Bilateral adrenal histoplasmosis presenting as adrenal insufficiency in an immunocompetent host in the Philippines.

Disseminated histoplasmosis, with the adrenal glands as being the only site of demonstrable disease in an immunocompetent adult, is a rare infection leading to adrenal insufficiency. This disease carries high mortality when unrecognised. We describe the first reported case of adrenal histoplasmosis in the Philippines in a 72-year-old immunocompetent, Filipino man who presented with a 3-month history of intermittent flank pain, weight loss and generalised weakness. His imaging demonstrated bilateral adrenal masses on ultrasonography and contrast-enhanced CT scan. The initial impression was adrenal cancer, however, fine-needle aspiration cytology revealed the presence of yeast cells and blood culture grew Histoplasma capsulatum The diagnosis of the case represents a diagnostic challenge in immunocompetent individuals because they manifest with non-specific symptoms. A heightened suspicion is therefore needed to prevent significant morbidity and mortality.

The bacteriology of urine in urologic patients with prolonged indwelling urinary catheters in the Philippine General Hospital

OBJECTIVE: The objective of this study was to determine the bacteriologic pattern (strain and sensitivity) of the urine of urologic patients with prolonged indwelling urinary catheters. The study also aimed to determine the presence and nature of any relationship between age, presence of significant pyuria/ hematuria, catheter type, elevated creatinine level, duration of catheterization and a positive urine culture.MATERIALS AND METHODS: This is a prospective surveillance study of urine cultures of urologic patients with prolonged indwelling urinary catheters. A urine specimen was aseptically collected for urinalysis and urine culture. Blood was also extracted for serum creatinine determination. The susceptibility and resistance pattern of isolated bacteria against the most commonly used antibiotics in the Philippine General Hospital were evaluated. Various patient factors were statistically analyzed using Fisher's exact test and unpaired T-test to determine their association with a positive urine culture.RESULTS: A total of 116 patients were included in this study. The most commonly isolated microorganism was Escherichia coli. Of the 44 samples with E. coli, 97.73% showed sensitivity against meropenem. This was followed by nitrofurantoin (75.00%) and ceftazidime (59%). Other gram-negative organisms isolated were Enterobacter aerogenes (12.41 %), Pseudomonas aeruginosa (9.66%), Enterobacter agglomerans (9.66%) and Proteus mirabilis (6.21 %). Most of the bacteria isolated were resistant to ampicillin, with a resistance rate of 92.14%., ciprofloxacin (80.71 %), and cotrimoxazole (80.0%). Not enough evidence was found to associate any clinical factor with a positive urine culture.CONCLUSION: Escherichia coli was found to be the most common bacteria in the urine of urologic patients with long-term indwelling catheters. Meropenem, nitrofurantoin and ceftazidime were found to be the most effective antibiotics against E. coli. High resistance rates were demonstrated with ampicillin, ciprofloxacin and cotrimoxazole. A larger study is recommended to establish the association of patient factors to the occurrence of bacteriuria in catheterized patients.