RESUMEN
To describe the misidentification of Brucella melitensis as Bergeyella zoohelcum by MicroScan WalkAway, a commonly used bacterial identification system. A 35-year-old man was admitted to the Intensive Care Unit with sepsis syndrome. Three sets of aerobic blood culture samples were positive after 48 h of incubation. The isolated organism was identified as B. zoohelcum using the MicroScan WalkAway [Siemens Healthcare Diagnostics Inc., West Sacramento, Calif., USA]. However, due to the rareness of the pathogen, the isolate was reidentified as B. melitensis with Vitek 2 system and later 16S ribosomal sequence analysis confirmed the isolate as B. melitensis having 100% match. This case showed that Brucella can be misidentified using MicroScan WalkAway. Countries where brucellosis is endemic need to be careful while using such automated identification systems in order not to miss the diagnosis of Brucella
RESUMEN
In Oman, consent for lumbar puncture [LP] is infrequently given by patients and /or parents, necessitating empiric treatment. We sought to determine if refusal for LP leads to a worse clinical outcome in patients with suspected meningitis. A case-control study and retrospective review of medical records of all patients seen or hospitalized at the Sohar Regional Hospital from January 2004 through October 2005 with a diagnosis of suspected meningitis. Clinical, treatment, and outcome features were compared between subjects consenting to [n = 7] and refusing [n = 12] LP. Patients refusing LP were more likely to be younger [6 yrs vs. 25 yrs; p < 0.001] and to be admitted to the pediatric service [10/12 vs. 2/7], to receive empiric antibiotics [12/12 [100%] vs 3/7 [43%]], to have an incomplete course of antibiotics [6.4 vs. 10 days], to have a shorter duration of hospital stay [6.5 vs. 10 days], and to leave the hospital against medical advice and /or be transferred to another facility. Patients undergoing LP were more likely to have clinical improvement and be discharged home. Two patients in the LP group had treatable CNS infections [tuberculous and cryptococcal meningitis] that would not have been adequately covered by empiric antimicrobial therapy. Diagnostic LP improves the management and prognosis for patients with suspected meningitis