1/3. hypercalcemia associated with infection by cryptococcus neoformans and coccidioides immitis.BACKGROUND: Of the 13 reported cases of hypercalcemia associated with fungal infection, 1 was caused by cryptococcus neoformans and probably mediated by increased levels of 1,25-dihydroxyvitamin D [1,25(OH)2D]. Eight others were associated with coccidioides immitis, of which only 2 had measured 1,25(OH)2D levels; in both, they were diminished. We report a patient with human immunodeficiency virus infection and simultaneous C. immitis and C. neoformans pneumonia and C. immitis fungemia associated with hypercalcemia. methods: Consecutive measurements of serum total and ionized calcium, phosphorous, blood urea nitrogen, creatinine, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrp) and albumin were performed over a period of 46 months. RESULTS: While the patient was hypercalcemic, intact serum PTH and PTHrp were undetectable, serum 25(OH)D levels were normal, and serum 1,25(OH)2D levels were in the high normal range. Successful treatment of the C. immitis and C. neoformans infections resulted in resolution of the hypercalcemia and increase of PTH and PTHrp to the normal range. CONCLUSION: In some patients with hiv infection, coincident hypercalcemia, and severe fungal infection, the responsible factor may be 1,25(OH)2D. Although total serum levels of this compound may not be frankly elevated, they are inappropriately high for the circumstances. Free 1,25(OH)2D levels should be determined in this situation.- - - - - - - - - - ranking = 1keywords = immitis (Clic here for more details about this article) |
2/3. Primary diagnosis of disseminated fungal disease by fine-needle aspiration of soft-tissue lesions.Two cases of disseminated fungal infections diagnosed by fine-needle aspiration of soft-tissue masses are presented. Both patients were initially treated on an outpatient basis for a presumed musculoskeletal disorder before the diagnostic biopsy was obtained. The first patient apparently contracted coccidioides immitis infection while residing in arizona, but the diagnosis was rendered on an aspirate of a buttock mass performed in boston. The second patient, a non-insulin-dependent diabetic, was diagnosed with a cryptococcal abscess on an aspirate of a shoulder mass performed in the emergency room. The diagnosis of coccidioidomycosis was confirmed by culture and that of Cryptococcus by serology. Fungal infection was clinically unsuspected in both patients and the cytologic diagnosis facilitated rapid implementation of therapy.- - - - - - - - - - ranking = 0.125keywords = immitis (Clic here for more details about this article) |
3/3. Isolation of human fungi from soil and identification of two endemic areas of cryptococcus neoformans and coccidioides immitis.The present study was carried out in two different areas of Province of Cordoba, argentina, where there was a suspicious of endemic mycosis. The previous data were the presence of a clinical case of pulmonary cryptococcosis in one area (Alta Gracia) and the previous findings of a high incidence of coccidioidin and cryptococcin reactors in the population of the second one (Villa Dolores). In both areas soil samples for fungi were studied and cryptococcus neoformans was found in 2/25 samples from Alta Gracia. In Villa Dolores coccidioides immitis was isolated in 2/40 samples, and C. neoformans in 1/40 samples. Delayed hypersensitivity test with cryptococcin was determined in the population from Alta Gracia and it was found to be 5.3%. Positive cutaneous tests with coccidioidin (33.8%) and cryptococcin (31.9%) in Villa Dolores were obtained. With these findings two endemic areas of systemic mycoses in Cordoba, argentina were delimited.- - - - - - - - - - ranking = 0.625keywords = immitis (Clic here for more details about this article) |