SummaryDescending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to this high mortality, but awareness of such a complication and early diagnosis using computed tomographic scanning leads to prompt surgical drainage, proper antibiotic therapy, and survival.

Background: Tuberculous meningitis is the severest and commonest form of central nervous system tuberculosis causing high mortality and morbidity. We aim to study the clinical, biochemical, and radiological characteristics of tuberculous meningitis in adult patients in Qatar and to calculate the incidence. Methods: A descriptive retrospective 7-year study was conducted at the Hamad General Hospital (the only tertiary referral center and sole health care provider for tuberculosis in Qatar) between the 1st of January 2006 and the 31st of December 2012, to describe the clinical presentation, diagnosis, treatment, outcome, and the incidence of adult tuberculous meningitis in Qatar. Results: Tuberculous meningitis was diagnosed in 80 patients (65 male, 15 female), with a mean age of 30.3 w 8.9. The majority of patients (76.3%) were from the Indian subcontinent. The commonest clinical features were fever (79%), headache (71%), and meningism (56%). Cerebrospinal fluid tuberculosis culture was positive in 44% of patients. Almost 39% of patients were in Stage I, 46% in Stage II and 15% in Stage III of the disease. The commonest neuroimaging features were leptomeningeal enhancement (34%) and hydrocephalus (33%). Cranial nerve palsy, limb weakness, and an elevated C-reactive protein were associated with a poorer outcome. Sixty eight percent had complete recovery, 10% had residual neurological sequelae without disability, 17% had disability, and 5% died. The average incidence of tuberculous meningitis over 7 years was 0.9 per 100,000 adult population. Conclusion: The characteristics of tuberculous meningitis were described in our population. Our data indicate that the incidence of tuberculosis meningitis in Qatar has increased. Tuberculous meningitis in Qatar is mainly an imported disease. i 2014 S. Karger AG, Basel

Multiresistant Salmonella seems to be a growing problem in Qatar and its treatment remains problematic. Of 100 Salmonella bacteraemias that occurred between 1 October 1989 and 30 September 1990, 30 were caused by S. typhi resistant to one or more of the conventional antibiotics usually recommended for the treatment of typhoid fever (ampicillin, chloramphenicol, and trimethoprim-sulphamethoxazole). Of those, 25 (83%) were acquired by patients during visits to the Indian subcontinent. Two patients with isolates sensitive to ampicillin were successfully treated with amoxicillin, 6 paediatric patients were cured with cefotaxime, and 20 adult patients responded favourable to ciprofloxacin. A 9 year old boy failed initial therapy with cefuroxime but responded well to ciprofloxacin. One adult patient was treated successfully with a combination of ciprofloxacin and cefotaxime. We conclude that cefotaxime and ciprofloxacin can serve as first line therapy for typhoid fever in areas where multi-resistant Salmonella is prevalent.

Rabies is a zoonotic disease with the highest fatality rate of any infectious disease. The clinical features of rabies encephalopathy are highly nonspecific at the onset and clinicians from low endemic areas usually face difficulties in recognizing cases during the early stages. The need for establishing a rapid and accurate test to identify rabies during the ante-mortem period is important. However, in actual clinical practice, the latter may remain difficult for various reasons. In human rabies, positively identifying the antigen, antibody or genetic material by various diagnostic methods during the symptomatic period is affected by the unpredictable nature of viremia, levels of antibody immune response of the host, and the virulence of the infecting strain. Also, more advanced testing with greater sensitivity may not be readily available at all centers. Here we describe a case of a young male who was bitten by a rabid dog and developed progressive encephalopathy with a fatal outcome, with negative antibodies in the cerebrospinal fluid (CSF). A review of the literature on the clinical features, diagnostic tests, treatment and prevention of rabies is also presented.

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