[Evaluation of diagnostic value of procalcitonin in severity indexes of acute pyelonephritis]

Background: Due to the characteristics of the low CRP and WBC count in acute pyelonephritis, Procalcitonin [PCT] measurement can be a useful and practical option in acute pyelonephritis. According to different results in the investigation of the diagnostic value of PCT; the aim of this study was to evaluate the diagnostic value of PCT in differentiation of the lower urinary tract infection from acute pyelonephritis

Methods: All patients with a diagnosis of urinary tract infection in Imam Reza and Sina hospitals were enrolled in this study. Positive urine culture was considered as a urinary tract infection. If urinary tract infection with a pathogen colony more than 105 or more than 104 colonies is marked in person, it was considered as a urinary tract infection. In all patients, leukocyte count, ESR, CRP, and serum PCT was measured. In all patients with febrile urinary tract infection, radioisotope scan was performed. If a parenchymal defect was found in scan, they were considered as acute pyelonephritis. And also, patients without fever and normal radioisotope scan were considered as urinary tract infection. The end prolactin levels were compared according to final diagnosis

Results: In this study, 100 patients were studied: 47 patients with acute pyelonephritis, 53 cases with cystitis. Mean age of patients in acute pyelonephritis and cystitis did not differed significantly; but its P value was 0.106, which was significantly higher than the cut-off point. Gender also had no significant differences between two groups [P-value=0.948]. The mean of Procalcitonin was 6.34%; with the range of 2% - 38%

Conclusion: No statistically significant differences were found between both groups. But the mean of WBC was higher in acute pyelonephritis than cystitis. ESR levels between bath groups were significantly different and it was significantly higher in patients with acute pyelonephritis. The mean of Procalcitonin in the two groups had no significant difference

Acute meningitis on account of orbital bone fracture: a case report

Background: Streptococcus pneumoniae [S. pneumoniae] is a gram-positive pathogen bacteria which causes a variety of diseases, including otitis media, bacteremia, and meningitis

Cases Report: A 19-year-old man with paroxysm was admitted to emergency department of hospital. He was diagnosed with S. pneumoniae meningitis on the basis of an analysis of the cerebrospinal fluid and blood culture

Conclusion: We present a rare case of meningitis. The treatment was successful by just relying on the antibiogram test results. Vancomycin treatment was discontinued, and the patient fully recovered with Ceftriaxone

Possible effect of Chlamydophila pneumoniae on COPD exacerbation

Chlamydophila pneumoniae is one of the common causative agents of respiratory infections. The present study aims to find the role of Chlamydophila pneumoniae infection in infectious exacerbation of chronic obstructive pulmonary disease [COPD] Sixty-five nasopharyngeal swab specimens of COPD patients were studied using fluorescent antibody staining with chlamydia specific conjugated antibody and with fluorescent microscopes. Data were analyzed by using SPSS software, version 13. A total of 65 COPD patients [as defined by the American Thoracic Society], 53 [81.5%] males and 12 [18.5%] females were included in the study. Forty-six [70.7%] subjects had exacerbated COPD while 19 [29.3%] were stable COPD patients. We found 4 positive cases of chlamydophila infection [6.15%], 3 of which [2 men and 1 woman] belonged to the exacerbation group and 1 had stable COPD. Data analysis revealed that there was no significant correlation between chlamydophila infection and COPD exacerbation

Abdominal and cervical lymphadenopathy and multiple abscesses due to mycobacterium tuberculosis; a case report

Mycobacterium tuberculosis is the cause of 43% of the peripheral lymphadenopathy cases in developing countries. However, psoas abscesses are usually secondary to the extension of infection from an adjacent site. In the present study, we describe a case of abdominal and cervical lymphadenopathy and multiple abscesses due to mycobacterium tuberculosis. A 55 years old man with abdominal and cervical lymphadenopathy, psoas muscle sheath abscess and a large abscess of abdominal wall was admitted. Vertebral column was intact and the patient didn't have immunodeficiency or history of illicit drug use. Analysis of aspirated pus with PCR for mycobacterium tuberculosis was positive, however, Ziehl-Neelsen and gram staining was negative. Culture of pus was positive for mycobacterium. Treatment was commenced with 4 drug antituberculosis regimen. During the treatment period, paradoxical reaction occurred and prednisolone was administered. Following 9 months of treatment, the abscesses resolved and the patient recovered completely. our patient presented with a group of uncommon extrapulmonary presentations including GI involvement, paraaortic lymphadenopathy and abscess formation secondary to tuberculosis that was aroused without any immunodeficiency context with hematogenous origin. He responded well to our therapeutic protocol

Pleural fluid CA-125 in patients with pleural effusion

Primary and secondary infections and malignancies are inflammatory causes of fluid accumulation in the pleural space. TB is one of the infective causes of pleural effusion and is similar to malignancies because of its subacute and chronic process; although their management is extremely different. CA-125 is a glycoprotein tumor marker with molecular weight of 200 KD, which is found on the surface of ovarian and some normal and inflammatory cells. In both malignancy and tuberculosis, this tumor marker increases in serum and consequently in pleural fluid. This study was conducted to evaluate and compare CA-125 tumor marker in pleural effusion resulting from malignancies and tuberculosis. twenty-seven TB patients [18 men and 9 women], with the mean [ +/- SD] age of 37.3 +/- 13.9 yrs. and 23 patients affected by malignant tumors [16 men and 7 women] with the mean [ +/- SD] age of 57.9 +/- 17.7 yrs. were evaluated during 2004-2005. In malignant cases, diagnosis was made through microscopic inspection of the biopsy samples and cytology of pleural fluid. For recognition of tuberculosis, culture and smear of sputum or gastric lavage, biopsy of pleura and pleural fluid and PCR methods were used. Pleural fluid samples were collected and the amount of their CA-125 was measured by CLIA method. The cut-off value of CA-125 was obtained from a ROC curve. The mean [ +/- SD] level of CA-125 in pleural fluid was 159.1 +/- 214, and 2149.2 +/- 4513.6 U/ml in tuberculosis and malignancies, respectively; which showed a statistically significant difference between the two groups [p < 0.01]. CA-125 marker levels in pleural effusion may be used as a diagnostic index for differentiation of TB and malignancy induced pleural effusions