Tehran University Medical Journal

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Brucellosis is an endemic disease in Iran with variety of clinical manifestation. Special characteristics of clinical diagnosis and treatment issues may cause some problems in manegement of patients. In this descriptive study 505 patients with Brucellosis retrospectively were evaluated from clinical point of view, Lab exams and therapeutic issues for 10 years (1990 to 1999). From 505 patients, 321 cases were male and 184 were female. 42.7 percent of cases were in age group of 10 to 30 years. Ingestion of un-pasteurized dairy products was detected in (66.7 percent) and 31.86 percent of cases were sheep herders. The most common symptoms and signs were fever (65 percent), sweating (61 percent), arthritis (30.09 percent), sacroilitis (21.5 percent), orchitis (8.2 percent), spondylitis (2-3 percent) and endocarditis (1.18). In this survery blood culture for Brucella melitensis became positive in 48.5 percent and bone marrow in 61 percent. Standard tube agglutination was positive in 96 percent (?1.80). Doxycyclin plus Rifampin was the most common regimen we used (37.8 percent). 4 patients died, but just one of those was directly because of Brucella Endocarditis. In this article we have discussed about some interesting cases as well.

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Background: The diagnosis of acute bacterial meningitis rests on CSF examination by lumbar puncture. Before lumbar puncture, intracranial mass lesions that increase intracranial pressure, must be ruled out, so brain CT-scan may be considered . In this study we evaluated the accuracy of physical examination for intracranial mass in patients with meningismus.

Materials and Methods: 100 patients who had symptoms and signs of acute meningitis were evaluated and then brain scan was performed. After this, clinical manifestations were compared with CT results and sensitivity, specificity, positive and negative predictive values and accuracy were analyzed.

Results: 73% of patients were men and 27% women. Most of patients were between 22 to 31 years old. 34% of patients had meningitis, 22% had SOL, 69% had one neurological symptom or sign at least. As a whole, sensitivity, specificity, pos. and neg. predictive values and accuracy in diagnosis of contradictions of L.P. are 90.9%, 37.1%, 28.9%, 93. 5%, 59% .

Conclusion: This study shows that with help of symptoms and signs fundoscopy in patients suspected to have meningitis, we can perform LP without brain CT preliminary.