RESUMEN
PURPOSE: To report a cluster of postoperative Acanthamoeba endophthalmitis after routine cataract surgeries. METHODS: A brief summary of sentinel events leading to the referral of 4 patients of postoperative endophthalmitis to our hospital is followed by clinical descriptions and the various diagnostic approaches and interventions used. Genotyping and phylogenetic analysis are also discussed. RESULTS: Four cases of postoperative cluster endophthalmitis, presumed to be bacterial and treated as such, were referred to our hospital. The presence of an atypical ring infiltrate in the first case facilitated the diagnosis of Acanthamoeba endophthalmitis. All patients had vitritis, corneal involvement, and scleral inflammation. Multiple diagnostic methods, such as corneal scrapings, confocal microscopy, aqueous and vitreous taps, scleral abscess drainage, histopathological studies, polymerase chain reaction, and genotyping and phylogenetic analyses of isolated Acanthamoeba, were used to confirm the diagnosis of endophthalmitis and to establish the extent of ocular involvement. Various medical and therapeutic interventions used to control the infections were also documented. The isolated Acanthamoeba were confirmed as belonging to the T10 genotype, an environmentally and clinically rare variety. CONCLUSIONS: This is the first report of a cluster of postoperative T10 genotype Acanthamoeba endophthalmitis, occurring after routine cataract surgery in immunocompetent individuals. Contrary to current perceptions, a rapidly evolving infection can occur with Acanthamoeba.
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Acanthamoeba/genética , Amebiasis/parasitología , Endoftalmitis/parasitología , Infecciones Parasitarias del Ojo/parasitología , Complicaciones Posoperatorias/parasitología , Acanthamoeba/aislamiento & purificación , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Antiprotozoarios/uso terapéutico , Humor Acuoso/parasitología , Extracción de Catarata , Córnea/parasitología , ADN Protozoario/genética , ADN Ribosómico/genética , Punto Alto de Contagio de Enfermedades , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/tratamiento farmacológico , Femenino , Técnicas de Genotipaje , Humanos , Masculino , Microscopía Confocal , Filogenia , Reacción en Cadena de la Polimerasa , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , ARN Ribosómico 18S/genéticaRESUMEN
Strongyloidiasis is a disease caused by the nematode Strongyloides stercoralis that is endemic in rural regions in tropical and subtropical countries. Immunosuppressed patients have an increased risk of infection by this parasite and are at risk of developing a hyperinfection syndrome which involves a higher risk of death. The syndrome is treated with ivermectin, however, there is no parenteral presentation of this medication for human use in Colombia or the world, which is an important problem in patients who have compromised enteral absorption, for instance, those with intestinal obstructions. We present a case of hyperinfection syndrome by Strongyloides stercoralis in Colombia, which was treated with subcutaneous ivermectin. Our purpose is to encourage pharmacokinetic and pharmacodynamic studies to establish this route of administration in the future as an alternative for those patients who have a high risk of therapeutic failure with the oral route.
La estrongiloidiasis es una enfermedad causada por el nematodo Strongyloides stercoralis, endémico en las regiones rurales de los países tropicales y subtropicales. Los pacientes inmunosuprimidos tienen un mayor riesgo de infección con este parásito y pueden terminar desarrollando un síndrome de hiperinfección que conlleva un alto riesgo de muerte. En el tratamiento se utiliza la ivermectina, pero, ni en Colombia ni en el mundo, existe una presentación parenteral del medicamento para uso en humanos, lo cual es un problema en aquellos pacientes que puedan tener comprometida la absorción intestinal, como es el caso de aquellos con obstrucciones intestinales. Se reporta el caso de un síndrome de hiperinfección por S. stercoralis en Colombia tratado con ivermectina subcutánea; la idea al presentarlo es incentivar los estudios de farmacocinética y farmacodinamia que analicen esta vía de administración como alternativa para el tratamiento de pacientes con riesgo de fracaso terapéutico con la vía oral.
