Shortly after his return to the Netherlands from a trip to Ontario, a part of Canada where infection with West-Nile virus has been reported, a 69-year-old man became increasingly confused and generally unwell, accompanied by fever. The clinical picture was compatible with viral encephalitis and this was supported by EEG findings and the results of the cerebrospinal-fluid examination. MRI of the brain did not contribute to the diagnosis. The patient was treated with aciclovir because herpes simplex encephalitis was suspected, and he recovered from his illness within a few days. The EEG normalised as well. The most important remaining symptom was diminished short-term memory function. After the patient was discharged, rising antibody titres against West-Nile virus were found in two consecutive sera; there were no antibodies to other encephalitis-causing viruses (such as Q fever virus and St. Louis encephalitis virus). This case report concerns the second imported case of West-Nile fever in the Netherlands and the first one with encephalitis.
There has been a tradition of preventive home visiting to the elderly by Public Health Nurses for quite a time. There is no agreement as to the effect of these visits; until now no study has been performed on this topic in the Netherlands. Studies from other countries suggest a positive effect: viz. a reduction in mortality and hospital admissions. Recommendations for a replication study in the Netherlands are made.
OBJECTIVE: To determine the clinical spectrum and incidence of neuroborreliosis in the Netherlands. DESIGN: Retrospective. METHOD: All neurological practices in 106 hospital locations in the Netherlands were asked to look for patients with the codes 'other neurological infections' or 'Borrelia burgdorferi' in their Diagnosis & Treatment Combinations registration or the Neurological Coding System, respectively, concerning the year 2001, then to identify the patients with neuroborreliosis and to send a copy of the correspondence with the family doctor and the laboratory data on these patients, after making them anonymous, for data extraction. Pleocytosis in the cerebrospinal fluid combined with a positive test for IgM or IgG antibodies of B. burgdorferi in the serum or cerebrospinal fluid was used as the criterion for the diagnosis neuroborreliosis. RESULTS: Forty-seven (44%) neurological practices did not respond and twenty-two (21%) either did not use any kind of diagnosis registration system or linkage between the registration and the patient file was impossible. Of the 37 (35%) neurological practices that provided information, 17 had diagnosed neuroborreliosis in 30 patients, 20 of whom met the specified criteria. Fifteen (75%) patients had a radiculopathy, 8 (40%) a peripheral facial palsy and 3 (15%) a myelopathy. CONCLUSION: The clinical spectrum of patients with neuroborreliosis was consistent with that described in Denmark. The incidence of neuroborreliosis found was 3.6 per million inhabitants. The real incidence was probably higher because the registration systems used allowed patients with neuroborreliosis to be booked under other (symptomatic) diagnostic codes, paediatricians were not involved in the study, and relatively few participating neurologists practiced in high-risk areas for tick bites and erythema migrans. The low incidence of neuroborreliosis in combination with a high background level of seropositivity in the population implies a low predictive value of positive Borrelia serology. It is therefore essential that when neuroborreliosis is suspected, the cerebrospinal fluid should always be investigated.
Comment In: Ned Tijdschr Geneeskd. 2004 Apr 3;148(14):655-815106315
Statistics from Great Britain, Finland, the US and Sweden show a continuing increase in the number of extrauterine pregnancies. Since the 1970s, methods of diagnosing extrauterine pregnancies have been improved, and at the present, echoscopy and laparoscopy are generally used. Based on the 30,000 sterilizations performed in the Netherlands each year, and 2% pregnancies, 12-30% of these are extrauterine. Of the 1300 extrauterine pregnancies, there were 72-180 unsuccessful tubal operations. Increased IUD use is not considered to be the reason. The IUD protects against intrauterine as well as extrauterine pregnancy, but is more effective against the former. 3-4% of IUD users had extrauterine pregnancies vs. .8% for other pregnant women. Salpingitis can result from extrauterine pregnancy. The IUD is a possible cause of salpingitis, even after it is removed. An increase in infections among IUD users due to more frequent change in sexual partners is shown. The death rate for mothers as the result of extrauterine pregnancies was 10% (in Great Britain as well as in the US). Aside from early diagnosis and prompt treatment, the following can be done: selective implantation of IUDs (avoiding women who frequently change partners, those with a history of interrupted fertility, adhesions due to salpingitis or tubal operations); good treatment and diagnosis of conditions that could lead to salpingitis; and sterilization using methods with a high success rate.