CASE PRESENTATION: A 50-year male was admitted with low-grade fever, night sweats, weight loss (13 kg), malaise, and generalized weakness for the past 6 months. On clinical examination, he was febrile with 39.0°C, an average heart rate of 54 bpm, and 100/40 mmHg blood pressure. On cardiovascular examination, S1 and S2 were soft with pan systolic murmur present in the mitral area, and the early diastolic murmur was present in the left third intercostal space. Electrocardiography was suggestive of third-degree heart block with AV dissociation. Transthoracic echocardiography showed mobile vegetations attached to multiple valves- an aortic valve (18.2x11.9mm) and a mitral valve (2.9x7.5mm) with perivalvular abscess. He was given oral doxycycline (100mg B.D.) and rifampicin (600mg/day); the patient responded, but the AV block did not resolve.
CONCLUSION: This report has drawn attention to multivalvular involvement and cardiac rhythm abnormalities in Brucellosis (in this case, A.V. dissociation was present) because early diagnosis and treatment can cause a significant decrease in morbidity as well as mortality by appropriate treatment.
OBJECTIVE: To estimate the global, regional, and national prevalence and disability burden of anorexia nervosa and bulimia nervosa-and mortality attributable to anorexia nervosa-from 1990 to 2023, and to forecast prevalence to 2050.
DESIGN, SETTING, AND PARTICIPANTS: Using Global Burden of Disease (GBD) 2023 methods, data were synthesized from systematic literature reviews, population surveys, and vital registration systems. Estimates were produced for 204 countries and territories from 1990 to 2023, with forecasts through 2050. These data were analyzed from October 2025 to August 2026.
EXPOSURE: Anorexia nervosa or bulimia nervosa diagnosis.
MAIN OUTCOMES AND MEASURES: Counts and age-standardized rates with 95% uncertainty intervals (UIs) for anorexia nervosa and bulimia nervosa prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs), and anorexia nervosa mortality, reported by age, sex, and location.
RESULTS: In 2023, an estimated 18.1 million people (95% UI, 13.9-24.0) globally were living with anorexia nervosa or bulimia nervosa, of whom 12.6 million (69.4%) were female, 5.5 million were male (30.6%), and 41.2% were aged 10 to 24 years. These cases accounted for 3.83 million DALYs (95% UI, 2.23-5.69). Since 1990, the global number of prevalent cases increased by 71.0%, while age-standardized prevalence and DALY rates rose by about 21%. Females experienced substantially higher prevalence and DALY rates than males. The highest age-standardized prevalence rates were observed in high-income regions, particularly Australasia and Western Europe, whereas the largest relative increases in age-standardized prevalence occurred in East Asia, South Asia, and Southeast Asia. Forecasts indicate continued increases in prevalent cases through 2050.
CONCLUSIONS AND RELEVANCE: This GBD 2023 analysis found that anorexia nervosa and bulimia nervosa contribute substantially to global nonfatal health loss. These findings support the integration of eating disorders into mental health surveillance, prevention, and service planning worldwide.