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Antihelmínticos/administración & dosificación , Ivermectina/administración & dosificación , Complicaciones Posoperatorias/tratamiento farmacológico , Strongyloides stercoralis , Estrongiloidiasis/tratamiento farmacológico , Adulto , Albendazol/uso terapéutico , Animales , Antihelmínticos/farmacocinética , Antihelmínticos/uso terapéutico , Líquido del Lavado Bronquioalveolar/parasitología , Femenino , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Inyecciones Subcutáneas , Absorción Intestinal , Obstrucción Intestinal/etiología , Intubación Gastrointestinal , Ivermectina/farmacocinética , Ivermectina/uso terapéutico , Trasplante de Riñón , Larva , Pulmón/parasitología , Complicaciones Posoperatorias/parasitología , Strongyloides stercoralis/crecimiento & desarrollo , Strongyloides stercoralis/aislamiento & purificaciónRESUMEN
BACKGROUND: Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has world-wide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction. CASE PRESENTATION: We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it's further complications had not been observed before the operation. CONCLUSIONS: Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it's results depends on the invasion period the patient is operated on. After the surgery the patient requires careful follow - up, to detect early complications.
Asunto(s)
Equinococosis Hepática/cirugía , Echinococcus multilocularis , Hepatectomía/efectos adversos , Hipertensión Portal/parasitología , Complicaciones Posoperatorias/parasitología , Adulto , Animales , Equinococosis Hepática/parasitología , Humanos , MasculinoRESUMEN
Amebiasis caused by protozoa Entamoeba histolytica (EH) is the third leading parasitic cause of human mortality. Although amebiasis is endemic in India, only about 10% of the infected individuals manifest disease. Clinical spectrum of amebiasis ranges from asymptomatic colonization to amebic colitis to hemorrhagic and fulminant colitis. Factors causing an invasive infection are not completely understood. Pathogen virulence, host immunity, and ability of the pathogen to evade host immune response play vital role in determining the disease course. Host factors such as immunocompromised states may make an individual susceptible to develop symptomatic infection. Malignancies usually result in chronic debilitation which may make the individual prone to develop invasive amebiasis with rapid progression. We report two cases of invasive amebiasis which developed a fulminant course in the immediate postoperative period after abdominal surgeries for visceral malignancies.
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Carcinoma/cirugía , Colecistectomía/efectos adversos , Disentería Amebiana/diagnóstico , Entamoeba histolytica/aislamiento & purificación , Neoplasias de la Vesícula Biliar/cirugía , Gastrectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Complicaciones Posoperatorias/parasitología , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Antiinfecciosos/uso terapéutico , Disentería Amebiana/tratamiento farmacológico , Femenino , Humanos , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Resultado del TratamientoRESUMEN
No disponible
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Humanos , Femenino , Persona de Mediana Edad , Dermatosis Facial/parasitología , Trasplante de Riñón , Complicaciones Posoperatorias/parasitología , EscabiosisAsunto(s)
Antirreumáticos/efectos adversos , Enfermedad de Crohn/complicaciones , Enfermedades del Íleon/diagnóstico , Válvula Ileocecal , Infliximab/efectos adversos , Pólipos Intestinales/diagnóstico , Trasplante de Riñón , Leishmaniasis Visceral/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Antirreumáticos/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Diagnóstico Diferencial , Glomerulonefritis por IGA/complicaciones , Glomerulonefritis por IGA/cirugía , Humanos , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/parasitología , Enfermedades del Íleon/patología , Válvula Ileocecal/parasitología , Infliximab/uso terapéutico , Leishmania infantum/aislamiento & purificación , Masculino , Complicaciones Posoperatorias/parasitología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/fisiologíaRESUMEN
Introduction. The immunosuppression used after transplantation (Tx) is associated with an increased risk of opportunistic infections. In Europe, parasitic infections after Tx are much less common than viral, bacterial and fungal ones. However, diseases caused by parasites are very common in tropical countries. In the last years the number of travellers with immunosuppression visiting tropical countries has increased. Methods. We performed a literature review to evaluate a risk of parasitic infections after Tx in Europe. Results. There is a real risk of parasitic infection in patients after Tx travelling to tropical countries. Malaria, leishmaniasis, strongyloidiasis and schistosomiasis are the most dangerous and relatively common. Although the incidence of these tropical infections after Tx has not increased, the course of disease could be fatal. There are also some cosmopolitan parasitic infections dangerous for patients after Tx. The greatest threat in Europe is toxoplasmosis, especially in heart and bone marrow recipients. The most severe manifestations of toxoplasmosis are myocarditis, encephalitis and disseminated disease. Diarrhoea is one of the most common symptoms of parasitic infection. In Europe the most prevalent pathogens causing diarrhoea are Giardia duodenalis and Cryptosporidium. Conclusions. Solid organ and bone marrow transplantations, blood transfusions and immunosuppressive treatment are associated with a small but real risk of parasitic infections in European citizens. In patients with severe parasitic infection, i.e., those with lung or brain involvement or a disseminated disease, the progression is very rapid and the prognosis is bad. Establishing a diagnosis before the patient's death is challenging.
