Hussam Al Soub

Tuberculoma of the Cavernous Sinus

A case of tuberculoma of the cavernous sinus is described and 4 other previously reported cases are reviewed. The condition is very rare, and predominantly affects Asians. Periorbital pain, ptosis and ophthalmoplegia are the most common presenting features. Clinical and radiological findings are not sufficiently sensitive to differentiate it from other diseases affecting the cavernous sinus. Treatment is primarily medical, with antituberculous drugs, and the outcome is good. Surgery has a limited role in the management of this condition, mainly for establishing the diagnosis.A case of tuberculoma of the cavernous sinus is described and 4 other previously reported cases are reviewed. The condition is very rare, and predominantly affects Asians. Periorbital pain, ptosis and ophthalmoplegia are the most common presenting features. Clinical and radiological findings are not sufficiently sensitive to differentiate it from other diseases affecting the cavernous sinus. Treatment is primarily medical, with antituberculous drugs, and the outcome is good. Surgery has a limited role in the management of this condition, mainly for establishing the diagnosis.

Myocardial abscess and bacteremia complicating Mycobacterium fortuitum pacemaker infection: case report and review of the literature.

A case of pacemaker infection complicated by bacteremia and myocardial abscess caused by Mycobacterium fortuitum is reported and 9 other cases of pacemaker infection associated with rapidly growing mycobacteria are reviewed. Most cases developed within 6 months from implantation suggesting nosocomial acquisition. Wound discharge, fever, and pain at generator site were the most common presenting features. At presentation they had a median duration of symptoms of 34 days. Concomitant bacteremia was present in half of the cases. Antibiotics therapy and removal of the pacemaker system were needed to achieve cure in the majority of cases. Clarithromycin and fluoroquinolones were the most commonly used antibiotics.

Mycobacterium fortuitum abdominal wall abscesses following liposuction

We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

Primary Nocardia meningitis in a patient without a predisposingcondition: Case report and review of the literature

A case of primary Nocardia meningitis in a patient without a predisposing condition is presented and 4 other reported cases are reviewed. The presenting features were fever, headache, altered consciousness, and neck stiffness. Cerebrospinal fluid examination (CSF) revealed hypoglycorrhachia (<40 mg/dl), elevated protein (>100 mg/dl), and pleocytosis with predominant neutrophils in all patients. Culture of CSF was positive for Nocardia in 4 of the 5 patients. Mortality was 50%. Diagnosis was frequently delayed and this probably contributed to the high mortality. Compared with Nocardia meningitis in association with a predisposing condition, primary Nocardia meningitis without a predisposing condition has similar clinical features and outcome.

Herpes simplex virus type 2 (Mollaret's) meningitis: a case report.

INTRODUCTION Mollarets meningitis is an unusual and under-appreciated syndrome of benign, recurrent aseptic meningitis. The available literature indicates that the causative agent is herpes simplex virus type 2 (HSV-2) in the majority of cases and much less frequently herpes simplex virus type 1 (HSV-1). CASE REPORT We report the case of a 49-year-old Indian female who had four attacks of recurrent lymphocytic meningitis (Mollarets meningitis) occurring over a 7-year period. The diagnosis of herpes simplex meningitis was made at the time of the fourth episode by a positive PCR for herpes simplex virus infection in the cerebrospinal fluid. During the first three episodes, the patient was treated with anti-tuberculous drugs and antibiotics for bacterial meningitis; however for the last episode, once the diagnosis of herpes simplex meningitis was confirmed, only symptomatic treatment was given. No long-term suppressive therapy was given and no recurrence has been experienced so far. CONCLUSIONS Mollarets meningitis should be suspected in all cases of recurrent lymphocytic meningitis. Early diagnosis may prevent prolonged hospital admissions, unnecessary investigations, and exposure to unnecessary medications, with the associated considerable costs. Treatment with acyclovir may be beneficial in decreasing the severity and duration of attacks and in preventing further episodes. [Au?1].

Improving influenza vaccination rates of healthcare workers: a multipronged approach in Qatar

We assessed whether an influenza vaccination (IV) campaign was effective at increasing vaccination rate in healthcare workers (HCWs) in 2 hospitals in Doha, Qatar that had no mandatory IV policy. The campaign comprised promotional, educational and vaccine delivery interventions; a dedicated IV team; telephone hotline; free IV with improved access, leadership involvement; incentives; group educational sessions; and reporting/tracking activities. During the 2014/15 influenza season, IV rates according to hospital and HCW category were calculated and compared with the 2 seasons before the intervention. The combined mean rate for IV for both hospitals increased for 2014/15 (64.3%) compared with 2013/14 (37.2%) and 2012/13 (28.4%). There was increased IV uptake among doctors and nurses at each hospital, and the IV rate for the 2 hospitals (59.1 and 69.5%) were higher than in 2013/14 (21.1% and 53.2%) and 2012/13 (17.2% and 39.6%). The findings highlight the importance of improving IV rates among HCWs in hospitals with no mandatory vaccination policies through multicomponent interventions.

