| diagnosis of the human cyclosporiasis is reported in Sao Paulo, SP, Brasil. cyclospora cayetanensis has been identified in the feces of a patient by a modified Kinyoun staining method, with later sporulation in a solution of 2.5% potassium dichromate. The probability that this parasite is the eventual cause of gastrointestinal disturbances in the country was stimulated by this finding, which was arrived at by a simple technique. It had been kept in mind that the disease was expressing itself mainly among immunocompromised patients, whose number is increasing; especially in those with acquired immunodeficiency syndrome (AIDS), which is caused by the human immunodeficiency virus (hiv). ( info) |
2/64. cyclosporiasis: clinical and histopathologic correlates. Although the histopathologic changes associated with cyclospora cayetanensis infection have been previously described, the histopathology and the appearance of various life cycle stages have not been correlated with severity, stage, and duration of clinical disease. We report a prospective clinical investigation of disease characteristics and histopathologic findings in three otherwise healthy, immunocompetent patients with symptomatic C. cayetanensis infection, the duration of which ranged from 6 to 60 days. Varying degrees of gross and microscopic gastrointestinal inflammation were seen before treatment. An electron-dense phospholipid membrane/myelin-like material was variably present both before and after treatment. The greatest amount of myelin-like material was seen in the patient with prolonged disease. The results of our study suggest that inflammatory changes associated with C. cayetanensis infection may persist beyond parasite eradication. It is intriguing to speculate that the myelin-like material is a marker for persistent inflammation, but further study and confirmation are needed. ( info) |
3/64. Two simultaneous cases of cyclospora cayatensis enteritis returning from the dominican republic. According to the "International Passenger Survey," published in 1996 by the Office of Trading Standards, 534,000 British people traveled to the Caribbean area (personal communication, ABTA, 1998). The dominican republic, the eastern end of a large Caribbean island, has become in recent years one of the most popular destinations for UK holidaymakers as well as for travelers from many other countries. cyclospora cayatensis has been firmly identified as a cause of gastroenteritis among international travelers,1 including human immunodeficiency virus (hiv)-positive individuals,2 but it has not been previously reported in the literature in British individuals returning from this increasingly popular vacation destination. ( info) |
4/64. cyclospora cayetanensis in sputum and stool samples. We report the observation of acid-fast cyclospora cayetanensis oocysts in a sputum sample. The patient, a 60 year-old, hiv negative man, was successfully treated for pulmonary tuberculosis during 1997. On February 1998, he was admitted to our center due to loss of weight, cough with purulent expectoration, dysphonia and a radiological picture of pulmonary fibrosis. Bacilloscopic study of sputum (negative for acid-fast bacilli) stained with Ziehl-Neelsen technique showed large (8-10 microm) spherical, acid-fast cyclospora cayetanensis oocysts. No other pathogens were isolated on cultures from this sample or from laryngeal biopsy. Serial parasitologic studies showed C. cayetanensis and also eggs of trichuris trichiura, ascaris lumbricoides and hymenolepis nana and of entamoeba coli cysts. The patient lives in the outskirts of Buenos Aires in a brick-made house with potable water and works as builder of sewers. He travelled in several occasions to the rural area of province of Tucuman which has poor sanitary conditions. C. cayetanensis is an emergent agent of diarrhea and as far as we know this is the first time the parasite is observed in respiratory samples. ( info) |
5/64. cryptosporidiosis in an immunosuppressed renal-transplant recipient with iga deficiency. Cryptosporidia are sporozoan parasites that infect epithelial cells of the gastrointestinal tract. Infection with cryptosporidia has been found most commonly in a variety of animal species and only rarely in man. The authors report a case of an immunosuppressed renal-transplant recipient with iga deficiency who experienced diarrhea and fever and was found to have cryptosporidia in a jejunal biopsy specimen and in air-dried smears of the specimen. By electron microscopy, trophozoite, schizont, and macrogamete forms were identified, and these forms ahd morphologic features similar to those of cryptosporidia previously found in guinea pigs. Treatment of the cryptosporidial infection in this case was with trisulfapyrimidines. The efficacy of this treatment could not be evaluated because of complications. ( info) |
| Motile Enterococci are rare causes of enterococcal bacteremia, usually in immunocompromised patients. We describe a case of polymicrobial bacteremia, including enterococcus casseliflavus, escherichia coli, and morganella morganii, in an 80-year old woman, shortly after a liver biopsy performed to exclude cholangiocarcinoma. We further discuss the unique genetic characteristics and the clinical significance of such isolates, such as their intrinsic resistance to vancomycin, and the low virulence exhibited clinically. Further workup on the mechanisms of motile Enterococci resistance to vancomycin could probably yield useful information in achieving new ways of facing resistance attributed to the more usual, and malignant Enterococci. ( info) |