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Huésped Inmunocomprometido , Terapia de Inmunosupresión/efectos adversos , Infecciones Oportunistas/complicaciones , Enfermedades Parasitarias/complicaciones , Complicaciones Posoperatorias/parasitología , Receptores de Trasplantes , Europa (Continente)/epidemiología , Humanos , Infecciones Oportunistas/clasificación , Infecciones Oportunistas/epidemiología , Enfermedades Parasitarias/clasificación , Enfermedades Parasitarias/epidemiología , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Receptores de Trasplantes/estadística & datos numéricos , Viaje/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Strongyloides stercoralis (SS) can cause hyperinfection and disseminated infection in immunosuppressed individuals, with risk of mortality. We report the case of a cadaveric kidney transplant recipient who developed gastrointestinal symptoms and eosinophilia, approximately 3 months after transplantation. Stool examination and esophagogastroduodenoscopy with biopsies were positive for SS larvae. The patient was started on oral ivermectin and immunosuppression was reduced, but still the clinical picture got worse with metabolic ileus and respiratory symptoms, with the need for administration of subcutaneous ivermectin and combined therapy with albendazol. The patient survived and graft function was preserved. The patient was unlikely to be the source of infection. We also present a review of cases of SS infection in kidney transplant recipients.
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Eosinofilia/inmunología , Huésped Inmunocomprometido , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/inmunología , Estrongiloidiasis/inmunología , Sobreinfección/inmunología , Albendazol/uso terapéutico , Animales , Antiparasitarios/uso terapéutico , Biopsia , Quimioterapia Combinada , Eosinofilia/parasitología , Humanos , Terapia de Inmunosupresión/métodos , Ivermectina/uso terapéutico , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/parasitología , Strongyloides stercoralis , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/parasitología , Sobreinfección/tratamiento farmacológico , Sobreinfección/parasitologíaRESUMEN
Visceral leishmaniasis is a disease caused by the protozoan Leishmania and is transmitted by Lutzomyia longipalpis (sand fly). It is an endemic parasitic infection in numerous areas around the Mediterranean basin. Though immunocompetent patients may not develop the disease, in transplant recipients the use of corticoids and intensified immunosuppressants to prevent graft rejection may accelerate the disease, causing severe damage to the liver, spleen, and hematopoietic system. We report 2 cases of visceral leishmaniasis with an atypical presentation in transplant recipients. The first patient, who had a kidney transplant, was treated successfully with liposomal amphotericin B, and the second patient, a combined kidney-pancreas transplant recipient, suffered a relapse 3 years after treatment. Visceral leishmaniasis should be considered in the differential diagnosis of pancytopenia or unexplained fever occurring after organ transplantation in patients living in endemic areas or returning from endemic countries.
