Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis / Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis

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)

[Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis]. / Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis.

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.

Expanded Milan criteria on pathological examination after liver transplantation: analysis of preoperative data.

BACKGROUND: We sought to evaluate the accuracy of imaging techniques related to the Milan criteria (MC) compared with the explant histology and the survival of these patients. METHODS: Between 1997 and 2006, we selected 45 cirrhotic patients with hepatocellular carcinoma distributed into two groups according to explant histology: MC and Expanded Milan Criteria (EMC). Age, gender, preoperative imaging (ultrasound [US] and/or computed tomography [CT]), maximal tumor dimension, number of tumors, explanted histology, histology degree, alpha-fetoprotein (AFP) level and vascular invasion were compared among the patients to evaluate the value of these prognostic factors for survival after liver transplantation. RESULTS: By histology 42.2% explants were identified as EMC. The mean AFP level was 204.5 ng/mL. Vascular invasion was detected in 31.5% of explants and 68.4% showed incidental tumors. The survival rates after 10 years were 47.4% whereas MC patients showed 57.77%. The mean AFP level among MC patients was 150.2 ng/mL with vascular invasion detected in 7.7% of explants, and 47.4% with incidental tumors. The overall sensitivity of the imaging techniques was 83.3% for CT and 75% for US. The specificity was 96% for CT and 80.1% for US. CONCLUSION: Scan examinations in the preoperative evaluation underestimated about 42.2% of tumors. Those patients had vascular invasion but the survival after 10 years was similar between the ECM and MC groups.

[An unusual mediastinal opacity]. / Une opacité médiastinale inhabituelle.

A 36-year old immunocompetent male from Senegal with an uneventful history was admitted for exploration of a bullous collection in the posterior mediastinum. Multifocal tuberculosis was diagnosed. Computed tomography-guided drainage removed 600 cc of caseum. The diagnosis as rupture of intrathoracic Pott's abscess complicated by a probably esophageal fistula. The clinical course was rapidly favorable with later development of mediastinal fibrosis. This uncommon case illustrates the contribution of interventional radiology recently developed in the Principal Hospital in Dakar, Senegal.

[Clinical and laboratory features of typhoid fever in Senegal. A 70-case study]. / Aspects clinique et biologique de la fièvre typhoïde au Senegal: étude de 70 cas.

Clinical and laboratory features, complications and treatment were retrospectively studied in 70 patients with bacteriologically documented typhoid fever, treated between January 1995 and June 2002 at Principal Hospital in Dakar, Senegal. Data analysis was done on a global basis as well as comparatively between the 37 children (under 15 years) and 33 adults. Mean age was 16.7 years (range, 1 to 52). The sex ratio was 1.4. Clinical manifestations included fever (97%), headache (50%), vomiting (71%), abdominal pain (54%), diarrhoea (49%), nnd splenomegaly (10%) without statistically significant difference between children and adults. Lyinphopenia was found in 51% of patients and anaemia in 78%. Coexisting illnesses Included malaria in 25.5% (mainly children) and hepatitis (transminases > 10N) in 24%. Complications included cholecystitis in 3 patients, gastrointestinal haemorrhage in 2, peritonitis in one, endocnrditis in one and osteomyelitis in one. Only one patient (HIV-positive) died. The incidence of antibiotic resistance was low, i.e., ainoxicilline: 2%, nalidixic acid: 1% and cotrimoxazole: 8.2%. No multidrug resistance was observed. This study shows that typhoid fever remains a major health problem in Dakar with slow resolution and potential complications. Amoxicililne and chloramphenicol can still be used for first-line treatment of typhoid fever. Little difference was found between children and adults.

[Dating anti-Toxoplasma IgM in pregnancy using VIDAS-ELFA methods]. / Datación de IgM anti-Toxoplasma en el embarazo con métodos VIDAS-ELFA.

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.

[Seroprevalence of toxoplasmosis in women of childbearing age, 1992-1999].

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.

[Acardiac acephalic fetus and twin pregnancy. Report of a case]. / Foetus acardiaque acéphale et grossesse gémellaire. A propos d'un cas.

The present case describes an acardiac, acephalic fetus, diagnosed by ultra-sound, during the 33rd gestational week of an insulin dependent diabetic parturient, who had developed toxemia gravida. The diagnosis had been confirmed by the autopsy. The differential diagnosis from an in-utero death of the second twin had been raised. The acardiac acephalic foetus is a rare congenital malformation observed during the monozygotic twin pregnancy. The second fetus being normal, our approach consisted in the clinical observation of the parturient, followed by cesarean section delivery the 4th day of the 36th gestational week to avoid worsening of toxemia gravida.

[Analysis of a case of severe congenital toxoplasmosis]. / Análisis de un caso de toxoplasmosis congénita grave.

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.