Case fatality

In very extreme cases fatal overdoses have occurred. 

Filoviruses Ebola virus Long filamentous rods composed of a lipid envelope surrounding a helical nucleocapsid lOOOnm long, 80nm in diameter The virus is widespread amongst populations of monkeys. It can be spread to humans by contact with body fluids from the primates. The resulting haemorragic fever has a 90% case fatality rate... 

Cl 0.08-0.96) and symptomatic pulmonary embolism (PE) (OR 0.34, 95% Cl 0.17-0.69), but an increase in major extracranial hemorrhage when compared to placebo (OR 2.17, 95% Cl 1.10. 28). Nonsignificant reductions in combined death and disability, as well as increases in case fatality and sICH were also observed. The authors concluded that insufficient evidence existed to support the routine use of LMWH in the management of patients with ischemic stroke. 

Low-molecular-weight heparins and heparinoids are not recommended in the treatment of acute ischemic stroke.11 A meta-analysis was performed using data from 10 randomized controlled trials.19 A non-significant decrease in combined death and disability and a non-significant increase in case fatality and hemorrhage were seen. A reduction in venous thromboembolic events was observed in acute stroke patients however, there was also an increase in extracranial bleeding. 

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.21 Patients with significant disease should receive a short antibiotic course, 1 to 3 days, to shorten the duration of illness and decrease the number of stools. Doxycycline 300 mg once daily is the drug of choice. Other antibiotics shown to be effective include erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.2 Antibiotic resistance has been documented in V cholerae since 1977.2 Antibiotic prophylaxis is not warranted. 

HAV infection usually produces a self-limited disease and acute viral infection with a low case-fatality rate, and confers lifelong immunity. 

Caution Tularemia has long been a weapon of war used and/or studied by the Japanese, the Russians, and the United States. Chemoprophylaxis is not recommended following potential natural exposures (tick bite, and/or rabbit or other animal exposures). Inhalation tularemia can lead to fulminant pneumonia with a case fatality rate of 30 to 60 percent without treatment. 

Within the first 2 to 3 days of exposure a person will experience symptoms such as malaise, fever, headache, chills, and backache. The fever can last 1 to 5 days. Usually after the fever is gone, a skin eruption or rash appears. It begins as a pimple lesion for 1 to 4 days, becomes blister-like for 1 to 4 days, and then fills with pus for 2 to 6 days. It then forms a crust that falls off 2 to 4 weeks after the first skin lesion appears, leaving pink scars. An important characteristic is that all smallpox lesions in any affected area are generally found in the same state. In contrast, chickenpox lesions are not synchronous they form in crops. Smallpox lesions are also said to be more numerous on the face and extremities rather than the trunk, unlike chickenpox. The case fatality rate in unvaccinated patients is 15 to 40%. In vaccinated people, the fatality rate is <1%. Patients with smallpox are infectious as soon as a rash is evident and remain infectious until their scabs fall off— a duration of about 3 weeks.3... 

Virulence The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/ or the ability of the organism to invade the tissues of the host. [NIH]... 

Severe, life-threatening, and, in some cases, fatal hepatotoxicity, including fulminant and cholestatic hepatitis, hepatic necrosis, and hepatic failure, has been reported in patients treated with nevirapine (see Warnings). 

Bacterial meningitis remains a very important disease worldwide. Attack rates of 46 cases per 100,000 population with a case fatality rate of 33% have been described. Early recognition and prompt treatment remain essential for the prognosis of this serious illness. 

Several nonmetallic inorganic species may act as toxicants that affect ecosystems. Spills of salts of cyanide ion, CN, from mining operations have temporarily sterilized small streams. Nitrate ion, NO3, in contaminated well water may be reduced to nitrite ion, N02, in the stomachs of ruminant animals and infants. The nitrite converts the iron(II) in blood hemoglobin to iron(III), thus producing methemoglobin, which is useless for transporting oxygen in blood. In extreme cases, fatalities have resulted in livestock and human infants. Excessive levels of carbon dioxide, C02, in water or air can be detrimental or even fatal. 

Stroke mortality rises rapidly with age (Rothwell et al. 2005). The increase in mortality in the elderly is mainly a result of the steep rise in the incidence of stroke with age, but also, to a lesser extent, reflects the increase in case fataUty in older patients. In other words, older people are more likely to have a stroke (incidence) and, if they do have one, it is more likely to be fatal (case fatality). 

Bonita R, Broad jB, Beaglehole R (1997). Ethnic differences in stroke incidence and case fatality in Auckland New Zealand. Stroke 28 758-761... 

Rothwell PM, Coull AJ, Giles MF et al. (2004). Change in stroke incidence, mortality, case-fatality, severity and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 363 1925-1933 Rothwell PM, Coull AJ, Silver LE et al. (2005). Population-based study of event-rate, incidence, case fatality and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). 

Stegmayr B, Asplund K, Wester PO (1994). Trends in incidence, case fatality rate, and severity of stroke in Northern Sweden, 1985-1991. Stroke 25 1738-1745 Sudlow CLM, Warlow CP (1996). Comparing stroke incidence worldwide. What makes studies comparable Stroke 27 550-558 Sudlow CLM, Warlow CP (1997). Comparable studies of the incidence of stroke and its pathological types. Results from an international collahoration. Stroke 28 491-499... 

Tunstall-Pedoe H, Kuulasmaa K, Amouyel P et al. (1994). Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90 583-612 Wald NJ, Law MR (2003). A strategy to reduce cardiovascular disease by more than 80%. British Medical Journal 326 1419 White H, Boden-Albala B, Wang C et al. (2005). Ischemic stroke subtype incidence among whites, blacks and Hispanics the Northern Manhattan Study. Circulation 111 1327-1331 Wityk RJ, Pessin MS, Kaplan RF et al. (1994). Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 25 362-365. 

Although cerebral blood flow is strongly related to hematocrit, any effect of increasing hematocrit on risk of stroke, or type of stroke, is weak and confounded by cigarette smoking, blood pressure and plasma fibrinogen (Welin et al. 1987). However, raised hematocrit does seem to be associated with an increased case-fatality in ischemic stroke (Allport et al. 2005). 

Stevens RJ, Coleman RL, Adler Al et al. (2004). Risk factors for myocardial infarction, case fatality and stroke case fatality in type 2 diabetes UKPDS 66. Diabetes Care 27 201-207... 

A prospective study of acute cerebrovascular disease in the community the Oxfordshire Community Stroke Project 1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. Journal of Neurology, Neurosurgery and Psychiatry 53 16-22... 

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