Chryseobacterium gleum bacteraemia: first reported cases from Qatar.

Chryseobacterium gleum is a Gram-negative aerobic bacillus. It commonly colonizes mechanical devices, causing device-associated infections like central line-associated bloodstream infection and ventilator-associated pneumonia. We describe two cases of C. gleum bacteraemia in patients admitted to our intensive care unit in Qatar, one of which resulted in death. Long hospital stays and indwelling devices are risk factors for C. gleum bacteraemia. Because C. gleum is inherently resistant to ß-lactam antibiotics, rapid identification and antimicrobial susceptibility testing are essential for guiding therapy.

Isolation of Exophiala dermatitidis from endotracheal aspirate of a cancer patient.

Exophiala (Wangiella) dermatitidis is a melanised (darkly pigmented) yeast-like organism that has been reported from the environment and wild animals. The organism is a frequent coloniser of lungs of patients with cystic fibrosis and causes occasional disseminated phaeohyphomycosis and fungaemia. Exophiala dermatitidis is distributed worldwide, but cerebral cases are restricted to East Asia. We report a case of 54-year-old Qatari female patient with a known history of cancer, suffering from pulmonary disorder. Culture of endotracheal aspirate revealed the growth of E. dermatitidis concomitant with Candida krusei. The final diagnosis of E. dermatitidis and attribution to genotype B was achieved by sequencing the rDNA internal transcribed spacer (ITS) region. The present case concerns a pulmonary colonisation by E. dermatitidis, similar to that commonly seen in cystic fibrosis patients. For the detection of E. dermatitidis in clinical specimens culturing techniques are required. The patient finally expired with persistent cancer and C. krusei fungaemia. Review of literature and listing of E. dermatitidis cases published after 1992 show a sharp increase in clinical cases during the 1990s.

Miliary tuberculosis in Qatar: a review of 32 adult cases.

BACKGROUND: This study was conducted to define the demographic, clinical and laboratory features, methods of diagnosis and outcome, in patients with miliary tuberculosis (TB) in Qatar, and compare the findings with other reported studies. PATIENTS AND METHODS: A retrospective review of 32 cases of miliary TB treated at the Hamad Medical Corporation during a seven-year period (1992 to 1998) was undertaken. The 32 patients comprised 24 males and 8 females, and their mean age was 33.3 years. The majority (90%) were expatriates. The clinical features of the patients were similar to those of previously reported series. The most common presenting symptoms were fever, cough, night sweats, weight loss and sputum production. Fever, rales, lymphadenopathy, altered mental status and hepatomegaly were the most common signs. Chest radiograph was abnormal in 94% of patients, and showed a miliary pattern in 69%. Sputum, cerebrospinal fluid, bronchial washings, and urine smears for acid-fast bacilli were rarely positive, however, cultures for Mycobacterium tuberculosis were positive in 54.8%, 37.5%, 33%, and 25%, respectively. The diagnoses in the majority of patients were made on the basis of the clinical presentation and supported by a miliary pattern on chest radiograph. In those whom chest radiograph did not show the classic miliary pattern, transbronchial biopsy was diagnostic in 1 of 2 patients (50%), bone marrow biopsy in 5 of 11 (45%), liver biopsy in 1 of 2 (50%), and lymph node biopsy in all 7 patients (100%). Thirty patients were treated with a four-drug regimen consisting of isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol. Mortality due to miliary TB was 3%. CONCLUSION: Miliary TB is common in Qatar, especially among expatriates. Because the clinical features of the disease are nonspecific, a high index of suspicion is essential for early diagnosis in order avoid delays in therapy and poor outcome.

Tuberculous meningitis: a clinical and laboratory study of 20 patients in Qatar.

Twenty cases of tuberculous meningitis were diagnosed at the Hamad Medical Corporation between 1990 and 1995. Most of the patients (90%) were expatriates. The most common presenting features were fever, headache, neck stiffness and altered mental status. Five patients were in stage 1 disease at the time of presentation, 11 in stage 2, and four in stage 3. Examination of cerebrospinal fluid showed at least one abnormal finding in all patients, and culture grew Mycobacterium tuberculosis in 50%. A positive tuberculin skin test in 50% of patients, abnormal chest X-ray in 35%, abnormal CT scan or MRI showing tuberculoma or hydrocephalus in 55%, and positive sputum culture for M. tuberculosis in 15% helped establish the diagnosis. All the patients were treated with antituberculous drugs and steroids. Seventeen (85%) survived, three with severe neurological sequelae; three (15%) died. Poor outcome was associated with advanced stage of disease at presentation and high CSF protein. Tuberculous meningitis continues to be an important disease in Qatar, especially in expatriates, and should be considered in the differential diagnosis in any patient presenting with fever and change in sensorium.

A clinical comparison of typhoid fever caused by susceptible and multidrug-resistant strains of Salmonella typhi.

The clinical features and response to therapy with ciprofloxacin were studied in two groups of patients: those infected by susceptible strains of Salmonella typhi and others infected by multidrug-resistant strains. There was no significant difference in the clinical presentation, laboratory findings and outcome between the two groups. Patients infected with multidrug-resistant strains, however, defervesced in significantly longer time (5.5 days) than those infected by susceptible strains (4.35 days) (p = 0.031). In areas with high prevalence of multidrug-resistant Salmonella infection, empiric treatment with quinolones or third-generation cephalosporins of all patients with suspected typhoid fever until the results of culture sensitivity tests are available may lead to better outcome.

Descending necrotising mediastinitis.

Descending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to this high mortality, but awareness of such a complication and early diagnosis using computed tomographic scanning leads to prompt surgical drainage, proper antibiotic therapy, and survival.