Disseminated cryptococcosis with cutaneous lesions.

A case of disseminated cryptococcosis in an HIV-negative patient presenting with cutaneous lesions is described for the first time in Egypt. The patient, a 16-year-old male, presented with cough, expectoration, loss of weight, and cutaneous lesions, mainly on the face and trunk. The lesions consisted of vegetating crusted plaques discharging purulent to sanguinous fluid and flattened, shiny, erythematous to brownish plaques. Anorexia, headache and personality changes soon followed. Histopathological examination of lesions was highly suggestive of a deep mycosis, particularly cryptococcosis. The fulminant disease advanced with central nervous system involvement. The progression was not arrested when systemic antifungal therapy was administered late in the disease course. Pathological examination of lungs, liver, pancreas and spleen revealed disseminated infection with no evidence of other underlying pathology. Disseminated cryptococcosis is a morbid infection, rare in an area where heightened awareness and raised index of suspicion will surely allow earlier diagnosis, management and better prognosis.

Evaluation of hepatic fibrosis after oxamniquine therapy of murine schistosomiasis.

Chemical and histological indices of liver fibrosis were measured after eight, 18 and 28 weeks in mice infected with Schistosoma mansoni and treated at eight weeks with oxamniquine, in mice infected with S. mansoni and not treated and in mice not infected with S. mansoni. Total worm burdens and liver egg counts were determined in the infected mice to determine severity of infection. Treatment with oxamniquine resulted in near total eradication of S. mansoni worms after 10 weeks and in their complete killing and marked reduction of eggs in the liver at 10 and 20 weeks. Liver fibrosis 10 weeks after oxamniquine treatment was not significantly different than in the untreated, infected group but there was no progression between 10 and 20 weeks after oxamniquine treatment. Fibrosis did however increase between 10 and 20 weeks in the untreated infected group. In the murine model, oxamniquine is an effective treatment for S. mansoni and prevents progression of liver fibrosis.

Re-examination of Rattus norvegicus as an animal model for Aeromonas-associated enteritis in man.

We have developed an oral feeding model for Aeromonas hydrophila enteritis using Rattus norvegicus with clindamycin pretreatment. All animals in the clindamycin group developed a self-limited, loose stool by day four of feeding. Intestinal examination revealed evidence of enteritis. Moreover, antibiotic usage may be a predisposing risk factor to infection.

Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study.

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated. This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. II. Obstructive uropathy.

In a series of 32 unselected consecutive autopsies of Egyptian male adults, we found a significant prevalence of schistosomal obstructive uropathy (SOU) and of precursor lesions of stenosis, fibrosis and induration of the ureters (62.5%). Lower urinary tracts with obstructive uropathy had a significantly higher total egg burden (TEB) than did lower urinary tracts with any other type of gross lesion (i.e., benign prostatic hypertrophy, other urethral outlet obstruction, or SOU precursor lesions). In turn, lower urinary tracts with any type of gross change had higher egg burdens than did tracts which appeared grossly normal. Lower urinary tracts with any type of gross lesion had significantly larger seminal vesicles than did tracts which were grossly normal. Moreover, relative weight of seminal vesicles could be correlated with the S. haematobium egg burdens in the seminal vesicles. In a series of lower urinary tracts taken from unselected consecutive American autopsies, seminal vesicle weight could be correlated with increase in prostatic weight in those tracts with prostatic hypertrophy; the same correlation could not be found in tracts without prostatic hypertrophy. Thus, seminal vesicle hypertrophy appears to correlate with obstructive uropathy in general, not solely obstructive uropathy of schistosomal origin. Digital evaluation of seminal vesicle size may be useful in the clinical evaluation of such patients.

Reversal of hepatic fibrosis after praziquantel therapy of murine schistosomiasis.

We examined the effect of parasitologic cure of S. mansoni infection on liver fibrosis in mice. Praziquantel, 250 mg/kg body weight, was administered orally to mice 8 weeks after infection with 50 S. mansoni cercariae. We assessed liver fibrosis by chemical measurement of collagen content as measured by the estimation of hydroxyproline and by histologic examination at the time of treatment, and at 10 and 20 weeks post-treatment, in comparison with the same measurements in untreated S. mansoni-infected mice and age-matched normal control mice. The extent of infection was monitored by liver egg counts. Compared to normal uninfected mice, mice with untreated S. mansoni infection showed steady accumulation of liver collagen at the 3 measurement periods, reaching an average level of 15-fold greater than that found in normal mice at 28 weeks after infection. Mice treated with praziquantel showed a prompt decrease in S. mansoni liver egg load with no viable eggs 10 weeks after treatment. Liver fibrosis was modestly diminished in treated mice compared to untreated controls 10 weeks after treatment; fibrosis was arrested and liver collagen content had diminished to normal levels by 20 weeks after treatment. No praziquantel toxicity was noted. The survival of treated mice was markedly greater than that of untreated infected animals. We conclude that parasitologic cure of murine S. mansoni infection is followed by arrest and eventual partial reversal of liver fibrosis under the conditions employed.