Cases reported "Chronic Disease"

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1/12. Systemic brucellosis with chronic meningitis: A case report.

    A young adult presenting with 11 months history of fever, headache, vomiting was found to have CSF lymphocytic pleocytosis with increased protein. His serum tested strongly positive for Brucella (standard tube agglutination titre 1: 320) whereas CSF was weakly positive. He became asymptomatic on treatment with tetracycline, rifampicin and streptomycin with significant CSF response. This case is reported because of its rarity.
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2/12. Type 2B Hiroshima: a variant of von Willebrand disease characterized by chronic thrombocytopenia and the presence of all von willebrand factor multimers in plasma.

    Type 2B von Willebrand disease (vWD) is a von willebrand factor (vWF) subtype with increased binding affinity for platelet glycoprotein (GP) Ib and is characterized by increased ristocetin-induced platelet agglutination at low concentrations of ristocetin. Usually there are no high molecular weight multimers of vWF, and platelet counts are within normal ranges in patients with type 2B vWD. We identified a variant of type 2B vWD showing the full range of vWF multimers in plasma accompanied by thrombocytopenia, which seemed to be caused by circulating platelet aggregation. Since the A1 domain and surrounding region of vWF alleles, in which mutation sites are known to be clustered in type 2B vWD, appeared normal on nucleotide sequencing, this increased binding affinity of vWF for GPIb may be due to a novel mechanism differing from that which usually underlies type 2B vWD.
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3/12. Keratopathy from congenital syphilis.

    PURPOSE: Therapeutic decision-making in syphilitic corneal disease is discussed after seeing a patient with keratopathy from congenital syphilis. methods: Case report and review of the literature. RESULTS: Laboratory evaluation of our patient revealed a nonreactive serum rapid plasma reagin (RPR) test and a positive microhemagglutination assay-treponema pallidum (MHA-TP) test. CONCLUSION: Any patient with residual interstitial keratopathy, especially if bilateral, should be suspected to have congenital syphilis if the patient or parents were ever treated for a sexually transmitted disease, if stigmata of congenital syphilis are present, or if childhood ocular inflammation occurred.
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4/12. Treatment of vaginal agglutination associated with chronic graft-versus-host disease.

    OBJECTIVE: To describe the presentation and clinical course of two patients after development of vaginal agglutination associated with chronic graft-versus-host disease. DESIGN: Case report. SETTING: Tertiary referral center for pelvic reconstructive surgery. PATIENT(S): Two patients with the diagnosis of chronic graft-versus-host disease who later developed vaginal agglutination requiring treatment. INTERVENTION(S): Surgical lysis of vaginal adhesions and postoperative use of vaginal dilators. MAIN OUTCOME MEASURE(S): Successful treatment of vaginal adhesions. RESULT(S): Both patients underwent successful surgical lysis of vaginal adhesions and maintained vaginal patency with postoperative use of vaginal dilators. CONCLUSION(S): Prompt diagnosis of vaginal agglutination in patients with chronic graft-versus-host disease and appropriate surgical correction of this complication rather than prophylaxis is the correct treatment course.
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5/12. Serial observations of chronic rotavirus infection in an immunodeficient child.

    Chronic rotavirus infection of an infant with severe combined immunodeficiency (SCID) was studied by virological examinations in association with long-term observation of his symptoms and immune status. During eleven months of hospitalization, the patient was suffering from incurable severe diarrhea with persisting excretion of rotaviruses detected by electron microscopy and the reversed-passive hemagglutination (R-PHA) test and had transient hepatitis symptom despite multiple administrations of human gammaglobulin and high calorie fluids. The detected viruses were morphologically recognized as rotavirus with double capsid structure. Polyacrylamide gel electrophoretic (PAGE) analysis of their genomic RNAs showed the long electropherotype of group A virus with abnormal migration profiles changing considerably from the early to the late phase of illness: (1) The 11th segment became undetectable; (2) the molecular weight of the 6th segment slightly increased; (3) seven to fourteen extra segments appeared; and (4) PAGE patterns of viral genomic RNAs changed every three or four months. These findings suggest that chronic infection with rotavirus accompanied the generation of extra viral genomic segments and their unusual assortments in an immunodeficient host.
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6/12. Autoimmune neutropenia in infancy due to anti-NA1 antibody: detection of antibody with immunofluorescence and agglutination test.

