Simultaneous chronic pulmonary paracoccidiodomycosis and disseminated cryptococcosis in a non-HIV patient

An unusual case of chronic pulmonary paracoccidiodomycosis and disseminated cryptococcosis in a non-HIV infected patient is reported in a 72-year-old previously healthy man. A chest radiograph disclosed a bilateral diffused interstitial infiltrate involving middle and lower lung fields. Specimen samples taken from the tracheal tube revealed yeast-like organisms suggestive of Cryptococcus neoformans and Paracoccidiodes brasiliensis. Blood and cerebrospinal fluid culture was positive forC. neoformans and the immunodiffusion test against paracoccidiodin revealed a precipitation band. The patient died 24 days after the admission.     

Paracoccidioides brasiliensis in a postpartum Pap smear. A case report

BACKGROUND: There are several reported cases that describe female genital tract infections with opportunistic fungi, such as Blastomyces dermatitidis, Coccidioides immitis, Aspergillus flavus, Cryptococcus neoformans and Mucor. We describe a case of paracoccidiodomycosis limited to the uterine cervix. To the best of our knowledge, no such case has been described before in the English-language literature. CASE: A 27-year-old, healthy female, gravida 3, para 2, abortion 1, presented for a routine gynecologic examination at six weeks' postpartum. Her past medical history was unremarkable. A routine cervical/endocervical smear revealed the presence of multiple fungal forms at different stages of development with a characteristic "pilot's wheel" appearance consistent with Paracoccidioides brasiliensis. Detailed medical examination of the patient did not reveal the presence of the primary infection in any other system. Cultures of the endometrium revealed no growth of the fungal organisms. The patient was asymptomatic, and therefore no therapy was initiated. Repeat Papanicolaou smears were negative for organisms. CONCLUSION: Paracoccidioidomycosis can present as a limited form, involving the cervix only. Identification and recognition of the infection are important in cytopathology.     

Polymorphism in the flanking regions of the PbGP43 gene from the human pathogen Paracoccidioides brasiliensis: search for protein binding sequences and poly(A) cleavage sites

Background  

Paracoccidioides brasiliensis is a thermo-dimorphic fungus that causes paracoccidiodomycosis (PCM). Glycoprotein gp43 is the fungal main diagnostic antigen, which can also protect against murine PCM and interact with extracellular matrix proteins. It is structurally related to glucanases, however not active, and whose expression varies considerably. We have presently studied polymorphisms in the PbGP43 flanking regions to help understand such variations.     

Lymphocyte subpopulations and cytokine production in paracoccidioidomycosis patients.

Despite the postulated role of the immune system in the control of the infection by Paracoccidioides brasiliensis, only a few studies have addressed this point in patients. The determination of total lymphocytes and their subpopulations in 6 untreated patients with the chronic form of paracoccidiodomycosis showed that half of them were lymphopenic, because of low number of CD4+ T-lymphocytes. All patients had low CD4/CD8 ratios. On the contrary, B-lymphocytes were normal in all patients. An additional patient, studied on treatment with ketoconazole, had normal lymphocyte counts in all subpopulations, as did one of the patients previously studied at diagnosis when he received specific antimycotic treatment. The production of interferon and tumor necrosis factor, determined by bioassay in supernatants of mononuclear blood cells of the patients, induced by interleukin 2 in vitro was significantly lower than that of normal subjects. These results show that patients with paracoccidioidomycosis have a defect in blood lymphocyte subsets as well as in the ability to produce regulatory cytokines.     

True median cleft of the upper lip associated with three pedunculated club-shaped skin masses

A rare case of true median cleft of the upper lip associated with three skin masses is reported. While 114 cases of median cleft of the upper lip have been reported, in our literature review we found only 1 case, reported by Sharma, in which the median cleft was associated with skin masses. The embryology of this case is also discussed.     

Monocyte adherence to Paracoccidioides brasiliensis,zymosan-C3b and erythrocyte-hemolysin in patients with paracoccidioidomycosis

Independent and dependent (C3b/Fc receptors) opsonic adherence ability of monocytes from thirty-three patients with acute or chronic paracoccidioidomycosis and from 13 healthy individuals were studied in the presence of Paracoccidioides brasiliensis (Pb), Paracoccidioides brasiliensis opsonized by patient's serum (PbPS) or normal serum (PbNS), zymosan opsonized by fresh sera from healthy donors (ZyNS) and erythrocytes opsonized by hemolysin (EA). Statistically significant differences concerning the percentage of adhered monocytes to PbPS (number of adhered monocytes/total number of monocytes) were detected between control and chronic (active and inactive) groups. Significant differences in relationship to the mean number of PbPS (number of fungi in monocytes/total number of monocytes) were also observed between control and chronic active mycosis. Present data suggest that patients with chronic disease have more ability in the first step of phagocytic activity, considered as the main effector mechanism to control the dissemination and severity of paracoccidiodomycosis. This revised version was published online in June 2006 with corrections to the Cover Date.     