Epidemiology, Risk Factors, Clinical Features, and Outcome of Adult Patients With Severe Pandemic A/H1N1/2009 Influenza in Qatar: A Retrospective Study

ObjectiveThe aim of this research was to study the epidemiology, risk factors, clinical manifestations, and outcome of adults with severe pandemic A/H1N1/2009 influenza in Qatar.The records of all polymerase chain reaction-proven cases of adults with severe pandemic A/H1N1/2009 who were admitted to the intensive care units at the Hamad General Hospital in Qatar between July 2009 and January 2011 were reviewed. ResultsDuring the 19-month study period, 40 adult patients with polymerase chain reaction-proven severe pandemic A/H1N1/2009 influenza were admitted to the intensive care unit at the Hamad General Hospital in Qatar. Qataris and those from the Indian subcontinent accounted for most patients, accounting for 52.5% and 32.5%, respectively. In addition, 82.5% of the patients had one or more risk factors, with diabetes mellitus, hypertension, and obesity being the most common. Fever, cough, and shortness of breath were the most common presenting symptoms, with a mean duration of symptoms of 4.3 days. Respiratory failure and septic shock were the most common reasons for intensive care unit admission. Laboratory abnormalities such as anemia, leukopenia, theombocytopenia, and elevated serum creatinine level and transaminases were common at presentation. Chest radiograph abnormalities were seen in most patients (95%), with bilateral involvement in most of them. Treatment with oseltamivir was given to all except one. Sixty percent of the patients needed ventilatory support. Complications developed in 37.5%, with renal failure being the most common. Seventy-five percent of the patients survived. Factors associated with increased risk of death included smoking, high Acute Physiology and Chronic Heath Evaluation II at presentation, and delay in initiation of oseltamivir therapy. ConclusionsMost adult patients admitted with severe pandemic A/H1N1/2009 have one or more risk factors that increase their potential for a severe disease. Clinical features and laboratory finding are nonspecific and are similar to those reported by others, as well as hospital mortality. Being a smoker or having a high Acute Physiology and Chronic Heath Evaluation II score at admission increases the risk of death due to disease. Starting antiviral therapy as early as possible also increases the chance of survival.

Value of Examining 3 Sputum Samples in the Diagnosis of Active Pulmonary Tuberculosis in Qatar

ObjectiveTo assess the need for testing a third sputum sample for the diagnosis of active pulmonary tuberculosis (PTB). MethodReview of the records of all sputum culture proven cases of active PTB in the state of Qatar diagnosed from 2002 to 2008. ResultsDuring the 7-year study period, 687 cases of culture proven PTB were diagnosed in Qatar. Five hundred one cases had at least one positive sputum smear for acid-fast bacillus (73%). Among these, 363 cases had 3 consecutive sputum samples tested. There was no statistically significant difference in sensitivity between the first, second, and third sputum samples in detecting the acid-fast bacilli on direct fluorescent microscopy (81.3%, 83.5%, and 82.3%, respectively). The sensitivity of the first sample in establishing diagnosis was 81.3%, increasing to 96.2% if 2 sputum specimens were tested (14.9% incremental benefit). Testing a third specimen increased the sensitivity to 100% (3.8% incremental benefit). ConclusionBased on our results and to deal with the increasing number of cases of suspected PTB seen in the State of Qatar in the last few years as well as to minimize the increasing demand for isolation rooms and the burden on our laboratory, we recommend that testing only 2 sputum specimens for acid-fast bacilli instead of 3 is probably safe and is adequate for the diagnosis of PTB.

A case report of TB versus idiopathic granulomatous mastitis with erythema nodosum, reactive arthritis, cough, and headache

Tuberculous mastitis (TBM) is relatively rare disease with an incidence ranging between 0.1 and 4%. Most of the cases are culture negative and often mistaken with chronic benign idiopathic granulom...Tuberculous mastitis (TBM) is relatively rare disease with an incidence ranging between 0.1 and 4%. Most of the cases are culture negative and often mistaken with chronic benign idiopathic granulomatous mastitis (IGM). It is very crucial to distinguish culture negative TBM from other causes of mastitis as the treatment differs tremendously. We describe here in a young woman originally from India and residing in Qatar; a non endemic area of tuberculosis; for more then fifteen years. She presented with 2 months history of right breast mass, followed by low grade fever, dry cough, headache, erythema nodosum, arthritis, and arthralgia. In view of the origin of the patient, positive family history for tuberculosis and positive quantiferon, the patient was started empirically on anti-tuberculous treatment (ATT). One week later she developed paradoxical reaction to ATT. This case illustrates unusual and rare manifestations of primary TBM and highlights the importance of differentiating and treating culture negative TBM from IGM.

Streptococcus anginosus Infections; Clinical and Bacteriologic Characteristics: A 6-Year Retrospective Study of Adult Patients in Qatar

BackgroundThe aim of this study was to assess clinical presentation and antimicrobial susceptibility of Streptococcus (S.) anginosus group infections in Hamad General Hospital, a tertiary care hospital in the state of Qatar, which is a multinational community. The S. anginosus group is a subgroup of viridans streptococci that consist of 3 different species: S. anginosus, S. constellatus, and S. intermedius. Although a part of the human bacteria flora, they have potential to cause suppurative infections. MethodWe studied a total of 101 patients with S. anginosus group infections from January 2006 until March 2012 by reviewing medical records and identification of organisms by VITEK 2 and MALDI-TOF. ResultsThe most common sites of infection were skin and soft tissue, intra-abdominal, and bacteremia (28.7%, 24.8%, and 22.7%, respectively). Abscess formation was seen in approximately 30% of patients. Streptococcus constellatus was the most common isolated species (40%) followed by S. anginosus (30%) and S. intermedius (7%). In 23% of specimens, the species was unidentified. The most common type of specimen for organism isolation was blood followed by pus and tissue (50%, 22%, and 8%, respectively). Streptococcus constellatus was more frequently associated with abdominal and skin and soft tissue infections than the other 2 species, whereas S. anginosus was isolated more frequently from blood. All isolates were susceptible to penicillin, ceftriaxone, and vancomycin. Susceptibility to erythromycin and clindamycin was also good, reaching 91% and 95%, respectively. Forty percent of patients needed surgical drainage along with antibiotic therapy. ConclusionsIdentification of S. anginosus group to species level is helpful in clinical practice because different species exhibit different pathogenic potentials.