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An epidemic of respiratory tract diptheria began in Russia in 1989. In 1994 more than 2,500 cases occurred in St. Petersburg alone. We describe clinical findings in the 1,860 adult patients treated in Botkin's Hospital. The study is based on a retrospective review of patient records. In 98% of the patients the diagnosis was confirmed by a positive throat culture growing a toxin producing strain of Corynebacterium diphtheriae. A catarrhal disease without membranes was present in 1,256 (67.5%) patients, 150 patients had membranes on tonsils only, 268 patients on tonsils, the uvula, soft palate and posterior pharynx and 35 patients on larynx or in the lower respiratory tract. 42 patients (2.3%) died. Among the deceased patients 26 were alcoholics, whereby the death rate for non-alcoholics was probably around 1%. 151 patients (8.1%) had a toxic form of the disease with swelling of the neck. This form of the disease carried a high mortality, 25.7%. In a subgroup of 1,045 patients the protective efficacy of vaccination could be evaluated. A 2.2-fold protection was found, but the study may underestimate the efficacy. We conclude, that if a wide diphtheria epidemic affects an industrialized country, it would probably not any more be the big killer that it was in Europe and in the United States in the 1950's and 1960's.

The risk of cancer was evaluated in a cohort of 1,234 patients with severe infectious mononucleosis between 1954 and 1983. The diagnosis of mononucleosis was confirmed by reviewing patient records. The observed numbers of cancer cases up to 1988 were obtained through record linkage from the Finnish Cancer Registry, which is nationwide and population-based. There were 11 cases of cancer in the cohort, as against 17.4 expected on the basis of the 24,288 person-years at risk and of incidence rates specific for age, sex and period in the area. This gives a standardized incidence ratio of 0.6 (95% confidence interval 0.3-1.1). There was only 1 lymphoma case. No malignancies were diagnosed during the first 5 years after infectious mononucleosis. The results indicate that infectious mononucleosis with severe symptoms does not imply an increased risk of cancer.

In a controlled, randomized, double-blind study, 100 patients (66 women, 34 men; age 18-69 years) with acute salmonellosis were treated with norfloxacin (400 mg) or placebo tablets twice daily for 10 days to compare the effects on the excretion time of salmonella bacteria. In all patients salmonellae were detected in the stools before the start of treatment. The follow-up included 6 stool cultures after the start of treatment: day 3-4, day 12-14, and 4 times during 1-6 months. At 3-4 days there were 98% non-excretors in the norfloxacin group (46/47 patients) compared to 38% (17/45) in the placebo group (p< 0.001). The cumulative 6-month elimination rate in norfloxacin patients at 3-4 days was 72%, which was significantly (p =0.0001) greater than the 31% in the placebo patients. However, there was no significant difference in the proportion of non-excretors or the elimination rate between the 2 groups at the following visits. Only one patient had an adverse event resulting in discontinuation of the treatment. We conclude that norfloxacin treatment for 10 days decreased the excretion of salmonella bacteria during the first week, but there was no difference in excretion rates 1-6 months after treatment initiation in the treatment versus placebo group.

We estimated Epstein-Barr virus (EBV) antibody-associated relative risks (RR) of malignant lymphoma/leukemia within a cohort of 39,000 healthy Finnish adults followed up for 12 years. Antibody analyses to EBV capsid antigen (VCA), early antigen (EA), and nuclear antigens (EBNA, EBNA1, and EBNA2) were based on concomitantly evaluated ELISA techniques. No increased risk was associated with mere EBV seropositivity. However, elevated EBV EA and EBNA antibody levels were associated with a statistically significant excess risk of malignant lymphoma/leukemia (RREA=3.4, 95 percent confidence interval [CI]=1.0–11.0; RREBNA=4.5, CI=1.2–16.9). These elevated antibody responses may be due either to destruction of neoplastic EBV positive B-cells and/or to activation of latent EBV infection early in the lymphomagenesis.

The clinical findings are described in the first reported European case of fatal encephalitis of bat origin caused by a rabies-related virus. A bat zoologist developed the symptoms of rabies 51 days after his last exposure to a bat bite. The clinical disease of 23 days duration was a combination of the paralytic and ‘furious’ forms of rabies. Serial BAEP and EEG recordings, CT and MR scans of the brain, as well as CSF findings, demonstrated severe ascending destruction of the brain. An unusual progression from isolated brainstem death to cortical brain death occurred. Neuropathologically, the brain showed severe lytic changes. The presence of rabies-related virus antigens in brain smears was shown using a panel of fluorescent antibodies. The virus was inoculated into and isolated from suckling mice. The virus had a close resemblance to European bat rabies isolates, which belong to the group of rabies-related viruses. Of particular concern is whether the virus can spread from bats to terrestrial animals and whether the European type of bat rabies constitutes a danger to man.