1/30. Revival of tetracyclines--in the treatment of visceral leishmaniasis?A 37-year-old immigrant from kosovo who had been in switzerland for 2 years developed fever, cough, weight loss and malaise. serology (complement binding reaction) was positive for leptospirosis. The symptoms resolved very rapidly under vibramycin 2 x 100 mg/day for 3 weeks. However, a flare-up occurred after cessation of medication. Reexposure to tetracyclines improved the symptoms though they did not subside completely. bone marrow analysis demonstrated intracellular leishmania (amastigotes). Analysis of frozen serum preserved since the first hospitalisation and samples from the second admission were positive for leishmania (indirect fluorescence antibody test) and confirmed the diagnosis of visceral leishmaniasis. Reevaluation of the serology for leptospirosis was negative using the specific microagglutination method. Treatment with antimony for 28 days resolved all symptoms. The parasites of visceral leishmaniasis grow intracellularly and eradication may be impossible in patients with an impaired cellular immune response. Flare-ups thus recur in 60-100% of patients with organ transplants or AIDS, despite regular treatment. Our finding raises the question whether relapses are suppressed in immunocompromised patients by tetracyclines, drugs known to be well tolerated even under long-term exposure. Randomised studies are required in this setting.- - - - - - - - - - ranking = 1keywords = leishmaniasis (Clic here for more details about this article) |
2/30. 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.- - - - - - - - - - ranking = 1keywords = leishmaniasis (Clic here for more details about this article) |
3/30. Relapse of cutaneous leishmaniasis in a patient with an infected subcutaneous rheumatoid nodule.Cutaneous leishmaniasis is a protozoal infection generally considered to be limited to the skin. In israel, the disease is common in geographically defined areas and is caused predominantly by leishmania major. Sporotrichoid subcutaneous spread has been reported but is uncommon. We describe a patient with rheumatoid arthritis, treated with methotrexate and prednisone, in whom numerous rheumatoid nodules concomitant with cutaneous leishmaniasis were found, mimicking sporotrichoid spread of the disease. In a rheumatoid nodule that was examined by electron microscopy, Leishmania parasites were found at intracellular and extracellular locations. This observation supports the hypothesis that cutaneous leishmaniasis parasites persist after clinical cure of the disease and may re-emerge as a result of immunosuppression.- - - - - - - - - - ranking = 1.1666666666667keywords = leishmaniasis (Clic here for more details about this article) |
4/30. Absence of bone marrow amastigotes in a child with kala-azar and acute lymphoblastic leukaemia.Visceral leishmaniasis is suspected on the basis of clinical findings and a pancytopenic blood picture and is usually confirmed by the detection of amastigotes (Leishman-Donovan bodies) in a bone marrow aspirate. We describe a child on maintenance treatment for acute lymphoblastic leukaemia who developed visceral leishmaniasis and in whom amastigotes could not be detected in repeated bone marrow aspirates. Immunofluorescence antibody testing was positive. Immunocompromised patients in endemic areas who develop features of visceral leishmaniasis should have serological tests performed in addition to bone marrow aspiration in order to maximize the chances of making a diagnosis.- - - - - - - - - - ranking = 0.5keywords = leishmaniasis (Clic here for more details about this article) |
5/30. Hemophagocytic syndrome: a rare life-threatening complication of visceral leishmaniasis in a young boy.The authors report a case of hemophagocytic syndrome (HPS) associated with acute visceral leishmaniasis (VL). A 4-year-old boy was admitted with high fever, hepatosplenomegaly, and pancytopenia. Elevated serum ferritin and triglyceride, low fibrinogen levels, and bone-marrow (BM) histiocytic hyperplasia with prominent hemophagocytosis were consistent with a HPS. An initial diagnosis of kala-azar was refuted because of negativity of BM aspiration and serology for this parasite, and the diagnosis HPS was made. Three months after first admission, reevaluation of the BM aspiration revealed many amastigotes of Leishmania parasites. The serology of VL became positive, finally establishing the diagnosis of VL. Although specific therapy for VL was instituted, the patient died 4 weeks after the diagnosis.- - - - - - - - - - ranking = 0.83333333333333keywords = leishmaniasis (Clic here for more details about this article) |
