Psychotic Symptoms of Hashimoto's Encephalopathy: A Diagnostic Challenge

Hashimoto's encephalopathy (HE) is a rare and underdiagnosed neuropsychiatric illness. We present the case of a 17-year-old girl who was admitted to a tertiary-care psychiatric center with acute onset psychosis and fever. Her psychotic symptoms were characterized by persecutory and referential delusions, as well as tactile and visual hallucinations. Her acute behavioral disturbance warranted admission and treatment in a psychiatric setting (risperidone tablets, 3 mg/day). She had experienced an episode of fever with a unilateral visual acuity defect approximately 3 years before admission, which was resolved with treatment. Focused clinical examination revealed an enlarged thyroid, and baseline blood investigations, including thyroid function test results were normal. Abnormal laboratory investigations revealed elevated anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) levels (anti-TPO of 480 IU/mL; anti-TG of 287 IU/mL). Results of other investigations for infection, including cerebrospinal fluid examination, electroencephalography, and brain magnetic resonance imaging were normal. She was diagnosed with HE and was treated with intravenous corticosteroids (methylprednisolone up to 1 g/day; tapered and discontinued after a month). The patient achieved complete remission of psychotic symptoms and normalization of the anti-thyroid antibody titers. Currently, at the seventh month of follow-up, the patient is doing well. This case highlights the fact that in the absence of well-defined clinical diagnostic criteria, a high index of suspicion is required for early diagnosis of HE. Psychiatrists need to explore for organic etiologies when dealing with acute psychiatric symptoms in a younger age group.

Surveillance data on micro-organisms in respiratory tract infections at a tertiary care teaching hospital in South India.

Background: Respiratory tract infections are the leading cause of infections and associated hospitalizations in India. Generally, there is little control on the use of antibiotics. Community awareness of the issues involved in antibiotic therapy is poor and this is compounded by over-the-counter availability. The main aim was to compare the resistance developed by respiratory microbes. Methods: A retrospective and prospective study was designed and conducted to compare the pattern of resistance developed by microorganisms affecting the respiratory tract. Results: The sensitivity of K. pneumoniae to cefepime/tazobactum has decreased from 91.9% to 47.6% and S. aureus to Linezolid has decreased from 93.4% to 80% and S. pyogenes to azithromycin from 51.4% to 24.8%. Whereas sensitivity pattern of S. pneumoniae to amoxicillin/clavulanate is increased from 65.6% to 82.3%. The prevalence of Klebsiella pneumoniae was increased 19% to 25.2% whereas the prevalence of S. pneumoniae was decreased from 66.8% to 65.2%. Our study suggests that all microorganisms isolated are susceptible to carbapenems and cefepime/tazobactum in the cephalosporin class. Conclusions: There is major shift in the sensitivity pattern of microorganisms towards antibiotics. Therefore, these results must be kept in mind by the practitioners in the study site, prior to making decisions over a medication regimen empirically for patients and also to maximize the output of medications by rational prescribing and dosing.