Acute Haemophilus parainfluenzae endocarditis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Numerous pathogens can cause infective endocarditis, including <it>Haemophilus parainfluenzae</it>. <it>H. parainfluenzae</it> is part of the <it>H. aphrophilus, Actinobacillus actinomycetemcomitans</it>,<it> Cardiobacterium hominis</it>,<it> Eikenella corrodens</it>, and <it>Kingella kingae</it> group that may cause about 3% of the total endocarditis cases, and is characterized by a subacute course and large vegetations.</p> <p>Case presentation</p> <p>Acute <it>H. parainfluenzae</it> endocarditis developed in a 54-year-old woman, with no underlying predisposing factors. The patient presented with fever of 3 days duration and a severe headache. Magnetic resonance imaging of the brain revealed multiple cerebral emboli with hemorrhagic foci. Upon suspicion of endocarditis, cardiac transesophageal ultrasonography was performed and revealed massive vegetations. The patient underwent emergency mitral valve replacement, and was further treated with ceftriaxone. Blood cultures grew <it>H. parainfluenzae</it> only after valve replacement, and a 6-week course of ceftriaxone was prescribed.</p> <p>Conclusion</p> <p>We underline the typical presentation of large vegetations in <it>H. parainfluenzae</it> endocarditis, which are associated with embolic phenomena and resulting severity. Although the majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that <it>H. parainfluenzae</it> endocarditis may develop rapidly. Thus, awareness of the imaging characteristics of the pathogen may enhance early appropriate diagnosis and therapeutic response.</p

Abnormalities of brain neural circuits related to obesity: A Diffusion Tensor Imaging study.

PURPOSE Increased Body-Mass-Index (BMI) has been associated with brain atrophy in both gray and white matter structures. However, little is known concerning the integrity of white matter tracts in obesity. The purpose of the study was to evaluate the pattern of changes in white matter microstructure in human adiposity. MATERIAL AND METHODS The study included 268 participants (52 obese, 96 overweight and 120 normal-weight) that were retrospectively evaluated by Diffusion Tensor Imaging. The fractional anisotropy, axial, radial and mean diffusivity values were compared between the above groups using Tract Based Spatial Statistics. RESULTS The analysis revealed that the increased BMI was related with decreased fractional anisotropy in several white matter regions including the anterior and posterior thalamic radiation, the inferior fronto-occipital fasciculus, the inferior and superior longitudinal fasciculus, the corpus callosum (callosal body and forceps minor), the uncinate fasciculus, the internal capsule, the corticospinal tract and the cingulum (cingulate gyrus and hippocampus). CONCLUSIONS Anisotropic diffusion of anatomic regions governing important brain circuits such as reward seeking inhibition, motivation/drive and learning/conditioning decreases with increasing BMI