A case of supernumerary nostril

A very rare case of supernumerary nostril is reported. This case is different from previously reported cases, because this accessory nostril was located nearer the nasal septum than the natural nostril and its opening was on the same level as the natural one. Although its cause and development are only speculative due to the small number of reported cases, a new hypothesis is proposed and discussed, since our findings are contradictory to previous literature.     

Are bowing of long tubular bones and preaxial polydactyly signs of the Meckel syndrome?

We describe four cases with signs resembling those of Meckel syndrome. Two cases demonstrated postaxial polydactyly; one case, preaxial polydactyly; and one case, pre- and postaxial polydactyly. Since there is at least one other reported case with preaxial polydactyly, it may be a rare sign of the Meckel syndrome. In all four cases, various degrees of bowing of the long tubular bones were observed. Since at least two cases exhibited typical Meckel syndrome and since in a few further reported cases X-ray examination revealed bowing of long tubular bones, this sign is considered to be a further, hitherto not well recognized sign of the Meckel syndrome, and not grounds for delineation of a new syndrome. An extensive review of the literature revealed, that shortened and bowed extremities may be present in about one-sixth of all cases with Meckel syndrome.     

Problemas clínicos en micología médica: problema número 47

A 66 year-old man, who had lived in Paraguay and was a rural worker, was admitted to Infectious Diseases Hospital F. J. Muñiz in Buenos Aires. He presented fever, loss of body weight, cough, mucopurulent expectoration, wide perianal ulceration, paresthesia and paresis of both legs as well as vesical and anal sphincter dysfunction. He was a heavy smoker and drinker. Thorax X-ray examination showed bilateral micronodular interstitial lesions. With a NMR of the dorsolumbar spine region a nodular lesion outside the spinal cord (which produced compression of this organ) was shown. The diagnosis of disseminated paracoccidiodomycosis was based on the finding of Paracoccidioides brasiliensis in the skin ulcer in histopathology and mycology studies, and on the positive results of serologic tests with paracoccidioidin antigen. The patient was treated with trimethoprim-sulfamethoxazole with good clinical outcome.     

沭阳县2006-2009年急性弛缓性麻痹病例流行病学分析

为了进一步掌握沭阳县急性弛缓性麻痹(AFP)病例流行特征,从而提高AFP病例的监测工作质量。根据AFP病例个案调查表进行统计分析。结果显示,沭阳县2006-2009年AFP病例监测系统共报告AFP患者28例,15岁以下儿童AFP病例年平均报告发病率为2.31/10万,其中0~4岁发病占67.86%,全程免疫占89.29%,地级医院报告病例占32.14%,AFP患者粪便标本采集率为100%。沭阳县AFP病例监测工作的各项监测指标完成情况较好,但存在薄弱环节,建议不断提高基层医务人员的AFP病例的识别能力和报告意识,消除薄弱环节,不断提高AFP监测工作质量。     

Rhinosporidiosis in man: Case reports

Three cases of rhinosporidiosis with complications, hitherto not reported, are presented. Frog-faced deformity and seizures were observed in one case, excessive bleeding, loss of olfactory sensation and septal perforation were noticed in the second case, while the third one exhibited a disseminated type of the disease. Clinical findings of these cases are discussed.     

Transcultural aspects of eating disorders: A critical literature review

A review of studies addressing anorexia nervosa and bulimia nervosa among Native Americans, African-Americans, Hispanics, Asians, Africans, and Middle Easterners yielded only 35 studies, of which 22 were qualitative case reports, three were clinical quantitative studies, and ten were non-clinical quantitative studies. The case studies reported symptoms similar to those of Caucasian patients, and eating disorders were reported in all SES classes. The clinical studies, all reported from Asian countries, described a number of cases for eating disorders quite different from one another. The non-clinical quantitative studies reported a number of cases consistent with the ranges previously reported for controlled samples of non-clinical Caucasian populations. We found few or no quantitative studies on eating disorders from Hispanic, Middle Eastern, African, or Asian countries other than Japan.     

