Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis

It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis [EPTB] compared to those of pulmonary tuberculosis [PTB] among adult immunocompetent patients. A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period [2007-2012]. Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. Of the 372 patients, 227 [61%] were males and 168 [45.2%] had EPTB; 204 [54.8%] patients had PTB. The most frequent sites of EPTB were the lymph nodes [n = 45, 12.1%], pleura [n = 40, 10.7%] and brain [n = 7, 1.8%]. The most common symptoms were cough [n = 174, 46.7%], night sweats [n = 127, 34.1%] and fever [n = 123, 33%]. Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guerin vaccination [odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001]. Eighty-one [48.2%] of the EPTB and 146 [71.6%] of the PTB patients were males. Pulmonary involvement was more common among men [n = 146, 71.6%] than among women [n = 58, 28.2%; p = 0.000]. There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB

Hearing loss and accompaning disturbance of Neurobrucellosis cases

Up to 5-10% of Brucellosis cases manifest with neurobrucellosis and course with various forms such as meningocephalitis, cerebellitis, acute meningitis, myelopathy, radiculopathy neuropsychiatric syndromes and cranial neuropathy. Brucella toxin damages the inner ear and leads to sensorineural hearing loss. We aim to report seven patients who were diagnosed as neurobrucellosis accompanying with hearing loss problem and were hospitalized to Infectious Diseases Department between 2005 and 2010. Long term fever, headache, hearing loss, walking disability were the predominant symptoms, Bilateral sensorineural hearing loss was the most frequent finding. And the other findings were also dysarthria, ataxia walking and increased deep tendon reflexes. Common symptoms were long term fever [100%], headache [71.4%], chills [57%], vomiting and exhaustion [29%]. Neurologic findings such as walking instability [four patients], paraplegia [two patients] and hearing disturbances [seven patients] were recognized. Rifampicin, doxycycline and trimethoprim/ sulfamethaxazole agents were administered to our patients and the duration of treatment should be decided depending upon individual cases [4-12 months]. Hearing thresholds were restored after treatment in five patients. Only two patients' hearing loss were partially improved after therapy. Neurobrucellosis should be considered in long term fever accompanying the unexplained neurological symptoms such as hearing loss. In neurobrucellosis patient should be tested in hearing thresholds

Acute Bacterial Meningitis as a Complication of Otitis Media and Related Mortality Factors

The aim of this study was to evaluate the characteristics of patients with acute bacterial meningitis (ABM) developed secondary to acute and chronic otitis media (OM). Between 1991 and 2001, among 269 adult patients with ABM, 56 who were secondary to OM were included in the study. We reviewed the charts of patients who were diagnosed as ABM following acute or chronic OM. Risk factors associated with mortality were determined by using a logistic regression model. The mean age of the patients, 38 male and 18 female, was 25.8 +/- 10.8 years (range 14 - 65). Forty-four of these cases (79%) have had chronic OM, of whom 19 (43% of the 44) have also had chronic mastoiditis and 12 (27% of the 44) acute OM. Twenty-three patients (41%) died, during either hospitalization or the follow-up period. Univariate analysis revealed comatose mental status on admission, inappropriate antibiotic treatment before admission, and elevated erythrocyte sedimentation rate (ESR) as significant risk factors for mortality. In multifactorial analysis, comatose mental status (OR=42.5, CI=6.4-280.1, p=0.001) and elevated ESR (OR=1.0, CI=1.01-1.07; p=0.005) remained as significant predictors for mortality. In conclusion, the primary sources of infection leading to the development of ABM should be investigated carefully to reduce the morbidity and mortality rates. It is hoped that this study will raise awareness among general practitioners and otolaryngologists concerning the role of ABM as one of the most important complications of OM.