ABSTRACT
Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.
With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement
Subject(s)
Humans , Male , Adult , Pneumonia/etiology , Toxoplasmosis/complications , Immunocompetence , Pneumonia/drug therapy , Pneumonia/diagnostic imaging , Aspartate Aminotransferases/analysis , Asthenia , C-Reactive Protein/analysis , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Radiography , Tomography, X-Ray Computed , Toxoplasmosis/diagnosis , Toxoplasmosis/immunology , Cytomegalovirus Infections/diagnosis , Herpesvirus 4, Human/immunology , Epstein-Barr Virus Infections/diagnosis , Cough/diagnosis , Cytomegalovirus/immunology , Diagnosis, Differential , Alanine Transaminase/analysis , Fever/diagnosis , Anemia , Anti-Bacterial Agents/therapeutic useABSTRACT
Introducción: La parasitosis por Equinococus granulosus es un problema de salud pública en Chile. El hombre, huésped intermediario, se infecta por fecalismo, generando el Quiste Hidatídico (QH), con mayor frecuencia en hígado y pulmón. Su diagnóstico generalmente es incidental mediante radiografía de tórax (RTx). Habitualmente su tratamiento es quirúrgico. Presentación del caso: Escolar, sexo femenino, 6 años; consulta en Hospital de Yungay por exacerbación de dolor en hemitórax izquierdo (HI) de 4 días de evolución, no irradiado, tipo puntada, EVA10/10, comienzo súbito, con tope inspiratorio, limita la deambulación y se asocia ese día a fiebre de 38°C. Vivienda con servicios básicos, ocasionalmente faenan animales para consumo propio, actualmente sin mascotas. Examen físico: Murmullo Pulmonar (MP) disminuido en base izquierda. RTx muestra imagen redondeada. Se deriva a Hospital Clínico Herminda Martin de Chillán. Ingresa afebril, hospitalizándose en el Servicio de Cirugía Infantil. Exámenes de Laboratorio: PCR 57,5 mg/L, GB 15,88x103/uL, VHS 54 mm/hr. Imagenológico: Ecografía: Opacidad de 6,4 cm de diámetro en HI, que por alta endemia en la zona sugiere ser QH. Hígado normal. Al séptimo día de hospitalización se realiza Quistectomía Pulmonar, la extracción de membrana hidatídica confirma diagnóstico. Alta al séptimo día postoperatorio dada evolución asintomática y normalización de exámenes. Discusión: El diagnóstico de QH requiere de alta sospecha clínica, ayuda de exámenes e imagenología. Al tratamiento quirúrgico puede asociarse el uso de Albendazol si durante el procedimiento se genera ruptura del QH.
Introduction: The Equinococus granulosuss parasitic infection is a public health problem in Chile. Human beings are intermediate host that get infected by contact with feces of an infected animal, creating the hydatid cyst (HQ), which is more often located in liver and lung. Its diagnosis is usually incidental throw a chest x-ray (RTx). Usually the treatment is surgical. Case report: Child, female, 6 years old. She consults in Yungays Hospital because of an episode of exacerbated left hemithorax (LH) pain of 4 days of evolution, none irradiated, with stabbing pleuritic character and EVA10/10 intensity, sudden onset that limitedambulation and that was associated with fever of 38°C. House with basic services where occasionally animal slaughters where done for their own consumption, currently without pets. Physicalexamination: pulmonary murmur (MP) decreased in LH. RTx showed a rounded image. Shes derived to Herminda MartinClinical Hospital of Chillán, where shes hospitalized in the Pediatric Surgery Service presenting no fever. Laboratory Tests: CRP 57.5 mg/L, 15.88 GBx103/uL, VHS 54 mm/hr. Ultrasound-Scan: Opacity of 6.4 cm of diameter in LH, which, because the area was highly endemic, suggested a HQ. Normal liver. On the seventh day of hospitalization a Pulmonary Cystectomy is made. Hydatid membrane extraction confirmed diagnosis. Discharge on the seventh postoperative day because of asymptomatic evolution and normal tests results. Discussion: The diagnosis of HQ requires high clinical suspicion and imaging tests support. Surgical treatment may be associated with the use of albendazole if during the procedure the HQ is broken rupture.
Subject(s)
Humans , Female , Child , Echinococcosis, Pulmonary/surgery , Echinococcosis, Pulmonary/diagnosisABSTRACT
Lophomonas sp. es un parásito habitual del tracto intestinal de las cucarachas y que no es reconocido como patógeno humano. Sin embargo, en la literatura mundial existen escasos reportes de Lophomonas sp. en secreciones del tracto respiratorio en pacientes con enfermedad pulmonar grave, principalmente en adultos. Presentamos evidencias de Lophomonas sp. en el tracto respiratorio inferior de niños atendidos en el centro de referencia nacional de enfermedades pediátricas de Lima, Perú, en el periodo 2009-2010. Se encontró seis casos, 4/23 provenientes de muestras de lavado broncoalveolar y 2/794 muestras de aspirado traqueal de niños. Cinco de ellos tuvieron neumonía y uno atelectasia, cuatro estuvieron en la unidad de cuidados intensivos. Es necesario conocer más sobre la presencia de este organismo en infecciones respiratorias así como su rol patogénico real.
