Ugeskrift for laeger
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Ugeskrift for laeger · Jun 2010
Case Reports[Chronic meningococcemia with meningitis triggered by steroid therapy].
We present a case of chronic meningococcemia in a 27-year-old male with seven weeks of cyclic fever, arthralgia, and exanthema. While numerous blood cultures were negative, immunosuppressive treatment led to acute meningitis, and Neisseria meningitidis was detected. Serial meningococcal antibody tests were retrospectively analyzed and showed discrete seroconversion. Chronic meningococcemia is important to recognize since it can lead to acute meningitis in immunosuppressed or untreated patients resulting in high morbidity and mortality.
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Infant botulism is a rare disease that affects infants below the age of 12 months following absorption of neurotoxins produced by ingested Clostridium botulinum spores. The clinical manifestations are caused by symmetrical cranial nerve palsies followed by descending, symmetric flaccid paralysis of voluntary muscles. ⋯ The diagnosis is made on the basis of clinical examination and confirmed by isolating the toxin in serum or stools. Treatment consists of supportive intensive care and treatment with antitoxins.
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Prognostic factors for chronic whiplash-associated disorder (WAD) are identified. In WAD grade I-III, 50% report neck pain after one year (30% in background population). ⋯ While reduced active neck mobility is associated with a 4.6 times raised risk for work disability after one year, the impact-of-event score yielded an increase in OR of 3.3, and intense pre-injury distress was associated with a 2.1 OR for pain after one year and a 2.8 OR for work disability. Intense headache/neck pain and a multitude of non-painful complaints were both associated with a 3.5 to 4.0 times raised risk of work disability after a year.
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It is important to recognize the diagnosis of fibromyalgia (FM) to adequately advise patients with this chronic pain disease. FM coexists with other rheumatic diseases and may therefore serve as a confounder in connection with estimation of disease activity. The aetiology and pathogenesis of FM remain unknown, although central sensitisation seems to play a major role. Following exclusion of a number of differential diagnoses, the remaining patients have several treatment options including centrally-acting medication.
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Fibromyalgia is characterised by chronic widespread pain and mechanical hyperalgesia. It is associated with a higher pain intensity, fewer pain-free intervals and more pronounced pain-related interference in function than other musculoskeletal pain conditions. Increasing evidence supports an underlying augmented central pain processing which includes sensitization of pain-transmitting neurons and dysfunction of pain inhibitory pathways. If this permanent change in the function of the nociceptive system is shown to equal fibromyalgia, the condition may be considered a neuropathic pain condition.