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Rabies developed in an Austrian man after he was bitten by a dog in Agadir, Morocco. Diagnosis was confirmed by reverse transcription-polymerase chain reaction and immunohistochemistry. The patient's girlfriend was bitten by the same dog, but she did not become ill.

Introduction: Sepsis is a life-threatening disease, requiring instant treatment in an intensive care unit (ICU). The aim of this study was to determine the direct and indirect costs occurring in Austria due to this disease., Patients and Methods: Direct costs were calculated based on a retrospective chart analysis in four adult Austrian ICUs, evaluating 74 patient records from the years 2000/2001. Patients were identified to have suffered from severe sepsis using ACCP-definitions. Assessed resource use (medication, laboratory analysis, microbiology analysis, consumer-goods, diagnostic procedures, staff costs, and basic bed costs) was linked with related center specific costs to determine direct costs per patient. Indirect costs due to productivity losses were calculated using official statistical material., Results: The mean length of ICU stay (LOS ICU) of a severely septic patient was 18.1 days. Overall ICU mortality was found to be 43.2% and showed no gender difference. The mean daily direct ICU costs of care for severely septic patients were [symbol: see text] 1,617 and the mean total direct ICU costs per septic patient were [symbol: see text] 28,582. In total costs, survivors were equally expensive as non-survivors ([symbol: see text] 28,699 vs. 28,463) although their length of study was considerably longer (21.9 vs. 13.2 days). Considering a range of patients with severe sepsis in Austria from 6,700 to 9,500 per year, total direct costs in Austria range from [symbol: see text] 192 million to [symbol: see text] 272 million. Indirect costs determined by productivity losses due to unfitness for work (temporary and permanent) and premature death amount to [symbol: see text] 484 million to [symbol: see text] 686 million in Austria per year (same incidence range). Total costs, i.e. burden of illness, combining direct costs with indirect costs, range from [symbol: see text] 676 million to [symbol: see text] 958 million., Conclusion: Patients with severe sepsis have a high mortality rate, spend prolonged periods of time in the ICU, and are expensive to treat. Indirect costs of severe sepsis due to productivity losses, particularly by premature death, are considerable.

The clinical spectrum of acute pancreatitis ranges from mild, self-limiting disease of fulminant illness that may rapidly lead to multiple organ failure and death. To identify factors associated with a subsequent severe course and/or high mortality we investigated retrospectively 91 patients admitted to the medical intensive care unit (ICU) with acute pancreatitis during a 2 year period. 67% of the attacks were mild (< or = 1 complication). The overall mortality rate was 9%, whereby 3% of patients with alcoholic and 13% with biliary pancreatitis died. 75% of the patients in the group with a fatal outcome were aged over sixty and 30% in the group with a mild course (p < 0.05). Females with pancreatitis of biliary origin had a mild course in 57% and a severe (> or = 2 complications) or fatal outcome in 43%. In males with alcohol abuse we observed a mild form of pancreatitis in 79% and a severe or fatal course in 21%. The delay between onset of abdominal pain and commencement of treatment in hospital was greater than 12 hours in 70% of all patients studied and there was no association with severity and development of subsequent complications. The median of the acute physiology and chronic health evaluation scoring system (APACHE-III) on the day of admission was 19 in patients with mild disease, which was significantly lower than in patients with severe (40) or fatal acute pancreatitis (53) (p < 0.0001). Serial APACHE-III measurements over 5 days after admission provided further differentiation between mild and severe or fatal cases (p < 0.0001), but no significant difference was observed between survivors with severe course and fatal outcome. In addition, RANSON scores were calculated for comparison with APACHE-III at admission and after 48 hours: concerning the recognition between mild and severe/fatal pancreatitis both scoring systems exhibited similar significant differences on day 1 and day 2. The RANSON scoring system provided further a significant differentiation between survivors with a severe course of pancreatitis when compared to deaths on day 2, whereas the APACHE-III scoring system did not. Advanced age, female sex, biliary obstruction and elevated RANSON and APACHE-III scores are risk factors for an increased rate of life-threatening complications in acute pancreatitis. The daily assessment of such scoring systems may allow the recognition of such patients and may be helpful in the routine clinical management and monitoring of acute pancreatitis.