Michael W. Felz

Ticks parasitizing humans in Georgia and South Carolina

From 1990 through 1995, 913 ticks removed from 460 human patients in Georgia or South Carolina were identified and recorded. The majority of these specimens (758, 83.0%) were lone star ticks, Amblyomma americanum. One hundred and four (11.4%) American dog ticks Dermacentor variabilis, 36 (3.9%) blacklegged ticks Ixodes scapularis, 9 (1.0%) Gulf coast ticks Amblyomma maculatum, and 6 (0.7%) brown dog ticks Rhipicephalus sanguineus were also recovered. All active stages (larvae, nymphs, and adults) of A. americanum were represented, whereas nymphs and adults of D. variabilis and I. scapularis and only adults of A. maculatum and R. sanguineus were recorded. Compared with data published for other regions in the U.S.A., A. americanum was a much more prevalent parasite of humans in the current survey. Only 1 (3%) of the I. scapularis collected was a nymph. Because these tick species are vectors of zoonotic pathogens or cause tick paralysis in humans, the data have epidemiological significance.

Late Postpartum Eclampsia 16 Days after Delivery: Case Report With Clinical, Radiologic, and Pathophysiologic Correlations

Background: Postpartum eclampsia is a rare, frightening, and potentially tragic complication of hypertensive pregnancies, usually developing within 48 hours of delivery. Seizures occurring days to weeks after parturition are exceedingly uncommon and require rapid, precise clinical evaluation by multiple specialists. . Methods: A case presentation of delayed postpartum eclampsia illustrates unique features of the syndrome. Extensive review of the literature highlights pathogenesis, controversies, and dilemmas surrounding this enigmatic hypertensive disorder. Results and Conclusions: A 39-year-old hypertensive patient had an uneventful full-term delivery by her family physician only to develop headache, double vision, and recurrent tonic-clonic seizures 16 days later. Initial evaluation showed severe hypertension, diplopia, hyperreflexia, proteinuria, and hyperuricemia. She was given a magnesium sulfate infusion. Magnetic resonance imaging (MRI) documented asymmetric ischemic foci within gray matter in the distribution of the posterior cerebral arteries. All symptoms, signs, and abnormal laboratory values resolved within 4 days. A follow-up MRI showed complete resolution of all cytotoxic cortical lesions. Based on human autopsy data, radiologic investigations, and animal studies, eclampsia is believed to result from explosive vasospasm, endothelial dysfunction, and cytotoxic edema of cerebral cortex. This central nervous system vasculopathy is most prominent in the posterior cerebral vasculature and is often rapidly reversible. Difficulties in differential diagnosis, typical findings on neuroimaging, and urgent management strategies are discussed. The time limit for postpartum eclampsia probably should be lengthened to 4 weeks, as indicated by our case and other clinical series.

Orbital myositis due to Kawasaki's disease

Abstract Kawasakis disease is an inflammatory syndrome of young children that affects multiple organ systems. The most common ophthalmologic manifestations of Kawasakis disease are bilateral conjunctival injection and nongranulomatous iridocyclitis. To our knowledge, this patient is the first with Kawasakis disease to demonstrate extraocular muscle palsy and orbital myositis.

Breath Test Diagnosis of Helicobacter pylori in Peptic Ulcer Disease: A Noninvasive Primary Care Option

Background: Helicobacter pylori is implicated as the causative agent for most duodenal and gastric ulcers. Invasive (endoscopy and biopsy) and noninvasive (serology, breath test) methods are currently available for definitive diagnosis of infectious peptic ulcer disease. Methods: Twenty-six patients with chronic gastritis symptoms underwent upper endoscopy, biopsy, rapid urease test, and [14C]urea breath test for the detection of H pylori. Results: Twenty of 26 patients (77 percent) had biopsy-proved H pylori infection. All 20 (100 percent) with definite H pylori proved by invasive diagnosis had strongly positive results on urea breath test. Six patients with absence of H pylori on biopsy had negative urea breath test results. The urea breath test displayed 100 percent sensitivity, specificity, and predictive value compared with endoscopy and biopsy. Conclusions: [14C]Urea breath testing is comparable to endoscopy and biopsy in the diagnosis of H pylori infection and could become useful in primary care settings for noninvasive evaluation of peptic ulcer disease.