6/30. melioidosis in systemic lupus erythematosus: the importance of early diagnosis and treatment in patients from endemic areas.Serious infection is a common problem in immunosuppressed patients with systemic lupus erythematosus (SLE). melioidosis is caused by the Gram-negative bacterium burkholderia pseudomallei and may present as an acute fulminant pneumonia or septicaemia that is often fatal. The organism is endemic in much of South-east Asia but is being increasingly reported from other parts of the world, including india, Northern australia and North and south america. In addition to occurring in people who come into contact with contaminated soil or water in endemic areas, the infection is more common in immunosuppressed patients and must be recognised early and treated with appropriate antibiotics. Importantly, it can activate many years after the initial exposure, causing diagnostic confusion. We present the cases of three patients with SLE who were admitted with fever and in whom burkholderia pseudomallei was isolated from blood cultures. Following treatment with intravenous ceftazidime all patients made a good recovery. These cases demonstrate the importance of considering this infectious organism in patients from endemic areas with unexplained fever. They also illustrate how successful outcomes can be achieved in a frequently fatal disease if an early diagnosis is made and appropriate antibiotics are started promptly.- - - - - - - - - - ranking = 3.49546792764E-6keywords = world (Clic here for more details about this article) |
7/30. Cutaneous protothecosis: report of five cases.prototheca, a genus of achlorophyllic algae, is a rare cause of opportunistic infection in humans. About 80 human cases, mostly cutaneous infection caused by P. wickerhamii, have been reported world-wide. We describe the clinicopathological findings and treatments of five cases diagnosed in our department during the period 1991-97. The patients, including four elderly farmers, presented with pyoderma-like lesions or infiltrating papules and plaques on the extensor side of the extremities or face. All patients were immunocompromised, mostly due to systemic or topical steroids. The diagnosis was made in each case by finding typical endospores with morula-like structures in skin biopsy specimens. P. wickerhamii was isolated in four cases in which pretreatment culture of skin tissue was done. Except for one patient who died of asthma, the infection was cured after 2-7 weeks of amphotericin b, ketoconazole, itraconazole or fluconazole. Our cases illustrate that cutaneous protothecosis commonly manifested non-tender, pyoderma-like or infiltrating lesions and should be considered in the differential diagnosis of deep fungal or mycobacterial infection. This rare infection seemed more frequent in our region, possibly due in part to common steroid abuse among old people in taiwan and there was a large population of elderly farmers in our area.- - - - - - - - - - ranking = 3.49546792764E-6keywords = world (Clic here for more details about this article) |
8/30. Human deep tissue infection with an entomopathogenic beauveria species.beauveria spp. are ubiquitous fungal entomopathogens that are commercially distributed as biological insecticides worldwide. In this paper we describe the clinical manifestation, diagnosis, and therapy of the first documented human deep tissue infection with an entomopathogenic beauveria species in a patient receiving immunosuppressive therapy and describe the morphological and molecular characterization of the mold.- - - - - - - - - - ranking = 3.49546792764E-6keywords = world (Clic here for more details about this article) |
9/30. cytomegalovirus infection in renal transplant patients with hepatitis b--case report.cytomegalovirus (CMV) infection in hepatitis b carrier renal transplant patients who are immunosuppressed can be easily overlooked especially in those presenting with jaundice and liver failure. Recognising hepatitis due to CMV in renal transplant patients who are also hepatitis b carriers is important therapeutically as measures for the treatment and prevention of CMV infection are already available. This is especially so as hepatitis b has a moderately high prevalence in this part of the world. We describe our clinical experience of cytomegalovirus infection in two renal transplant patients who are also asymptomatic hepatitis b carriers.- - - - - - - - - - ranking = 3.49546792764E-6keywords = world (Clic here for more details about this article) |
10/30. sepsis with bullous necrotizing skin lesions due to vibrio vulnificus acquired through recreational activities in the Baltic Sea.This report describes the case of a 59-year-old woman with a history of non-Hodgkin's lymphoma who developed bacteremia with vibrio vulnificus. The patient had been swimming in the unusually warm Baltic Sea in the summer of 2002. She presented with symptoms of septicemia and severe bullous necrotizing skin lesions of the extremities. blood culture revealed vibrio vulnificus as the pathogenic organism. Under treatment with cefotaxime and gentamicin, she recovered slowly without further complications. vibrio vulnificus is a marine bacterium that is present in aquatic ecosystems worldwide, especially when water temperatures exceed 20 degrees C. Infections with vibrio vulnificus are uncommon in europe, and most cases are reported from subtropical or tropical regions.- - - - - - - - - - ranking = 3.49546792764E-6keywords = world (Clic here for more details about this article) |
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