Clinical profile of brucellosis from a tertiary care center in southern India

Objective:To highlight the spectrum of clinical manifestations,labs,complications,treatment and outcome of brucellosis.Methods:Retrospective study was conducted in Kasturba Medical College,Manipal University,Karnataka,India which included 68 confirmed cases of brucellosis from January 2006- April 2010.Diagnosis of brucellosis was made by culturing the sera/body fluids by standard BACTEC method(or) by testing the sera for Brucella agglutinins using the standard agglutination test(SAT).A titer of 1:320 or more was considered as significant.SPSS 16 was used for statistical analysis and Microsoft Excel for graphical representation.Results:Of the 68 patients,46(68%) were male and 22(32%) were female patients with age distribution of 9-75 years.Forty four(64.7%) had history of contact with unpasteurized dairy products or infected animals.Symptoms included fever(68,100%),myalgia(21,31%),musculoskeletal symptoms (23,34%),headache(16,24%),gastrointestinal symptoms(19,28%) and altered sensorium(3, 4%).Co-morbidities and associations included HIV positivity(2,3%),type 2 diabetes mellitus (13,19%),steroid therapy(3,4%) and HBsAg positivity(8,12%).Ten(15%) patients had cervical lymphadenopathy,4(6%) had splenic enlargement,6(7%) had hepatomegaly,19(28%) had hepatosplenomegaly and 2(3%) got meningeal signs.Anaemia was observed in 39(57.3%) cases,high erythrocyte sedimentation rate(ESR) was present in 55(80.8%) cases,leucocytosis in 10(14.7%),leucopenia in 10(14.7%),thrombocytopenia in 23(33.82%) and thrombocytosis in 2(2.94%) cases.Conclusions:In countries like India,where brucellosis and tuberculosis are endemic;rapid,sensitive and highly specific diagnostic methods are required to make early diagnosis and prevent resistance as there is an overlap in therapy.

Brucella meningoencephalitis with hydrocephalus masquerading as tuberculosis

Neurobrucellosis is a rare form of localized brucellosis usually with no systemic manifestations. We report a rare case of brucellosis presenting as meningoencephalitis associated with hydrocephalus.This patient had a lymphocytic predominant CSF and was initially treated with empirical anti tubercular therapy and steroids.A week later,when his CSF culture grew Brucella species,the treatment was changed to a combination of streptomycin,doxycycline and rifampicin and the patient improved with this therapy.This case illustrates the need to consider neurobrucellosis as a close differential diagnosis of neurotuberculosis in endemic areas when the patient presents with meningo encephalitis with lymphocytic CSF.

A case report of herpetic and candidal esophagitis in an immunocompetent adult

Reports of combined candidal and herpetic esophagitis in immunocompetent states are rare and sporadic.A 44-year-old previously healthy lady presented with a one week history of progressive dysphagia,odynophagia and fever.Esophagogastroduodenoscopy(EGD) showed extensive desquamation of the entire esophagus except for distal 4 cm.Histopathological examination revealed ulcerated and inflamed squamous epithelium with the margin of ulcer showing a few overhanging squamous cells with dense eosinophilic cytoplasm,multinucleated and faceted nuclei with glassy chromatin,and an occasional Cowdry type A intranuclear inclusion bodies.Few candidal spores were seen in the underlying stroma.Intravenous acyclovir,fluconazole and pantoprazole were initiated.Oral analgesics were given for pain relief.She was treated for a total of 14 days.She showed significant improvement and was tolerating oral intake after discharge.The patient was asymptomatic with no evidence of recurrence at a 2-month follow-up.

Clinical profile of disseminated cryptococcal infection-a case series

Objective:To study disseminated cryptococcal infection in a tertiary care hospital in Southern India.Methods:The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed.Results:7(58.3%) presented with fever 【 30 days and 3(25%) 】 30 days whereas 2(16.7%) did not have fever.All the 12(100%) had headache. 2(16.7%) had altered sensorium,one(8%) seizure.5(41.7%) had diarrhea and vomiting.6(50%) had oral candidiasis,and anemia.9(75%) had elevated erythrocyte sedimentation rate(ESR).6(50%) had neck stiffness.Cerebrospinal fluid(CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neqformans(C.neoformans) in 11(91.7%) and CSF culture positive in all 12(100%),one(8%) had urine culture positive.India ink preparation was positive in 10(83.3%).CD4 count was less than 50/microl in 4(33.3%),between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200.6(50%) were treated with parenteral amphotericin B(0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d.5(41.6%) were treated with fluconazole alone.8(66.7%) improved and 4(33.3%) patients died.Among those who succumbed to the illness,2(16.7%) received amphotericin and fluconazole,2(16.7%) patients received fluconazole alone.Conclusions:Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non- HIV individuals.At times,its presentation closely mimics that of Tuberculosis.Early diagnosis and appropriate treatment should be started as early as possible.