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espanolResumen Introduccion La brucelosis es una zoonosis reemergente ampliamente distribuida en el planeta. Produce una alta morbilidad y perdidas sociosanitarias muy cuantiosas en los paises en los que es endemica. Etiopatogenia Producida por coco-bacilos Gram negativos del genero Brucella, del cual existen diferentes especies con hospedadores y patogenicidad propias. B. melitensis, B. abortus y B. suis son las especies mas frecuentes y B. melitensis la mas patogena en seres humanos. Capaz de eludir mecanismos de la respuesta inmune, la infeccion por Brucella tiene tendencia a producir cuadros prolongados, recaidas y complicaciones focales. Espectro clinico y diagnostico Habitualmente la brucelosis se manifiesta como un cuadro febril sin focalidad aparente, de comienzo agudo o subagudo acompanado de escalofrios, sudoracion profusa, artromialgias y malestar general. Aproximadamente, un tercio de los pacientes desarrollara una complicacion focal a lo largo del curso evolutivo de la enfermedad. Por lo inespecifico de su espectro clinico, siempre debe intentarse el diagnostico microbiologico, bien mediante el aislamiento del microorganismo, para lo cual la muestra mas rentable es el hemocultivo, o mediante la demostracion de anticuerpos especificos a titulos significativos o seroconversion. Tratamiento El tratamiento mas eficaz es doxiciclina 100 mg por via oral cada 12 horas durante 6 semanas, junto a estreptomicina las primeras 2 semanas. Aunque algo menos efectiva, por su comodidad, doxiciclina junto con rifampicina 600-900 mg/dia, ambas durante seis semanas, es una buena alternativa. El tratamiento de las complicaciones focales difiere segun la localizacion y gravedad del caso. EnglishIntroduction Brucellosis is a re-emerging zoonosis that is widely distributed around the globe. It causes high morbidity and very substantial social and health losses in the countries in which it is endemic. Aetiopathogenesis Caused by Gram-negative coccobacilli of the Brucella genus, of which there are different species with their own hosts and pathogenicity. B. melitensis, B. abortus and B. suis are the most common species and B. melitensis is the most pathogenic in human beings. Capable of eluding immune response mechanisms, Brucella infection tends to cause prolonged symptoms, relapses and focal complications. Clinical spectrum and diagnosis Brucellosis routinely manifests with a fever of no apparent focus of infection, of acute or subacute onset accompanied by chills, profuse sweating, arthromyalgia and general malaise. Approximately a third of patients will develop a focal complication as the disease progresses. Because its clinical spectrum is so non-specific, microbiological diagnosis must always be attempted, either by isolating the microorganism, haemoculture is the most cost-effective method, or by demonstrating specific antibodies at significant titres or seroconversion. Treatment The most effective treatment is doxycycline p.o. 100 mg every 12 hours for 6 weeks, combined with streptomycin for the first 2 weeks. And for convenience, although somewhat less effective, doxycycline combined with rifampicin 600-900 mg/day, also for six weeks, is a good alternative. The treatment of focal complications varies according to their location and severity.

Infective endocarditis (IE) can be the first presentation of a silent patent ductus arteriosus (PDA). PDA IE vegetations usually accumulate at the pulmonary end of the PDA and shower septic emboli to the lungs. A 66-year-old female presented with 3 weeks of general malaise, fever and night sweats

We report the case of a 30-year-old man with fever, headache and general malaise who, as an antecedent of interest, had recently returned from Africa. Nowadays, travelling abroad and the development of illnesses uncommon in our society upon the traveller's return are increasingly frequent. We provide a brief review of the differential diagnosis of fever without source in travellers and the treatment of our patient's disease (Katayama syndrome).

Sweet's syndrome represents the epitome of the neutrophilic dermatosis, a group of reactive cutaneous diseases characterized histopathologically by the existence of an infiltrate composed by neutrophils. Clinically, it is characterized by the abrupt onset of tender or painful plaques accompanied by fever, general malaise, and neutrophilic leukocytosis. Sweet's syndrome is a marker of several internal conditions, especially infections, inflammatory bowel disease, autoimmune disorders, and malignant neoplasm (predominantly of hematological origin). Sweet's syndrome reflects a neutrophilic reaction that affects the skin and sometimes internal organs. For this reason it is important to reach a correct diagnosis and assess appropriately both the triggering factors and the concomitant internal involvement. There are several therapeutic approaches that achieve either the resolution or the satisfactory management of this condition.

Summary Eosinophilic meningitis is a rare clinical entity. The most frequent cause in travellers to the tropics is infection with the rat lungworm Angiostrongylus cantonensis . In this report, we describe a case of eosinophilic meningitis due to infection with this nematode in a traveller who presented with slight headache, diarrhoea, general malaise and thoracic radicular pain after a trip through Latin America and the Fiji Islands. She responded less than optimally to repeated steroid and albendazole treatments, but finally recovered completely.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug-induced reaction. It is characterized by fever, skin eruption, lymphadenopathy, haematological abnormalities and involvement of internal organs. We describe the case of a 74-year-old woman, who developed DRESS, due to intake of allopurinol. She was admitted to the hospital 6 weeks after she had begun taking allopurinol with fever, maculopapular erythema, lymphadenopathy and general malaise. Blood tests revealed eosinophilia, lymphocytosis, severe inflammation and involvement of liver and kidney. PET-CT showed increased FDG uptake in several lymphnotes. She was diagnosed with DRESS, the culprit drug was withdrawn and she was given oral prednisolone. Symptoms resolved within a month. DRESS is a serious condition with mortality up to 10%. It is associated with diagnostic difficulties, as the clinical symptoms are variable and may mimic other conditions. Our case focuses on the recognition and treatment of DRESS.