Asunto(s)
Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Leishmaniasis Visceral/inmunología , Complicaciones Posoperatorias/inducido químicamente , Adulto , Antiprotozoarios/uso terapéutico , Femenino , Humanos , Leishmaniasis Visceral/tratamiento farmacológico , Leishmaniasis Visceral/parasitología , Masculino , Persona de Mediana Edad , Pancitopenia/tratamiento farmacológico , Pancitopenia/inmunología , Pancitopenia/parasitología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/parasitologíaRESUMEN
PURPOSE: Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this study was to evaluate the impact of Toxoplasma infection on liver transplantation patients. METHODOLOGY: We searched PubMed, Lilacs, Medline, Science direct, Scielo, Ebsco, Springer, Wiley, Ovid and Google Scholar for reports published up to June 2017, and a systematic review was performed. RESULTS: Twenty cases were analysed before and after liver transplantation. Primary and reactivated infections were investigated. Before transplantation, positive IgG antibodies were the predominant serological markers in donors and recipients: 40â% (D+/R-), 20â% (D+/R+) and 20â% (D-/R+). IgM was present in only 5â% of the donors (D+/R-). In four cases, the serological markers were not specified or were negative (D?/R? or D?/R-). After transplantation, IgM anti-Toxoplasma antibodies were found in 30â% of the recipients, and in 67â% of the seronegative recipients the presence of Toxoplasma DNA or tachyzoites was reported, suggesting a primary infection. Clinical symptoms were meningitis, massive cerebral oedema, encephalitis and seizures. Treatment was administered in 70â% of the patients, and 40â% died after presenting symptoms associated with Toxoplasma infection. CONCLUSIONS: Although we review Toxoplasma infection and liver transplantation cases, problems associated with the parasite may be greater than identified. Hence, follow-up studies on Toxoplasma infection in liver transplantation patients are recommended.
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Trasplante de Hígado/estadística & datos numéricos , Complicaciones Posoperatorias/parasitología , Toxoplasma/aislamiento & purificación , Toxoplasmosis/parasitología , Anticuerpos Antiprotozoarios/sangre , Anticuerpos Antiprotozoarios/inmunología , Humanos , Complicaciones Posoperatorias/sangre , Toxoplasma/inmunología , Toxoplasma/fisiología , Toxoplasmosis/transmisiónRESUMEN
We report the case of a 61 year-old male who underwent heart transplantation eight months before developing a systemic condition with central nervous system, lung, kidney, colonic, cutaneous, and hematologic involvement, found to be secondary to a systemic toxoplasmosis despite co-trimoxazole prophylaxis in a previous-to-transplant seronegative patient receiving a heart from a seropositive donor. A review of prophylactic options in our environment is discussed.
Asunto(s)
Trasplante de Corazón , Complicaciones Posoperatorias/etiología , Toxoplasmosis/transmisión , Anticuerpos Antiprotozoarios/sangre , Antivirales/uso terapéutico , Terapia Combinada , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/transmisión , Progresión de la Enfermedad , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Intercambio Plasmático , Complicaciones Posoperatorias/parasitología , Complicaciones Posoperatorias/prevención & control , Recurrencia , Seroconversión , Donantes de Tejidos , Toxoplasmosis/prevención & control , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Viremia/tratamiento farmacológico , Viremia/transmisiónRESUMEN
Resumen Se reporta el caso de un paciente de sexo masculino, de 61 años de edad, quien ocho meses después de someterse a un trasplante de corazón presentó una enfermedad sistémica con compromiso del sistema nervioso central y del sistema inmunológico, así como de pulmón, riñón, colon y piel, y a quien finalmente se le diagnosticó toxoplasmosis diseminada, a pesar de haber recibido profilaxis con trimetoprim-sulfametoxazol, debido a que el órgano provenía de un donante positivo para toxoplasmosis siendo él un receptor negativo. Se discuten las opciones de profilaxis en nuestro medio.
