Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report.

BACKGROUND: Primary psoas tuberculosis is the presence of "Koch's bacillus'' within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis. CASE PRESENTATION: In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid-rifampin-pyrazinamide-ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up. CONCLUSIONS: This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.

Assessing the Syrian Population's Knowledge, Attitudes, and Practices Regarding Antibiotic Usage.

Background Antibiotic resistance is a serious public health threat that results mainly secondary to antibiotics misuse. The present study aimed to determine the knowledge, attitude, and practice toward antibiotic use among the Syrian population. Methods This cross-sectional study was conducted at the outpatient clinics of two major hospitals in Damascus, Syria. Applying a random convenience sampling, data were collected in a 1-week period by interviewing participants using a structured questionnaire, which targeted demographics, practice, knowledge, and attitude. Data were used to assess the relationship between the knowledge level and attitudes and demographics. Results Most respondents had a moderate level of knowledge (187, 74.8%) and a moderate attitude score (148, 59.2%). In addition, most respondents (149, 59.6%) stated that they take antibiotics based on pharmacist advice only and do not complete the full antibiotic course (200, 80%). A significant association was found between the knowledge level and financial status ( p -value = 0.003), education level ( p -value = 0.001), and having relatives working in the health care sector ( p -value = 0.021). In addition, a significant association was found between the attitude and having health insurance. Conclusion This study provides baseline evidence about the knowledge, attitudes, and practices regarding antibiotics among the Syrian population, that will help in designing targeted interventions to solve the inappropriate use of antibiotics.

The Impact of Modifying Empirical Antibiotic Therapy Based on Intestinal Colonization Status on Clinical Outcomes of Febrile Neutropenic Patients.

BACKGROUND: This paper aimed to inspect factors affecting febrile neutropenia patients with hematologic malignancies. The intestinal colonization rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) was assessed. The rate of subsequent ESBL-E and CRE bacteremia correlated with corresponding bacterial colonization was evaluated. Further, the risk factors for ESBL-E and CRE intestinal colonization were examined. Finally, the impact of rectal swab screening combined with adapted empirical antibiotic therapy on the mortality rate of patients with febrile neutropenia was assessed. MATERIALS AND METHODS: Febrile neutropenia patients underwent rectal swabs and collection of blood culture specimens upon admission. Empirical treatment was subsequently modified according to rectal swab results if necessary. Bacteremia patients were treated according to blood culture results. Explorative forward-stepwise logistic regression analyses were used to identify risk factors for ESBL-E and CRE fecal carriage and mortality. RESULTS: In total, 201 rectal swabs and 402 blood samples were collected from 163 patients during 201 febrile neutropenia episodes. Of these episodes, 38 (18.90%) were colonized with ESBL-E and 30 (14.92%) with CRE. Bloodstream infections developed in 29/201 (14.42%) episodes. Only bacteremia episodes caused by Gram-negative bacilli were included in our analysis. The development of Gram-negative-rod bacteremia was observed in eight out of 38 (21.05%) ESBL-E colonized episodes and four out of 30 (13.33%) CRE-colonized episodes. A BSI developed in three out of 38 (7.89%) ESBL-E colonized episodes, and two out of 30 (6.66%) CRE-colonized episodes developed BSI with the respective organism. Multivariate analysis identified previous quinolone use as the only independent risk factor for fecal colonization of multi-drug-resistant (MDR) Enterobacteriaceae (ESBL-E and CRE) (odds ratio, 17.09; 95% confidence interval, 5.29 - 55.18; P <0.0001). No significant association was observed between ESBL-E and CRE carriage and increased risk of developing subsequent bacteremia. No significant differences were detected between groups receiving modified and non-modified treatments in duration of hospitalization or antibiotic therapy (univariate analysis) and 28-day mortality rate (logistic regression). CONCLUSION: Quinolone exposure was a major risk factor for ESBL-E and CRE fecal carriage. Performing rectal swab screening for MDR Enterobacteriaceae and modifying empirical antibiotic therapy accordingly did not improve clinical outcomes of febrile neutropenia patients.

Susceptibility to and severity of tuberculosis is genetically controlled by human leukocyte antigens.

OBJECTIVE: To assess the role of HLA polymorphism in the susceptibility to tuberculosis in Syria. METHODS: We used the polymerase chain reaction with sequence specific primer method to study the DRB1* locus in 147 Syrian patients with positive sputum smear or sputum culture for Mycobacterium Tuberculosis strains, and 209 Syrian healthy matching individuals with negative tuberculin skin test. Patients were randomly recruited from the Damascus Health Center of Tuberculosis and Pulmonary Diseases during 2005--2007. The study was carried out at the Laboratory for Research and Genetic Consultations, in the Faculty of Medicine of Damascus University, Damascus, Syria. RESULTS: A significant decrease of the DRB1*11 allele was observed in patients compared to controls (34.7% in patients versus 51% in control, odds ratio [OR]=0.51, p=0.003, corrected p=0.04), whereas the DRB1*04 allele was increased in patients (38.8% in patients versus 26.4% in controls, OR=1.77, p=0.01, corrected p>0.05). This increase became significant when individuals with the DRB1*11 allele were removed from both patients and controls (33% in DRB1*11 negative patients versus 17% in DRB1*11 negative controls, OR=2.5, p=0.003, corrected p=0.03). In addition, pulmonary cavitation was significantly increased in the DRB1*04 positive patients compared to patients without the DRB1*04 allele (33% in DRB1*04 positive patients versus 16% in DRB1*04 negative patients, OR=2.7, p=0.04). CONCLUSION: The DRB1*04 allele is associated with susceptibility to pulmonary tuberculosis, whereas DRB1*11 is associated with protection from pulmonary tuberculosis in the Syrian population. In addition, cavity formation in patients with pulmonary tuberculosis seems to be favored by presence of the DRB1*04 allele.

Usefulness of procalcitonin and some inflammatory parameters in septic patients.

OBJECTIVE: To evaluate the efficacy of procalcitonin PCT to identify critically ill patients with sepsis in comparison with leukocyte count, body temperature, C-reactive protein CRP, erythrocyte sedimentation rate ESR, and interleukin-6 IL-6. METHODS: We performed our prospective observational study in 75 patients admitted with acute systemic inflammatory response and suspected infection. The final diagnosis was systemic inflammatory response syndrome SIRS in 38 patients, sepsis in 22, severe sepsis in 10, and suspected viral sepsis in 5. Blood samples were taken on the first day of hospitalization in Al Mwasaa Hospital, Damascus, Syrian Arab Republic, from July 2006 to January 2007. We estimated the relevance of the different parameters by using the t-test, Pearson's correlation coefficient, and area under the receiver operating characteristic curves. RESULTS: Mean PCT concentrations on admission were 0.37 ng/ml for SIRS n=38, 3.31 ng/ml for sepsis n=22, 40.2 ng/ml for severe sepsis n=10, and significant differences existed in plasma PCT levels among the 3 groups. The PCT was the only distinguisher between sepsis and non-infectious SIRS, whereas it exhibited the best discriminative power between sepsis and severe sepsis with an area under the curve AUC of 0.966 followed by IL-6 with an AUC of 0.836. The PCT also do not correlate with any of the studied parameters within the SIRS group and the sepsis group. CONCLUSION: Assessing PCT levels is a more reliable way to indicate sepsis in newly admitted patients with systemic inflammations compared with conventional inflammatory parameters and IL-6.