Clinical and demographic characteristics of confirmed cases in H1N1 [2009] influenza

Presentation of pandemic H1N1 influenza [H1N1] is widely evolving as it continues to involve different geographic locations and populations. This study was conducted to improve the precision of clinical diagnosis of H1N1 [2009] influenza infection in an outpatient setting. A prospective cross-sectional study was conducted among adult patients [age >15 years] with influenza-like illnesses [ILI] from November 2009 to February 2010. Clinical, laboratory and epidemiological findings in the first week of illness were collected using a standardized datasheet. Influenza testing was performed by real-time reverse-transcriptase polymerase chain reaction [rRT-PCR]. Thirty nine [24%] patients were positive for H1N1 and 123 [76%] were negative for any subtype of influenza A virus. Whilst otalgia [14% vs. 0 p= 0.01] was more prevalent in non-influenza A cases, cough [90% vs. 72% p = 0.03] and shortness of breath [67% vs. 47% p = 0.02] were more often associated with H1N1-infection. Comparative analysis of coexisting conditions and demographic factors of patients revealed no other significant differences between the two groups. The clinical presentation of H1N1 [2009] infection is largely indistinguishable from other acute respiratory diseases. Although previous studies suggested significant differences in demographic and co-existing conditions of H1N1 infected patients, our study shows that as the pandemic spreads worldwide and affects the majority of the population, H1N1 diagnosis based on clinical presentation and demographic characteristics has become less practical and much more difficult in tertiary care centers

Is pulmonary aspergillosis common in diabetes mellitus patients?

Aspergillosis is a rapidly progressive, often fatal infection that occurs in severely immunosuppressed patients, including those who are profoundly neutropenic, recipients of bone marrow or solid organ transplants and patients with leukemia, lymphoma, advanced AIDS or phagocytic disorders such as chronic granulomatous disease. Patients with severe liver disease are at a higher risk for infections. Immunocompetent individuals rarely develop this infection and do so only in the presence of pulmonary and systemic abnormalities such as fibrotic lung disease, suppurative infection or when they are on corticosteroids. We present 2 cases of pulmonary aspergillosis in diabetic patients. They presented with cough and dyspnea. Aspergillus was found in obtained respiratory samples. Pulmonary aspergillosis was confirmed in our first case by transbronchial lung biopsy [TBLB] and Galactomannan assay. In the second case, diagnosis of pulmonary aspergillosis was established by thoracic CT guided biopsy plus Galactomannan assay. These patients had none of the suggested risk factors for Aspergillus infection but they had uncontrolled diabetes mellitus. This report highlights that pulmonary aspergillosis can occur in individuals with diabetes mellitus even in the absence of other risk factors such as corticosteroid use, severe granulocytopenia or other associated immunosuppressive factors. It is; therefore, valuable to recognize that in patients with diabetes mellitus pulmonary aspergillosis should be considered as an important differential diagnosis for respiratory problems

Comparison of pulmonary TB patients with and without diabetes mellitus type II

There are several studies on the effect of diabetes mellitus [DM] on clinical symptoms and radiological findings of multi-drug resistant tuberculosis [MDR-TB] and bacteriological findings in pulmonary tuberculosis patients. Considering the contradictory results of these studies, this study was conducted for further investigation in this regard. This was a case-control study conducted in Masih-Daneshvari Hospital in Tehran. Forty-seven patients with tuberculosis infection and diabetes type II were selected as the case group and 102 TB cases without diabetes were considered as controls. There were significant differences in hemoptysis, dyspnea and loss of appetite between the two groups, but no significant difference was found in cough, sputum production, chest pain, night sweat, fever or weight loss. Also, there was no significant difference between the 2 groups in terms of MDR-TB and bacteriological findings. On CXR, diabetic patients had a higher prevalence of typical presentations along with cavitary lesion[s] but no significant difference was found between the 2 groups in terms of radiological presentation. In this study, diabetes type II did not have much influence on clinical symptoms and bacteriological findings of TB patients. However, PTB-DM type II cases may be considered more contagious due to the higher prevalence of cavitary lesions compared to those without DM. Prevalence of MDR-TB was the same in both groups

Update on 2009 pandemic influenza a [H1N1] virus

The pandemic influenza A [H1N1/2009] virus as a new challenge for health care providers has caused significant morbidity and mortality worldwide. Although many aspects of this virus are similar to other human influenza viruses, there are some disparities. This article reviews different aspects of influenza H1N1/2009 virus with focus on clinical features and management of patients

49-year-old woman with refractory chronic sinusitis. Sarcoidosis with granulomatous sinusitis Photo Quiz

A 49-year-old married, non- smoker housewife had purulent rhinorrhea, nasal congestion, post nasal drip [PND], and feeling of sinus pressure following an episode of common cold. She had no complaints of fever, cough, dyspnea, or arthralgia. Physical examination revealed PND and a posterior auricular lymphadenopathy [1cm X 1cm]. The patient received amoxicillin for 2 weeks with mild improvement. But again, she experienced the exacerbation of signs and symptoms a week later. CT-scan of the paranasal sinuses was performed [Figure 1]. She also had erythematous patches on her face around the right eye and her back, along with splenomegaly. The patient was treated with amoxicillin/clavulanate [for two weeks], loratadine, and beclomethasone nasal spray as well as normal saline nasal wash. There was a slight improvement in patient's signs but, repeatedly after two weeks signs and symptoms exacerbated. Due to the lack of response to antibiotics, a biopsy of the skin lesion was taken which revealed the following histopathological findings

Recurrent non-typhoidal salmonella bacteremia in a patient with interleukin -12p40 deficiency

The South eastern region of Iran is an endemic area for salmonellosis. Sometimes bacteremia due to nontyphoidal salmonella occurs but certain patients are at increased risk for recurrent bacteremia. The risk of invasive salmonellosis and recurrent bacteremia is increased in the patients with immunosuppression, especially impaired cell-mediated immunity, lymphoproliferative diseases and in patients with IL-12 deficiency. In recent years, a series of inherited disorders of IL-12-IFN-gamma axis have been described that predispose affected individuals to disseminated disease caused by environmental mycobacteria and non-typhoidal salmonella. We report here the first such patient originating from and living in Iran. The patient was a 26-year-old man, suffering from IL-12p40 deficiency and presented with recurrent episodes of systemic salmonellosis. This report indicates that there are patients with inherited defects of the IL-12-IFN-gamma circuit in Iran. We recommended to consider this group of disorders in all patients with recurrent non-typhoidal salmonella bacteremia, wherever they are found