Der Internist
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Review
[Toxoplasma gondii-Current drugs and future vaccines against an underestimated protozoan infection].
Toxoplasma gondii is a unicellular organism of the Apicomplexa that occurs worldwide and is therefore a close relative of the malaria pathogen Plasmodium. As T. gondii infests every warm-blooded vertebrate species as an intermediate host and has a very high prevalence worldwide, toxoplasmosis is one of the most important international foodborne diseases. Potential vaccines (human as well as veterinary) play a crucial role in controlling this disease.
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Atrial fibrillation is frequent and has severe sequelae, such as stroke, cardiovascular death and cardiac insufficiency. These sequelae can be effectively reduced by anticoagulants, a meticulous recognition and treatment of cardiovascular comorbidities and an early rhythm-preserving treatment. Catheter ablation leads to a better preservation of the sinus rhythm and in symptomatic patients to a better quality of life in comparison to treatment with antiarrhythmic agents. This should be included in the planning of early rhythm-maintaining treatment.
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In the investigation of hypercalcemia of an 81-year-old female patient, the typical laboratory value constellation of primary hyperparathyroidism (pHPT) emerged. The staged imaging diagnostics with sonography of the neck, sestamibi parathyroid gland scintigraphy and C‑11-methionine positron emission tomography-computed tomography (PET CT) resulted in negative or inconspicuous findings for all procedures. The exploratory surgical resection of two hyperplastic epithelial bodies led to a normalization of calcium levels. Inconspicuous imaging findings do not exclude the diagnosis of pHPT.
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This case report concerns a 48-year-old male patient presenting the classic clinical picture of Wernicke encephalopathy with orientation disorder, ophthalmoplegia and ataxia. Wernicke encephalopathy is a neurological emergency that should be treated immediately with high-dose intravenous thiamine for a week, if suspected. Recognition of the disease in the emergency room is essential. Due to the limited compliance in patients with alcohol-use disorder, early diagnosis can be challenging.