| BACKGROUND: Pericardial involvement with coccidioides immitis is an infrequent occurrence with a relatively unfavorable prognosis. methods: A case of coccidioidal pericarditis is presented along with a review of the medical literature on coccidioidal pericarditis to give the clinician a better understanding of the various presentations, complications and outcomes of this disease. medline (National Library of medicine, Bethesda) was electronically searched covering the years 1966-2003 using search words coccidioidomycosis and pericarditis. RESULTS: Sixteen patients were identified from the literature review and one new patient was added. All the patients were males with a mean age of 37.5 years. chest pain, dyspnea and cough were the most common presenting symptoms. Five patients had evidence of pericardial tamponade, pulsus paradoxus was noted in three patients and three patients presented with pericardial constriction. One patient had Kussmaul's sign, one patient had pericardial frictional rub and another had pericardial knock. cardiomegaly on chest x-ray was present in ten patients; EKG was noted to have low voltage in five and ST segment elevation in four patients. Delayed hypersensitivity to coccidioidal antigen was reported in nine patients and positive in eight patients. Complement fixation titers were positive in all 11 patients in whom it was assayed. Fifty-three percent of the patients with coccidioidal pericarditis died. CONCLUSION: Coccidioidal pericarditis is a rare disease entity that has a relatively unfavorable prognosis, yet many patients present with diagnostic clues to this disorder. An enhanced understanding of the clinical features of coccidioidal pericarditis may lead to improved outcomes. ( info) |
8/64. isospora belli infection in a patient with Hodgkin's disease: report of a case. A 42-year-old woman with a history of documented Hodgkin's disease for 1 year presented with watery diarrhea for 6 months. She developed watery diarrhea following recurrence of the underlying disease and use of herbs. After institution of chemotherapy, watery diarrhea persisted despite remission of the underlying disease. Stool cultures and examinations for several pathogens were negative. Later, oocysts of Isopora belli were identified in the stool. The immunological status was typical of patients with Hodgkin's disease. However, HTLV-1 seropositivity and an intact skin test for delayed hypersensitivity were noted. Institution of co-trimoxazole led to prompt resolution of the gastrointestinal symptoms within the ensuing 24 hours. Later she developed recurrent isosporiasis after chemotherapy for the underlying disease, but institution of co-trimoxazole again resolved the symptoms. She remains on maintenance therapy with co-trimoxazole. isospora belli infection should be considered in opportunistic infections in patients with Hodgkin's disease. ( info) |
9/64. isospora belli infection. A report of two cases in patients with AIDS. OBJECTIVE: To present the findings of isospora belli infection in two patients with the acquired immunodeficiency syndrome (AIDS). CLINICAL FEATURES: One patient was part Aboriginal, the other an immigrant recently arrived from peru. Both men were infected with the human immunodeficiency virus (hiv). They presented with watery diarrhoea, one with severe weight loss. isospora belli oocysts were detected in multiple faecal specimens from both patients. One patient had a concomitant infection with cryptosporidium sp. INTERVENTION AND OUTCOME: There was a rapid response to treatment with cotrimoxazole (960 mg, four times a day for 10 days). A complete response was obtained in the patient with concurrent cryptosporidiosis. The diarrhoea recurred after cessation of treatment, necessitating maintenance therapy. CONCLUSION: Although isospora belli is an uncommon cause of gastroenteritis in australia, it is increasingly recognised as a cause of diarrhoea in travellers, immigrants from endemic areas and immunocompromised people. It has also been reported in the Aboriginal community; this article reports the first case of AIDS-related isosporiasis in an Aborigine. It is likely that both patients acquired isospora belli before they become hiv seropositive. ( info) |
| In summary, we present this as the first reported case of both isosporiasis and strongyloidiasis complicating HTLV-I-associated ATLL. Prompt diagnosis and treatment of these parasites in the immunocompromised host are necessary to prevent severe wasting and dehydration. This should also prevent the significant morbidity and mortality associated with dissemination well-described for strongyloides, and recently seen at autopsy in a patient with isosporiasis. Recurrent infections are common with both organisms, therefore chronic suppressive therapy and prophylactic treatment prior to chemotherapy or steroid administration is warranted. ( info) |