Disseminated Mycobacterium kansasii in an HIV-negative patient

Disseminated Mycobacterium kansasii infection is a rare infection in non-HIV patients. This research has uncovered a very rare manifestation of disseminated M. kansasii infection in a non-HIV patient with lung and pericardial involvement

Clinical and demographic characteristics of confirmed cases in H1N1 [2009] influenza

Presentation of pandemic H1N1 influenza [H1N1] is widely evolving as it continues to involve different geographic locations and populations. This study was conducted to improve the precision of clinical diagnosis of H1N1 [2009] influenza infection in an outpatient setting. A prospective cross-sectional study was conducted among adult patients [age >15 years] with influenza-like illnesses [ILI] from November 2009 to February 2010. Clinical, laboratory and epidemiological findings in the first week of illness were collected using a standardized datasheet. Influenza testing was performed by real-time reverse-transcriptase polymerase chain reaction [rRT-PCR]. Thirty nine [24%] patients were positive for H1N1 and 123 [76%] were negative for any subtype of influenza A virus. Whilst otalgia [14% vs. 0 p= 0.01] was more prevalent in non-influenza A cases, cough [90% vs. 72% p = 0.03] and shortness of breath [67% vs. 47% p = 0.02] were more often associated with H1N1-infection. Comparative analysis of coexisting conditions and demographic factors of patients revealed no other significant differences between the two groups. The clinical presentation of H1N1 [2009] infection is largely indistinguishable from other acute respiratory diseases. Although previous studies suggested significant differences in demographic and co-existing conditions of H1N1 infected patients, our study shows that as the pandemic spreads worldwide and affects the majority of the population, H1N1 diagnosis based on clinical presentation and demographic characteristics has become less practical and much more difficult in tertiary care centers

Prevalence of oseltamivir-resistant 2009 H1N1 influenza virus among patients with pandemic 2009 H1N1 influenza infection in NRITLD, Tehran, Iran

Oseltamivir-resistant cases were reported during the 2009 pandemic influenza outbreak and therefore, widespread emergence of oseltamivir-resistant 2009 H1N1 virus is imaginable. Underlying medical conditions like immunosuppression increase the chance of oseltamivir resistance. In a retrospective cross-sectional study, respiratory tract specimens of confirmed cases of 2009 H1N1 influenza referred to the Masih Daneshvari Hospital were analyzed for presence of H275Y mutation. From November 2009 through March 2010, oseltamivir-resistant 2009 H1N1 infection was observed and confirmed in 4 patients [including 2 immunocompromised patients] by performing H275Y mutation molecular testing. Close monitoring of resistance to neuraminidase inhibitors is essential in tertiary care centers. The H275Y mutation [oseltamivir-resistant genotype] could appear in the absence or presence of selective drug pressure

Is pulmonary aspergillosis common in diabetes mellitus patients?

Aspergillosis is a rapidly progressive, often fatal infection that occurs in severely immunosuppressed patients, including those who are profoundly neutropenic, recipients of bone marrow or solid organ transplants and patients with leukemia, lymphoma, advanced AIDS or phagocytic disorders such as chronic granulomatous disease. Patients with severe liver disease are at a higher risk for infections. Immunocompetent individuals rarely develop this infection and do so only in the presence of pulmonary and systemic abnormalities such as fibrotic lung disease, suppurative infection or when they are on corticosteroids. We present 2 cases of pulmonary aspergillosis in diabetic patients. They presented with cough and dyspnea. Aspergillus was found in obtained respiratory samples. Pulmonary aspergillosis was confirmed in our first case by transbronchial lung biopsy [TBLB] and Galactomannan assay. In the second case, diagnosis of pulmonary aspergillosis was established by thoracic CT guided biopsy plus Galactomannan assay. These patients had none of the suggested risk factors for Aspergillus infection but they had uncontrolled diabetes mellitus. This report highlights that pulmonary aspergillosis can occur in individuals with diabetes mellitus even in the absence of other risk factors such as corticosteroid use, severe granulocytopenia or other associated immunosuppressive factors. It is; therefore, valuable to recognize that in patients with diabetes mellitus pulmonary aspergillosis should be considered as an important differential diagnosis for respiratory problems

Comparison of pulmonary TB patients with and without diabetes mellitus type II

There are several studies on the effect of diabetes mellitus [DM] on clinical symptoms and radiological findings of multi-drug resistant tuberculosis [MDR-TB] and bacteriological findings in pulmonary tuberculosis patients. Considering the contradictory results of these studies, this study was conducted for further investigation in this regard. This was a case-control study conducted in Masih-Daneshvari Hospital in Tehran. Forty-seven patients with tuberculosis infection and diabetes type II were selected as the case group and 102 TB cases without diabetes were considered as controls. There were significant differences in hemoptysis, dyspnea and loss of appetite between the two groups, but no significant difference was found in cough, sputum production, chest pain, night sweat, fever or weight loss. Also, there was no significant difference between the 2 groups in terms of MDR-TB and bacteriological findings. On CXR, diabetic patients had a higher prevalence of typical presentations along with cavitary lesion[s] but no significant difference was found between the 2 groups in terms of radiological presentation. In this study, diabetes type II did not have much influence on clinical symptoms and bacteriological findings of TB patients. However, PTB-DM type II cases may be considered more contagious due to the higher prevalence of cavitary lesions compared to those without DM. Prevalence of MDR-TB was the same in both groups