Tsukamurella tyrosinosolvens - An unusual case report of bacteremic pneumonia after lung transplantation

Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop. Granulomatous hepatitis cases have been previously reported; however, only one case with tuberculous peritonitis exists in the current literature. We hereby present two cases, one of which is the second tubercular peritonitis case following Bacillus Calmette-Guérin treatment to be reported, and the other a case with granulomatous hepatitis. Complete cure was achieved in both cases with specific therapy. In the patient who developed peritonitis, intravesical Bacillus Calmette-Guérin therapy was recommenced after antituberculosis treatment, and completed without further complications.     

Diagnostic Alternatives Used by Veterinary Surgeons for the Recording of Udder Diseases in the Norwegian Health Card System for Cattle

A questionnaire, in which 7 cases of udder disease were described, was distributed to 890 veterinarians in Norway. They were requested to classify the cases according to the diagnostic alternatives listed in the Norwegian Health Card System for Cattle (NHCSC). The NHCSC recordings are used for progeny testing of bulls, for disease monitoring, and for research purposes. The aim of this study was to evaluate the quality of the recordings for udder diseases. The questionnaire was answered by 633 veterinary surgeons. Four cases of clinical mastitis (CM) with abnormal secretion as well as other clinical signs of inflammation were correctly classified as CM by almost 100% of the veterinary surgeons. A cow in the final stage of lactation, showing no clinical signs except for clots in the milk, was considered not to be a clinical case by more than 25% of the veterinary surgeons. A typical case of subclinical mastitis (SM) was reported as SM by 83% of the veterinary surgeons, and as CM by 16%. A subclinical case with a recent history of clots in the secretion was classified as SM by 66% of the veterinary surgeons, but almost 40% either reported CM as their sole diagnosis or considered the case to be CM in combination with SM. Of the clinical cases, those exhibiting marked local signs of inflammation and a systemic reaction were correctly classified as acute clinical mastitis (ACM) by 96%–98% of the veterinary surgeons. In the NHCSC, the diagnostic alternatives for cases of CM are ACM and chronic clinical mastitis (CCM). One case, for which the diagnosis subacute clinical mastitis was appropriate according to standard definitions, was classified as CCM by 66%), and as ACM by 6%. Based on the information given in the questionnaire, the diagnosis for 2 of the clinical cases could have been either ACM or CCM, and for both cases each of these 2 alternatives was reported by more than 43% of the veterinary surgeons. A teat lesion, which was present together with ACM in one cow, was reported by 91% of the veterinary surgeons.     

Chronic pulmonary sporotrichosis

We report a case of chronic human pulmonary sporotrichosis which was not associated with superficial manifestations involving the skin or lymph nodes. As it is difficult to verify an etiology, it is possible that some undiagnosed pulmonary granulomas could represent pulmonary sporotrichosis of the chronic type. These may have been treated for other diseases, such as a mycobacterial infection as in this case. Since the immunodiffusion test is a simple procedure and is almost always positive in chronic disease, its greater utilization should help in defining this disease more frequently. The skin test, agglutination test and culture are variably useful as documented in the literature.Sporotrichosis is a common mycotic infection which is usually confined to the skin and superficial lymph nodes. In disseminated disease, the lung is very rarely involved. Pulmonary sporotrichosis then represents a second form of primary infection though less common than the lymphocutaneous disease. Scott et al. (18) reported two cases of pulmonary sporotrichosis. Ridgeway et al. (15) at about the same time reviewed the previously reported cases up to 1962 and concluded that 12 of the cases could be accepted as sporotrichosis and added two cases of their own. Subsequently, Siegrist & Ferrington (20) and Trevathan & Phillips (23) each reported a case. Presently, approximately 50 cases have been reported in the United States (1–10, 12, 13, 16). Chronic and acute involvement have been delineated by Ridgeway et al. (15) It is believed that the following case represents one of primary pulmonary sporotrichosis of the chronic type without manifest involvement of other organs.     

Unilateral dermatomal superficial telangiectasia.

A new case of unilateral dermatomal superficial telangiectasia (UDST) is described, bringing the number of reported cases to 48. This case is unusual in that there was no underlying systemic disorder and no correlation between the onset of the disease and the physiologic hormonal states that have frequently been reported with the acquired type of UDST. The etiopathogenetic mechanisms of this disorder are discussed.     

Infanticide in wedge-capped capuchin monkeys, Cebus olivaceus

Three cases of infanticide are reported from a well-studied population of wedge-capped capuchin monkeys, Cebus olivaceus, located in the Venezuelan llanos. For each case, we examined the social context and the consequences to the reproductive success of the infanticidal male. In 1 case, the male probably killed his own son. In 2 cases, the male killed an unrelated animal. In all 3 cases, the female conceived in the following breeding season, but in only 1 case did the infanticidal male possibly enhance his own reproductive success. These data are interpreted in the light of current hypotheses for infanticide.