Cryptococcus neoformans in a child with CSF rhinorrhoea: A cytopathological diagnosis.

Cryptococcosis is caused by Cryptococcus neoformans and is fatal in children. The fungus is known to enter respiratory tract by inhalation and localizes in lungs in immunocompetent host. Patients with immunocompromised state facilitate dissemination of disease. However, disseminated cases have been described in immunocompetent HIV-negative individuals. CSF rhinorrhoea as a predisposing cause of cryptococcal meningitis has been rarely reported. We hereby describe C. neoformans directly spreading to the meninges in 1 year child due to CSF rhinorrhoea and the fungus was detected on fluid cytology.

No evidence for distinguishing bacterial from viral acute rhinosinusitis using symptom duration and purulent rhinorrhea: a systematic review of the evidence base.

OBJECTIVE: To evaluate the diagnostic value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. DATA SOURCES: PubMed, EMBASE, and the Cochrane Library. REVIEW METHODS: We performed a comprehensive systematic search on March 28, 2013. We included studies on the diagnostic value of duration of symptoms and purulent rhinorrhea in patients suspected of having acute bacterial rhinosinusitis. We assessed study design of included articles for directness of evidence and risk of bias. We extracted prevalence and positive and negative predictive values. RESULTS: Of 4173 unique publications, we included 1 study with high directness of evidence and moderate risk of bias. The prior probability of bacterial rhinosinusitis was 0.29 (95% confidence interval [CI], 0.24-0.35); we could not extract posterior probabilities. Odds ratios (95% CI) from univariate analysis were 1.03 (0.78-1.36) for duration of symptoms and 2.69 (1.39-5.18) for colored discharge on the floor of the nasal cavity. CONCLUSION AND RECOMMENDATION: We included 1 study with moderate risk of bias, reporting data in such a manner that we could not assess the value of symptom duration and purulent rhinorrhea in adults suspected of having acute bacterial rhinosinusitis. Recommendations to distinguish between a viral and a bacterial source based on purulent rhinorrhea are not supported by evidence, and the decision to prescribe antibiotic treatment should not depend on its presence. Based on judgment driven by theory and subsidiary evidence of a greater likelihood of bacterial rhinosinusitis after 10 days, antibiotic therapy may seem a reasonable empirical option.

Arcanobacterium haemolyticum: two case reports.

Two uncommon presentations of Arcanobacterium Haemolyticum infection (sinusitis and pharyngitis) are described, emphasizing the poor response to commonly used antibiotics and the possibility of serious local and systemic complications. The difficulties still encountered in the clinical diagnosis are underlined, since this organism could easily pass unrecognized in bacteriological cultures.

[Cerebrospinal fluid rhinorrhea and Streptococcus equisimilis-related meningitis 16 years after a head injury]. / Fístula de líquido cefalorraquídeo y meningitis por estreptococo equisimilis 16 años después de un traumatismo craneoencefálico.

A case of meningitis caused by Streptococcus Equisimilis and cerebrospinal fluid rhinorrhea, in which the head trauma occurred 16 years before, is presented. To the best of the author's knowledge this is the first case reported with such characteristics. Several precipitating factors could be responsible for the unusually late reopening of the fistula Streptococci equisimilis is an uncommon cause of the bacteremia. An appropriate antimicrobrial therapy against S. Equisimilis followed by surgical dural repair were performed.

Treatment of cerebrospinal fluid leaks and gram-negative bacillary meningitis with large doses of intrathecal amikacin and systemic antibiotics.

Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large doses of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics. Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.