[ prospective study of 42 consecutive patients with Sub-acute aseptic meningitis and Meningoencephalitis]

Introduction. Evaluation of patients with aseptic meningitis is a particularly challenging task. The term sub-acute aseptic meningitis refers to patients who have clinical and laboratory evidence of meningeal inflammation with negative routine bacterial cultures for more than one week. Forty two consecutive adults [ages > or = 14] with sub-acute aseptic meningitis [SAAM] and Meningoencephalitis [SAAME] treated in Mashhad medical university hospital, Iran, during years 2002 to 2004 were included in the study. The patients prospectively analyzed with respect to clinical symptomatology, cerebrospinal fluid [CSF] findings, clinical course, treatment and outcome. 54.8% of patients were female and 45.2% were male. Headache [95.2%] and fever [71.4%], nausea and vomiting [85.7] and altered mental status [26.2] were the presenting symptoms in the majority of cases. CSF findings at the first lumbar tap on admission generally revealed lymphocytic pleocytosis of less than 1000 cells per micro 1, mild to moderately elevated protein and hypoglycorrhachia. Initial antimicrobial therapy was achieved in 15 of cases, and consisted of empirical anti-tuberculosis, Ceftriaxon and Ampicillin in 23.8%, 7.1% and 4.8% respectively. Eighteen of the 42 SAAM and SAAME cases [42.9%] were caused by tuberculosis [TB], seven by Brucellosis [16.6%], three due to partially treated bacterial meningitis [7.1%], one due to carsinomatos Meningitis [2.4%], and in 13 patients [30.9%] the etiology remained unknown. Two of the patients with different type of meningitis [one Tuberculous and one carcinomatous] were died [4.7%]. The outcome was good in the majority of cases. In our country tuberculosis is an important cause of chronic or sub-acute meningitis; hence, abnormal CSF findings compatible with aseptic meningitis and low glucose and high protein should suggest Tuberculosis and specific anti-Tuberculous therapy should be started promptly

[ prospective study of 34 cases of hospital and community-acquired klebsiella pneumoniae bacteremia]

This prospective study attempted to determine the epidemiology, clinical manifestations and prognosis of patients with hospital and community-acquired bacteremia of Klebsiella pneumoniae. From July 1, 2004, to March 31, 2005, we prospectively studied 34 episodes of klebsiella pneumoniae bacteremia in 34 patients, treated in Imam Reza Hospital, Mashhad-IRAN. The disease was nosocomially acquired in 58.8% and community acquired in 41.2%. The different types of infection were sepsis [44.1%], burn wounds [26.5%], pneumonia [1 1.8%] endocarditis [2.9%], urinary tract infection [2.9%], and hepatic abscesses [2.9%]. Bum which was found in 9 [45%] patients, was the most common underlying disease, followed by renal failure in 3 [15%], Diabetes mellitus in 2 [10%], leukemia in 2 [10%], and intravenous drug abuse in 1 [5%]. The most frequent clinical findings in adult patients were fever [100%], leukocytosis [75%], thrombocytopenia [45%], jaundice [40%], cough [30%], tachycardia [30%], tachypnea [25%], rigors [25%], Hemoptysis [15%] and anemia [11.1%]. Carbenicillin and ciprofloxacin were the most active antibiotics. We observed that nosocomial infections are more prevalent than community aquired. Sepsis without focous, burn and neonatal infections were some of the most significant diseases in this study