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Coccidioidomicosis , Encefalitis , Femenino , Humanos , Texas , Coccidioides , Encefalitis/diagnósticoAsunto(s)
Coccidioidomicosis , Encefalitis , Femenino , Humanos , Texas , Coccidioides , Encefalitis/diagnósticoRESUMEN
Cutaneous mucormycosis typically occurs as a primary infection following traumatic inoculation or as a secondary disseminated disease in immunocompromised patients with hematologic malignancy or organ transplantation. We describe an unusual case of a poorly controlled type 1 diabetic patient presenting with wet gangrene of the hand due to angioinvasive dissemination from a primary pulmonary infection, with additional suspected foci of cardiac and central nervous system involvement. Despite combined medical and surgical treatment, the patient ultimately died due to complications of her infection. This case and the associated literature review of secondary cutaneous mucormycosis highlight that invasive fungal infections can present peripherally, and identifying the primary source is important in order to promptly pursue aggressive combined medical and surgical treatment for this highly fatal disease.
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Human African trypanosomiasis incidence has declined, but diagnosis remains difficult, especially in nonendemic areas. Our patient presented with fever, progressive lethargy, and weight loss for 5 months and had previously traveled to Ghana and Cameroon but had not been to areas with recently reported African trypanosomiasis. Extensive workup was negative, except for lymphocytic pleocytosis in cerebrospinal fluid; ultimately, a bone marrow aspiration revealed necrotizing granulomatous inflammation with 2 trypanosomes discovered on the aspirate smear, consistent with Trypanosoma brucei. The patient was treated with combination nifurtimox and eflornithine with full recovery.
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PURPOSE: To describe a unique case of bilateral Acanthamoeba panophthalmitis in a 65-year-old male resulting in bilateral enucleation. OBSERVATION: A 65-year-old man presented with a 10-year history of bilateral uveitis and scleritis, complicated by cataracts. He had undergone phacoemulsification with posterior chamber intraocular lens implantation in both eyes, left corneal transplant and pars plana vitrectomy, all without improvement in his vision and pain. Due to complete loss of vision and severe pain in his both eyes, the patient underwent bilateral enucleation. Pathologic examination of both eyes revealed severe acute, chronic, and granulomatous inflammation with abundant scar formation. Multiple large pre-retinal, choroidal, and vitreal cavitary lesions in both eyes were filled with necrotic debris, containing both Acanthamoeba trophozoites and cysts. These findings were consistent with a well-developed, bilateral Acanthamoeba panophthalmitis. CONCLUSIONS AND IMPORTANCE: This unique case represents the first ever reported bilateral Acanthamoeba panophthalmitis and illustrates the extreme complication of ocular Acanthamoeba infection.
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Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Sistemas de Atención de Punto/normas , Saliva/virología , Betacoronavirus/aislamiento & purificación , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Humanos , Pandemias , SARS-CoV-2 , Saliva/química , Factores de TiempoAsunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Neumonía Viral/diagnóstico , Saliva/virología , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , SARS-CoV-2RESUMEN
PURPOSE: To present a case of a unique complication of an Ahmed glaucoma shunt. The pathological and immunohistochemical findings will also be discussed. OBSERVATIONS: A 58-year-old woman with glaucoma secondary to Marfan syndrome and cataract surgery developed exposure of an Ahmed glaucoma tube, intraluminal white inflammatory material, and low-grade endophthalmitis five years after insertion. The patient was treated with topical and oral antibiotics and successfully underwent removal and replacement of the shunt. Pathologic analysis of the intraluminal contents revealed a bacterial infiltrate of mixed morphology. CONCLUSIONS AND IMPORTANCE: Concurrent tube exposure, intraluminal exudates, and endophthalmitis is a rare but potentially serious complication of glaucoma drainage device surgery. When this complication is encountered, prompt medical and surgical intervention is necessary to prevent significant vision loss. Ultimately, the glaucoma shunt may be revised, replaced, or removed altogether from the eye.
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OBJECTIVE: We evaluate diagnostic accuracy of the ARCHITECT chemiluminescent immunoassay (CIA) screening test in pregnancy, and evaluate pregnancy outcomes among screen-positive women. STUDY DESIGN: Samples from routine prenatal rapid plasma reagin (RPR) tests were collected between June 22 and August 18, 2017 and frozen. Samples were batch-tested with the Abbott ARCHITECT syphilis TP immunoassay (CIA, index test). We calculated sensitivity, specificity, predictive value, and false positivity. We compared pregnancy and neonatal outcomes among screen-positive women. RESULTS: Of 1,602 specimens, 35 (2.2%) were RPR + ; of those, 24 (69%) were CIA +/Treponema pallidum particle agglutination assay (TPPA)+ and 11 (31%) were CIA-/TPPA-. Of 1,567 RPR- specimens, 14 (0.9%) were CIA + ; of those, 13 (93%) were TPPA + , and one (7%) had a false positive CIA test. Sensitivity of the CIA (95% CI) was 100% (90.5-100%), specificity 99.9% (99.6-100%), positive predictive value 97.4% (86.2-99.9%), and false positive rate 0.06% (0.002-0.4%) for current or past syphilis. Among 37 CIA +/TPPA+ women, seven (19%) had RPR-negative status (Group 1), 11 (30%) had previously treated syphilis (Group 2), and 19 (51%) had active infection (Group 3). One stillbirth occurred in a woman with early, active syphilis identified at delivery; no adverse perinatal outcomes occurred among women in Groups 1 or 2. CONCLUSION: The ARCHITECT syphilis TP immunoassay accurately diagnoses current or past syphilis in pregnancy. Clinical history and staging remain essential using a reverse algorithm.