    The sera from two patients with chronic neutropenia in infancy were examined for the presence of antineutrophil antibodies and their specificity against neutrophil antigen by using granulocyte indirect immunofluorescence test and microleukocyte agglutination test. In the microleukocyte agglutination test, the patients' sera reacted with neutrophils from their parents and normal unrelated donors having the neutrophil antigen NA1, but not with neutrophils from NA1- donors. After the absorption of patients' sera with NA1 neutrophils, the antibody activity was completely abolished, resulting in the confirmation of the anti-NA1 antibody. In contrast, the granulocyte indirect immunofluorescence test showed positive reactions against both NA1 and NA1- neutrophils, and the specificity for anti-NA1 was found in the results of the sera absorbed with NA1 neutrophils. This suggested that the absorption experiment might be necessary to determine the specificity of the antibody for neutrophil antigen. Thus, we confirmed two cases with autoimmune neutropenia caused by anti-NA1 antibody. A combination of agglutination and immunofluorescence techniques would be recommended for investigation of neutrophil antibodies against the neutrophil-specific antigen.
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keywords = agglutination
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7/12. Surgical treatment of fungating lesion of foot due to moraxella phenylpyruvica. Case report.

    We present a case report of a man who had an abscess-like lesion on his left foot. The lesion discharged pus, enlarged, and became thicker, so that we could not differentiate the real toes from the out-growths. moraxella phenylpyruvica and pseudomonas putrefaciens were identified; direct agglutination tests were postive M. phyenylpyruvica. He was given antibiotics and antituberculosis therapy and had topical treatments. The foul odor disappeared with treatment, and the lesions were removed surgically 3 months later. The M. phenylpyruvica finally disappeared after the surgery. The final condition of this patient was markedly improved, although he had some residual scar contracture.
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8/12. Group-specific auto-immune antibodies directed to granulocytes as a cause of chronic benign neutropenia in infants.

    Chronic benign neutropenia of infancy is a disease which develops a few months after birth and which is characterized by a severe selective neutropenia, accompanied by benign but persisting infections. The cause of the disease is still unknown. The sera from 5 such patients were tested for the presence of granulocyte antibodies as a possible cause of the disease. For the detection of these antibodies immunofluorescence, agglutination and granulocytotoxicity were used. All sera contained antibodies which reacted both with the neutrophils of one or both parents of the patient and a part of a panel of unrelated donors. From the reaction patterns against the panel we could identify the specificity of three sera. Two sera were directed to the neutrophil-specific antigen NA2, and the third one reacted with a hitherto not yet recognized neutrophil-specific alloantigen which we called NE1. In 4 patients we could confirm the autoimmune character of the disease by demonstrating the antibody on the patients' own granulocytes. These results suggest that autoimmunity may be the cause of many cases of benign infantile neutropenia.
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9/12. Case report 875: Multifocal osteomyelitis--a manifestation of chronic brucellosis.

    A 62-year-old man who had had chronic brucellosis for at least 14 years, presumably caused by ingestion of unpasteurized milk, presented with recurrent, multifocal osteomyelitis involving both tibias and a humerus, which had a pathologic fracture. Radiographs showed a large destructive lesion in the humeral diaphysis with a pathologic fracture and multiloculated radiolucencies, together with sclerotic zones in multiple long bones. Histologically, necrotizing, granulomatous inflammatory changes were compatible with a diagnosis of osteomyelitis. Bone biopsy cultures and agglutination titers were positive for brucella abortus. The case represents an uncommon manifestation of Brucella infection which is particularly rare in the united states. A proper clinical examination should lead to consideration of the diagnosis.
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10/12. yersinia enterocolitica infection--an unrecognized cause of acute and chronic neurological disease? A 10-year follow-up study on 458 hospitalized patients.

    The purpose of the present study was to obtain further information about nervous system involvement associated with yersinia enterocolitica infection. During the period 1974-1983, the infection was diagnosed by antibody response (agglutination titer or ELISA) and/or isolation of the microorganism in 458 hospitalized patients. 2 patients presented with acute symptoms of the peripheral nervous system, and 6 with symptoms of the central nervous system. The 458 patients were followed for 4-14 years (until 1987). During the follow-up period another 6 patients developed chronic neurological conditions; 4 with peripheral symptoms, and 2 with central symptoms. 11 of the 14 patients experienced persistent complaints. In 1991 (10-17 years after the diagnosis of yersiniosis), 6 patients still had significant antibody response (ELISA). The possibility that the immunologically competent yersinia enterocolitica might have initiated the chronic neurological disease in these patients should not be disregarded.
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