Adult Klebsiella pneumoniae meningitis in Qatar:clinical pattern of ten cases

Objective:To describe the clinical presentation,underlying diseases,antimicrobial susceptibility,treatment and outcome of Klebsiella pneumoniae meningitis patients.Methods:This retrospective study involved all patients with 15 years of age or older who admit ted to Hamad General Hospital with culture proven Klebsiella pneumoniae meningitis from January 1,2007 to December 31,2012.Results:A total of ten cases were identified mine males and one female).Their mean age was i43.3±12.8) years.Eight patients(80%) had nosocomial meningitis with neurosurgery being the most frequent associated condition.Fever and altered consciousness were the most frequent symptom.Cerebrospinal fluid showed elevated protein and glucose levels.Oram slain showed Gram—negative rods in 50%of cases,while positive cerebrospinal fluid culture results were found in all patients.Multidrug resistance was observed in two cases,and all patients had received appropriate empirical and definitive antibiotic treatments.The mean duration of intravenous antimicrobial treatment was(19.3±7.0) d and all patients with external ventricular drains underwent removal of the device,while in—hospital mortality was 50%.Conclusions:The number of cases was too small to come up with therapeutic and prognostic conclusions.Further large-scale prospective study is needed.

Endogenous endophthalmitis and liver abscess syndrome secondary due to Klebsiella pneumoniae:report of three cases from Qatar

Endogenous endophthalmitis is a rare but devastating disease that may frequently result in visual loss despite appropriate and early antibiotic treatment Recent reports have suggested an increased incidence of endogenous endophthalmitis in East Asia,particularly in Taiwan,where the major source of infection has been liver abscess secondary to Klebsiella pneumoniae.Here we report three cases who presented in Qatar with severe endogenous endophthalmitis associated with Klebsiella pneumonia septicemia secondary to pyogenic liver abscess in a diabetes mellitus underlying.

Hematologic Characteristics of Patients with Active Pulmonary, Extra-Pulmonary and Disseminated Tuberculosis: A Study of over Six Hundred Patients

Background: Many inflammatory cells, cytokines, acute phase reactants as well as platelets are recruited in the battle against the invading mycobacterium. As a result, alterations in the hematologic profile of infected patients are anticipated. Objectives: The primary objective was to investigate the various hematologic characteristics of patients with active tuberculosis. The secondary objective was to study the correlation between such hematologic characteristics and the type of tuberculosis including pulmonary, extra-pulmonary, and disseminated. Methods: This was a retrospective, descriptive study investigating the hematological findings in adult patients (aged 18 years or older) with active, bacteriologically-confirmed tuberculosis infection. Results: Among the 605 confirmed active tuberculosis cases, 465 (78.8%) were pulmonary, 104 (17.6%) extra-pulmonary, and 21 (3.6%) disseminated type. The mean age at diagnosis was 33.4 ± 11.4 years and males constituted 80.2% of cases. Peripheral leukocytosis was observed in 177 (30.1%) and leukopenia in 7 (1.2%) (Pulmonary type of tuberculosis was significantly associated with leukocytosis (P = 0.000)). Neutrophilia, lymphocytosis, monocytosis, eosinophilia, and basophilia were observed in 15.3%, 3.1%, 10.4%, 6.3% and 4.7% respectively. Thrombocytopenia and thrombocytosis were observed in 3.9% and 26.7% respectively. Anemia was observed in 44.8% of all cases with 4.4% had severe anemia and 60.3% had anemia of chronic diseases. Erythrocyte sedimentation rate was high in 77.2% of cases and ≥100 mm/hr in 5%. C-reactive protein was high in 93.4% and it exceeded 40 mg/L in 69.3%. Conclusion: There is a wide range of variability in the leukocyte and differential leukocyte abnormalities observed in patients with active tuberculosis. Leukocytosis can be seen in one-third of patients with pulmonary tuberculosis. Anemia of chronic diseases is the most common type of anemia observed in tuberculosis patients. Erythrocyte sedimentation rate and C-reactive protein are elevated in the majority of patients with active tuberculosis. Levels of the sedimentation rate can be useful indices to determine the extent of the disease.

Diagnostic Utility of Sago-Like Nodules on Gross Thoracoscopic Appearance in Tuberculous Pleural Effusion and Their Correlation with Final Histo-Microbiologic Findings

Background: Distinguishing tuberculous pleural effusion (TPE) from other causes of exudative effusion is often challenging. Delay in treatment initiation can occur while awaiting histo-microbiologic confirmation owing to the paucibacillary nature of the disease. Sago-like nodules are the most common visual finding on gross thoracoscopic appearance. The primary objective was to determine the diagnostic utility of the presence of sago-like nodules on gross thoracoscopic appearance in TPE to help justify early initiation of tuberculosis (TB) treatment based on their finding while awaiting final histo-microbiologic confirmation. Secondary objective was to study the correlation between the presence of sago-like nodules and the final histo-microbiologic findings in pleural biopsy specimens. Methods: This was a retrospective-descriptive study of all patients with exudative pleural effusion who underwent diagnostic medical thoracoscopy (MT) at Hamad General Hospital during an eight-year period (from January, 2008 to December, 2015). Results: The presence of sago-like nodules on gross thoracoscopic appearance of the pleural surface had a sensitivity of 58%, a specificity of 89% and a positive predictive value of 97% for TPE with a diagnostic accuracy of 62%. There is significant association between the presence of sago-like nodules and demonstration of granulomatous inflammation in pleural biopsy specimens (P = 0.000). There is no association between sago-like nodules and positive TB smear and culture in biopsy specimens. Conclusion: The presence of sago-like nodules on gross thoracoscopic appearance has a high specificity and positive predictive value for TPE and significantly correlates with the presence of granulomatous inflammation. Patients from TB prevalent areas with exudative pleural effusion and sago-like nodules on gross thoracoscopic appearance may be commenced on TB chemotherapy while awaiting final histologic confirmation.