Abstract We report the case of a 61 year-old male who underwent heart transplantation eight months before developing a systemic condition with central nervous system, lung, kidney, colonic, cutaneous, and hematologic involvement, found to be secondary to a systemic toxoplasmosis despite co-trimoxazole prophylaxis in a previous-to-transplant seronegative patient receiving a heart from a seropositive donor. A review of prophylactic options in our environment is discussed.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Toxoplasmosis/transmisión , Trasplante de Corazón , Antivirales/uso terapéutico , Intercambio Plasmático , Complicaciones Posoperatorias/parasitología , Complicaciones Posoperatorias/prevención & control , Recurrencia , Donantes de Tejidos , Viremia/tratamiento farmacológico , Viremia/transmisión , Anticuerpos Antiprotozoarios/sangre , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Toxoplasmosis/prevención & control , Inmunoglobulinas Intravenosas/uso terapéutico , Terapia Combinada , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/transmisión , Progresión de la Enfermedad , Seroconversión , Inmunosupresores/efectos adversosRESUMEN
Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT). It frequently involves the central nervous system. The case is presented of cerebral toxoplasmosis in a 17-year-old youth with Fanconi anaemia treated with haematopoietic stem cell transplantation (HSCT).
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Anemia de Fanconi/cirugía , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Complicaciones Posoperatorias/parasitología , Toxoplasmosis Cerebral/parasitología , Adolescente , Anticuerpos Antiprotozoarios/inmunología , Anemia de Fanconi/inmunología , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/inmunología , Toxoplasma/aislamiento & purificación , Toxoplasma/fisiología , Toxoplasmosis Cerebral/etiología , Toxoplasmosis Cerebral/inmunologíaRESUMEN
Syndrome of inappropriate anti-diuretic hormone (SIADH) has been reported to be associated with systemic Strongyloides stercoralis. Here, we report a case of a stem cell transplant (SCT) recipient who developed severe SIADH secondary to systemic S Stercoralis. The SIADH resolved quickly after treating the systemic S Stercoralis with ivermectin. A systematic review of the literature was performed by PubMed, Scopus, and Cochrane database search. Only eight cases of S Stercoralis in allogeneic SCT recipients have been previously reported. To our knowledge, ours is the first reported case of SIADH secondary to S Stercoralis infection in an allogeneic SCT recipient. Prior to transplantation, even if asymptomatic, patients from endemic regions should be screened with strongyloides immunoglobulin (Ig)G serology. Pretransplantation eosinophilia should be evaluated by screening multiple stool samples for ova and parasites. Transplant candidates with positive serology or stool tests can be treated pretransplantation to eradicate infection. Patients at risk for S Stercoralis who develop nonspecific gastrointestinal complaints, rash, pulmonary infiltrates, or gram-negative bacteremia or meningitis may have S Stercoralis hyperinfection syndrome. Our case indicates that the development of SIADH may be an additional clue to this diagnosis. Appropriate diagnostic studies, including repeat stool and other body fluid sampling, should be expedited and ivermectin therapy initiated rapidly to prevent significant morbidity and mortality.
Asunto(s)
Enfermedades Duodenales/parasitología , Síndrome de Secreción Inadecuada de ADH/parasitología , Infecciones Oportunistas/complicaciones , Trasplante de Células Madre , Strongyloides stercoralis , Estrongiloidiasis/complicaciones , Anciano , Animales , Antinematodos/efectos adversos , Antinematodos/uso terapéutico , Enfermedades Duodenales/tratamiento farmacológico , Eosinofilia/parasitología , Humanos , Inmunoglobulina G/sangre , Ivermectina/uso terapéutico , Masculino , Infecciones Oportunistas/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/parasitología , Trasplante HomólogoRESUMEN
Aspergillus fungi can cause serious infections, including intra-abdominal infection, particularly in patients with compromised immune system. Described in the present report is case of 46-year-old female patient who had undergone laparoscopic cholecystectomy (LC) at another healthcare facility. In early postoperative period, she had increasing complaints of swelling, nausea, and vomiting. On postoperative 19th day, she was referred to our clinic with diagnosis of acute abdomen. Surgery was performed with suspected possibility of bile leakage. However, pathological examination of soft, yellow-green mass found in subhepatic space determined it was fungus ball caused by fungi of the genus Aspergillus. Patient was diagnosed postoperative intra-abdominal aspergillosis (IAA).
