Concurrent Sphingomonas paucimobilis and Mycobacterium tuberculosis Meningitis in an Immunocompromised Patient: A Rare Case Report and Comprehensive Review of Literature.

Sphingomonas paucimobilis is a gram-negative bacillus that is widely distributed in the environment but rarely causes infections in humans. Meningitis caused by S. paucimobilis is an extremely rare clinical entity with very few reported cases in the literature. The clinical presentation and management of S. paucimobilis meningitis are not well established, and further research is needed to better understand this rare infection. Therefore, the goal of this study was to present probably the only case of meningitis caused by co-infection with S. paucimobilis and Mycobacterium tuberculosis and to describe the diagnostic and therapeutic challenges encountered, in correlation with the other very few reported cases of S. paucimobilis meningitis. A 64-year-old male farmer residing in a rural area was admitted with symptoms of severe headache, somnolence, and confusion. He had several comorbidities, including adrenal insufficiency, duodenal ulcer, and hypercholesterolemia. Lumbar puncture showed elevated leukocyte counts, glucose, and a marked rise of cerebrospinal fluid (CSF) proteins, indicating bacterial meningitis, which was confirmed by CSF culture that isolated S. paucimobilis and Mycobacterium tuberculosis. Antituberculosis therapy was initiated with isoniazid (300 mg/day), rifampicin (600 mg/day), pyrazinamide (2000 mg/day), and streptomycin (1 g/day). Ceftriaxone was introduced nine days later, after CSF culture grew S. paucimobilis, and was discharged without complications after 40 days of hospitalization. The literature search revealed a total of 12 published cases of S. paucimobilis meningitis in patients ranging from two months old to 66 years old. Among these cases, eight (66%) reported a favorable outcome, while two (17%) cases resulted in a poor outcome, and two (17%) were fatal. It was observed among the 13 identified cases (including ours) that the CSF white blood cell count had an average of 178.9 × 103/mm3, an average glucose level of 33.0 mg/dL, and an average protein count of 294.2 mg/dL. Most cases improved appropriately under antibiotic therapy with intravenous ceftriaxone, Meropenem, and Vancomycin. In conclusion, although extremely rare, S. paucimobilis meningitis has good outcomes even in immunocompromised patients with appropriate antibiotic therapy and close monitoring, while the diagnosis should not be excluded even in immunocompetent patients.

The Effects of Vitamin D Supplementation on Respiratory Infections in Children under 6 Years Old: A Systematic Review.

Childhood respiratory tract infections (RTIs) pose a significant health burden, especially in children under six years old. The main objective of this systematic review was to assess the effectiveness of vitamin D supplementation in the prevention of RTI in this population while also exploring potential effect modifiers such as age, baseline vitamin D status, and type of respiratory infection. A systematic review of the literature published up to February 2023 was conducted according to PRISMA guidelines, searching PubMed, Web of Science, Cochrane, and Scopus databases. Eight studies met the inclusion criteria, which investigated the association between vitamin D supplementation and respiratory infections in children between zero and five years old. The included studies were conducted between 2012 and 2021, encompassing a total of 2189 children from five randomized trials, two case-control studies, and one prospective cohort study. The relationship between vitamin D supplementation and the prevention of childhood RTI was not consistently observed across all included studies. Pooled results demonstrated varied effects of vitamin D supplementation on respiratory infection incidence, severity, and symptoms. Three studies reported statistically significant associations between low vitamin D levels and respiratory infections (OR = 4.90, OR = 6.97), while one study found that children who received vitamin D supplementation of 800 UI/day for 3 months during the cold season had fewer episodes of respiratory symptoms (RR = 0.55) and recovered more quickly from acute RTI. Lastly, according to one study, vitamin D intake < 80 IU/kg/day was significantly associated with the risk of acquiring pneumonia (OR 7.9) but not bronchiolitis. The remaining five studies found no statistically significant differences in infection rates or severity (p-value > 0.050). The available evidence on the effectiveness of vitamin D supplementation for preventing and treating respiratory infections in children under six years old is limited, with only a few favorable effects being reported. In some cases, a dose of 80 UI/kg/day was found to provide significant protection for acute respiratory infections, although in the major trials the only benefit was a quicker recovery and fewer respiratory symptoms, with no impact on incidence and severity of respiratory infections. Nevertheless, the study protocol, the supplementation dose, and duration of supplementation had significant variations between studies, leading to inconclusive findings.

Efficacy of Bilateral Cochlear Implantation in Pediatric and Adult Patients with Profound Sensorineural Hearing Loss: A Retrospective Analysis in a Developing European Country.

This retrospective study aimed to evaluate the outcomes of bilateral cochlear implantation in patients with severe-to-profound sensorineural hearing loss at the Timisoara Municipal Emergency Clinical Hospital ENT Clinic. The study involved 77 participants, divided into four groups based on their hearing loss characteristics and implantation history. Assessments were conducted pre- and post-implantation, focusing on speech perception, speech production, and reading achievement. Standard surgical procedures were performed, and participants were provided with a comprehensive rehabilitation program involving auditory training and communication therapy. The variables considered for analysis included demographic factors, implantation period, and quality of life assessment, with no statistically significant differences pre-implantation between the four study groups. Results revealed significant improvements in speech perception, speech production, and reading achievement after cochlear implantation. In adult patients, speech perception scores increased from 21.3% to 73.4% for WIPI and from 22.7% to 68.4% for HINT after 12 months of rehabilitation. Speech production scores improved from 33.5% to 76.8% and reading achievement scores increased from 76.2 to 106.3. Moreover, there was a significant improvement in patients' quality of life following cochlear implantation, with mean scores increasing from 2.0 to 4.2. Although it is known that bilateral cochlear implantation significantly improves speech perception, speech production, reading achievement, and quality of life in patients with severe-to-profound sensorineural hearing loss, this is the first study of its kind from Romania. Further research is warranted to optimize patient selection and rehabilitation strategies to maximize outcomes and determine better policies towards funding and access of cochlear implants for a wider range of patients in need.