Giemsa and Grocott in the recognition of Histoplasma capsulatum in blood smears.

OBJECTIVE: To facilitate the recognition of intracellular yeasts of Histoplasma capsulatum and differentiate it from Leishmania amastigotes and other parasites, using the combination of Giemsa and a rapid modification of Grocott stains to peripheral blood smears in a hematological study. METHODS: The combination of both stains was applied consecutively (first Grocott and then Giemsa) to previously fixed peripheral blood smears. Microscopy was performed with 400× and 1 000×, the latter using immersion oil. RESULTS: The yeasts of Histoplasma capsulatum were observed into the cytoplasm of leukocytes as brownish oval elements, with 3-4 µm in diameter. CONCLUSIONS: The combination of both techniques is a simple and fast method to facilitate recognition of intracellular yeasts and it is different from intracellular parasitic elements. Moreover, it allows distinguishing the cell elements that are in the microscopic preparations. It may be very helpful in those cases in which the presumptive diagnosis of histoplasmosis has not been established yet and where other more sophisticated methods are not available.

A case report of cutaneous larva migrans in Argentina.

Cutaneous larva migrans (CLM) represents the most common tropically acquired dermatosis. CLM is caused by infection with hookworm larvae in tropical and sub-tropical areas, and people who have a history of foreign travel and of walking barefoot on sandy soil or beaches are at a high risk of getting infected with it. The diagnosis is usually made on the basis of the typical appearance of the lesion, intense itching and history of foreign travel. CLM is a common parasitic skin disease that can be easily prevented by wearing 'protective' footwear. A case of CLM is described in this article.

Cutaneous myiasis due to Cochliomyia hominivorax in a drug user.

Myiasis is the condition resulting from the invasion of tissues or organs of man or animals by dipterous larvae. The blowflies (Calliphoridae) of Argentina comprise several species that may cause myiasis by colonizing wounds or infected body orifices, and one specific parasite: Cochliomyia hominivorax. This species often causes traumatic myiasis in cattle, dogs and cats, and it is not rare in humans. The larvae consume living tissues, so they are dangerous unless speedily removed. Immediate operative exploration along with the removal of larvae and primary defect closure is recommended in every case. Here we report a case of myiasis in a scalp wound caused by blunt force trauma to the area, in a male patient with a case history of alcohol and drug abuse. Seventy-one living larvae were extracted from the wound and determined as C. hominivorax in the Forensic Entomology Laboratory. Given the aggressiveness of these larvae, specific and quick diagnosis as well as the application of appropriate treatment is crucial.

Atypical forms of Cryptococcus neoformans in CSF of an AIDS patient.

The microscopic recognition of typical rounded capsulated yeasts in centrifuged cerebrospinal fluid (CSF), stained with India ink, is a common, rapid and effective method for the diagnosis of cryptococcal meningitis among AIDS patients. The presence of atypical forms of Cryptococcus neoformans var. neoformans in samples of CSF of an AIDS patient with cryptococcosis treated at the University Hospital of Infectious Disease is presented. The India ink microscopy of three consecutive CSF samples revealed capsulated yeast with India ink particles in the deteriorated capsules and capsulated pseudohyophae. Clinically, the patient showed a subacute meningoencephalitis, with a clinical picture not particularly different from those commonly observed in patients with AIDS-associated cryptococcosis treated in our hospital. In all cases, the culture of the CSF showed colonies of C. neoformans with typical macro and micromorphology, and the in vitro susceptibility tests to amphotericin B, fluocitosine, itraconazole and fluconazole showed MIC values into the limits of sensitivity. The presence of atypical forms of C. neoformans, considered as an atypical finding, could be the consequence of an adaptive phenomenon of this fungal species to an impaired immunological status present in the host.

CNS cryptococcoma in an HIV-positive patient.

This is the first case of brain cryptococcoma in an AIDS patient reported in Argentina. The patient was a 28-year-old white heterosexual man with AIDS who presented with altered mental status, seizures, visual hallucinations, headache, and fever without significant focal neurological deficit. He had a lumbar puncture, and was treated for cryptococcal meningitis. Subsequent brain CT scanning and MRI disclosed a mass lesion in the occipital lobe. Histopathological examination of biopsy was compatible with cryptococcoma, and tissue culture revealed Cryptococcus neoformans. Resolution of the mass and edema resulted after treatment with intravenous amphotericin B for six weeks, which was followed with maintenance oral fluconazole. Intracranial mass is an uncommon complication in AIDS patients with cryptococcosis, and cryptococcoma should be considered as differential diagnosis of brain mass lesion in these patients. The etiologic diagnosis is necessary because central nervous system (CNS) toxoplasmosis, lymphoma, and tuberculoma can produce similar clinical syndromes and MRI or CT findings to cryptococcoma. Also, these pathologies may coexist with meningeal cryptococcosis.

Cryptosporidiosis in pediatric patients

Cryptosporidium foi detectado em 21 (3,8 por cento) amostras de fezes obtidas de 553 pacientes pediatricos atendidos em nosso centro medico, com a tecnica de concentracao de Telemann (formalina-eter-centrifugacao) e coloracao de Kinyoun modificada. A media etaria da populacao com criptosporidiose (16 meninos e 5 meninas) foi de 11 meses: 15 para as meninas e 6,5 meses para os meninos; 81 por cento das idades desses pacientes foram menores de 19 meses; 76 por cento eram moradores nas zonas marginais de Buenos Aires e 71 por cento com falta de agua potavel

Acid fast filaments in stool samples from an aids patient

The presence of filamentous bacteria morphologically similar to Nocardia in a fresh stool sample from an AIDS patient with pulmonary nocardiosis is here reported. The material was submitted to our laboratory for a parasitologic examination and was stained by the Kinyoun method, revealing numerous delicate, irregularly stained, branching acid-fast filaments. Nocardia asteroides had been isolated from sputum samples of this patient. The patient was a 32 year-old HIV+ female admitted to our center on june 1997 because of productive cough, right-sided thoracic pain and weight loss. Chest X rays showed the presence of right superior lobe excavated pneumonia. This was the first time we had observed filamentous bacteria similar to Nocardia in a stool sample submitted to parasitologic examination. For similar cases, and when its presence was not detected in other specimens collected from the same patient, intestinal endoscopy and biopsy should be performed for eventual lesions and smear examination repeated with Kinyoun stain and cultures for Nocardia.

Relación entre los resultados de las precipitinas para Candida y algunos parametros clinicos / Relation between of the precipitins results to Candida and some clinical parameters

Se procesaron 268 sueros para detectar la presencia de anticuerpos y antígenos de Candida por inmunodifusión en gel de agar o contrainmunoelectroforesis. Cuarenta y dos sueros dieron resultados positivos: 37 para anticuerpos, 4 para antígeno y 1 para ambos. Fueron comparados los datos clínicos de los pacientes que tuvieron resultados positivos, con los correspondientes al total de los enfermos cuyos sueros fueron analizados. La significación estadística de las diferencias encontradas, fue determinada por el método de X2. Pudo observarse un aumento significativo de la incidencia de resultados positivos en pacientes de edad avanzada (71-80 años), en los materiales procedentes de hospitales oncológicos, de servicios de cirugía o de terapia intensiva. También fue elevada la frecuencia de resultados positivos en pacientes diabéticos, con neumopatías y con tumores sólidos. Por el contrario, la incidencia de serologías positivas fue significativamente más baja en los sueros procedentes de hospitales pediátricos, en niños de 4 a 10 años, en los portadores de leucemias y en los pacientes inmunosuprimidos