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Aspergilosis/diagnóstico , Bilis , Colecistectomía Laparoscópica , Infecciones Intraabdominales/diagnóstico , Aspergilosis/parasitología , Diagnóstico Diferencial , Femenino , Humanos , Infecciones Intraabdominales/parasitología , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/parasitología , Periodo PosoperatorioRESUMEN
BACKGROUND: Ophthalmomyiasis is a rare entity seen mainly in immunocompromised host with neglected wounds under poor hygienic conditions. CASE: We report a case of extreme ophthalmomyiasis with extensive facial and scalp involvement in an old rural inhabitant following evisceration. CONCLUSION: Proper wound care and personal hygiene are of paramount importance for good wound healing.
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Evisceración del Ojo/efectos adversos , Infecciones Parasitarias del Ojo/etiología , Miasis/etiología , Complicaciones Posoperatorias/parasitología , Animales , Dípteros , Dermatosis Facial/parasitología , Humanos , Higiene , Larva , Dermatosis del Cuero Cabelludo/parasitologíaRESUMEN
Visceral leishmaniasis (VL) is a severe and potentially fatal disease caused by different Leishmania species, Leishmania chagasi prevailing in Brazil. Main symptoms include fever, malaise, anorexia, weight loss and abdominal enlargement with typically occurring hepatosplenomegaly Currently, VL is considered an opportunistic infection in immunocompromised hosts, including solid organ transplanted patients. The present study reports a case of VL associated to pregnancy after renal transplantation.
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Trasplante de Riñón , Complicaciones Posoperatorias/parasitología , Femenino , Humanos , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Adulto JovenRESUMEN
A hepatitis B virus carrier suffering from acute flare of chronic hepatitis B infection underwent deceased-donor liver transplantation. He was put on the immunosuppressive agent tacrolimus. On routine follow-up, he was found to have abnormal liver function. Computed tomography scan of the abdomen did not show any dilatation of the biliary system. Liver biopsy showed scattered microabscesses, and a microgranuloma was detected. Endoscopic retrograde cholangiography was performed and a biliary anastomotic stricture (BAS) was noted. In addition, the Chinese liver fluke, Clonorchis sinensis, was discovered. Balloon dilatation and stenting were performed. The patient was given a course of praziquantel. His liver function improved and normalized. We present the case of a liver transplant recipient with cholangitis caused by C. sinensis infestation and infection and biliary obstruction resulting from BAS.
Asunto(s)
Colangitis/parasitología , Clonorquiasis/diagnóstico , Ictericia/parasitología , Trasplante de Hígado , Complicaciones Posoperatorias/diagnóstico , Colangitis/diagnóstico , Clonorquiasis/etiología , Humanos , Ictericia/diagnóstico , Masculino , Complicaciones Posoperatorias/parasitologíaRESUMEN
Resumo A leishmaniose visceral (LV), ou Calazar, é uma doença grave e potencialmente fatal para o homem. É causada por espécies do gênero Leishmania, predominando no Brasil a Leishmania chagasi. Os principais sintomas são febre, mal-estar, anorexia, perda ponderal e aumento do volume abdominal. A esplenomegalia e hepatomegalia são os sinais característicos da leishmaniose visceral, atualmente considerada infecção oportunista em imunocomprometidos, incluindo os receptores de transplante de órgãos sólidos. O objetivo deste estudo foi relatar um caso de leishmaniose visceral associado à gravidez pós-transplante renal.
Abstract Visceral leishmaniasis (VL) is a severe and potentially fatal disease caused by different Leishmania species, Leishmania chagasi prevailing in Brazil. Main symptoms include fever, malaise, anorexia, weight loss and abdominal enlargement with typically occurring hepatosplenomegaly Currently, VL is considered an opportunistic infection in immunocompromised hosts, including solid organ transplanted patients. The present study reports a case of VL associated to pregnancy after renal transplantation.