Rhino-Orbital mucormycosis in an immunocompetent pediatric patient with hyperglycemia of the hospitalized patient.

INTRODUCTION: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. METHODOLOGY: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. RESULTS: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. CONCLUSIONS: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.

An Unexpected Case of Lagochilascariasis: Interdisciplinary Management and Use of 12S and 18S rDNA Analysis.

A Mexican 24-year-old male patient was referred to our hospital due to increased left retroauricular volume with skin fistulisation, resembling an infection by the uncommon worm Lagochilascaris minor. The patient was submitted to lateral skull base surgery. No adult worms or eggs were observed during light and scanning electron microscopy analysis, as well as by histopathologic examination of the small piece of removed tissue, only L3 stage larvae of Lagochilascaris spp. were identified. Polymerase chain reaction-sequencing assays were performed using primers for the mitochondrial 12S and the nuclear 18S rDNA gene. DNA of some L minor adults, previously identified, were used as control. The molecular analysis identified the worm as L minor. According to previous reports, lagochilascariasis is a complicated infection that requires an interdisciplinary management by different clinical specialists. This is the first time that 12S and 18S rDNA genes are reported as molecular markers for diagnosis of L minor.

Stenotrophomonas maltophilia: descripción de un agente altamente infeccioso / Stenotrophomonas maltophilia: description of a highly infectious agent

La Stenotrophomonas maltophilia es una bacteria oportunista que causa diversos tipos de infecciones asociadas con la atención sanitaria en pacientes debilitados, especialmente en aquellos que han recibido antimicrobianos de amplio espectro. La Stenotrophomonas maltophilia se posiciona hoy en día como un patógeno nosocomial de ámbito general, el cual se añade a otros multirresistentes como Staphylococcus aureus, Acinetobacter spp. y Pseudomonas aeruginosa. Presentamos este caso dado que es el primero que encontramos en nuestro servicio (el cual simula una infección recurrente por micobacterias) y con el objetivo de demostrar el protocolo utilizado para el diagnóstico y tratamiento. Este germen se reporta con poca frecuencia y todos los pacientes son inmunosuprimidos o con tratamiento antibiótico prolongado. Este agente infeccioso se debe considerar e incluir entre los diagnósticos diferenciales de conglomerados ganglionares abscedados. En pacientes con inmunosupresión sospechada o conocida es necesario descartar la presencia de microorganismos oportunistas, para poder proporcionarle un diagnóstico adecuado y un tratamiento específico.

Stenotrophomonas maltophilia is an opportunistic bacterium that can cause various types of infections associated with health care in debilitated patients, especially those who have previously received broad-spectrum antimicrobials. Stenotrophomonas maltophilia is positioned today as a nosocomial pathogen of general scope, such as adding other multiresistant Staphylococcus aureus, Acinetobacter spp. and Pseudomonas aeruginosa.We present this case because it is the first thing we find in our service (wich simulates a recurrent mycobacterial infection) and with the aim of demonstrating the protocol used in diagnosis and treatment. This germ is infrequently reported and all patients are immunosuppressed or with prolonged antibiotic treatment. This infectious agent should be considered and included in the differential diagnosis of lymph node abscessed conglomerates. In patients with suspected or known immunosuppression is necessary to rule out opportunistic organisms, to provide a proper diagnosis and specific treatment.

Paragangliomas laríngeos Comparación de su abordaje por faringotomía lateral y por laringofisura en dos casos / Laryngeal paragangliomas Comparing their approach by lateral pharyngotomy and laryngofissure in two cases

