Tuberculous aortitis

Tuberculous aortitis [TA] is a rare entity that is invariably indicative of disseminated tuberculosis. TA is associated with aneurysm formation in about half of cases. Another possible complication is perforation of adjacent structures [1-7]. Both abdominal and thoracic aorta are involved with equal frequency.[7-9] Fatal outcomes are frequently reported even after antituberculosis chemotherapy and surgical intervention. We present a case of tuberculous aortic aneurysm [TBAA] that underwent surgical resection and graft replacement in the bed of the infected aorta. Following an apparently successful chemotherapy, the patient died suddenly. We postulate that reactivation of the un-eradicated bacilli precipitated graft failure. Similar cases in the literature are reviewed. We propose lifelong suppressive therapy with antituberculosis agents to prevent such a catastrophic event

Human immunodeficiency virus in Saudi Arabia

The human immunodeficiency virus HIV type 1 has evolved as one of the most important global infectious pathogens. Although the virus had initially emerged among certain high risk groups in developed countries, it quickly gained momentum in developing countries threatening most population groups. The first case of acquired immunodeficiency syndrome from the Kingdom of Saudi Arabia was diagnosed in 1984. Twenty years later, by the end of 2003, 1509 patients have been reported to have acquired HIV 1. The majority of the early infected patients have acquired HIV 1 from blood product transfusion. Subsequently, the most prevalent mode of transmission became heterosexual. In this review, the distribution of HIV infected persons, prevalence data, and future outlook are presented. Communities considered conservative are not immune from a sexually transmissible virus that has infected 60,000,000 people globally

Extrapulmonary tuberculosis, clinical presentation and outcome

To identify patterns, features, and outcome of extrapulmonary tuberculosis in a tertiary care setting. A retrospective case-series was carried out of all cases diagnosed and treated as extrapulmonary tuberculosis during 1991 through to 2000 at King Faisal Specialist Hospital and Research Centre [KFSH and RC], Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, laboratory, and outcome data were abstracted from medical records. Over a 10-year period, 394 cases of extrapulmonary tuberculosis were diagnosed and treated at KFSH and RC. Isolated extrapulmonary tuberculosis was identified in 339 [86%] patients, 55 cases [14%] had both pulmonary and extrapulmonary tuberculosis. Mean age was 45-years, and 188 patients [47%] had co-morbidities, most commonly diabetes mellitus in 14.2% of patients. Laboratory confirmation of extrapulmonary tuberculosis was available on 386 patients. The most frequent site involvement was lymphadenopathy in 41% of the time. Chest x-ray was normal in 75% of patients. Among 298 patients with follow up data, 10 [3.4%] had documented relapse and 50 [16%] died. Death was related to tuberculosis in 24 [48%] patients. A high level of clinical suspicion is essential for early diagnosis and treatment of extrapulmonary tuberculosis to reduce the significant morbidity and mortality

Mycobacterium tuberculosis susceptibility in Saudi Arabia

To present the available susceptibility data of Mycobacterium tuberculosis [M. tuberculosis] isolates from the Kingdom of Saudi Arabia [KSA] published in peer-reviewed journals. In a meta-analysis, studies published between 1966 and 2001 were included. Publication sites include Medline-indexed and non-indexed. Numbers of grown and resistant isolates were tabulated for first-line anti-tuberculosis agents. Twelve studies met the pre-set criteria. Data on 6,316 isolates between 1979 and 2000 were available. Resistance to at least one agent of the first-line anti-tuberculosis agents was 18.4%. Monoresistance to a single first-line agent was found in 10.9%, while polyresistance was noted in 7.6%. Multidrug-resistant M. tuberculosis was noted in 5.7% of all isolates. Resistance to isoniazid was most common noted in 11% of isolates. Resistance rates to other agents were: rifampin 9.7%, streptomycin 9.1%, pyrazinamide 3.1%, and ethambutol 2.5%. The overall resistance rate to at least one agent was not statistically different in isolates grown between 1979-1991 [18.5%] and 1989-2000 [18.3%]. There were large regional variations and higher resistance rates in the Western and Southern regions. Mycobacterium tuberculosis resistance rates to first-line antituberculosis agents and multidrug-resistant M. tuberculosis are high in KSA. A survey and monitoring program for drug-resistant tuberculosis will determine resistance rates at the community level

Urinary tract infection in spinal cord injury patients

Development and industrialization, military conflicts and various sports have dramatically increased the number of spinal cord injury patients. the skills of caring for these victim have also improved significantly. A common problem encountered by these patients, and their care providers, remains without significant recent advances. Urinary tract infections in spinal cord injury patients are frequent, difficult to evaluate, treat and prevent. At this stage, no antimicrobial prophylaxis is advocated routinely. The best available preventative measure remains simple hygienic techniques, intermittent catheterization and close monitoring. This review will summarize the pathogenesis, epidemiology, diagnosis, treatment and prevention of urinary tract infections in spinal cord injury patients