RESUMEN
Se presenta el caso de un paciente de origen sudamericano con una enfermedad pulmonar diagnosticada inicialmente de sarcoidosis y tratado con corticoides. A pesar de una mejora inicial, el paciente fue empeorando hasta que por fin el cuadro se atribuyó a una paracoccidioidomicosis. Esta micosis sistémica tiene rasgos comunes con la sarcoidosis, pero el tratamiento difiere hasta el punto de que los corticoides pueden poner en peligro la vida del paciente (AU)
We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pulmonares Fúngicas , Paracoccidioidomicosis/complicaciones , Paracoccidioidomicosis , Radiografía Torácica , Prednisona/uso terapéutico , Análisis de los Gases de la Sangre/métodos , Insuficiencia Respiratoria/complicaciones , Itraconazol/uso terapéutico , Paracoccidioides/aislamiento & purificación , Paracoccidioides/efectos de la radiación , Paracoccidioides/patogenicidad , Fotomicrografía/métodosRESUMEN
We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk.
Asunto(s)
Enfermedades Pulmonares Fúngicas/diagnóstico , Paracoccidioidomicosis/diagnóstico , Sarcoidosis/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: To study the usefulness of IgG and IgM titration, and avidity of IgG to date IgM anti-Toxoplasma gondii. METHODS: VIDAS Toxo IgG, VIDAS Toxo IgM and VIDAS Toxo IgG Avidity tests were used. 64 sera containing both IgM and IgG T. gondii antibodies were analyzed, 32 from 12 individuals infected 40 weeks previously (group I), and the remainder from 17 individuals with an infection of more than 40 weeks (group II). RESULTS: An IgM index < 1.05 was associated with an infection > 12 weeks. An avidity index > 0.164 excluded 100% infections of < or = 12 weeks. Avidity indexes > 0.26 and 0.45 excluded infections of < or = 20 and < or = 40 weeks, respectively. CONCLUSIONS: The serology methods used in this study can adequately identify residual IgM anti-T. gondii, often avoiding the need of a new blood extraction to analyze IgG kinetics in pregnant women.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Técnica del Anticuerpo Fluorescente Indirecta , Inmunoglobulina M/sangre , Complicaciones Parasitarias del Embarazo/inmunología , Toxoplasmosis/inmunología , Adolescente , Adulto , Anticuerpos Antiprotozoarios/biosíntesis , Afinidad de Anticuerpos , Femenino , Humanos , Inmunoglobulina G/biosíntesis , Inmunoglobulina G/sangre , Inmunoglobulina M/biosíntesis , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Parasitarias del Embarazo/sangre , Complicaciones Parasitarias del Embarazo/parasitología , Trimestres del Embarazo , Curva ROC , Juego de Reactivos para Diagnóstico , Factores de Tiempo , Toxoplasmosis/sangre , Toxoplasmosis/parasitologíaRESUMEN
UNLABELLED: To determine the need of prenatal screening for toxoplasmosis in our hospital from a seroepidemiological point of view. PATIENTS AND METHODS: The prevalence of IgG anti-T. gondii was retrospectively analyzed in 7.090 women of childbearing age attended in the Hospital Clínic of Barcelona from February 1992 to April 1999. The association among the seroprevalence and the variables year, age, birthplace (province of Barcelona/other provinces) and place of residence (urban/rural) was analyzed. A decreasing trend was observed in the prevalence (p < 0.001), currently being < 40% in the average women between 15 and 45 years. Infection was also directly related to age of women (p < 0.001) and birthplace out of the province of Barcelona (p = 0.001). Habitat (rural or urban) was not associated with seroprevalence. Prenatal screening for toxoplasmosis is necessary due to the high rate of seronegative women exposed to infection and the evidence of a high number of primoinfections in the childbearing period.
Asunto(s)
Toxoplasmosis/epidemiología , Adolescente , Adulto , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Prevalencia , Estudios Retrospectivos , Estudios Seroepidemiológicos , España/epidemiología , Toxoplasmosis/prevención & controlRESUMEN
BACKGROUND: To describe a case of severe congenital toxoplasmosis because of inadequate surveillance of a seronegative pregnant woman and to evaluate the usefulness of different microbiological diagnostic methods after birth. METHODS: We applied serology, DNA amplification by one-tube semi-nested PCR, cell culture and mice inoculation analysis. RESULTS: Anti. T. gondii serology was useful for the diagnosis of congenital toxoplasmosis. PCR analysis of neonate cerebrospinal fluid and peripheral blood were positive, and yielded negative results after a few days of specific treatment. Cellular culture and mice inoculation yielded negative results. CONCLUSIONS: Our results suggest that serology and PCR are useful methods for the diagnosis of toxoplasmosis in newborns. Prenatal toxoplasmosis screening and suitable follow up of the seronegative pregnant women are necessary to prevent cases of severe infection in our area.