Los paragangliomas son las neoplasias vasculares benignas más comunes del cuello. Surgen de células paragangliónicas extraadrenales derivadas de la cresta neural. El 90% se presentan en el tejido adrenal y 10% en tejidos extraadrenales de los cuales el 85% son abdominales, 12% torácicos y 3% en cabeza y cuello. El sitio más común de presentación es el cuerpo carotídeo, seguido por yugulotimpánicos y vagales. Otros sitios infrecuentes incluyen laringe, cavidad nasal, órbita, tráquea, cuerpo aórtico y mediastino. Se presentan los casos de dos pacientes con paragangliomas laríngeos en quienes se realizó faringotomía lateral y laringofisura, para connotar la importancia de tener presentes los diagnósticos diferenciales ante el hallazgo de una masa supraglótica y plantear un flujograma diagnóstico y terapéutico. Aunque con ambos abordajes se logra la remoción completa, son comunes las complicaciones postoperatorias; la faringotomía lateral es técnicamente más difícil y las complicaciones potenciales son más serias que con laringofisura.

Paragangliomas are the most common type of benign vascular tumors of the neck. Extraadrenal paraganglionicas arise from cells derived from the neural crest. 90% occur in the adrenal tissue and 10% in extra-adrenal tissues of which 85% are abdominal, thoracic 12% and 3% in head and neck. The most common site is the carotid body, followed by yugulotimpánicos and vagal. Other rare sites include the larynx, nasal cavity, orbit, trachea, mediastinum and aortic body. We present the cases of two patients with laryngeal paragangliomas who underwent to pharyngotomy and laryngofi ssure; in order to connote the importance of differential diagnoses present before a fi nding of a supraglottic mass and pose diagnostic and therapeutic fl owchart. Although both approaches allows the complete removal of the mass; postoperative complications are common; pharyngotomy approach is technically more diffi cult and potential complications are more serious than laryngofi ssure.

[Rhino-Orbital Mucormycosis. Cohort study of its treatment according disease extent and reversion of its pathophysiology]. / Mucormicosis rinoorbitaria. Estudio de cohorte de su tratamiento de acuerdo a la extensión de la enfermedad y reversión de su fisiopatología.

Mucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.

Difference between early clinical features of swine origin A H1N1 influenza confirmed and not confirmed infection in Mexico.

INTRODUCTION: The Swine Origin A H1N1 Influenza Virus (SOIV) pandemic emerged in April 2009 affecting people and health-care systems worldwide. This study examined the differences among the early clinical features presented in confirmed SOIV cases, those who tested negative for SOIV infection, fatalities, and hospitalized cases. METHODOLOGY: We reviewed 1,024 initial medical records of patients presenting with acute respiratory symptoms who attended the respiratory emergency room of a general hospital in Mexico and had a confirmatory test for influenza AH1N1 by RT-PCR from April to December 2009. RESULTS: Out of 1,024 cases, 457 (44%) were men with a mean age of 31±17 years; however, of these, SOIV confirmed cases were younger (26±8, p=0.000). SOIV infection was confirmed in 36% of the patients. Most (%?) cases presented mild infection, 20% of the patients required hospitalization, and 0.09% patients died. Asthma was more frequent in confirmed cases (p=0.028). Presence of COPD, systemic arterial hypertension, and diabetes mellitus was significant in confirmed hospitalized cases. Pulmonary rales, wheezing, and sudden symptom onset were more frequent and statistically significant in confirmed patients. Influenza-like illness was more frequent in confirmed cases (p=0.049).  CONCLUSIONS: This study presents one of the largest series of the new SOIV infection confirmed by RT-PCR reported. This infection is frequently mild and affects mainly young adults. Sudden symptoms onset, pulmonary rales, and wheezing are early features of this infection. Asthma, COPD, systemic arterial hypertension, and diabetes mellitus should be identified to identify potentially severe and fatal cases. ILI helps distinguish SOIV infection.

[Histology of submandibular gland tumours, 10 years' experience]. / Histología de tumores de glándulas submandibulares. Experiencia de 10 años.

INTRODUCTION AND OBJECTIVES: There are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%. OBJECTIVES: Determining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010. METHODS: A retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed. RESULTS: Twenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men. CONCLUSIONS: A greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones.