Cases reported "Opportunistic Infections"

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1/39. Identification of mycobacterium shimoidei by molecular techniques: case report and summary of the literature.

    A 53-year-old woman from Melbourne, australia, with squamous cell carcinoma of the oesophagus was shown by computed tomography (CT) scan to have a left apical cavity and inflammatory changes in the right lung consistent with aspiration. Acid-fast bacilli isolated from bronchial washings were identified biochemically first as mycobacterium terrae, but later as M. shimoidei on the basis of 1) restriction fragment analysis and 2) sequencing of polymerase chain reaction (PCR) amplified 16S rDNA. Nine other descriptions of patients with M. shimoidei isolates were collated. The salient feature of isolates considered to be pathogenic was pulmonary cavitation. Most patients had underlying lung disease, including past tuberculosis or malignancy. Six of eight patients died of progressive respiratory illness, although the contribution of M. shimoidei was not always clear, and two patients improved. One patient with the acquired immune-deficiency syndrome (AIDS) died with salmonella enteritidis and M. shimoidei isolated from blood cultures. One isolate was regarded as a coloniser. There are insufficient clinical or sensitivity data on which to base recommendations for therapy, but a combination of ethambutol, rifabutin and pyrazinamide could be considered.
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ranking = 1
keywords = malignancy
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2/39. Visceral leishmaniasis: an opportunistic infection in haematological malignancy.

    Visceral leishmaniasis is a rare but potentially life threatening opportunistic protozoan infection in immunocompromised patients. The clinical manifestations in these patients are unusual and the diagnosis is difficult. They need prolonged treatment and are liable to have relapses. Here we report three patients with haematological malignancy (one with acute lymphoblastic leukaemia, one with chronic myeloid leukaemia, and one with myelodysplastic syndrome) complicated with visceral leishmaniasis. The clinical presentation, diagnosis, and outcome are discussed.
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ranking = 947.75656633096
keywords = haematological malignancy, malignancy
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3/39. cunninghamella infection post bone marrow transplant: case report and review of the literature.

    cunninghamella spp., in the class Zygomycete and order mucorales, are unusual opportunistic pathogens that have been identified with increased frequency in immunocompromised patients. Infections with this group of organisms have been seen most frequently in patients with hematologic malignancy. We describe an allogeneic bone marrow recipient who developed fungal pneumonitis and disseminated fungal dermatitis caused by cunninghamella spp. To our knowledge, this is the first reported case of cunninghamella infection in a BMT recipient. The case highlights the mortality associated with opportunistic infections in immunocompromised patients and confirms the risk factors associated with non-candida fungal infections after bone marrow transplantation.
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ranking = 1
keywords = malignancy
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4/39. Two cases of fungemia due to candida lusitaniae and a literature review.

    Reported here are two cases of candidemia caused by candida lusitaniae that occurred in two immunocompromised patients at Hospital Universitario "La Fe" in Valencia, spain. Case 1 involved a low-birth-weight premature infant with congenital nephrotic syndrome who was successfully treated with amphotericin b, and case 2 involved a 50-year old woman with a high-grade malignancy lymphoma who succumbed to the infection. Antifungal susceptibility testing of the candida lusitaniae isolates recovered from both patients revealed sensitivity to amphotericin, 5-flucytosine and fluconazole. Results are presented and discussed together with a comprehensive review of the literature, covering all previously reported cases of fungemia caused by this emerging pathogen.
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ranking = 1
keywords = malignancy
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5/39. An unusual abdominal mass in a renal transplant recipient.

    Renal transplant recipients are at increased risk of malignancy and infection. We present the case of a 72-year-old-man with recurrent bladder carcinoma, abdominal aortic aneurysm repair, and end-stage renal failure due to renovascular disease. He received a cadaveric renal allograft into his left iliac fossa, was given cyclosporin A, azathioprine, and prednisolone triple therapy immunosuppression, and had no rejection episodes. He presented four years post-transplantation with a two-year history of intermittent sweats and fevers. Previous episodes had been investigated with no firm diagnosis made. This time he had right iliac fossa pain of three weeks' duration. Examination revealed a tender mass. Investigations showed unchanged graft function, but elevated inflammatory indices. ultrasonography and computed tomography detailed an infiltrating mass associated with the sigmoid colon, which colonoscopy failed to visualise. At laparotomy a 6-cm tumor was removed, with adherent sigmoid colon and bladder dome. Macroscopically the mass was an abscess, and microscopy found acute and chronic inflammatory giant cells and fibrillary masses suggestive of actinomycosis, with no malignancy. The patient recovered uneventfully on antibiotics. At six months' follow-up, examination, inflammatory markers, and radiographic imaging showed no evidence of recurrence. Twelve months later the patient died of rupture of his proximal abdominal aorta. There was no evidence of recurrence at postmortem examination. We conclude with a brief review of actinomycosis in transplant recipients.
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ranking = 2
keywords = malignancy
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6/39. Disseminated infection due to scedosporium apiospermum in a patient with acute myelogenous leukemia.