We report on an elderly patient who came to the clinic due to general malaise. The complicated progress and gradual worsening led us to conduct a deeper study of the status of the patient, finding a liver abscess that could be satisfactorily treated.

The effect of intracerebroventricular (i.c.v.) injection of leptin was investigated using broiler and Single Comb White Leghorn (SCWL)-type chickens. These represent relatively fast- and slow-growing birds, respectively. The i.c.v. injection of leptin decreased food intake in both broilers and Leghorns in a dose-dependent manner. The most efficacious dose appeared to be 10 microg in both types of chickens. Water intake was generally not affected by leptin, indicating that this effect was not due to general malaise. It appears that leptin can act within the central nervous sytstem of birds to decrease food intake.

Background Recent changes in Healthcare have resulted in a general malaise among physicians leading to negative advice to young people about career choices in the medical field. The author uses his experiences in academic surgery to show that medicine continues to be an exciting and desirable career choice. Data Sources Relevant literature from surgery, toxicology, molecular biology, carcinogenesis, and epidemiology fields. Conclusions Significant advances have occurred in the understanding of colon cancer. These advances have occurred because of extensive collaborations across many different scientific fields. The methods used and the collaborations involved provide a model for other physicians to unravel the mysteries of disease and to make academic medicine fun and exciting. The risk of colon cancer depends on genetically determined factors that combine with environmental exposure (diet) to determine risk. Microwaving meat before cooking and eating more cruciferous vegetables may reduce this risk. Additional prevention steps are in the planning stages.

A 48-year-old male had suffered from body weight loss and general malaise for 2 months. Abdominal computed tomography showed a dilated intrahepatic duct with stones and a hypodense nodular mass in the spleen. A splenectomy and distal pancreatectomy were performed under the preoperative impression of a malignancy. Histological examination of the specimens revealed tuberculosis.

The patient was a 53-year-old man who was receiving angiotensin-converting enzyme inhibitors for hypertension, smoked 20 cigarettes a day, and requested emergency care because of chest pain. He explained that he had been coughing more than usual for a week and that, at times, the cough was accompanied by a certain degree of pain. His cough was nearly unproductive, and the few secretions produced were whitish. He did not have fever. That morning, while he was getting dressed for work, he felt severe pain in the center of his chest, which continued to intensify. He found it difficult to breath and experienced general malaise, nausea, and profuse sweating. The electrocardiogram (Figure) was performed 2 and a half hours after symptom onset.

From the Division of Hematology (Y.L), and the Department of Internal Medicine (L.T.H.), Mayo Clinic, Rochester, MN. A 41-year-old man was admitted to the hospital for evaluation of fevers, rigors, and general malaise of 3 weeks’ duration. His history was remarkable for chronic asthma treated with prednisone. Examination showed an ill-appearing man without localized findings. Fevers persisted despite broad-spectrum antibiotics. Laboratory findings included anemia (9.1 g/dL), leukopenia (2.4 10/L), thrombocytopenia (72 10/L), abnormal liver function (AST 377 U/L), and hyperferritinemia (37,630 mcg/L). Bone marrow aspirate demonstrated clusters of macrophages containing engulfed

A 52-year-old woman of Caribbean origin, who had lived in the UK for 30 years, presented in December, 1998, 2 days after a 3-week visit to Trinidad, with fever, malaise, and painful scalp ulcers. Whilst away she had received numerous insect bites whose sites had recently become red and painful. This coincided with fevers, rigors, general malaise, and a throbbing pain over the back of her head in which holes developed. She had been previously well and took no medication. She had made annual visits to Trinidad for several years. Her eight travel companions were well. She was feverish (38·3oC); there were three small deep ulcers on the back of her head; the largest measured 2 cm 2 cm 1 cm deep, the others 1 c m 1 c m 1 cm. All had black necrotic centres (figure). The overlying skin was erythematous, warm, and tender in an area extending from occiput to vertex. Except for this, and multiple inflamed bite marks on the arms and legs, physical examination was normal. Intravenous benzylpenicillin (1·2 g 6-hourly), flucloxacillin (1 gm 6hourly), and metronidazole (500 mg 8-hourly) were started. Haemoglobin was 12·9 gm/dL, platelets 3 8 5 1 0/L, and white cells 26·7 1 0/L, with 79% neutrophils. C-reactive-protein was 306·4 mg/L. Liver and renal function tests were normal. A skull radiograph showed no evidence of osteomyelitis. A group A haemolytic Streptococcus was isolated from blood cultures, scalp ulcers, and bite sites.

As a broad generalization, there appears to be little intrinsic difference in the biological behaviour of the common malignant liver tumours in respect of presentation, clinical course, clinical features and prognosis. Whatever the tumour's origin, patients present with some combination of abdominal pain, hepatomegaly, weight-loss and general malaise and death occurs within 3 years of the onset of symptoms. It is the state of the non-tumorous liver (cirrhotic/non-cirrhotic) and the anatomical site of the tumour (as with hilar cholangiocarcinomas) that are responsible for any significant differences. Metastatic carcinoid tumours, epithelioid haemangioendotheliomas, stage IV-S neuroblastomas and the fibrolamellar variant of HCC are exceptions to this rule with a genuinely better prognosis.

1. 1. Rickettsialpox is a new rickettsial disease transmitted to man by the rodent mite. 2. 2. The disease thus far is confined to New York City but may conceivably occur elsewhere in endemic form. 3. 3. Rickettsialpox is a benign disease characterized by chills, fever, sweating, backache, headache, general malaise, and a maculopapular vesicular exanthema and an oral enanthema. 4. 4. Diagnosis is established by the clinical course and the complement fixation test. 5. 5. Aureomycin and Chloromycetin may prove to be therapeutically effective.