Further details of third recorded case of redwater (Babesiosis) in man

Clinical details and laboratory and postmortem findings of a human case of redwater (piroplasmosis or babesiosis) caused by Babesia divergens. This is the third proved case in man. All three patients had had splenectomies.     

Visual impairment from fibrous dysplasia in a middle-aged African man: a case report

Introduction

Fibrous dysplasia is a benign tumour of the bones and is a disease of unknown aetiology. This report discusses a case of proptosis and visual deterioration with associated bony mass involving the right orbit.

Case presentation

A 32-year-old Nigerian man of Yoruba ethnic origin presented to the eye clinic of our hospital with right-eye proptosis and visual deterioration of 7-year duration. Presentation was preceded by a history of trauma. Proptosis was preceded by trauma but was non-pulsatile with no thrill or bruit but was associated with bony orbital mass. The patient reported no weight loss. Examination of his right eye showed visual acuity of 6/60 with relative afferent pupillary defect. Fundal examination revealed optic atrophy. Computed tomography showed an expansile bony mass involving all the walls of the orbit. The bony orbital mass was diagnosed histologically as fibrous dysplasia. Treatment included orbital exploration and orbital shaping to create room for the globe and relieve pressure on the optic nerve.

Conclusion

Fibrous dysplasia should be considered in the differential diagnosis of slowly developing proptosis with associated visual loss in young adults.

     

Babesiosis in Italy: an overview

Babesiosis is a tick-transmitted disease caused by hematotropic parasites of the genus Babesia. Tick-borne diseases (TBD) have increasingly been recognized in the world as public health problems. The piroplasms are transmitted by ticks and are able to infect a wide variety of vertebrate hosts which are competent in maintaining the transmission cycle. Babesiosis occurrence is usually linked to seasonal variations that affect the vector, but climatic changes have not been common in the subtropical regions of Italy, especially during the last few years. This paper is aimed at compiling information about babesiosis in Italy both from the available literature and from the records of our Centre. Recent biotechnological approaches have aid to the detection of parasites and the monitoring of tick vectors. Moreover, our research has lately been focused on the investigation of the presence of Babesia parasites in wild animals, yielding very interesting results.     

Neurilemoma of the breast in a man. A case report.

A case of neurilemoma of the left breast in an 83-year-old man is presented, including the fine needle aspiration and biopsy diagnosis. A review of the literature did not reveal the existence of such a tumor in a man's breast. The aspirate yielded a cellular smear composed of clusters of spindle-shaped cells showing minimal atypia and Verocay bodies. The final diagnosis was established on the excised mass through histopathologic study.     

Laryngeal inflammatory myofibroblastic tumor in a man: a case report

Inflammatory myofibroblastic tumor (IMT) is a pseudosarcomatous lesion occurring in soft tissue and organs. It is known under a wide number of terms, such as inflammatory pseudotumor, plasma cell granuloma, pseudosarcomatous myofibroblastic proliferation. IMT is most commonly located in the lung, while laryngeal location is rarely described. Due to its biology it can be misdiagnosed as a malignant tumor. We present a case of IMT of larynx, recognized in time and treated with laser ablation. Our case demonstrates the importance of timely IMT recognition in order to avoid overtreatment. This diagnosis should also alert clinicians to close follow-up of these patients.     

Diagnosis of Strongyloides stercoralis in a peritoneal effusion from an HIV-seropositive man. A case report

BACKGROUND: Strongyloides stercoralis, a nematode parasite in humans with free-living and autoinfective cycles, is often an asymptomatic infection of the upper small intestine. If the host becomes immunocompromised, autoinfection may increase the intestinal worm burden and lead to disseminated strongyloidiasis. The parthenogenetic adult female larvae can remain embedded in the mucosa of the small intestine for years, producing eggs that develop into either rhabditiform, noninfective larvae or filariform, infective larvae. Manifestations of dissemination occur when the filariform larvae penetrate the intestinal wall and migrate into the blood. Pulmonary involvement is common, and the central nervous system may be affected. Blood eosinophilia is typical, and gram-negative sepsis from enteric bacteria may occur. Much less commonly described is invasion of the peritoneal cavity with peritoneal effusion. CASE: A 49-year-old man who came to the United States from Liberia 4 years earlier presented with sudden onset of severe abdominal distention, generalized weakness and marked pedal edema. Diagnostic paracentesis showed numerous filariform larvae of S stercoralis. Stool examination confirmed the presence of both rhabditiform and filariform larvae. Subsequently the patient was found to be HIV seropositive, with a CD4 lymphocyte count of 59. CONCLUSION: Early detection of S stercoralis may alter the often-fatal course of infection. The present case is the second reported one in the English-language literature of the diagnosis of S stercoralis in ascitic fluid.     

Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.     

Babesiosis: persistence in the face of adversity

Many babesial parasites establish infections of long duration in immune hosts. Among different species, at least four mechanisms are known that could facilitate evasion of the host immune response, although no one species is (yet) known to use them all. This update strives to illustrate the ramifications of these mechanisms and the interplay between them.     

Sporotrichosis in an HIV-positive man with oral lesions: a case report

BACKGROUND: Sporotrichosis is a granulomatous fungal infection caused by Sporothrix schenckii, which frequently causes cutaneous or lymphocutaneous lesions and rarely has oral manifestations. CASE: A 38-year-old, white, HIV-positive man complained of a 5.0-cm, symptomatic, ulcerated lesion with thin, superficial granulation in the soft palate extending to the uvula. Exfoliative cytology of this oral lesion showed chronic granulomatous inflammatory alterations and extracellular fungal structures consisting of periodic acid-Schiff-positive budding cells and spherical or elongated (cigar bodies) free spore forms. CONCLUSION: The clinical and cytologic findings allowed the diagnosis of sporotrichosis, demonstrating the importance of cytodiagnosis in fungal diseases.     

Babesiosis: recent insights into an ancient disease

Ever since the discovery of parasitic inclusions in erythrocytes of cattle in Romania by Victor Babes at the end of the 19th century, newly recognised babesial pathogens continue to emerge around the world and the substantial public health impact of babesiosis on livestock and man is ongoing. Babesia are transmitted by ixodid ticks and infection of the host causes a host-mediated pathology and erythrocyte lysis, resulting in anemia, hyperbilirubinuria, hemoglobinuria, and possibly organ failure. Recently obtained molecular data, particularly for the 18S rRNA gene, has contributed significantly to a better understanding of the sometimes puzzling phylogenetic situation of the genus Babesia and new information has been added to help determine the taxonomic position of many species. Moreover, it seems that owing to higher medical awareness the number of reported cases in humans is rising steadily. Hitherto unknown zoonotic babesias are now being reported from geographical areas where babesiosis was not known to occur and the growing numbers of immunocompromised individuals suggest that the frequency of cases will continue to rise. This review covers recent insights into human babesiosis with regard to phylogeny, diagnostics and treatment in order to provide new information on well known as well as recently discovered parasites with zoonotic potential.