Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection in a patient with diabetes mellitus: A case report

Opportunistic fungal infections are life-threatening conditions with a high rate of morality, mostly occurring in immunocompromised hosts. We reported the case of mixed mold infection in a 69 year-old patient with latent diabetes mellitus. She was initially admitted for right orbital cellulitis. Cerebro-rhino-orbital mucormycosis and aspergillosis coinfection was diagnosed from mycological testing and histology after nasal biopsy sample. The patient received amphotericin B deoxycholate then voriconazole combined to surgical debridement with a favorable outcome

Tuberculous meningitis in adults: MRI contribution to the diagnosis in 29 patients

SummaryObjectivesTuberculous meningitis (TBM) is a life-threatening disease and is difficult to diagnose. We aim to promote the role of magnetic resonance imaging (MRI) in TBM diagnosis and survey.Design and methodsThis was a retrospective study undertaken between 1996 and 2003 in which we reviewed all cases of TBM that had undergone cerebral computed tomography (CT) and MRI performed with and without contrast.ResultsWe reviewed 29 patients; all had had subacute lymphocytic meningitis. Diagnosis was definite in only 11 cases and presumptive in 18 cases. MRI was performed showing one or more abnormalities in 26 cases. The use of MRI allowed the detection of CNS lesions in both brain and spine.ConclusionCerebrospinal MRI performed when TBM is suspected aids in its diagnosis and is also a useful means of monitoring the course of the disease under treatment

Meningitis due to Streptococcus equi in a 73 year old woman with an osteodural defect

Meningitis caused by Streptococcus equi (SE) is a rare disease associated with high rates of complications. Commonly identified risk factors are regular horse contact and consumption of unpasteurized dairy products. When diagnosed promptly, this infection can be cured.We report the case of a 73 year old woman who presented to the hospital with a sudden holocranial headaches, fever, photophobia, sonophobia, vomiting and behavioural disorders.She lived in a rural area and regularly consumed unpasteurized milk products. She had a medical history of osteodural defect, chronic otitis, high blood pressure and pulmonary fibrosis.We suspected bacterial meningitis associated with an ear infection. A lumbar puncture was performed. Streptococcus equi zooepidemicus(SEZ) was discovered in the CSF’s culture. Initially, the patient was treated with ceftriaxone. She had a tonic-clonic seizure 2days later. On the cerebral enhanced MRI, we found a right temporal pored cavity adjacent to a tegmen tympani bone breach. The patient received 15 days of antibiotic therapy with a good outcome. However, she was readmitted 24 h after being discharged for the same initial symptomatology. She received a total of 25 days of antibiotics and 4 days of corticoids with good results.Only a few cases of Streptococcus equi meningitis have been documented. We reported this case to insist on the importance of considering this diagnosis in patients with risk factors. We also point out that severe complications may occur despite the early initiation of adequate treatment

Paradoxical reaction associated with cervical lymph node tuberculosis: predictive factors and therapeutic management

Objectives: The aims of this study were to determine predictive factors of paradoxical reaction in patients with cervical lymph node tuberculosis (TB) and to discuss the therapeutic management of this condition. Materials and methods: A retrospective study was performed of 501 patients managed for cervical lymph node TB over a period of 12 years (from January 2000 to December 2011). Statistical data were analyzed using IBM SPSS Statistics version 20.0. Results: Paradoxical reaction occurred in 67 patients (13.4%), with a median delay to onset after starting TB treatment of 7 months. Lymph node size ≥3 cm and associated extra-lymph node TB were independently associated with paradoxical reaction. Treatment consisted of surgical excision (71.6%), restarting quadruple therapy (10.4%), reintroduction of ethambutol (23.8%), and addition of ciprofloxacin (20.8%); steroids were given in two cases . All patients recovered after an average treatment duration of 14.91 ± 7.03 months. Conclusion: The occurrence of paradoxical reaction in cervical lymph node TB seems to be predicted by associated extra-lymph node TB and a swelling size ≥3 cm. The treatment of paradoxical reaction remains unclear and more randomized trials are necessary to improve its management

Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries

Background. Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in > 95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries

Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries

Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries