A Young Man With Hemoptysis and Cavitary Lung Lesions.

CASE PRESENTATION: A man in his 20s presented with 2 months of mild fatigue and intermittent hemoptysis of less than a tablespoon per episode. He was previously healthy and was on no medications. He denied fevers, night sweats, weight loss, wheezing, dyspnea, musculoskeletal symptoms, and rashes. He had emigrated from a South American country to the United States 3 years earlier. He worked as a groundskeeper but had no exposures to animals, mold, or dusts. He reported rare prior cigarette smoking with no history of alcohol or drug use. He was unsure whether he had received the Bacillus Calmette-Guérin vaccine.

Stridor and emphysema due to cystic echinococcosis in cattle and buffalo intermediate hosts in Punjab, India.

The clinical symptoms associated with hydatid disease in the bovine populations remain largely unknown and the disease is usually considered asymptomatic in these intermediate hosts. We report occurrence of symptoms such as sudden onset of continuous stridor, coughing and wheezing due to hydatid cysts present in the lungs of infected cattle and buffalo. Two cattle and one buffalo presented to the Teaching Veterinary Hospital, Guru Angad Dev Veterinary & Animal Sciences University with the complaint of continuous stridor, coughing and wheezing with normal feed and water intake were followed up. The comprehensive clinical examination followed by haematology, radiography of upper and lower respiratory tract, ultrasonography of lungs, liver and reticulum revealed presence of multiple hydatid cysts in the lung parenchyma. There was presence of subcutaneous emphysema in one of the infected animal. Radiography revealed cysts occupying up to 60% of alveolar space in the lungs. Endoscopy up to hilus was carried out to rule out the presence of any other mass/lesion in the respiratory tract. Per cutaneous aspiration (Ultrasound guided) of cystic fluid confirmed the diagnosis and fertile nature of hydatid cysts. The current study reports association of stridor and emphysema with hydatid disease in bovine hosts and it is important that veterinary practitioners in endemic areas consider hydatid disease for differential diagnosis when investigating the etiology of stridor and emphysema in bovine intermediate hosts.

Loiasis with pleural and peritoneal involvement.

We describe a case of atypical loiasis presenting with a chronic pleuroperitoneal effusion in a 50-year-old woman from the Democratic Republic of Congo. Effusions disappeared with conventional treatment and no recurrence was detected after 4 months of follow-up. Such cases of loiasis involving visceral sites have been unusually reported in the literature.

Acute onset of dyspnea associated with Oslerus osleri infection in a dog.

OBJECTIVE: To describe an unusual clinical presentation of Oslerus osleri infection in the dog and to review current diagnostic and treatment strategies for this infection. CASE SUMMARY: A 2-year-old Briard presented as an emergency for evaluation of acute respiratory distress. Radiographs of the thorax revealed an intratracheal masses near the bifurcation of the trachea. Biopsies of the masses identified parasitic fragments consistent with O. osleri infection. The patient was successfully treated with fenbendazole and the patient's clinical signs have not reoccurred over the last 5 months. UNIQUE INFORMATION PROVIDED: This report documents an uncommon presentation of acute respiratory distress associated with O. osleri infection in the dog, as previously reported cases usually report a history of chronic cough. In this case, the patient presented with an acute onset of dyspnea and no history of chronic cough suggesting that O. osleri infection may be a consideration in any young dog presented with acute respiratory distress.

[Leeches of the upper aerodigestive tract]. / Sangsues des voies aérodigestives supérieures.

INTRODUCTION: The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation. PATIENT AND METHODS: This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT. RESULTS: Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients. DISCUSSION: UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

VEGF promotes malaria-associated acute lung injury in mice.

The spectrum of the clinical presentation and severity of malaria infections is broad, ranging from uncomplicated febrile illness to severe forms of disease such as cerebral malaria (CM), acute lung injury (ALI), acute respiratory distress syndrome (ARDS), pregnancy-associated malaria (PAM) or severe anemia (SA). Rodent models that mimic human CM, PAM and SA syndromes have been established. Here, we show that DBA/2 mice infected with P. berghei ANKA constitute a new model for malaria-associated ALI. Up to 60% of the mice showed dyspnea, airway obstruction and hypoxemia and died between days 7 and 12 post-infection. The most common pathological findings were pleural effusion, pulmonary hemorrhage and edema, consistent with increased lung vessel permeability, while the blood-brain barrier was intact. Malaria-associated ALI correlated with high levels of circulating VEGF, produced de novo in the spleen, and its blockage led to protection of mice from this syndrome. In addition, either splenectomization or administration of the anti-inflammatory molecule carbon monoxide led to a significant reduction in the levels of sera VEGF and to protection from ALI. The similarities between the physiopathological lesions described here and the ones occurring in humans, as well as the demonstration that VEGF is a critical host factor in the onset of malaria-associated ALI in mice, not only offers important mechanistic insights into the processes underlying the pathology related with malaria but may also pave the way for interventional studies.

Dyspnea and dysentery: a case report of pleuropulmonary amebiasis.

