Neumonía lipoidea exógena crónica y sobreinfección por Mycobacterium tuberculosis / Chronic Exogenous Lipoid Pneumonia and Superinfection by Mycobacterium Tuberculosis

Introducción: la neumonía lipoidea exógena es una enfermedad pulmonar inflamatoria poco común, desencadenada por la inhalación o aspiración de material graso de origen animal, vegetal o mineral. El diagnóstico se establece a través de confirmación histo-patológica, por la presencia de macrófagos cargados de lípidos en muestras respirato-rias, asociado a las características clínicas específicas al momento de su presentación.Requiere de un alto nivel de sospecha y una adecuada anamnesis de los antecedentes exposicionales del paciente debido a que muchos casos son subdiagnosticados y trat-ados como neumonía adquirida en la comunidad, lo que retrasa su diagnóstico y mane-jo, sumado a la ausencia de guías disponibles para su tratamiento.Se han reportado pocos casos de sobreinfección por tuberculosis en pacientes con neu-monía lipoidea exógena crónica. Caso clínico: femenino 33 años, con antecedentes de exposición crónica a sustancias desinfectantes de características aceitosas sin protección de vía aérea, con cuadro de tos y dolor torácico. Conclusión: el diagnóstico temprano, asociado a tratamiento de soporte, general-mente conservador, favorece la mejoría clínica y radiológica, y de esta manera dis-minuye la morbimortalidad. (AU)

Introduction: exogenous lipoid pneumonia is a rare inflammatory lung disease, trigge-red by inhalation or aspiration of fatty material of animal, vegetable or mineral origin. The diagnosis is established through histological confirmation by the presence of lipid-laden macrophages in respiratory samples, associated with the specific clinical charac-teristics at the time of presentation. It requires a high level of suspicion and an adequate anamnesis of the patient's expo-sure history, since many cases are underdiagnosed and treated as community-acquired pneumonia, what delays its diagnosis and management, added to the absence of avai-lable guidelines for its treatment. Few cases of tuberculosis superinfection have been reported in patients with exoge-nous lipoid pneumonia.Clinical case: 33-year-old female, with a history of chronic exposure to oily disinfectant substances without airway protection, with symptoms of cough and chest pain.Conclusion: early diagnosis, associated with supportive treatment, generally conser-vative, favors clinical and radiological improvement, thus reducing morbidity and mor-tality. (AU)

Neumatocele traumático: una presentación inusual del trauma cerrado de tórax en paciente de 21 años / Traumatic pneumatocele: an unusual presentation of blunt chest trauma in a 21-year-old patient

El neumatocele traumático, o pseudoquiste pulmonar traumático, es una complicación infrecuente del trauma cerrado de tórax, caracterizada por lesiones cavitadas únicas o múltiples de paredes fibrosas bien delimitadas, sin revestimiento epitelial. Representa un reto diagnóstico ante la prevalencia de etiologías más frecuentes de cavitación pulmonar, presentación clínica inespecífica y el carácter subreportado de la patología. Se presenta el caso de un paciente de 21 años, con cuadro clínico de fiebre y dolor torácico posterior a traumatismo contuso por accidente en motocicleta, con identificación de una lesión cavitada rodeada de vidrio esmerilado, ubicada en lóbulo superior derecho en tomografía de tórax. Se ofreció tratamiento antibiótico ante la sospecha clínica de sobreinfección. Sin embargo, se atribuyó la alteración pseudoquística pulmonar al antecedente traumático. En ocasiones las cavitaciones pulmonares postrauma no son identificadas en la atención inicial, por ende, es fundamental la evaluación clínica e imagenológica subsecuente.

Traumatic pneumatocele, or traumatic pulmonary pseudocyst, is a rare complication of blunt chest trauma, characterized by multiple or unique cavitary lesions, with well-defined fibrous walls without epithelial lining. It represents a diagnostic challenge due to the higher prevalence of other etiologies of lung cavities, nonspecific clinical features and the under-reported nature of this pathology. We present the case of a 21-year-old male with fever and chest pain after a blunt chest trauma in a motorcycle accident, with identification of a cavity in the right upper lobe, surrounded by ground glass opacities. Antibiotic therapy was administered after clinical suspicion of superinfection, however, the cavitary lesion was attributed to the trauma. Occasionally, traumatic pulmonary pseudocysts are not identified during initial assessment, therefore, clinical and imagenologic follow-up is essential.

Superinfection / Sobreinfección

Actualmente, en la jerga médica se oyen algunos usos inadecuados de este término, como EPOC sobre infectada, sobreinfección de úlcera venosa, venas varicosas sobre infectadas, enfermedades que en principio no son de origen infeccioso, aunque puedan llegar a complicarse con una infección secundaria. Conocer la etimología ayuda a aclarar la situación.

Terapia vestibular en vestibulopatía bilateral por gentamicina: reporte de un caso y revisión de la literatura / Vestibular therapy in a case of gentamicin-induced vestibulopathy: case report and literature revision

La vestibulopatía bilateral es poco frecuente, se caracteriza principalmente por inestabilidad al caminar o al estar de pie, visión borrosa inducida por el movimiento u oscilopsia al caminar o al realizar movimientos rápidos de la cabeza o del cuerpo, empeoramiento de la estabilidad en la oscuridad o terrenos irregulares, reducción de los síntomas al estar en condiciones estáticas, ganancia del reflejo vestíbulo-ocular angular reducida de forma bilateral, entre otros. Existen múltiples causas. Dentro de las causas identificables, se describen principalmente medicamentos ototóxicos, meningitis y enfermedad de Ménière. Se presenta el caso de una paciente de 64 años diagnosticada con vestibulopatía bilateral posterior a tratamiento intramuscular con gentamicina por sobreinfección bacteriana cutánea de las manos. La evaluación vestibular complementada con videonistagmografía y prueba de impulso cefálico asistida por video confirman el diagnóstico y se inicia tratamiento con rehabilitación vestibular enfocada en promover la compensación central a través de estrategias de sustitución principalmente; además de habituación y adaptación vestibular, favoreciendo la estabilización de la mirada, mantención del equilibrio, control postural, marcha y reducción de los síntomas.