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Algoritmos , Inmunoensayo/métodos , Complicaciones Infecciosas del Embarazo/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Femenino , Prueba de Absorción de Anticuerpos Fluorescentes de Treponema , Humanos , Luminiscencia , Embarazo , Resultado del Embarazo , Serodiagnóstico de la Sífilis , Treponema pallidum/inmunologíaRESUMEN
Miltefosine is an alkylphosphocholine compound that is used primarily for treatment of leishmaniasis and demonstrates in vitro and in vivo antiamebic activity against Acanthamoeba species. Recommendations for treatment of amebic encephalitis generally include miltefosine therapy. Data indicate that treatment with an amebicidal concentration of at least 16 µg/ml of miltefosine is required for most Acanthamoeba species. Although there is a high level of mortality associated with amebic encephalitis, a paucity of data regarding miltefosine levels in plasma and cerebrospinal fluid in vivo exists in the literature. We found that despite aggressive dosing (oral miltefosine 50 mg every 6 h) and therapeutic plasma levels, the miltefosine concentration in cerebrospinal fluid was negligible in a patient with AIDS and Acanthamoeba encephalitis.
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Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Amebiasis/tratamiento farmacológico , Amebicidas/sangre , Amebicidas/líquido cefalorraquídeo , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológico , Encefalitis Infecciosa/tratamiento farmacológico , Fosforilcolina/análogos & derivados , Infecciones Oportunistas Relacionadas con el SIDA/sangre , Infecciones Oportunistas Relacionadas con el SIDA/líquido cefalorraquídeo , Acanthamoeba/efectos de los fármacos , Acanthamoeba/aislamiento & purificación , Adulto , Amebiasis/sangre , Amebiasis/líquido cefalorraquídeo , Amebicidas/administración & dosificación , Encéfalo/parasitología , Infecciones Protozoarias del Sistema Nervioso Central/sangre , Infecciones Protozoarias del Sistema Nervioso Central/líquido cefalorraquídeo , Humanos , Encefalitis Infecciosa/sangre , Encefalitis Infecciosa/líquido cefalorraquídeo , Masculino , Fosforilcolina/administración & dosificación , Fosforilcolina/sangre , Fosforilcolina/líquido cefalorraquídeoRESUMEN
Head and neck cancer is a diverse group of rare diseases such as neuroendocrine tumors which can be thought of as extrapulmonary small-cell cancer. Surgery, chemotherapy, and radiation can frequently cure this disease, possibly due to early detection.
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Rapid diagnostic tests are needed to improve patient care and to combat the problem of antimicrobial resistance. The Accelerate Pheno system (Accelerate Diagnostics, Tucson, AZ) is a new diagnostic device that can provide rapid bacterial identification and antimicrobial susceptibility test (AST) results directly from a positive blood culture. The device was compared to the standard of care at two academic medical centers. There were 298 blood cultures included in the study, and the Accelerate Pheno system provided a definitive identification result in 218 instances (73.2%). The Accelerate Pheno system provided a definitive and correct result for 173 runs (58.1%). The Accelerate Pheno system demonstrated an overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 94.7%, 98.9%, 83.7%, and 99.7%, respectively. An AST result was available for analysis in 146 instances. The overall category agreement was 94.1% with 12 very major errors, 5 major errors, and 55 minor errors. After a discrepancy analysis, there were 5 very major errors and 4 major errors. The Accelerate Pheno system provided an identification result in 1.4 h and an AST result in 6.6 h; the identification and AST results were 41.5 h and 48.4 h faster than those with the standard of care, respectively. This study demonstrated that the Accelerate Pheno system is able to provide fast and accurate organism identification and AST data. A limitation is the frequency with which cultures required the use of alternative identification and AST methods.
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Centros Médicos Académicos/estadística & datos numéricos , Bacteriemia/diagnóstico , Cultivo de Sangre/instrumentación , Cultivo de Sangre/métodos , Juego de Reactivos para Diagnóstico , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Cultivo de Sangre/estadística & datos numéricos , Exactitud de los Datos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/sangre , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
A 22-year-old female with sickle cell disease presented with fevers, bilateral knee pain, and lethargy. Laboratory data revealed a leukocytosis and lactic acidosis. Blood and synovial fluid cultures grew a non-toxin-producing strain of Clostridium difficile. This case highlights the fact that nontoxigenic Clostridium difficile can cause significant disease.
