RESUMEN
Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri, a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95-98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri. PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient's history of freshwater exposure and the physician's high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae.
Asunto(s)
Infecciones Protozoarias del Sistema Nervioso Central , Naegleria fowleri , Niño , Humanos , Infecciones Protozoarias del Sistema Nervioso Central/diagnóstico , Infecciones Protozoarias del Sistema Nervioso Central/tratamiento farmacológico , Encéfalo , Cambio Climático , Progresión de la EnfermedadRESUMEN
Hantavirus pulmonary syndrome remains an uncommon yet emerging viral zoonosis that causes respiratory failure and hemodynamic instability in children and adolescents. Due to its acutely progressive course and high mortality rate, clinicians treating hantavirus pulmonary syndrome should understand its epidemiologic risk factors, clinical syndrome and radiographic findings. We present a case of hantavirus pulmonary syndrome in a 14-year-old female from North Dakota who survived the infection without sequelae.
Asunto(s)
Síndrome Pulmonar por Hantavirus , Adolescente , Humanos , Femenino , Síndrome Pulmonar por Hantavirus/diagnóstico , North Dakota , Orthohantavirus/aislamiento & purificación , AnimalesRESUMEN
Tuberculosis (TB) can cause significant morbidity and mortality among solid organ transplant (SOT) recipients, including disseminated disease. Most TB cases after SOT occur in kidney transplant recipients, although data about TB in this population are sparse. Tuberculosis may present atypically in immunocompromised patients, underscoring why physicians must maintain high clinical suspicion when pertinent epidemiological risk factors are present, including birth or former residence in a country with endemic TB. We describe a unique case of disseminated TB in a 54-year-old Filipino woman who developed central nervous system tuberculoma, Pott's disease, chorioretinitis, and a perinephric fluid collection after kidney transplantation. Despite being a preventable and curable disease, TB remains a relevant and challenging infection with complex diagnostic and treatment guidelines.
RESUMEN
Tuberculosis (TB) is a leading infectious killer worldwide. Over two-thirds of new TB diagnoses in the United States occur among first-generation immigrants, especially within a year of migration. Hodgkin lymphoma (HL) accounts for a minority of lymphoma cases but presents similarly to disseminated or extrapulmonary TB. Clinical overlap between TB and HL increases patient risk of misdiagnosis. Concomitant presentation of both diseases is not uncommon but infrequently reported. We present a case of isoniazid-resistant TB with progressively worsening lymphadenopathy and splenomegaly despite appropriate TB treatment. The patient was diagnosed with HL following PET/CT and axillary lymph node biopsy.
RESUMEN
Allen O. Whipple was an American surgeon who popularized the pancreaticoduodenectomy (Whipple procedure) for periampullary cancer, which remains the gold standard for pancreatic tumor resections. Whipple was educated at Princeton University (B.S., 1904) and Columbia University College of Physicians and Surgeons (M.D., 1908). He swiftly ascended the academic ranks, culminating in his appointment as Professor of Surgery at Columbia and Director of Surgical Services at Presbyterian Hospital in 1921. Whipple published three criteria (Whipple's triad) for evaluating hyperinsulinism secondary to pancreatic insulinoma. He also revived interest in portocaval anastomosis to reduce portal hypertension, determining it to be a consequence of liver disease. During his 40-year career, Whipple introduced the concept of multidisciplinary teams and prospective data collection. He also shaped the structure of surgical training as President of the American Surgical Association and Chairman of the American Board of Surgery. Beyond the walls of the operating room, Whipple was a Renaissance Man whose childhood in Persia (Iran) engendered a lifelong interest in the region's art, culture, history, and medicine. Dr. Allen Oldfather Whipple is remembered as a pioneering physician and surgeon beloved by those who trained under him.