Update on 2009 pandemic influenza a [H1N1] virus

The pandemic influenza A [H1N1/2009] virus as a new challenge for health care providers has caused significant morbidity and mortality worldwide. Although many aspects of this virus are similar to other human influenza viruses, there are some disparities. This article reviews different aspects of influenza H1N1/2009 virus with focus on clinical features and management of patients

Smoking effects on clinical manifestations and drug resistance patterns in pulmonary TB patients

Considering the rising trend of tuberculosis [TB] and cigarette smoking, an evaluation of the clinical manifestations and drug resistance patterns in TB patients with regard to smoking status seemed beneficial. Clinical manifestations and drug resistance patterns were studied in 872 new pulmonary TB patients classified as non-smokers, ever-smokers, and passive smokers during 3 years at the National Research Institute of Tuberculosis and Lung Disease. Both univariate and multivariate analyses were performed. Ever-smokers were mostly male [p<0.001], Iranian [p<0.001], and drug and alcohol users [p<0.001]. They were found to have a longer patient delay [15.9 versus 8.7 and 6.3 days, p=0.008], shorter diagnostic delay [106.8 versus 132.6 and 156 days, p=0.01], greater weight loss [p=0.01], and higher sputum expectoration [p<0.001]. Notably, the degree of smear positivity was associated with smoking [p<0.001] in both univariate and multivariate analyses. No statistical significance was found for the aforementioned factors among non-smokers and passive smokers. Some of the clinical manifestations of TB are significantly different with regard to the patients' smoking status.The degree of sputum smear positivity for acid fast bacilli was higher and patient delay was longer in ever-smoker patients

Risk factors associated with multidrug-resistant tuberculosis

Multi-drug resistant tuberculosis [MDR-TB], a form of TB resistant to isoniazid and rifampin, is considered as a major threat to TB control worldwide. Moreover, the infectivity of MDR-TB is similar to that of non-MDR TB. This study aims to find the risk factors associated with the development of MDR-TB among TB patients admitted to Masih Daneshvari Hospital, the national referral center for tuberculosis and lung diseases. The national referral institute for tuberculosis and lung diseases in Tehran [NRITLD] receives all the MDR-TB cases from all over the country. Based on this criterion alone, forty-eight pulmonary MDR-TB patients who were referred to this center between 2002 and 2005 were included in this study. For the purpose of comparison, 234 patients diagnosed with pulmonary TB were also selected randomly as the control group. The two groups were compared based on 102 demographic and clinical variables. These variables included age, sex, nationality, drug and opium use, method of referral, symptoms and etc. Immigration and refugee status as well as history of anti-TB medication were found to be the most significant among the risk factors associated with MDR-TB. Also, 95.8% of the MDR-TB cases reported a previous history of anti-TB medication. This number was 23.1% in the non-MDR group. MDR-TB was more prevalent among the Afghan patients; out of a total of 78 Afghan patients, 22 [46.8%] composed the MDR-TB category, whereas, 56 [23.9%] Afghan patients belonged to the non-TB category. All MDR-TB patients had positive smears whereas 13.2% of non-MDR-TB patients had negative smears. Dyspnea and weight loss were among other significant variables. History of close contact, diabetes, smoking, drug use, fever, and BCG scar in both MDR TB and non-MDR-TB groups were among the insignificant variables found in this study. The limited sample size and location of the study may have resulted in insignificant variables. However, based on the obtained data, patient's status as an immigrant or a refugee is an important risk factor for both MDR and non-MDR TB and is of particular concern in the growing trend of MDR-TB

49-year-old woman with refractory chronic sinusitis. Sarcoidosis with granulomatous sinusitis Photo Quiz

A 49-year-old married, non- smoker housewife had purulent rhinorrhea, nasal congestion, post nasal drip [PND], and feeling of sinus pressure following an episode of common cold. She had no complaints of fever, cough, dyspnea, or arthralgia. Physical examination revealed PND and a posterior auricular lymphadenopathy [1cm X 1cm]. The patient received amoxicillin for 2 weeks with mild improvement. But again, she experienced the exacerbation of signs and symptoms a week later. CT-scan of the paranasal sinuses was performed [Figure 1]. She also had erythematous patches on her face around the right eye and her back, along with splenomegaly. The patient was treated with amoxicillin/clavulanate [for two weeks], loratadine, and beclomethasone nasal spray as well as normal saline nasal wash. There was a slight improvement in patient's signs but, repeatedly after two weeks signs and symptoms exacerbated. Due to the lack of response to antibiotics, a biopsy of the skin lesion was taken which revealed the following histopathological findings