Subject(s)
Cardiomyopathies/parasitology , Echinococcosis , Pulmonary Artery , Adult , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Echinococcosis/complications , Echinococcosis/diagnosis , Female , Humans , Vascular Diseases/complications , Vascular Diseases/diagnosis , Vascular Diseases/pathologyABSTRACT
Mediterranean spotted fever (MSF) is endemic in Tunisia. Diagnosis is confirmed retrospectively based on serology. Clinical features are suggestive of diagnosis if the triad (fever, rash, and eschar) is present. Otherwise clinical diagnosis could be difficult. A diagnosis score was already proposed by Raoult et al. The aim of this study was to evaluate this score, considering only clinical parameters, in order to help clinicians in diagnosing MSF before confirmation. We retrospectively analyzed 62 consecutive charts of patients with diagnosis of suspected MSF. Diagnosis confirmation was made by serology (IgG anti-R. conorii exceeding 128 or seroconversion). Epidemiological and clinical features and total score for each patient were reviewed. To validate the clinical score, we calculated sensitivity, specificity and the Youden index for each score in order to establish the ROC curve. SPSS was used for these statistical tests. Area under curve was 0.70 (P = 0.02). The cutoff score with the most predictive value of MSF diagnosis was 18, according to our study (sensitivity 60%, specificity 84,6% and Youden index 0.44). The MSF diagnosis score is a helpful tool to aid the clinician with presumptive management before confirmation. In our study we demonstrated that a score based only on epidemiological and clinical features could be sufficient, but we have to indicate that these results and cutoff score of 18 were from a retrospective study and should be confirmed by a well-designed prospective one.
Subject(s)
Boutonneuse Fever/diagnosis , Animals , Bites and Stings , Boutonneuse Fever/epidemiology , Boutonneuse Fever/transmission , Diagnosis, Differential , Humans , Incidence , ROC Curve , Reproducibility of Results , Retrospective Studies , Ticks/microbiology , Tunisia/epidemiologyABSTRACT
A mediastinal hydatid cyst is rare (< 0.1% of hydatidosis). It most frequently progresses to calcification rather than a pulmonary hydatid cyst because there is no relationship to ventilation. We report a case of calcified mediastinal hydatid cyst which was confirmed on histological examinations from the operative specimen, in an agricultural worker of 58 who presented with a homolateral paralysed diaphragm.
Subject(s)
Agricultural Workers' Diseases/parasitology , Calcinosis/complications , Echinococcosis/complications , Mediastinal Diseases/complications , Respiratory Paralysis/parasitology , Biopsy , Calcinosis/diagnosis , Calcinosis/surgery , Echinococcosis/diagnosis , Echinococcosis/surgery , Humans , Male , Mediastinal Diseases/diagnosis , Mediastinal Diseases/surgery , Middle Aged , Tomography, X-Ray ComputedABSTRACT
The frequency of tuberculous cerebral involvement associated with miliary tuberculosis is not well known; some authors have evaluated it at around 22%. We report the case of a 43-year-old man hospitalised in the pulmonology department with bacillary positive miliary tuberculosis. On the 26th day of antituberculosis treatment he complained of frontal headaches, with impairment in visual acuity. Examination of the optic fundus showed bilateral papillary oedema. Cerebral computed tomography showed diffuse rounded lesions with significant oedema. Antituberculosis chemotherapy was supplemented with steroid treatment. Clinical and radiological progress was good.
