Pathology
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While bacterial antigen detection (BAD) tests have been used on cerebrospinal fluid (CSF) with success in the diagnosis of bacterial infection in developing countries, their value in the developed world has been recently questioned. In Darwin, Northern Territory (NT), there are good diagnostic resources but high rates of infectious disease, so it was unclear which findings were applicable to our own population. This study aimed to determine the utility of the BAD tests in detection of bacterial meningitis from CSF in patients studied at Darwin, using a retrospective review of hospital case records and microbiology laboratory reports, over a 19 month period, and utilising a clinical component in the case definition of bacterial meningitis. ⋯ No cases of bacterial meningitis which were positive on the BAD test were missed on Gram's stain of CSF. We conclude that in our setting BAD tests alone are not sensitive enough to confidently diagnose bacterial meningitis. BAD tests are more costly and offer no advantage in speed of diagnosis or in antibiotic pre-treated patients, compared to routine Gram's stain.
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Pseudoepitheliomatous hyperplasia of the epidermis occurring with Mycobacterium ulcerans skin infection may result in localization of the infected area with discharge of necrotic material, followed by healing leaving a depressed scar. The process represents more than simple re-epithelization of an ulcerated skin surface; it is a mechanism which produces active extrusion of necrotic material containing viable mycobacteria and should be seen as part of a protective physiological response to the infection.
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The Harlequin infant represents the most severe form of nonbullous ichthyosis. Although the clinical features of infants with Harlequin ichthyosis are generally similar, histological, ultrastructural, and biochemical analyses have not shown consistent findings. ⋯ Light microscopic and ultrastructural investigations of skin biopsies are detailed. The presence of extracellular lipid material in the stratum corneum has not been described in the previously reported cases of Harlequin ichthyosis.
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The immune status of 29 members of the Australian National Antarctic Research Expeditions (ANARE) was investigated before, during, and after a 56 day summer voyage to Antarctica and correlated with psychological and physiological parameters. All subjects were healthy. Expedition personnel demonstrated decreased cell mediated immune responses (CMI) assessed by the CMI Multi-test; 21% were hypoergic. ⋯ Stress factors are postulated to induce depression of the immune response in Antarctica. The association with anxiety suggests that brain peptides or associated cytokines may have a role in mediating these immune events. Such alterations in immune status have implications for health management in isolated and extreme conditions.
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Case Reports
Tension pneumocephalus--a rare complication of radiotherapy in nasopharyngeal carcinoma.
A patient with nasopharyngeal carcinoma (NPC) treated by radiotherapy developed tension pneumocephalus due to a naso-cranial fistula. The fistula was due to a pathological fracture at the base of skull affected by bone necrosis. The clinical features, neuro-radiological and post-mortem findings are presented. ⋯ The cause of the tension pneumocephalus in relation to radiation bone necrosis and the possible role of pneumocephalus in producing the multifocal cerebral infarction are discussed. The more common radiation necrosis of brain is also discussed. The pathogenesis of the pneumocephalus in this patient is distinctly different from the more common causes such as head injury and surgery.