belonging to 41 species were collected. We present the first faunistic data on Culicoides species in the former Yugoslav Republic of Macedonia (FYROM), Kosovo, Montenegro and Serbia. For other countries (Bosnia and Herzegovina, Bulgaria and Croatia), all historical records were compiled for the first time and then expanded with our findings to various extents. In all countries, confirmed or suspected BTV vector species belonging to the subgenera Avaritia and Culicoides were collected. The total number of species sampled during our field collections was 20 in Bosnia and Herzegovina (15 new records), 10 in Bulgaria (2 new records), 10 in Croatia (5 new records), 13 in FYROM, 9 in Kosovo, 15 in Montenegro, and 28 in Serbia. Of these, 14 species were registered for the first time in this part of the Balkans.Conclusions: This paper provides the first data about Culicoides fauna in FYROM, Kosovo, Montenegro and Serbia, as well as new records and an update on the checklists for Bosnia and Herzegovina, Bulgaria and Croatia. These findings provide preliminary insights into the routes of BTV introduction and spreading within the Balkans, and present a valuable contribution to further research related to Culicoides-borne diseases in Europe