Hepatitis in a Family Infected by Chlamydia Psittaci

Hepatic involvement is considered a rare complication of psittacosis. Occurrence of icteric hepatitis as the cardinal manifestation of the disease has been rarely reported. We describe two members of a family infected by psittacosis, in whom icteric hepatitis was the prominent expression of the disease.

The diagnosis of psittacosis was confirmed by isolation of the pathogen and by detection of serum antibodies to Chlamydia species. No serological evidence for acute TWAR infection was found. Chlamydia psittaci was also isolated from the family's parrot.

Chemical Composition of Herbal Macerates and Corresponding Commercial Essential Oils and Their Effect on Bacteria Escherichia coli

This study addresses the chemical composition of some commercial essential oils (clove, juniper, oregano, and marjoram oils), as well as appropriate herbal extracts obtained in the process of cold maceration and their biological activity against selected Escherichia coli strains: E. coli ATTC 25922, E. coli ATTC 10536, and E. coli 127 isolated from poultry waste. On the basis of the gas chromatography-mass spectrometry (GCMS) analysis, it was found that the commercial essential oils revealed considerable differences in terms of the composition and diversity of terpenes, terpenoids and sesquiterpenes as compared with the extracts obtained from plant material. The commercial clove, oregano, and marjoram oils showed antibacterial properties against all the tested strains of E. coli. However, these strains were not sensitive to essential oils obtained from the plant material in the process of maceration. The tested strains of E. coli show a high sensitivity, mainly against monoterpenes (α-pinene, β-pinene, α,β,γ-terpinene, limonene) and some terpenoids (thymol, carvacrol). The commercial juniper oil contained mainly monoterpenes and monoterpenoids, while the extracts contained lower amounts of monoterpenes and high amounts of sesquiterpenes—the anti-microbiotic properties of the juniper herbal extract seem to be caused by the synergistic activity of mono- and sesquiterpenes.

Haemoptysis as the sole presenting symptom of dissection of the aorta

A 75 year old man who had had haemoptysis for 24 hours was found to have his left lower lobe compressed by a dissection of the aorta, which was otherwise symptomless.

Severe Chlamydia trachomatis pneumonia in a patient with no immune deficiency

A 40-year-old patient with no immune deficiency was admitted because of severe bilateral pneumonia and pleural effusion. The diagnosis of Chlamydia trachomatis pneumonia was confirmed by isolation of the pathogen and the appearance of serum antibodies to Chlamydia species.

Serological cross-reactions between Rickettsia typhi, Proteus vulgaris OX19, and Legionella bozemanii in a series of febrile patients

The sera of 19 patients with a febrile disease of undetermined etiology were positive in the indirect immunofluorescence assay (IFA) to Legionella bozemanii serogroup 1 (Lb) and Rickettsia typhi (Rt). To both antigens, high titers of IgG-class and IgM-class antibodies were demonstrated. Several of the patients also had positive IFA and Weil-Felix reactions to Proteus vulgaris OX19 (PX 19). A sharp reduction of the serotiters to all three antigens was achieved by absorption of the sera with any one of the organisms. We demonstrated, by crossed immunoelectrophoresis with an Lb extract and a rabbit reference anti-Lb serum, that a heat-stable and trypsin-resistant antigen (antigen no. 1) reacted consistently with patients' sera that had been incorporated into an intermediate gel. Sera from five patients with high-titer IFA reactions to Rt, but no reaction to Lb, showed no interaction with antigen no. 1.

Exposure to Legionella in geriatric institutions

A study of seroreactivity to six Legionella species (L. pneumophila, L. longbeachae, L. micdadei, L. gormanii, L. dumoffii and L. bozemanii) performed in two geriatric hospitals, a day club for the aged and a group of aged with independent life styles revealed a high prevalence of seropositivity in the hospitals. A titer of 1:256 to at least one antigen was obtained in 30.5% of the patients and 35.7% of the staff members from one hospital, 12.1% of the patients and 17.2% of the staff members from a second hospital, 9.1% of the day club attendants, and in none of the 26 old people living in their own households. A second study of the possible source of Legionella spp. in three geriatric hospitals was performed. Three strains of L. pneumophila [serogroup (SG) 1, 3 and 6] were isolated from water, one water sample was positive for L. pneumophila SG 1-4 (pool), by direct immunofluorescence staining only. In a survey of seroconversion to Legionella antigens, 105 new patients were investigated on their arrival day and over a 2-year period; 24% of the patients who could be followed up significantly seroconverted to at least one of the Legionella antigens. Although the findings proved that Legionella existed on the premises of two hospitals, and the high prevalence of seropositivity to Legionella spp. indicated intramural exposure to the agents of legionellosis at one hospital, we found no evidence linking these agents to patient illness.

