Infection of the lymphatic system by Aureobasidium pullulans in a patient with erythema nodosum leprosum

Aureobasidium pullulans is a causal agent of phaeohyphomycosis, occasionally found in men and animals. As an agent of different opportunistic fungal processes, it may cause fungemia, systemic infections and abscesses in different viscera. This paper aims to report a case of a patient with infection of the lymphatic system by A. pullulans. A 23-year-old patient being treated for erythema nodosum leprosum presented a 60-day complaint of daily fever, hoarseness, odynophagia and weight loss. Laboratory tests showed pancytopenia with severe neutropenia, cervical adenomegaly and solid contrast uptake lesion in the oropharyngeal region. Due to neutropenia and sepsis the patient was initially treated with cefepime and vancomycin, but there was no clinical improvement. Lymph node puncture-aspiration showed yeast-form fungus identified as A. pullulans by sequencing ITS region. The patient was treated with amphotericin B deoxycholate, leading to complete recovery of bone marrow function and regression of adenomegaly and the oropharyngeal lesion.

AIDS encephalopathy in a 14-Year-old girl

Human immunodeficiency virus [HIV] syndrome encephalopathy is a known clinical entity, but it is not a common presenting feature in HIV infected children. It is usually associated with a long illness history and low CD4 counts. We report a young patient who had many rare features at presentation. She had acquired HIV infection vertically from her mother. The other rare feature she had was gross hepatomegaly due to extensive fatty infiltration proved by liver biopsy to be exclusively due to HIV infection

An Outbreak of Oropharyngeal Tularemia with Cervical Adenopathy Predominantly in the Left Side

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.

Percutaneous ultrasound-guided fine needle aspiration of abdominal lymphadenopathy in AIDS patients.

OBJECTIVE: To analyse the causes of abdominal lymphadenopathy in AIDS patients and evaluate the performance success rate, diagnostic yielding rate and safety of ultrasound (US)-guided fine needle aspiration (FNA). MATERIAL AND METHOD: Medical records of HIV seropositive with abdominal lymphadenopathy who underwent percutaenous US-guided FNA from August 1997 to January 2002 were retrospectively reviewed. Records of clinical and ultrasonographic findings, numbers of FNA performed, numbers of obtained specimen, laboratory results and postoperative problems were analysed. Performance success is defined as obtaining a specimen while diagnostic yielding is performance success with laboratory result. RESULTS: FNA was done 72 times in 71 patients obtaining specimens in 68 cases (performance success rate = 94.4%) with positive laboratory result in 63 cases (diagnostic yielding rate = 87.5%). The culture gave results in 56 cases; M. tuberculosis (TB) = 36, TB with other organisms = 5, Mycobacterium avium complex = 2, Nontuberculous mycobacterium = 10, C. neoformans = 1, Salmonella with positive fungal stain = 1, E. coli with P. mirabilis = 1. Five cases had positive AFB without culture specimen and one revealed positive AFB stain but negative culture. Lymphoma was found in only one case. No postoperative hemorrhage, peritonitis or perforated bowel in patient or needle stick injury to medical staff was reported. CONCLUSION: Abdominal lymphadenopathy at Bamrasnaradura Hospital is mostly caused by TB and the second most common is nontuberculous mycobacterium. Percutaneous FNA under US guidance could yield definite diagnosis with a high performance success rate, high diagnostic yielding rate and was safe.

Septic shock secondary to scrub typhus: characteristics and complications.

Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi transmitted by the bite of larval trombiculid mites (chiggers). A prospective study was conducted in septic shock patients in Maharat Hospital, Nakhon Ratchasima Province, Thailand, from 12 November 2001 to 5 January 2002. Of the 51 septic shock patients studied during the 7 week period, 18 (35.3%) were found to have evidence of scrub typhus infection; 3 patients (16.7%) died. In this study, septic shock caused by Orientia tsutsugamushi is the most prominent (35.3%) in endemic area of scrub typhus. Scrub typhus with septic shock patients results in organ failure: respiratory failure, DIC were predominant, followed by renal and hepatic involvement. Two deaths were due to respiratory failure and one death was as a result of combined respiratory and renal failure. Fever was the most common symptom, followed by headache, myalgia and dyspnea; lymphadenophathy and eschar are common signs. Laboratory findings revealed that almost all of the patients had a mild leukocytosis, reduced hematocrit and thrombocytopenia; SGOT, ALP, direct bilirubin (DB), total billirubin (TB), BUN, Cr were elevated; hypoalbuminemia was noted. Urinalysis showed that 88.9% of the patients had albuminuria. 77.8% of patients had abnormal chest X-rays.

Cutaneous lymphatic sporotrichosis.

The first case of cutaneous lymphatic sporotrichosis from Nagaland and a case of cutaneous sporotrichosis from Kerala who had acquired infection from Assam are reported. The diagnosis in both cases were established by isolating Sporothrix schenckii from multiple cutaneous lesions. The dimorphic nature of fungus was established in vitro by demonstrating the mycelial phase at 25-30 degrees C and yeast phase at 37 degrees C and pathogenicity to white mice. Both the patients were successfully treated with oral administration of potassium iodide for 3 months.

Cytologic diagnosis of tuberculous lymphadenitis in children by fine needle aspiration.

One hundred consecutively diagnosed cases of tuberculous lymphadenitis in children have been analysed retrospectively. All cases were stained by May Grunwald Giemsa for cytomorphology and Ziehl Neelsen stain for acidfast bacilli (AFB). In 52 cases the material was sufficient and AFB cultures were possible. A diagnosis of tuberculosis was made when smears showed epithelioid cell granulomas or AFB on either smears or culture. M. tuberculosis and atypical mucobacteria were cultured in 26 and 3 cases respectively. In 6 cases the diagnosis of tuberculosis would have been missed but for culture studies, the cytologic smears were necrotic and stains for AFB negative.