Leptospirosis in an asplenic patient -case report.

BACKGROUND: The presentation of clinical leptospirosis has been historically associated with animal workers, slaughterhouse workers and medical veterinarians. This association has shifted to be related to flooding events and outdoor activities; few cases are related to high-risk factors found in immunosuppressed patients. Scarcely a handful of cases have serological evidence of immune response against Leptospira serovar Bratislava representing serogroup Australis, a serovar associated with poor reproductive performance in swine and horses, and recently with cats. CASE PRESENTATION: Herein, we describe a rare clinical presentation of disseminated Leptospira infection in an immunosuppressed 65-year-old woman. She was admitted to the emergency room with fever, bacteraemia, bilateral uveitis and pulmonary involvement. The patient denied outdoor activities; she only had wide exposure to faeces and urine from cats living in her home. Her medical history included idiopathic thrombocytopenic purpura (ITP) diagnosed at the age of 18. She did not respond to medical treatment, and a splenectomy was performed. At age 60, she was diagnosed with Chronic Myeloid Leukemia (CML), and was treated with a tyrosine kinase inhibitor (TKI) -Imatinib. The patient voluntarily discontinued the treatment for the last 6 months. After extensive workup, no microorganisms were identified by the commonly used stains in microbiology. The diagnosis was performed through dark-field microscopy, microagglutination test (MAT), Leptospira genus-specific PCR, the IS1500 PCR for identification of pathogenic species, and 16S based sequencing for the genus identification. CONCLUSION: Immunosuppressed patients may acquire uncommon infections from ubiquitous microorganisms. In this case, serology evidence of exposure to Leptospira serovar Bratislava by MAT and the presence of the Leptospira genus were identified. It should be on mind for the diagnosis in otherwise healthy patients, and thoroughly search on splenectomised patients exposed to animals. Additionally, this report highlights the usefulness of PCR for diagnosis of this potentially life-threatening illness.

Zygomycosis in two hematologic cases.

Zygomycosis are invasive mould infections, rarely diagnosed in hematologic patients. Most of the cases published are in patients with prolonged neutropenia, along with other risk factors such as the use of prior broad-spectrum antibiotics (including new antifungal agents, such as voriconazole), diabetes mellitus (with or without ketoacidosis), malnutrition, iron overload (with or without the use of deferoxamine). These infections have poor prognosis due to the involvement of vital anatomic structures and late diagnosis. Until recent years, the treatment was based on high doses of amphotericin B plus surgical debridement. Here we present two patients with hematologic diseases (one with leukemia, the second with aplastic anemia) with an impaired immune system and the diagnosis of zygomycosis. The survival of one of them was mainly due to early diagnosis and surgical debridement; unfortunately the second was misdiagnosed as an extensive ecchymosis due to thrombocytopenia and died with CNS involvement.

Whole-body (18)F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration.

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms.

Whole-body 18F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration

Paciente mujer de 82 años con hipotiroidismo y tiroiditis de Hashimoto, observó desde hace tres años la presencia de un bocio asimétrico pequeño (izquierdo > derecho). Sin embargo, un crecimiento rápido de la glándula en un periodo de 3-6 meses causó disfagia y respiración corta. La ecografía y la gammagrafía tiroidea mostraron imágenes consistentes con bocio multinodular con un nódulo hiperfuncionante en el lóbulo derecho. Por la historia previa de tiroiditis de Hashimoto y el aumento rápido en el tamaño de la glándula tiroides, se consideró un diagnóstico de linfoma tiroideo y cáncer tiroideo anaplásico. Se realizó tiroidectomía en un hospital externo para aliviar los síntomas compresivos. La aspiración con aguja fina fue insuficiente para el diagnóstico, y en la pieza de la tiroidectomía se confirmó el diagnóstico de un linfoma difuso de células grandes tipo B. En nuestro centro se realiza un rastreo con FDG-PET/CT para estadificación, mostrando metástasis intra y extraganglionares. La quimioterapia con ciclofosfamida, vincristina y dexametasona (COP modificado), produjo una respuesta dramática del tumor y una resolución completa de los síntomas compresivos

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms

[Knowledge, application, and diffusion of results of clinical research: the case of porto-systemic encephalopathy]. / Conocimiento, aplicación y difusión de los resultados de la investigación clínica: el caso de la encefalopatía portosistémica.

The objectives of this survey were to evaluate the medical knowledge, acceptance and application of research results, and to identify the main sources of information in our environment. Portal-systemic encephalopathy (PSE) was the specific health problem addressed. Three hundred seventy-seven attendants to the National Mexican Gastroenterology Week (december 14-19, 1991) were surveyed. The results point out: 1) Gaps in PSE knowledge, since 30% or more incorrect answers were obtained for some PSE manifestations and therapeutic measures; 2) A persistent use of measures with doubtful efficacy, which is exemplified by the regular use of neomycin by (80%) of the respondents, 3) frequent influence of the availability of therapeutic measures (68%), as the satisfaction with therapeutic response (66%) on PSE treatment patterns, and 4) important role of continuing education courses and/or scientific meetings (> 66%) and medical journals (> 57%) as sources of information.

[Epidemiology of gallstone disease in Mexico]. / Características de la litiasis biliar en México.

Prevalence of gallstone disease in autopsies from Mexico is 14.3%, 8.4% in men and 20.4% in women respectively. Frequency of cholelithiasis has increased remarkably from 12.2% in 1950 to 15.8% in 1980 (p < 0.05). Population of low socioeconomic status is apparently more affected. Obesity is the clinical association more frequently found in the population studied. Cholesterol gallstones showed the highest frequency. Economic cost of this disease is high. We conclude that gallstone disease is a public health problem for our country.