1/9. Chronic pulmonary paracoccidioidomycosis in the state of Rio Grande do Sul, brazil.Since 1942, when paracoccidioidomycosis was first identified in the state of Rio Grande do Sul, paracoccidioidal pulmonary lesions became a great concern to physicians. The present study focuses on 53 patients diagnosed over a seven-year period who presented paracoccidioidal lesions circumscribed to the lungs. These patients presented clinical and radiological features that simulated several pulmonary infectious and non-infectious conditions. Four unusual cases are briefly discussed. A sequence of laboratorial tests should be established for the diagnosis of pulmonary paracoccidioidomycosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Coccidioidomycosis in non-endemic areas: a case series.Coccidioidomycosis is a systemic infection caused by the soil fungus coccidioides immitis, which is endemic to the south-western united states. Manifestations range from flu-like illness to pneumonia and septic shock. diagnosis may be delayed or missed in non-endemic areas because of the low index of suspicion. We describe a series of 23 patients with coccidioidomycosis at one institution in a non-endemic area. diagnosis was often delayed. In two patients, the route of exposure could not be determined, but 20 patients had a history of residence or travel to endemic areas, and the remaining patient had an occupational history of exposure to fomites from an endemic region. Five patients were immunosuppressed. Most patients responded well to medical therapy, surgery, or both. Although coccidioidomycosis is rare in non-endemic areas, physicians must keep it in mind when evaluating patients who have traveled to endemic areas or who are immunosuppressed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. urine antigen detection of blastomycosis in pediatric patients.blastomycosis is an uncommonly recognized disease in pediatric patients. We describe 4 cases of pediatric blastomycosis that presented to our children's hospital, 2 with isolated pulmonary blastomycosis and 2 with disseminated blastomycosis. Because of variable clinical presentations and morbidity if treatment is delayed, physicians must maintain a high index of suspicion and obtain appropriate diagnostic tests promptly. For the first time, we report the effect of therapy on blastomyces antigen clearance. In our experience, the urine antigen detection for B. dermatitidis is useful for diagnosis and follow up during therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Invasive candidiasis in infants: experience from saudi arabia.There are few reports about invasive candidiasis in infants in the tropics in general and in the Kingdom of saudi arabia in particular. Two Saudi infants with invasive candidiasis are reported and their clinical features and response to treatment are compared with that found in the paediatric literature, mainly from the developed world. Prematurity, low birthweight, invasive procedures, long hospital stay and prolonged use of broad-spectrum antibiotics were found to be predisposing factors in the two patients, and we believe that a lack of awareness of these by the referring physicians led to a delay in diagnosis. The need for greater awareness and vigilance, and the dangers inherent in overlooking isolates of candida from clinical materials are emphasized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. epidural abscess, vertebral destruction, and paraplegia caused by extending infection from an aspergilloma.An aspergilloma developed in a lung cyst in a 53-year-old man. Aspergillus infection then contiguously spread to the epidural space, causing an abscess, vertebral destruction, and paraplegia at the level of T4. Chronic alcoholism, liver cirrhosis, and corticosteroid treatment may have been predisposing factors in this patient. Although Aspergillus epidural abscess has been described infrequently, this complication has not been described in association with an aspergilloma. Symptoms, signs, or roentgenographic or laboratory findings suggestive of vertebral or meningeal pathologic lesions in patients with aspergilloma should alert the physician to the possibility of contiguous spread of infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Pulmonary penicillosis marneffei: report of the first imported case in canada.A 57-year-old female, born in laos and who had lived in thailand prior to immigrating to canada in 1989, was seen by her physician with a chief complaint of cough and dyspnea. Her chest X-ray showed bilateral pulmonary air fluid levels. A fungus, with a diffusible red pigment, tentatively identified as penicillium marneffei, was isolated from the patient's bronchial washings and sputum specimens. At 37 degrees C, the fungus converted to a yeast form when cultured on brain heart infusion agar. Microscopic examination of this culture revealed yeast cells that reproduced by fission. The identity of the patient's isolate was confirmed as P. marneffei with an exoantigen test. The patient's serum demonstrated specific antibodies to P. marneffei antigen. Treatment with amphotericin b and ketoconazole resulted in clinical improvement, clearing of chest x-rays and conversion to sero-negativity. Our case is the first recorded diagnosis of imported penicillosis marneffei in canada. The minimal inhibitory concentrations recorded for the patient's isolate to fluconazole, 5-fluorocytosine, itraconazole and miconazole were 12.5, 0.39, < 0.195 and < 0.195 micrograms/ml, respectively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Early onset of pulmonary mucormycosis with pulmonary vein thrombosis in a heart transplant recipient.Pulmonary infections are major complications in heart transplantation. Progress in antimicrobial chemotherapy has switched the clinical spectrum to an increased incidence of fungal pathogens, such as candida and Aspergillus species. mucormycosis is a rare opportunistic infection with high mortality in solid-organ transplant recipients usually ensuing several months after transplantation. We describe a 45-year-old patient with pulmonary mucormycosis manifestion 5 days after heart transplantation. The infection resulted in pulmonary vein thrombosis followed by hemorrhagic infarction. Despite antifungal treatment and surgical resection, the patient died on day 14 after transplantation. Antemortem diagnostic procedures were negative; autopsy confirmed the presence of rhizopus oryzae invading blood vessels. We conclude that physicians must be aware of mucormycosis even within one week after heart transplantation--which has not been described so far. Invasive diagnostic workup is mandatory in case of suspicion; amphotericin b and, in selected cases, surgical resection are the mainstays of therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. cystic fibrosis in an elderly woman.cystic fibrosis (CF) is thought of by most physicians as a disease of children. Advances in therapy have extended the life span of patients so that many pulmonary internists have responsibility for the care of young adults with CF. Nevertheless, the initial diagnosis of CF after the age of 30 years is unusual, and a diagnosis after the age of 60 years is rare. Such a case is reported here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Acute community-acquired pneumonia due to Aspergillus in presumably immunocompetent hosts: clues for recognition of a rare but fatal disease.This article reports a case of acute community-acquired pneumonia due to aspergillus fumigatus in a healthy patient and reviews 11 previously reported cases occurring in presumably immunocompetent hosts. The diagnosis was delayed for all patients; mortality was 100%. Clues that might suggest Aspergillus as a pathogen in community-acquired pneumonia include a chest radiograph revealing diffuse infiltrates or new cavitation; lack of bacterial or viral cause; a preceding influenza A infection; and respiratory secretion cultures positive for Aspergillus. When these clues are present, the physician should consider an early biopsy of lung tissue. Increased recognition and more timely diagnosis in future cases will improve the outcome of this rare but fatal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |