Periprosthetic tuberculosis of the knee joint treated with antituberculosis drugs: a case report.

We report a 55-year old man with periprosthetic tuberculosis infection following a total knee arthroplasty surgery performed during an active tuberculosis infection. The patient was conservatively treated with anti-tuberculosis drugs and retention of prosthesis. There was no recurrence during an 18-month follow-up period. Tuberculosis arthritis should be considered in the differential diagnosis in patients with osteoarthritis requiring replacement surgery. Conservative treatment with antituberculosis drugs may be an option in periprosthetic tuberculosis infections without loosening.

Comparative analysis of cerebrospinal fluid adenosine deaminase activity in meningitis.

AIM: The purpose is to determine the cut-off value of adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) of patients with tuberculous and non-tuberculous meningitis, and to assess its value in differential diagnosis. MATERIAL AND METHODS: This study was conducted in 91 patients with meningitis in two university hospitals in Turkey. 24 patients had tuberculous meningitis (TBM), 25 purulent meningitis (PM), 25 aseptic meningitis (AM) and 17 neurobrucellosis (BM). ADA activity of CSF was quantified by colorimetry. RESULTS: In our study, mean ADA values in CSF were 28.34 ± 14.83 IU/L in TB cases, 8.71 ± 5.83 IU/L in BM, 6.18 ± 2.54 IU/L in PM and 3.43 ± 3.48 U/L in AM cases. If we accept for CSF ADA an activity cut-off value of 12.5 IU/L for differential diagnosis of TBM and BM, its sensitivity was 92% and specificity was 88%. If we accept 12.35 IU/L for differential diagnosis of TBM and PM, its sensitivity was 92% and specificity was 100%. If we accept 6.45 IU/L for differential diagnosis of TBM and AM, its sensitivity was 100% and specificity was 92%. Additionally, we examined the cases after dividing them into two groups, viz. TB and non-TB. If we accept an ADA activity cut-off level of 11 IU/L for differential diagnosis of TB and non-TB by applying ROC analysis, its sensitivity was 92% and specificity was 90%. CONCLUSION: The sensitivity and specificity for CSF ADA activity are markedly high in differential diagnosis of TB from non-TB. Hence CSF ADA activity may be used as a simple, cost-effective and reliable test for early differential diagnosis of TB.

[A human rabies case with antemortem diagnosis]. / Yasarken tani konulan bir insan kuduz olgusu.

Rabies, which is an acute, progressive, fatal zoonotic infectious disease, is almost always caused by the bite of rabid animals containing rabies virus in their saliva. Since there is no established specific therapy for rabies, preventive and prophylactic measures are of critical importance. In this report a case of human rabies diagnosed antemortem, was presented. A 29 year old man was admitted to Harran University Hospital (in Sanliurfa province, located at southeastern Anatolia) emergency service with symptoms of high fever, general weakness, paresthesia of the right arm, hypersalivation and dysphagia. The patient with poor socioeconomical status was living in a rural area and his anamnesis revealed a history of dog bite about five months ago. It was learned that he refused vaccination against rabies after the bite event, despite the warnings of his relatives. Shortly after admission, the patient's neurological status severly deteriorated; he became increasingly agitated. Upon the development of progressive respiratory failure, the patient underwent ventilatory support and heavily sedated with presumptive diagnosis of rabies. A nuchal skin biopsy, cerebrospinal fluid, saliva and corneal smear were sent to the Ministry of Agriculture and Rural Affairs Etlik Central Veterinary Control and Research Institute Rabies Diagnosis Laboratory in Ankara. The corneal smear was positive for rabies virus antigen revealed by direct fluorescent antibody test and saliva sample was also positive for rabies virus RNA by reverse-transcriptase polymerase chain reaction assay. Thus, on the third day of the admission the diagnosis was confirmed and on day 11, the patient was deceased due to rabies encephalitis. This case report emphasizes the importance of public education particularly in low socio-economic and socio-cultural areas, about rabies transmission and preventive and prophylactic measures that should be taken after animal bite.