Shiraz Emedical Journal
Volume:2 Issue: 1, Jan 2001

Although uncommon, neurobrucellosis can affect any part of the central or peripheral nervous system clinical syndromes are ultimately diverse, and clinical picture may be confused by the coexistence of two or more clinical syndromes in the same patient. The most common neurologic manifestation is a subacute or chronic meningoencephalitis. Acute toxic manifestations (e.g., headache, neckache, backache, insomnia, depression and muscle weakness) are seen during the acute phase of infection. Incidence of eurobrucellosis cannot be exactly estimated. Most impportant clinical syndromes include:brucella meningitisand encephalitis, vascular syndromes, myelopathy and spinal disease and psychiatric disturbances. All of these syndromes usually occur without any underlying disease. Diagnosis is made by reviewing patient history, physical examination, CSF and serum serological and other laboratory studies. Detection of brucella antibodies in the CSF always indicates local infection, however, febrile agglutination tests are not reliable. Gram stains are usually negative and cultures are positive in only 25% of cases. Since the organism is located intracellularly, treatment is difficult. Doxycycline in addition to rifampin and streptomycin is the best-studied regimen which should be continued untill CSF is clear. In the yaer following treatment, serum agglutinins fall to normal. The efficacy of corticosteroids is not proved. Neurobrucella has a better prognosis than other forms of chronic meningitis and less mortality; however, incidence of minor sequella (not limiting the normal life) is high.

At the first look a hypothyroid heart resembles congestive heart failure, however, there are some important clinical and paraclinical differentiating points. Hypothyroidsm has many effects on the cardiovascular system which some of them are pericardial effusion, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure and primary pulmonary hypertension. Congenital hypothyroidsm has the same effects except for rarity of pericardial effusion. Electrocardiographic and echocadiographic effects of hypothyroidsm and also effect of cardiovascular diseases and procedures on the thyroid function are mentioned in the article

Fever is a major problem in intravenous drug users.The most common causes are cellulitis and pneumonia. Skin infections (the most common cause of admission, which is most commonly caused by S. aureus and B-hemolytic streptococci), endocarditis (Staph aureus is the dominant causative organsim, usually leading to fever and pulmonary emboli and poor response to antibiotic therapy), bacteremia, peripheral vascular infections(such as femoral mycotic aneurysm), bone and joint infections(the most commonly involved joint and bone are knee and lumbosacral spine), pulmonary infections and noninfectious insults (which are very common and include septic emboli, TB, community acquired pneumonia and lung abcess), hepatitis, CNS involvement (which accounts for the most serious complications and usually is a result of endocardtis), AIDS (about 25% of AIDS cases are IV drug abusers), splenic abcess, endophtalmitis(usually due to candidia infection) are causes of fever in infectious group. Non - infectious causes including: Cotton-fever, Rhabdomyolysis and herion hypersensitivity.

The case is a 17 year old girl, case of suicidal attempt by endosulfan, which had interactable convulsions and finally developed cardiac arrest. Endosulfan is a chlorinated insecticide that causes CNS hyperstimulation state. They are absorbed from GI, skin or respiratory tract and lead to nausea, vomiting, paresthesia, giddiness, convulsion, coma and respiratory failure. Hepatic, renal and myocardial toxicity, agranulocytosis, aplastic anemia and skin reaction have also been reported. Mortality and morbidity rates are high and there is no special treatment for this toxin. Supportive cares for these patients include decontamination of skin, gastric lavage, active charcoal, lidocaine for arrhythmia and treatment of status epilepticus.