Fulminant hepatic failure caused by Salmonella paratyphi A infection

We report a case of fulminant hepatic failure associated with Salmonella paratyphi A infection, in a 29-yearold patient who was admitted to the intensive care unit （ICU） with fever of two days, headache and vomiting followed by behavioural changes and disorientation. On examination, the patient appeared acutely ill, agitated, confused, and deeply jaundiced. Temperature 38.5℃, pulse 92/min, blood pressure 130/89 mmHg. Both samples of blood grew S. paratyphi A, which was sensitive to ceftriaxone and ciprofloxacin. Ceftriaxon was administered with high-dose dexamethasone. Two weeks after treatment with ceftriaxon, the patient was discharged in satisfactory condition.

Renal Replacement Therapy in Qatar—Past, Present and Future

The economic development of Qatar alongside the resultant lifestyle changes in the last few decades has contributed to increasing rates of obesity, diabetes mellitus and hypertension with consequent increased incidence and prevalence of chronic kidney disease and end-stage-renal-disease (ESRD). This article describes renal replacement therapy (RRT) services in Qatar and their evolution in response to challenges posed by the growth of ESRD with reference to regional and international data. It covers the history of RRT, highlighting significant advances in chronological order, as well as providing an overview of the current status of RRT in the multicultural and socioeconomically diverse society that inhabits Qatar. Finally, it casts a glance into the future, predicting how RRT services will further evolve to address the current limitations.

Pulmonary and Extra Pulmonary Tuberculosis in Qatar: A First Retrospective Population-Based Study

Background: There is limited information about extra pulmonary tuberculosis (EPTB) in Qatar. The aim of this study is to describe the demographic characteristics of patients with Tuberculosis (TB) in Qatar, and to compare the characteristics of EPTB with those of Pulmonary Tuberculosis (PTB). Patients and Methods: The study was conducted at Hamad Medical Corporation (HMC) in Qatar, from January 2005 to December 2008. It involves all cases of TB diagnosed in Qatar which do not include patients who are diagnosed by routine screening tests upon entry to state of Qatar. Results: 1221 cases of TB were reported;654 (53.6%) were EPTB;and 567 (46.4%) were PTB. Nine hundred fifty-one (77.9%) were males and two hundred and seventy (22.1%) were females;the mean age was 32.7 ± 811.7 years;only 6.9% (84/1221) of them were Qataris. The most frequent associated condition was diabetesmellitus (DM) (30;2.5%), and the most frequent site involved was lymph node (285 cases;43.5%). One thousand two hundred patients continued on first-line drugs while 21 patients received second line treatment. The mean duration of antituberculous therapy was 6.7 ± 1.7 months. Hepatitis was the main drug toxicity. Eight hundred and forty seven patients (69.3%) cured and eight patients (0.7%) died, whereas the remaining three hundred and sixty-six patients (30.0%) had left the country before completing therapy. The proportion of EPTB among females was higher than males, whereas diabetes mellitus was strongly associated with PTB. Conclusion: TB is still common in Qatar with predominance of EPTB. Although male predominated, the proportion of TB, EPTB among females was higher than males.

Melioidosis an Imported Infection in Qatar: Case Series and Literature Review

Introduction: Melioidosis is a tropical infectious disease caused by Gramnegative bacteria Burkholderia pseudomallei (B. pseudomallei). This soil-borne disease is endemic in Southeast Asia and Northern Australia. In our country it was reported once before in 2000 in a patient who presented with subdural empyema. Case Series Report: We are reporting six cases of Melioidosis presented to our hospital in very close time with different clinical presentations. All patients were from Indian subcontinent. In 3 cases we treated with Meropenem plus Trimethoprim-Sulfamethoxazole (TMP-SMX) followed by oral TMP-SMX and Doxycycline for around 6 months with good clinical and radiological response, while the fourth case was treated with oral TMP-SMX and Doxycycline for 1 month but he lost to follow up, the Fifth cases were treated with IV Ceftazidime followed by TMP-SMX and Doxycycline for 9 weeks, the Sixth cases were treated with IV Ceftazidime followed by TMP-SMX and Amoxicillin/Clavulanic acid for 20 days, there was no mortality reported in our case series for both types Bactraemic and Abactraemic Melioidosis. Conclusions: This case series highlights the importance of early identification of B. pseudomallei which requires a high index of clinical suspicion as well as good understanding of demographical and travel history. Microbiological identification of B. pseudomallei is essential and requires notification of the microbiologist for suspicion of that infection. Prolonged antimicrobial therapy is required for a better clinical outcome.

Plummer-Vinson syndrome associated with solidpseudopapillary tumor of the pancreas

Plummer-Vinson syndrome （PVS）, also known as Paterson-Kelly syndrome or sideropenic dysphagia1 is characterized by dysphagia, iron deficiency anemia and esophageal webs. This syndrome is known to be associated with an increased risk of hypopharyngeal and/or cervical esophageal cancer. Three to 15 percent of the patients with PVS, mostly women between 15 and 50 years of age, have been reported to develop esophageal or pharyngeal cancer. There is a decreasing trend in the overall incidence of hypopharyngeal cancer in women, probably due to the diminished prevalence of PVS. There are few reports of gastric cancer in association with PVS.2