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We report the first four cases of Melioidosis treated in Iceland and review the literature. Melioidosis is caused by the saprophytic Gram negative bacteria Burkholderia pseudomallei. Most disease occurs in residents of Southeast-Asia and North-Australia. The most common presentation of Melioidosis is pneumonia but as these cases demonstrate the infection has protean manifestations and B. pseudomallei can infect nearly every organ. It is important to notify the laboratory of the possibilty of Melioidosis as the bacteria can be difficult to identify and poses an infection risk to laboratory staff. Also, B. pseudomallei is resistant to many of the antibiotics normally used to treat pneumonia and due to its intracellular persistance requires prolonged therapy.

Brain abscess is a life threatening illness, demanding rapid diagnosis and treatment. Its development requires seeding of an organism into the brain parenchyma, often in an area of damaged brain tissue or in a region with poor microcirculation. The lesion evolves from a cerebritis stage to capsule formation. Brain abscesses can be caused by contiguous or haematogenous spread of an infection, or by head trauma/ neurosurgical procedure. The most common presentation is that of headache and vomiting due to raised intracranial pressure. Seizures have been reported in up to 50% of cases. Focal neurological deficits may be present, depending on the location of the lesion. Treatment of a brain abscess involves aspiration or excision, along with parenteral antibiotic therapy. The outcome has improved dramatically in the last decades due to improvement in diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. The authors provide an overview of the pathogenesis, diagnosis and management of brain abscesses.

Background: Multidrug resistant tuberculosis (MDR-TB) is a growing health problem in the world. Treatment outcomes are poorer, duration longer and costs higher. We report three cases of MDR-TB diagnosed in Iceland in a six year period, 2003-8., Case Descriptions: The first case was a 23-year-old immigrant with a prior history of latent TB infection treated with isoniazid. He was admitted two years later with peritoneal MDR-TB. He was treated for 18 months and improved. The second case was a 23-year-old immigrant diagnosed with pulmonary MDR-TB after having dropped out of treatment in his country of origin. Clinical and microbiological response was achieved and two years of treatment were planned. The third case involved a 27-year-old asymptomatic woman diagnosed with MDR-TB on contact tracing, because of her brother's MDR-TB. 18 months of treatment were planned., Conclusions: Clustering of cases of MDR-TB in the last six years, accounting for almost 5% of all Icelandic TB cases in the period, suggests that an increase in incidence might be seen in Iceland in coming years. The infection poses a health risk to the patients and the general public as well as a financial burden on the health care system. Emphasis should be put on rapid diagnosis and correct treatment, together with appropriate immigration screening and contact tracing.

Dystonia is defined as a syndrome of sustained involuntary muscle contractions, frequently causing twisting, repetitive movements and abnormal postures. Categorisation of the dystonia syndromes is variable and depends on etiology, age at onset, distribution of symptoms or genetic causes, reflecting the variability of the clinical spectrum of these diseases and the many underlying causes. The prevalence of the dystonias is largely unknown, as few epidemiological studies have been carried out and many of these have been service based rather than community based. This article reviews the phenomenology, pathophysiology, various etiologies and treatment of the dystonias.