Complicated Neurotuberculosis with sinus venous thrombosis: A case-report.

INTRODUCTION: Neurotuberculosis comprises around 6% of systemic tuberculosis. It targets a younger population, and it often leads to severe neurological complications or death. CASE REPORT: We report a young gentleman with a clinically defined tuberculous meningitis (TBM) and multiple neurological complication associated with TBM occurring simultaneously. This includes hydrocephalus requiring a ventriculoperitoneal shunt, vasculitic infarcts, cranial nerve palsies, TB granuloma and cerebral venous thrombosis. The cerebrospinal fluid polymerase chain reaction for tuberculosis as well as cultures remained negative repeatedly. The patient was treated with anti-tuberculous medication in addition to steroids based on validated scoring systems suggestive of TBM and made a good recovery. CONCLUSION: This report highlights the different complication seen with TBM and the importance of using clinical criteria to guide management plan particularly when cultures are negative.

Epidemiological and Clinical Features of Salmonella Typhi Infection Among Adult Patients in Qatar: A Hospital-based Study.

OBJECTIVES: We sought to describe the epidemiological and clinical features of typhoid fever in Qatar. METHODS: We conducted a retrospective study of adult patients treated for typhoid fever at Hamad General Hospital and Alkhor Hospital between 2005 and 2012. RESULTS: The mean age of the 354 patients enrolled in the study was 28.4±9.3 years; 296 (83.6%) were males. There were 42, 48, 39, 44, 46, 47, 52, and 36 cases of adults with typhoid fever in 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012, respectively. Overall, 343 (96.9%) patients had a history of travel to endemic areas. Among them, 93.0% acquired typhoid fever in the Indian subcontinent. Fever was observed in all cases, and the other predominant symptoms were abdominal pain (38.1%), diarrhea (35.6%), and headache (33.1%). Salmonella typhi, showed high resistance to ciprofloxacin (n = 163; 46.0%), and low resistance to ceftriaxone (n = 2; 0.6%). Four patients developed intestinal perforation, which was surgically repaired in two cases. Two patients (0.6%) died. CONCLUSIONS: Typhoid fever was frequent among immigrants to endemic areas. Travelers returning from endemic areas with suspected typhoid fever should be treated empirically with third-generation cephalosporin after obtaining appropriate cultures. Moreover, preventive measurements such as education on food and water hygiene, and effective vaccination of travelers should be practiced widely among travelers to endemic areas to reduce morbidity and mortality.

Adult tuberculous meningitis in Qatar: a descriptive retrospective study from its referral center.

BACKGROUND: Tuberculous meningitis is the severest and commonest form of central nervous system tuberculosis causing high mortality and morbidity. We aim to study the clinical, biochemical, and radiological characteristics of tuberculous meningitis in adult patients in Qatar and to calculate the incidence. METHODS: A descriptive retrospective 7-year study was conducted at the Hamad General Hospital (the only tertiary referral center and sole health care provider for tuberculosis in Qatar) between the 1st of January 2006 and the 31st of December 2012, to describe the clinical presentation, diagnosis, treatment, outcome, and the incidence of adult tuberculous meningitis in Qatar. RESULTS: Tuberculous meningitis was diagnosed in 80 patients (65 male, 15 female), with a mean age of 30.3 ± 8.9. The majority of patients (76.3%) were from the Indian subcontinent. The commonest clinical features were fever (79%), headache (71%), and meningism (56%). Cerebrospinal fluid tuberculosis culture was positive in 44% of patients. Almost 39% of patients were in Stage I, 46% in Stage II and 15% in Stage III of the disease. The commonest neuroimaging features were leptomeningeal enhancement (34%) and hydrocephalus (33%). Cranial nerve palsy, limb weakness, and an elevated C-reactive protein were associated with a poorer outcome. Sixty eight percent had complete recovery, 10% had residual neurological sequelae without disability, 17% had disability, and 5% died. The average incidence of tuberculous meningitis over 7 years was 0.9 per 100,000 adult population. CONCLUSION: The characteristics of tuberculous meningitis were described in our population. Our data indicate that the incidence of tuberculosis meningitis in Qatar has increased. Tuberculous meningitis in Qatar is mainly an imported disease.

Diagnostic value of pleural fluid interferon-gamma and adenosine deaminase in patients with pleural tuberculosis in Qatar.

OBJECTIVE: To investigate the diagnostic utility of interferon-gamma (IFN-γ) and adenosine deaminase (ADA) in tuberculous pleural effusions by determining the best cutoff levels of these two markers for pleural tuberculosis, in the context of the local epidemiological settings in Qatar. METHODS: We prospectively studied IFN-γ and ADA levels in the pleural fluid of patients presenting to Hamad General Hospital between June 1, 2009 and May 31, 2010. RESULTS: We studied 103 patients with pleural effusions, 72 (69.9%) with pleural tuberculosis, and 31 (30.1%) with nontuberculous etiologies. The mean IFN-γ concentration for the group with tuberculous effusions was significantly higher than that in the group with nontuberculous effusions (1.98 ± 81 vs 0.26 ± 10 pg/mL [P < 0.0001]). The mean ADA activity for the tuberculous effusions group was significantly higher than that in group with nontuberculous effusions (41.30 ± 20.09 vs 14.93 ± 14.87 U/L [P < 0.0001]). By analysis of receiver operating characteristic (ROC) curves, the best cutoff values for IFN-γ and ADA were 0.5 pg/mL and 16.65 U/L, respectively. The results for IFN-γ vs ADA were: for sensitivity, 100% vs 86%, respectively; for specificity, 100% vs 74%, respectively; for positive predictive value, 100% vs 88.5%, respectively; and for negative predictive value, 100% vs 69.7%, respectively. CONCLUSION: IFN-γ and ADA could be used as valuable parameters for the differentiation of tuberculous from nontuberculous effusion, and IFN-γ was more sensitive and specific for tuberculous effusion than ADA.