RESUMEN
Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.
Asunto(s)
Acanthamoeba/patogenicidad , Amebiasis/terapia , Antimaláricos/uso terapéutico , Absceso Encefálico/terapia , Trasplante de Hígado , Rifampin/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Acanthamoeba/inmunología , Adulto , Amebiasis/diagnóstico , Amebiasis/patología , Animales , Absceso Encefálico/diagnóstico , Absceso Encefálico/patología , Terapia Combinada , Quimioterapia Combinada , Lóbulo Frontal/patología , Lóbulo Frontal/cirugía , Humanos , Huésped Inmunocomprometido/inmunología , Inmunosupresores/inmunología , Trasplante de Hígado/inmunología , Masculino , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/terapia , Resultado del TratamientoAsunto(s)
Meningioma/patología , Recurrencia Local de Neoplasia/patología , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Meningioma/cirugía , Meningioma/ultraestructura , Microscopía Electrónica , Recurrencia Local de Neoplasia/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: In the United States, non-Hispanic blacks have higher rates of hypertension than other ethnic groups. In addition, they have higher rates of physical inactivity, a behavior linked to high blood pressure. We examined associations between ethnicity, leisure-time physical activity (LTPA), and hypertension prevalence in a representative sample of U.S. adults. METHODS: Using data on 16,246 adults in the third National Health and Nutrition Examination Survey, hypertension prevalence was determined for non-Hispanic white, non-Hispanic black, and Mexican Americans at various levels of LTPA (none, 0.1-4.9 bouts/week at any intensity, 5+ bouts/week of moderate-to-vigorous activity). Logistic regression was used to examine relationships between hypertension prevalence, race, LTPA, and other variables. RESULTS: Hypertension prevalence was significantly less in the most active group, compared with their sedentary peers (odds ratio = 0.73, CI 0.59 to 0.90). Blacks had an odds ratio for hypertension of 1.77 (CI 1.49 to 2.10) compared with non-Hispanic whites, after adjusting for gender, age, income, LTPA, smoking, BMI, salt intake, rural/urban dwelling, and alcohol intake. Mexican Americans had an adjusted odds ratio of 0.75 (CI 0.62 to 0.89), relative to non-Hispanic whites. CONCLUSION: Ethnicity and LTPA are both associated with hypertension prevalence after controlling for each other, as well as other confounders. Thus, race and physical activity are important independent contributors to hypertension prevalence.