Lophomonas sp. is a habitual parasite of the intestinal tract of the cockroaches and that is not recognized as pathogenic human being. Nevertheless, in the world literature are few reports of Lophomonas sp. in respiratory tract secretions in patients with severe pulmonary disease, mostly in adults. We present evidences of Lophomonas sp. in the respiratory low tract of children attended in the national reference center of paediatric diseases of Lima, Peru, in the period 2009- 2010. We found six cases, 4/23 from broncoalveolar lavage and 2/794 from tracheal aspirate samples of children. Five of them had pneumonia and one atelectasis, four were hospitalized in the intensive care unit. Increase knowledge about the presence of this organism in respiratory infections is needed, as its real pathogenic role.
Subject(s)
Adolescent , Animals , Child , Child, Preschool , Humans , Infant , Bronchoalveolar Lavage Fluid/parasitology , Lung Diseases/parasitology , Parasites/isolation & purification , Cross-Sectional Studies , Hospitalization , Severity of Illness Index , Trachea/parasitologyABSTRACT
Indivíduos infectados com Schistosoma mansoni na fase crônica da doença podem apresentar comprometimento pulmonar com sintomatologia e alterações radiológicas variáveis. Os pulmões podem ser acometidos pela migração anômala de ovos do sistema porta para o sistema arterial pulmonar (através de anastomoses porto-sistêmicas) e menos comumente por migrações ectópicas de vermes adultos. Há casos com extenso comprometimento parenquimatoso e outros com predomínio de arterites, com hipertensão pulmonar e cor pulmonale. Paciente jovem, residente em área endêmica de esquistossomose, com massa pulmonar sugestiva de neoplasia foi submetida a toracotomia exploradora sem possibilidade de ressecção da massa. Exame histopatológico mostrou vários granulomas esquistossomóticos e hiperplasia do tecido conjuntivo, sem sinais de neoplasia. Evoluiu com insuficiência respiratória e instabilidade hemodinâmica no pós-operatório imediato. Recebeu tratamento específico (praziquantel) associado a prednisona. A paciente cursou com infecção pulmonar e choque séptico. Recebeu antibioticoterapia, aminas vasoativas, suporte ventilatório e tratamento hemodiálitico sem melhora. Evoluiu para óbito 28 dias após cirurgia.
Patients with chronic Schistosoma mansoni infection may feature a range of pulmonary symptoms and radiological findings. Eggs, and rarely adult worms, may passively enter the pulmonary circulation, usually via the portal system, where they may cause pulmonary inflammation, fibrosis, hypertension and cor pulmonale. A 25-year-old patient who lived in a schistosomiasis endemic area with a pulmonary mass suggestive of malignancy underwent exploratory thoracotomy. The mass was adherent, with no resection possibility. The lung-biopsy specimen evaluation showed several granulomas with Schistosoma mansoni eggs and hyperplasic connective tissue with no sign of malignancy. The patient had respiratory failure and hypotension immediately post-surgery. Specific treatment (praziquantel) and prednisone were given. The patient had pneumonia and septic shock. The patient was given antibiotics, vasopressors, mechanical ventilation and hemodialysis with no improvement, and subsequently died 28 days after the surgery.
ABSTRACT
Objective To discuss the imaging features of pulmonary lophomonas blattarum infecfiom Methods Seventeen patients with renal homotransplantations presented fever without congh.dyspnea and shortness of breath in 1-4 months after the transplantation were included.Chest X-ray abnormalities were comfirmed as pulmonary lophomonag blattarum infection through fiberoptic bronchoscopy (FOB)and bronchoalveolar lavage(BAL).The X-ray and CT films were reviewed and the imaging features were summarized.Results X-ray appearances:Bilateral pulmonary shadows were seen in 16 patients.of which 9 cases presented patchy and cord shadows,and 7 cases presented large area of pathy shadows.Lung marking increase Wag seen in 1 case.CT appearances:CT abnormalities presented bilaterally and involved more than two lobes in all 16 patients.15 eases displayed ground-glass opacity.11 cases displayed patchy consolidation,14 cases displayed bandlike attenuation,and 8 cases displayed nodular opacity.Ground-glass opacity,consolidation and bandlike attenuation were seen simultaneously in 11 cases.Lymph node enlargement in mediastinum Wag presented in 10 cages.Conclusion Pulmonary lophomonas blattarum infection should be suspected in immunosuppressed patients combining the CT appearances and clinical information.