ABSTRACT
SETTING: Tuberculosis (TB) is the most common cause of pericarditis worldwide and carries a high mortality, even with effective anti-tuberculosis treatment. In the light of a randomized control trial in 2014, the American Thoracic Society and the Centers for Disease Control and Prevention/Infectious Diseases Society of America recently revised their recommendations against the routine use of adjunctive corticosteroids. OBJECTIVE: To evaluate the strength of evidence that resulted in this reversal of the guideline recommendations on the use of adjunctive corticosteroids in TB pericarditis by a meta-analysis, followed by a sensitivity analysis. DESIGN: Systematic review and meta-analysis of published randomized control trials. RESULTS: We identified five randomized control trials that met the eligibility criteria. Combining the results of the included trials, there was no overall mortality benefit from adjunctive corticosteroids (a random-effects model yielded a non-significant relative risk of 0.66 and 95%CI of 0.35-1.27). A sensitivity analysis further confirmed that the results of the meta-analysis were robust. CONCLUSION: Routine addition of oral corticosteroids to standard anti-tuberculosis treatment does not reduce mortality among patients with TB pericarditis.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Antitubercular Agents/therapeutic use , Pericarditis, Tuberculous/drug therapy , Administration, Oral , Humans , Pericarditis, Tuberculous/mortality , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Primary cerebral phaeohyphomycosis is caused by pigmented fungi that exhibit distinct neurotropism often in immunocompetent individuals. A 20-yr-old male presented with multiple brain abscess which was subsequently proven microbiologically to be due to Cladophialophora Bantiana. In spite of near total excision and appropriate antifungal agents succumbed to his illness. We report this case to highlight its rarity and high mortality in an immunocompetent host. There is no initial clinical or laboratory feature that makes a preoperative diagnosis possible and relies on microbiological confirmation.
Subject(s)
Ascomycota/isolation & purification , Brain Abscess/microbiology , Brain Abscess/therapy , Central Nervous System Fungal Infections/microbiology , Central Nervous System Fungal Infections/therapy , Adult , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Brain Abscess/diagnosis , Central Nervous System Fungal Infections/diagnosis , Cladosporium , Craniotomy , Drug Therapy, Combination , Fatal Outcome , Flucytosine/administration & dosage , Humans , Itraconazole/administration & dosage , MaleABSTRACT
Varied clinical presentations of Penicillium marneffei, an opportunistic pathogen in HIV disease has been rarely described in literature. We report a patient with advanced AIDS who presented to us with prolonged fever and had features of an acute abdomen. On radiologic imaging he had features of intestinal obstruction and mesenteric lymphadenitis. A diagnosis was made possible by endoscopic biopsies of the small bowel and bone marrow culture which grew P. Marneffei. He was treated with intravenous amphotericin for 2 weeks followed by oral itraconazole. This case is reported for its rarity and unusual presentation and to sensitise clinicians and microbiologists to consider this as an aetiology in patients with advanced HIV/AIDS who present with acute abdomen, more so in patients from a distinct geographic region--South-East Asia.