Pleuropulmonary amebiasis is an uncommon complication of Entamoeba histolytica infection. It typically occurs in endemic regions including Central and South America, Africa and the Indian subcontinent. The case of a previously healthy US Army male stationed in Liberia with an acute onset of fevers, abdominal pain and bloody diarrhea is presented. He developed a productive cough with pleuritic chest pain and imaging revealed multiple liver abscesses, with rupture through the diaphragm causing a large right pleural empyema. A positive Entamoeba histolytica serum antibody and pleural fluid antigen confirmed the diagnosis. Surgical drainage of the pleural empyema and medical treatment with antiparasitics were necessary for symptom and disease resolution.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

[Retrospective clinical and laboratory study of the toxocariasis cases hospitalised between 2005 and 2008]. / Studiu clinic si de laborator, retroprospectiv, asupra cazurilor de toxocaroza la copiii spitalizati in perioada 2005-2008.

UNLABELLED: The authors present the results of retroprospective clinical and laboratory diagnosis on toxocariasis cases hospitalized in the Paediatric Diseases Clinic of Iasi, between January 2005-June 2008. MATERIAL AND METHOD: The study included a number of 228 children. RESULTS: The most frequent clinical manifestation was pulmonary symptoms 80.70%: dyspneea, wheesing, asthma, cough, interstitial pneumonitis. The most frequent digestive symptoms were abdominal pain 41.22%, hepatosplenomegaly 29.38%; cutaneous manifestations were pruritus and urticaria. The laboratory diagnosis: hypereosinophilia was present at 94.73% childrens associated with hyperleucocytosis and hyper-gammaglobulinemia. All the patients were serologic confirmed with toxocariasis. The children responded well to treatment with albendazole.

Primary hydatid cyst of the posterior mediastinum.

Hydatid cystic disease is still a health problem in Morocco. Mediastinal localization is very rare. We report the case of a 24-year-old man who presented with right chest pain and dyspnea. Chest X-Ray and computed tomography showed a mediastinal mass. The diagnosis was confirmed perioperatively by macroscopic and histologic investigations. Resection of the cyst was performed, and a small part intimately adherent to the inferior vena cava and oesophagus was left in place. There were no complications or recurrence.

[Hydatid cyst of the heart and vessels, four cases]. / Kyste hydatique du coeur et des vaisseaux, 4 observations.

INTRODUCTION: The lung is the most frequent location of hydatid cysts (HC). Cardiac and vascular HC are rare, and the primary location in the pulmonary artery is exceptional. OBSERVATIONS: We report three cases of right cardiac HC cyst revealed by pulmonary hydatidosis, and 1 case of a primary HC of the pulmonary artery revealed by haemoptysis. Treatment consisted in surgical resection of the cardiac and pulmonary artery HC. Post-surgical antiparasite chemotherapy, based on albendazole, was prescribed for all patients. The evolution was towards a post pneumonectomy syndrome in the patient with a HC in the pulmonary artery, major pulmonary hypertension in the case of pulmonary embolic hydatidosis and an extension of the hydatid lesions in the third patient. Treatment is ongoing in the fourth patient with the development of many parenchymatous cysts. DISCUSSION: Cardiac and vascular hydatid cysts are rare and of bad prognosis. These cardiac and vascular cysts are of poor prognosis because of the risk of rupture and hematogenic dissemination. Treatments are only partially effective and more importance should be given to preventive treatment.

Pseudo-tumor of the lung, a rare clinical presentation of dirofilariasis.

INTRODUCTION: Pulmonary dirofilariasis is an uncommon entity. Known as a zoonotic disease it can affect humans as a secondary host. A pseudo-tumor of the lung called "coin" lesion is usually detected while performing a chest X-ray for another reason. OBSERVATION: We present a case of pulmonary dirofilariasis due to Dirofilaria sp. in a 72 year old immunocompetent patient who underwent surgery for suspicion of a neoplasm. DISCUSSION: Human pulmonary dirofilariasis should be evoked in asymptomatic patient from endemic area of canine dirofilariasis presenting with a pseudo tumor of the lung.

Assessment of doctors' management of severe malaria in urban centres in Eastern Nigeria.

Malaria remains a heavy burden in sub-saharan Africa and accounts for over one million deaths per annum. Prompt and appropriate management of severe cases is critical in both disease control and reduction in mortality. This study explores the management actions of doctors in urban settings in Nigeria. A survey of medical practitioners in four urban local government areas (LGAs) in two states in South- Eastern Nigeria was conducted. Using simple random sampling technique, sixty doctors were chosen in each of the four LGAs giving a total of two hundred and forty. They were interviewed on their management actions for children with severe malaria. The mean age of the doctors was 34.6 years. 83.5%(167) of them were males while 16.5% (33) were females. 65.5% (131) of the doctors attend to children regularly. The common features of severe malaria seen include; high fever 52.7% (69), persistent vomiting 27.5% (36), severe anaemia 24.4% (32), refusal of drinks 7.6% (10), convulsion 7.6% (10), loss of consciousness 4.6% (6) and respiratory distress 2.3% (3). 79.4% (104/131) of the doctors that see children regularly have diagnosed cerebral malaria in the last five years. Quinine is the drug of choice for the treatment of cerebral malaria 87.8% (115/ 131). 56.5% (74/131) of the practitioners see patients with severe anaemia requiring blood transfusion on a monthly basis. The monthly mean of such anaemic patient per physician is 6.7 patients. The median time for blood transfusion from time of request to onset of transfusion is 3 - 4 hours. The current state of health facilities and personnel is not meeting up with the malaria challenge. Urgent efforts need to be made to curb the scourge.