Pneumaturia: need for diagnostic alertness

Pneumaturia, an air-filled urinary bladder with or without passage of gas in the urine, is a rare phenomenon in the general population, but is more frequent in defined high-risk subgroups. Relevant symptomatology may be hardly noticeable for a relatively long period; however, the outcome may be serious and sometimes fatal. We present three such cases and discuss diagnostic and therapeutic aspects.

An esoteric occupational hazard for lead poisoning

A case of life threatening lead poisoning was diagnosed clinically in a Jewish scribe and verified by appropriate laboratory studies. The special ink used by the scribe was found to contain lead in appreciable amounts. Eleven more asymptomatic subjects, both scribes and manufacturers of the ink, were studied and five were found to have subclinical lead overload. Handling or production of this ink is a potential hazard for lead intoxication.

Primary pulmonary Hodgkin's disease with air bronchogram

A 30-year-old woman presented with a large pulmonary mass and air bronchogram. Hodgkin's disease of the nodular sclerosing type was diagnosed. Survival was short despite aggressive treatment. Primary pulmonary Hodgkin's disease is extremely rare. This is the first reported case of its presentation with an air bronchogram.

Should acute gold overdose be invariably treated?

Acute gold overload is rare and its clinical and pathophysiological consequences are not well delineated. Consequently the therapeutic approach has not been formulated. We describe 2 patients with rheumatoid arthritis in whom an acute gold overload was inadvertently administered. Their subsequent course, without specific treatment, was benign and uneventful. We suggest that with similar cases a conservative approach of watchful expectancy be adopted.

Symptomatic renal artery stenosis superimposed on chronic glomerulonephritis

We present two patients with proved chronic glomerulonephritis who had severe refractory hypertension and chronic renal failure. In both patients normal-sized kidneys were demonstrated in addition to vascular bruits and Grade III hypertensive retinopathy. These findings raised the suspicion of an etiological condition other than chronic glomerulonephritis underlying the hypertension and renal failure. Renal angiography revealed bilateral severe renal artery stenosis. In both cases renal revascularization was followed by a drop in blood pressure to normal or near normal levels. In selected cases with severe hypertension and chronic renal failure, renal artery stenosis should be considered, despite the coexistence of chronic glomerulonephritis.

Congenital afibrinogenemia: an unusual case

We describe a congenitally afibrinogenemic young man who experienced massive spontaneous bleeding episodes at unusual sites, including the thigh muscles, lung and brain. Each of these life-threatening episodes raised theoretical and critical practical problems. A large local hematoma was responsible for an accelerated consumption of fibrinogen, which was relieved following evacuation. It is unusual for an afibrinogenemic patient to survive a number of potentially lethal bleeding episodes.

Biopsy proven evolution of post streptococcal glomerulonephritis to rapidly progressive glomerulonephritis of a post infectious type

A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.

Levamisole circumvents inhibition of lymphocyte activation imposed by uremic serum

Uremic serum inhibits thymidine incorporation of phytohemagglutinin-stimulated lymphocytes originating in normal individuals. In this study the effect of levamisole on such inhibition was investigated. Preincubation with a wide range of levamisole concentrations resulted in complete prevention of the inhibitory effect imposed by uremic serum on thymidine incorporation. We would like to suggest that uremic serum possibly inhibits thymidine incorporation of normal lymphocytes by imposing an abnormal cyclic GMP/cyclic AMP intracellular ratio, and that levamisole may restore this ratio to normal.

Acute intoxication with ajmaline

A 57-year-old man ingested 1,000 mg of ajmaline with suicidal intent. He was unconscious, hypotensive and showed serious disturbances in cardiac conduction on admission. High serum and urine levels of ajmaline were found. Although only 4% of the ingested dose was excreted following forced diuresis, all evidence of toxicity disappeared within 21 h.

Regression of malignant thymoma with metastases after treatment with adrenocortical steroids

A patient with a malignant lymphoepithelial thymoma and pleural metastases is described. Incidental treatment with adrenocortical steroids after an allergic reaction resulted in a marked regression of the masses for a period of 18 months. A second course of treatment resulted in complete radiological regession of the tumors, and the patient has remained symptom free with normal chestX-rays for a further period of 18 months.