Assuntos
Leishmaniose Visceral/diagnóstico , Doença de Still de Início Tardio/complicações , Adulto , Medula Óssea/patologia , Ciclosporina/administração & dosagem , Diagnóstico Diferencial , Humanos , Leishmaniose Visceral/patologia , Síndrome de Ativação Macrofágica/diagnóstico , Masculino , Prednisona/administração & dosagem , Doença de Still de Início Tardio/tratamento farmacológicoRESUMO
We present the case of a 48-year-old HIV-positive man, who developed acute onset of pain in both upper limbs associated with proximal weakness and distal paraesthesia. Eight weeks prior to this presentation he had had varicella zoster affecting his right S1 dermatome. CD4 count was 355 cells/mm(3) and he was antiretroviral therapy (ART) naive. Power was 0/5 proximally and 4/5 distally in the upper limbs. Reflexes were absent and there was sensory loss in the C5, C6 and T1 dermatomes. Cerebrospinal fluid (CSF) examination showed a lymphocytosis with low glucose; however, CSF Mycobacterium tuberculosis (TB), and herpes simplex virus polymerase chain reaction (HSV PCR) were negative as was syphilis serology. Electromyography showed marked motor axonal loss. Magnetic resonance imaging (MRI) did not show any cervical spinal lesion. Varicella zoster virus (VZV) PCR was positive in the CSF. He was treated with high-dose intravenous aciclovir with good resolution of his syndrome over time and was commenced on ART. We believe this to be the first case report of varicella reactivation causing bilateral neuralgic amyotrophy in an HIV-positive patient.
Assuntos
Neurite do Plexo Braquial/virologia , Varicela/patologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Neurite do Plexo Braquial/fisiopatologia , Varicela/tratamento farmacológico , Herpesvirus Humano 3/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ativação ViralRESUMO
Varicella zoster virus (VZV) is an important pathogen after renal transplantation. In the present study, we examined the prevalence, clinical presentation and outcome of VZV infections in renal transplant recipients. Charts and medical records of adult renal allotransplant recipients were investigated to find patients with VZV infection. From December 1972 until July 2010, 1,139 patients received kidney allograft at our institution. VZV infection was diagnosed in 40 patients (3.51%). 28 patients (70%) had intensified immunosuppression prior to VZV infection occurrence. Median time of onset was 2.13 years after transplantation (range 9 days to 19.2 years). 35 patients developed VZV during the first post-transplant year (median 0.61 years). Four patients developed VZV infection more than 12 years after transplantation. 33 patients (82.5%) had dermatomal distribution, 5 (12.5%) disseminated herpes zoster (HZ), and 2 patients (5%) who were VZV IgG-negative before transplantation, developed chickenpox. Immunosuppression was reduced and patients received acyclovir. Cutaneous scarring was recorded in 7 cases (17.5%). Two patients developed post-herpetic neuralgia, which was accompanied by scarring and skin depigmentation in 1 of them. Five patients (12.5%) experienced relapse of HZ. Timely initiation of therapy may prevent development of complications and the visceral form of disease. Based on our experience with development of chickenpox, we suggest active immunization for all seronegative patients before organ transplantation.
Assuntos
Herpes Zoster/epidemiologia , Herpes Zoster/terapia , Herpesvirus Humano 3 , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Feminino , Herpes Zoster/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Prevalência , Resultado do TratamentoRESUMO
We examined a total of 1014 patients over 18 years of age; 252 with urethritis and 762 with chronic prostatitis syndrome. the mean age of patients with urethritis was 32.7 and with prostatitis syndrome 37.6 years. Clinical symptoms of urethritis were present from a few days to several months. in patients with chronic prostatitis syndrome, symptoms were present for at least 3 months. Chlamydia trachomatis alone was confirmed in 26 (10%) and in combination with Ureaplasma urealyticum in 6 (2%) patients with urethritis. in 171 (68%) patients with urethritis neither C. trachomatis nor U. urealyticum or Mycoplasma hominis were found. C. trachomatis alone was confirmed in 70 (9%), and in combination with other microorganisms in 7 (1%) patients with chronic prostatitis syndrome. in Croatia, the frequency of chronic chlamydial prostatitis has not significantly changed in the last 10 years, while the frequency of infections among adolescents decreased. the recommended regimen for acute chlamydial urethritis in Croatia is azithromycin 1.0 g as a single dose, and a total dose of 4-4.5 g azithromycin for chronic chlamydial prostatitis.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/epidemiologia , Prostatite/microbiologia , Uretrite/microbiologia , Adolescente , Adulto , Idoso , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Doença Crônica , Croácia/epidemiologia , Humanos , Masculino , Prostatite/tratamento farmacológico , Uretrite/tratamento farmacológicoAssuntos
Azitromicina/administração & dosagem , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/isolamento & purificação , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Adulto , Idoso , Infecções por Chlamydia/diagnóstico , Doença Crônica , Relação Dose-Resposta a Droga , Esquema de Medicação , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoAssuntos
Omento/cirurgia , Baço/transplante , Animais , Humanos , Métodos , Omento/diagnóstico por imagem , Radiografia , Ratos , Baço/diagnóstico por imagem , EsplenectomiaRESUMO
A new method of core body temperature monitoring is introduced and compared to currently used methods. A close correlation exists between urinary bladder temperatures and each of the techniques studied. The correlation is good when compared to esophageal and rectal temperature and best when compared to pulmonary arterial blood temperature. During rapid rewarming after extracorporeal circulation, the urine temperature consistently increases faster than rectal or esophageal and seemingly is a better measure of blood temperature rather than muscle mass temperature. Urine temperature monitoring is reliable, safe, convenient, and accurate for routine intraoperative and postoperative continuous use in adult patients with urethral catheterization.