Asian Pacific Journal of Tropical Medicine

143-152

Authors: Sayyed Gholamreza Mortazavi-Moghaddam, Abdol Sattar Pagheh, Ehsan Ahmadpour, Alacsandra Barac, Azadeh Ebrahimzadeh

In recent years, the number of cases of extrapulmonary tuberculosis in Iran has increased. The goal of this study was to determine the epidemiological status, clinical symptoms, diagnostic methods, and treatment strategies of extrapulmonary tuberculosis in Iran, with a focus on tuberculosis meningitis and miliary tuberculosis. Between January 1, 2000 and June 1, 2021, 1 651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran. The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan, South Khorasan, and Mazandaran compared with other provinces. The most prevalent symptoms of tuberculous meningitis were fever, anorexia, headache, neck stiffness, loss of consciousness, and vomiting. The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture. The most prevalent clinical symptoms of miliary tuberculosis were fever, lethargy, weariness, and anorexia. In 70% of chest radiographs, a miliary pattern was visible. Bone marrow biopsy was used to diagnose miliary tuberculosis in 80% of patients, while bronchoalveolar lavage was used in 20% of cases. The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations. Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease, the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

161-170

Authors: Hanife Nur Karakoc, Aysun Aksoy, Merve Aydin, Safiye Nur Ozcan, Gulcin Zengin, Hacer Aksit Yasar

Objective: To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia. Methods: We conducted a single-centre retrospective cohort study on hospitalised patients with clinical, epidemiological, and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1, 2020 and June 1, 2021. All data of the study participants were recorded, and all patients received intravenous high-dose corticosteroid pulse therapy. The Ordinal Scale for Clinical Improvement (OSCI), Charlson Comorbidity Index and Total Severity Score were calculated. Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality. Results: A total of 126 patients were included in the analysis. The 28-day mortality rate of the patients was 22.2%. Laboratory and clinical improvement were observed in 77.8% (98/126) of patients after high-dose corticosteroid pulse therapy. There was a statistically significant difference between the survivors and non-survivors in terms of age, platelet count, neutrophil/lymphocyte ratio, and OSCI, Charlson Comorbidity Index, and Total Severity Score (P<0.001). Multivariate Cox regression analysis revealed that age [HR 1.047 (95% CI 1.01-1.08)], use of prophylactic anticoagulation [HR 0.838 (95% CI 0.79-0.89)], and bacterial co-infection [HR 3.966 (95% CI 1.40-11.21)] were significant determinants of mortality. Early C-reactive protein (CRP) response, decreased oxygen requirement, and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement. Conclusions: CRP response, needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.

179-182

Authors: Prashant Gopal, Chaudhary Niraliben Hareshkumar, N.S.S Saranya, Pradnya Diggikar

Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.

186-187

Authors: Reza Rastmanes

None.