Clinical, paraclinical, and antimicrobial resistance features of community-acquired acute bacterial meningitis at a large infectious diseases ward in Tehran, Iran

In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult [> 18 years] individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients' medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients' outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia [33.33%] followed by Neisseria meningitidis [27.78%] and Haemophilus influenza [16.67%]. The most common antimicrobial regimen was ceftriaxone plus vancomycin [69.44%] followed by ceftriaxone plus vancomycin plus ampicillin [11.11%]. Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 [11.11%], 2 [5.56%], and 1 [2.78%] subjects, respectively. Regarding mortality, only 3 [8.33%] patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them

Pleural and pericardial effusions: rare presentations of brucellosis, Iran

We report a rare case of brucellosis presenting with pleural and pericardial effusions in a 35 year-old male rancher in Iran with fever and dyspnea. Such findings should prompt inclusion of brucellosis in the differential diagnosis in endemic areas