    A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. itraconazole and amphotericin b were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.
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ranking = 1
keywords = malignancy
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7/39. stenotrophomonas maltophilia septicemia with pyomyositis in a chemotherapy-treated patient.

    pyomyositis is a rare complication of chemotherapy. A 35-year-old male patient with myelodysplastic syndrome developed stenotrophomonas maltophilia bacteremia shortly after chemotherapy, and stenotrophomonas maltophilia-related pyomyositis was encountered after recovery from neutropenia. He recovered completely after surgical drainage and a protracted course of antibiotic treatment. It is postulated that subclinical myopathy, immunosuppression secondary to the malignancy, or chemotherapeutic drugs may predispose to pyomyositis. Early recognition of this unusual complication in a cancer patient undergoing chemotherapy can prevent further catastrophes.
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ranking = 1
keywords = malignancy
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8/39. Invasive fungal and bacterial infections of the temporal bone.

    OBJECTIVES/HYPOTHESIS: Objectives were to highlight the importance of surgical therapy in treating invasive polymicrobial infections of the temporal bone, to discuss the importance of antifungal therapy, and to review the differential diagnosis of ear canal granulomatous disorders. STUDY DESIGN: Retrospective case review at a tertiary care medical center. methods: A retrospective chart review of all patients diagnosed with invasive polymicrobial temporal bone infections was performed. Four patients were identified. All patients required surgical therapy for definitive management. All patients were followed for at least 1 year or until death. RESULTS: Three of four patients had invasive fungi as pathogens. One patient had an occult squamous cell carcinoma. At the time of writing, one patient was free of disease, two were dead of disease, and one was alive with disease. CONCLUSION: Invasive polymicrobial temporal bone infections can occur in immunocompromised patients and can possibly harbor an occult malignancy. Surgical debridement may be necessary to arrive at a correct diagnosis. Modified radical mastoidectomy with parenteral antibiotic therapy and other adjunctive measures may be necessary for disease resolution.
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ranking = 1
keywords = malignancy
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9/39. Primary effusion lymphoma. A case report.

    BACKGROUND: Primary effusion lymphoma (PEL) is a rare type of lymphoma that presents as an effusion, seldom with evidence of a solid neoplasm elsewhere; thus, cytology is the basic diagnostic method. It usually occurs in hiv-positive males with a history of Kaposi's sarcoma (KS), and dna sequences of human herpesvirus 8 (HHV-8) are detected by molecular analysis. The distinct morphologic, immunophenotypic, molecular and clinical characteristics render this neoplasm a new pathologic entity. CASE: A 57-year-old, hiv-positive man presented to the hospital with ascites and absence of neoplasm on radiologic investigation. Cytologic evaluation of the ascitic fluid revealed the presence of highly atypical, pleomorphic lymphoid cells. Immunocytochemistry of the lymphoma cells was positive for CD45 (leukocyte common antigen), CD30 and epithelial membrane antigen antigens and negative for panB, panT and cytokeratin antigens. dna sequences of HHV-8 were identified by polymerase chain reaction (PCR), and dna ploidy analysis showed aneuploidy. The patient died 5 months after the diagnosis. CONCLUSION: Conventional and ThinPrep (Cytyc Corp., Boxborough, massachusetts, U.S.A.) cytology, in combination with immunocytochemistry and PCR for HHV-8 dna sequences, can lead to an accurate diagnosis of PEL. dna ploidy analysis confirms the aggressive nature of this neoplasm.
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ranking = 0.334228515625
keywords = neoplasm
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10/39. Fatal meningitis due to listeria monocytogenes in elderly patients with underlying malignancy.

    adult patients with malignancies are considered to be at a high risk for listeria monocytogenes meningitis. The microbiology Laboratory's database of the University Hospital of Ioannina, greece, was searched for cases of L. monocytogenes during the period from January 1990 to December 2002. Listerial meningitis occurred in three patients: one with brain tumour, one with chronic lymphocytic leukaemia, and one with non-Hodgkin's lymphoma. All the patients were older than 70 and they were actively receiving therapy for their malignancy. L. monocytogenes type 4b was isolated from blood and cerebrospinal fluid. All were treated with ampicillin and gentamicin, but they died shortly after the initiation of the treatment. Experience with the three present cases indicated the high mortality rate due to listerial meningitis in this immunosuppressed population. So, listeriosis should be suspected in patients with meningitis and underlying malignancy. Since meningitis due to L. monocytogenes is not distinguishable clinically from other types of bacterial meningitis, it is recommended to cover Listeria in the initial empirical therapy of bacterial meningitis in immunosuppressed patients.
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ranking = 6
keywords = malignancy
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