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Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

BACKGROUND A Neisseria gonorrhoea infection is one of the most common sexually transmitted diseases and can present both urogenitally and extragenitally. CASE DESCRIPTION A 55-year-old woman presented at the emergency room with general malaise, abdominal pain and fever. Despite extensive surgical, gynaecological and radiological investigations no clear cause could initially be found. She was subsequently admitted to the surgical unit for observation. During the admission period the patient developed diffuse peritonitis and her infection parameters were rising. Diagnostic laparoscopy revealed extensive terminal ileitis with a reactive infiltrate of the uterine fundus and purulent peritonitis. A PCR test of the abdominal exudate was strongly positive for Neisseria gonorrhoeae, but cultures remained negative. Following an 8-day course of antibiotic treatment with intravenous ceftriaxone, the patient recovered from her symptoms. CONCLUSION Terminal ileitis with peritonitis is an unusual extragenital manifestation of a gonococcal infection. In order to make a diagnosis, surgical exploration with cultures is sometimes indicated.

Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27-54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures., (This article is copyright of The Authors, 2017.)