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Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Médula Ósea/microbiología , Fungemia/microbiología , VIH/aislamiento & purificación , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/orina , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/orina , Anciano , Anfotericina B/administración & dosificación , Anfotericina B/farmacología , Antirretrovirales/administración & dosificación , Antirretrovirales/farmacología , Histoplasma/efectos de los fármacos , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/orina , Humanos , Itraconazol/administración & dosificación , Itraconazol/farmacología , Masculino , Carga ViralRESUMEN
We present a case of a 4-year-old girl with abdominal angiostrongyliasis who presented with persistent fevers, hepatosplenomegaly, acute abdominal pain, and eosinophilia. Computed tomography scan identified thickening of the ascending colon with a narrowed lumen. Endoscopic evaluation revealed ulcerations and erythema in the ascending colon. The microscopic findings in biopsies included active chronic inflammation with prominent eosinophils and granulomas. A subset of granulomas contained the eggs of Angiostrongylus costaricensis. The definitive method of diagnosing A costaricensis is histology; peripheral blood serology has low specificity and the stool from infected patients does not contain eggs or larvae. Pathologists from endemic regions (Central and South America) are familiar with the typical histologic changes; however, because of increasing global travel, all pathologists should become familiar with A costaricensis, which may mimic common gastrointestinal diseases such as Crohn's disease, appendicitis, and Meckel's diverticulum.
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Angiostrongylus/aislamiento & purificación , Colitis Ulcerosa/patología , Granuloma Eosinófilo/patología , Infecciones por Strongylida/patología , Enfermedad Relacionada con los Viajes , Animales , Preescolar , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/parasitología , Colonoscopía , El Salvador , Granuloma Eosinófilo/diagnóstico , Granuloma Eosinófilo/parasitología , Femenino , Humanos , Infecciones por Strongylida/diagnóstico , Infecciones por Strongylida/parasitología , Tomografía Computarizada por Rayos X , Estados UnidosRESUMEN
We present a patient with advanced AIDS admitted with recurrent shock of unclear aetiology, fevers, altered mental status and refractory cytopenias. His case posed a diagnostic challenge because evaluation of septic shock in the setting of advanced AIDS requires a time-consuming work-up for broad infectious aetiologies that can delay consideration of other diagnoses, including primary or secondary haemophagocytic lymphohistiocytosis (HLH). After this patient did not improve with supportive care and empiric antimicrobials, there was concern for HLH given that he met ≥5 of the HLH consortium criteria. He underwent bone marrow biopsy, which was non-diagnostic. Empiric therapy for HLH was initiated, but unfortunately, the patient died. Autopsy revealed extensive haemophagocytosis in the spleen, bone marrow and liver, confirming the diagnosis of HLH. Postmortem, his soluble CD-25 returned 18 890 pg/mL (<1033 pg/mL), and his serum HHV-8 PCR resulted positive. The diagnosis was HLH secondary to Human Herpes Virus 8 (HHV-8) in a patient with advanced AIDS.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Herpesviridae/diagnóstico , Linfohistiocitosis Hemofagocítica/diagnóstico , Antiinflamatorios/uso terapéutico , Médula Ósea/patología , Recuento de Linfocito CD4 , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Resultado Fatal , Fiebre/etiología , Infecciones por Herpesviridae/sangre , Infecciones por Herpesviridae/complicaciones , Herpesvirus Humano 8/aislamiento & purificación , Humanos , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Choque Séptico/complicacionesAsunto(s)
Glándulas Suprarrenales/patología , Insuficiencia Suprarrenal/diagnóstico por imagen , Insuficiencia Suprarrenal/microbiología , Histoplasmosis/complicaciones , Histoplasmosis/diagnóstico por imagen , Insuficiencia Suprarrenal/complicaciones , Insuficiencia Suprarrenal/patología , Biopsia , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Diabetes Mellitus Tipo 2/patología , Diagnóstico Diferencial , Femenino , Histoplasmosis/patología , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico por imagen , Hipertensión/patología , Persona de Mediana Edad , Radiografía Abdominal , Tomografía Computarizada por Rayos XAsunto(s)
Coccidiosis/diagnóstico , Diarrea/diagnóstico , Infecciones por VIH/complicaciones , Sarcocystidae/aislamiento & purificación , Adulto , Enfermedad Crónica , Coccidiosis/parasitología , Coccidiosis/patología , Diarrea/parasitología , Diarrea/patología , Duodeno/patología , Hispánicos o Latinos , Histocitoquímica , Humanos , Masculino , MicroscopíaRESUMEN
We present the case of a native Texan who was diagnosed with tuberculoid leprosy and later developed a cutaneous infection with M. haemophilum following iatrogenic immunosuppression. To our knowledge, there are no such reports of M. haemophilum and M. leprae infection occurring simultaneously in the same host.