Tuberculous Meningitis in Adults: A Review of 160 Cases

Objective. This study aimed to evaluate epidemiological, clinical, laboratory, and neuroimaging features of 160 adult patients with tuberculous meningitis (TBM) according to “Thwaites' diagnostic index.” Methods. The subjects of this retrospective study are the patients with TBM who were followed up between years 1998 and 2009 in a tertiary referral hospital. Diagnosis of TBM was based on clinical, laboratory, and neuroimaging signs and Thwaites' diagnostic index. Results. Mycobacterium tuberculosis was isolated from CSF in 59 of 148 patients. Seventeen percent of the patients died, 71% recovered completely, and 13% recovered with neurological sequel at the end of the sixth month. Conclusions. Despite new developments in laboratory or neuroimaging techniques, the diagnosis of TBM is still based on clinical features with the help of laboratory. Early diagnosis by suspecting TBM may prevent therapy delay and may result in decrease in the mortality and morbidity

Tricuspid Endocarditis and Septic Pulmonary Embolism in an Intravenous Drug User with advanced HIV Infection

Abstract Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU) with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD 4 count are associated with increased risk of death. This report presents a case of isolated tricuspid valve endocarditis with advanced HIV infection who was also an IVDU

Tricuspid Endocarditis and Septic Pulmonary Embolism in an Intravenous Drug User with advanced HIV Infection

Cardiac complications are becoming increasingly important in patients with HIV infection. Right-sided endocarditis are more common in intravenous drug users (IVDU) with HIV infection. Some studies have pointed out that the clinical outcome of such patients depends on the affected valve referred to the responsible agent rather than the HIV serostatus. However, severe immunosupression and low CD4 count are associated with increased risk of death. This report presents a case of isolated tricuspid valve endocarditis with advanced HIV infection who was also an IVDU

Acinetobacter baumannii: A Rare Cause of Meningoencephalitis in a Patient on Peritoneal Dialysis

Multiple drug resistant Acinetobacter spp. are usually responsible for hospital-acquired infections. Development of a central nervous system infection due to Acinetobacter spp. without head trauma or neurosurgical procedure is rare. We report a case of meningoencephalitis caused by A. baumannii in a diabetic 36-year-old man on continuous ambulatory peritoneal dialysis. He was admitted to hospital because of sudden loss of consciousness and jaw tightening, and his physical examination revealed high fever and nuchal rigidity. Laboratory investigations showed elevated acute phase reactants, in addition to normal cranial computed tomographic and electroencephalographic findings. Cerebrospinal fluid (CSF) examination disclosed an elevated protein concentration and very low glucose level. Following the growth of A. baumannii in CSF culture, meropenem treatment provided a complete cure

Comparison of Incidence and Clinical Outcomes of COVID-19 among Healthcare Workers in the Pre- vaccination and Post-vaccination Periods: A Real-world Impact Study

Aim: Real-life data on the effect of coronavirus disease-2019 (COVID-19) vaccination is limited. We aimed to compare the incidence of COVID-19 among healthcare workers (HCWs) in the pre-vaccination and post-vaccination periods during the COVID-19 pandemic and identify associated factors for COVID-19 development.Methods: In this single-center and cross-sectional study, HCWs employed in a tertiary care hospital were included. Pre-vaccination (14 October, 2020 and 14 January, 2021) and post-vaccination periods (1 March, 2021 and 1 June, 2021) were compared. A subgroup analysis was performed on HCWs without a previous history of COVID-19. Additionally, univariate regression analysis of COVID-19 development in the post-vaccination period was performed.Results: Of 2,922 HCWs, 2,096 (71.7%) were vaccinated. The incidence of COVID-19 was higher in the pre-vaccination period (16.3%) than in the post-vaccination (6.6%) (p<0.01). In the subgroup analysis, the incidence of COVID-19 was 16.6% in the pre-vaccination period and 8.1% in the post-vaccination period (p<0.01). Previous history of COVID-19 (p<0.01) and double-dose vaccination (p<0.01) were associated with a decreased risk of COVID-19 development.Conclusion: This study demonstrates the real-life impact of COVID-19 vaccination in reducing disease development and preventing poor clinical outcomes in a setting where the vaccination rate among HCWs was fairly low

CITROBACTER PERITONITIS: TWO CASES AND REVIEW OF THE LITERATURE

One of the uncommon gram negative organisms causing peritonitis in peritoneal dialysis patients is Citrobacter. Because of this organism's resistant nature, treatment for Citrobacter peritonitis may be difficult, and removal of the catheter may be necessary in refractory cases. Here we present 2 cases of peritonitis caused by this organism and fully treated with antibiotics. The literature contains only a limited number of reports on Citrobacter peritonitis, mostly case reports or portions of general papers about the microbiological spectrum of peritonitis in the relevant units. Until enough data about this micro-organism have been accumulated to map out an approach, it is wise to individualize treatment by watching the response of the patient during the wait for the antibiogram result and not to hesitate to remove the catheter if the clinical situation deteriorates

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations

Abstract Introduction: The main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. Objective: The current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. Methods: Patients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. Results: No significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. Conclusions: Silicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential

A rare case of peritonitis: Streptococcus salivarius

Streptococcus salivarius is a Gram-positive bacteria that may cause infections like endocarditis and meningitis. However, it has not been reported as a causative agent of peritonitis in peritoneal dialysis patients. In this paper we present a rare case of peritonitis with Streptococcus salivarius admitted to our Clinic with abdominal pain, who had been on peritoneal dialysis treatment for 19 months. Streptococus salivarius was cultured from the effluent, sensitive to ampicillin and penicillin G. Patient was discharged completely cured. Peritonitis is the most important clinical issue that occurs in patients treated with peritoneal dialysis, and every effort should be invested to determine the causative agent while even rare bacteria as Streptococcus salivarius may be found