1/11. alternaria-associated asthma.In addition to house dust mites, there is increasing evidence that mold allergens, especially alternaria, are implicated in contributing to allergic reaction, rhinitis, and asthma indoors. Situations leading to the exacerbation of asthma in an employee were investigated and subsequent medical evaluations were performed. An industrial hygiene study was conducted and bioaerosol testing revealed several mold allergens were present. However, based on the medical evaluation and testing results (skin prick test and radioallergosorbent test [RAST]), it was concluded that alternaria was inducing the respiratory reaction. alternaria was present in the drip pan of the air conditioner unit and remedial actions were taken to remove the mold. Post-remedial bioaerosol sampling results revealed alternaria was no longer present in the air and the employee returned to the office without recurrence of symptoms. Practically, several factors should be considered prior to concluding an association between exposure and illness. First, the employee's symptoms and signs should be consistent with a medical diagnosis. Second, there should be either in vitro or in vivo evidence of exposure. Third, environmental assessment should reveal evidence of plausible biological exposure. Fourth, there should be substantial improvement or even resolution of the illness after appropriate remediation of the health hazard. This case study illustrates the importance of teamwork by industrial hygienists and occupational health physicians in treatment and prevention of occupational and environmental diseases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. More than tears in your eyes (exophiala jeanselmei keratitis).PURPOSE: To describe a patient with exophiala jeanselmei keratitis. methods. CASE REPORT: One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice. RESULTS: culture plates from corneal scraping showed a growth of the yeast exophiala jeanselmei, a rare causative agent of ocular infection. CONCLUSIONS: Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Deep mycoses prevalent in the Igbos of nigeria.During a 3-year period, 6 cases of Africal histoplasmosis, 6 of phycomycosis and 5 of mycetoma were recognized histologically in 0.4 per cent of 4,307 surgical specimens removed from Nigerian Igbos and examined at a central laboratory. Undoubtedly, these cases are but the representatives of the mycological iceberg existing in this part of the world. Our experience suggests that collaboration between physicians, pathologists and mycologists should bring about increased international awareness of the deep mycoses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Human pythiosis in Srinagarind Hospital: one year's experience.We have reported four cases of human pythiosis arteritis from Srinagarind Hospital, Khon Kaen, thailand. This unusual human infection occurring perhaps exclusively in thalassemia and hemoglobinopathy patients, should be noted by physicians, who work in areas with a high incidence of hemoglobinopathy, and for patients who present with unexplained arterial insufficiency. As our reported cases occurred within only one year, this condition may be more common than originally suspected and found more frequently if actively searched for.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Hepatic and splenic mycosis in children with acute leukemia.Three cases of hepatic and/or splenic mycosis in children with acute leukemia are reported. patients presented with fever not responding to broad spectrum antibiotics during or after prolonged and profound neutropenia. Noteworthy, in 1 case no abnormality in liver function tests was detectable at diagnosis. CT scan showed focal hepatic lesions in all patients. In 1 patient ultrasounds failed to detect hepatic lesions and showed only splenic lesions, while CT scan detected hepatic and not splenic lesions. Definitive diagnosis was performed by open liver biopsy and histological demonstration of fungal invasion. Cultures were negative in all cases. All patients survived with prolonged amphotericin b treatment (from 36 to 40 mg/kg), combined with flucytosine in two cases. In conclusion, this clinical entity should be taken into account by physicians taking care of neutropenic patients, even in the absence of abnormalities in liver function. CT seems to be the method of choice for diagnosis, although ultrasounds might be useful for detecting concomitant splenic lesions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Unsuspected infectious keratitis in host corneal buttons.Infectious keratitis may be unsuspected preoperatively in patients undergoing penetrating keratoplasty. We have diagnosed five cases of previously unknown corneal infection discovered only after post-keratoplasty histopathologic examination using specific stains. These cases of preoperatively unsuspected infectious keratitis illustrate examples where histopathologic examination using specialized stains may alert the physician to the need for appropriate postoperative antimicrobial therapy. Furthermore, these cases illustrate the ability of soft contact lenses to mask symptoms of infectious keratitis. Additionally, the clinical appearance of advanced bullous keratopathy may mask signs of infectious keratitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Synchronous bacterial and fungal septicemia. A marker for the critically ill surgical patient.Mixed septicemia (synchronous fungal and bacterial septicemia) is an occasional, but often fatal occurrence in the critically ill patient. We reviewed 14 such cases at two hospitals. Twelve of 14 patients were in the surgical intensive care unit. Eleven patients had an average of 2.7 major surgical procedures (range 2 to 4); persistent post-operative peritoneal sepsis was common occurring in 9 patients. bacteremia preceded mixed septicemia in 8 of 14 cases and gram negative enteric bacilli were the most common causes of bacteremia. fungemia was due to candida species in 13 of 14 patients and followed prolonged antibiotic therapy. The diagnosis of disseminated candidiasis was suspected during life in 13 patients and proven in six. Mixed septicemia is a marker for a distinct population of critically ill surgical patients with a high overall mortality (78% in this study). culture of both a fungal and bacterial pathogen in a blood culture, especially if preceded by bacteremia, should alert the physician to strongly suspect disseminated fungal infection and to commence appropriate treatment. mortality is likely to remain high unless the underlying disease states can be rapidly corrected and infection controlled.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Acute septic arthritis due to acremonium.A case of acremonium species arthritis in a previously healthy child is reported. This fungus has frequently been implicated in cases of mycetoma and keratomycosis in the tropics, and invasive disease has occurred almost exclusively in immunocompromised patients. The acute presentation of this illness and its successful treatment with IV amphotericin-B are highlighted to alert physicians to this pathogen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Allergic sino-orbital mycosis. A clinical and immunologic study.We present a case of pansinusitis with orbital involvement associated with an allergic response to the fungus Curvularia (Cochliobolus) lunata. Key elements to the diagnosis included a predominant eosinophilic response of the sinus mucosa, the presence of a characteristic mucoid exudate containing fungal hyphae, peripheral blood eosinophilia, serum precipitins against C lunata, elevated serum total and Curvularia-specific IgE and IgG concentrations, and immediate cutaneous reactivity to C lunata antigen. This report suggests that an exaggerated allergic response should be considered in the pathogenesis of pansinusitis. The presence of fungal hyphae in sinus mucosal specimens should alert the physician to the possibility of this disease. Sinus fungal cultures, as well as thorough immunologic evaluation, of such patients is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. superinfection: another look.superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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