Bilateral vestibulopathy is infrequent, and it is characterized mostly by unstable walking or when standing, blurred vision induced by movement, or oscillopsia when walking or performing fast movements; worsening of the stability in darkness or uneven ground, but with lack of symptoms in static conditions. Other symptoms may include bilateral reduction of the oculo-vestibular reflex. Among the identifiable causes, there is the use of ototoxic medication, meningitis, Ménière's disease, although it can be idiopathic or have a neurological cause. We hereby describe the case of a 64-year-old woman, diagnosed with bilateral vestibulopathy secondary to intramuscular treatment with gentamicin due to a bacterial hand infection. Vestibular assessment was complemented with video-nystagmography and video head impulse test which confirmed the diagnosis, and therapy was started with vestibular rehabilitation focused on promoting central compensation mainly, through substitution strategies. Also, habituation exercise and vestibular adaptation strategies were used, thus promoting sight stabilization, balance maintenance, postural control, walking, and reduction of the symptoms.

Superinfection exclusion studies using West Nile virus and Culex flavivirus strains from Argentina

In Argentina, many Flavivirus were recognised including West Nile virus (WNV). During 2009 several strains of Culex Flavivirus (CxFV), an insect-specific flavivirus, were isolated in the same region where circulation of WNV was detected. Hence, the objective of this study was to analyse the effect of co-infection in vitro assays using CxFV and WNV Argentinean strains in order to evaluate if CxFV could affect WNV replication. Our results showed that WNV replication was suppressed when multiplicity of infection (MOI) for CxFV was 10 or 100 times higher than WNV. Nevertheless, in vivo assays are necessary in order to evaluate the superinfection exclusion potential.

Caso clínico: neumonía de comunidad grave COVID-19 / Case report: serious community pneumonia COVID-19

In early December 2019, a group of patients with bilateral atypical pneumonia were identified in Wuhan. Later, the coronavirus 2 SARS-CoV-2 was identified as the etiological agent, which would receive the name of COVID-19. Currently, this virus is expanding worldwide, becoming a pandemic. Many of these patients require admission to intensive care units. We present the case of a patient treated and discharged from our unit. Despite not involving management that is out of the ordinary, he is a patient prototype of severe community acquired pneumonia due to coronavirus. Pneumonia that we have not faced before and that we are forced to manage in masse. At the beginning of the disease in Europe, we did not have this type of descriptions so we hope it will be helpful.

A principios de diciembre de 2019, se identificó en Wuhan un grupo de pacientes que presentaban neumonía atípica bilateral. Posteriormente, se identificó como agente etiológico el coronavirus 2 SARS-CoV-2 que recibiría el nombre de COVID-19. Actualmente, este virus presenta una expansión mundial convirtiéndose en una pandemia. Muchos de estos pacientes requieren ingreso en unidades de cuidados intensivos. Presentamos el caso de un paciente tratado y dado de alta en nuestra Unidad. Pese a no entrañar un manejo que se sale de lo normal, es un paciente prototipo de neumonía de comunidad grave por coronavirus. Una neumonía a la que no nos habíamos enfrentado hasta ahora y que nos vemos obligados a manejarla en masa. Al inicio de la enfermedad en Europa, no contábamos con este tipo de descripciones por lo que esperamos que sea de ayuda.

Acute hepatitis A, B and C but not D is still prevalent in Mongolia: a time trend analysis

BACKGROUND/AIMS: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. METHODS: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. RESULTS: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. CONCLUSIONS: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country.

Use of Novel Oral Anticoagulant to Treat Pulmonary Thromboembolism in Patient with Ulcerative Colitis Superinfected Cytomegalovirus Colitis / 대한소화기학회지

Crohn's disease and ulcerative colitis are the two major types of inflammatory bowel disease, and affect mainly the gastrointestinal tract but also have extraintestinal sequelae, such as arterial and venous thromboembolism. Thromboembolic complications, particularly pulmonary thromboembolism, can be life threatening and require prompt management with anticoagulants. Conventional vitamin K antagonists have been used for the treatment of thromboembolic complications, but the development of novel oral anticoagulants has shifted the paradigm. We report a case of a 42-year-old female with ulcerative colitis who experienced an acute flare-up due to cytomegalovirus superinfection with pulmonary thromboembolism. She was treated with oral mesalamine, intravenous steroid and ganciclovir and low-molecular-weight heparin, followed by rivaroxaban, a novel oral anticoagulant. Her symptoms resolved after treatment, and no recurrence was noted during a 6-month post-treatment follow-up.

Enfermedad invasora por Streptococcus pyogenes como coinfección en un paciente con influenza A H1N1 / Invasive disease due to Streptococcus pyogenes in a patient with A H1N1 influenza infection. Report of one case

Bacterial superinfection is a known complication among patients affected by viral respiratory tract infections. Streptococcus pyogenes, a major bacterial agent involved in acute tonsillopharyngitis, skin and soft tissue infections, was reported as a co-infecting microorganism during the 2009 A H1N1 influenza pandemic. We report a 65-year-old male patient who evolved with multifocal pneumonia and multiple organ failure with a fatal outcome. Influenza A H1N1 was detected by a polymerase chain reaction-based technique from a tracheal aspirate sample. S. pyogenes was identified by a rapid test from a nasopharyngeal sample and isolated afterwards from a positive blood culture.

Study on the prevalence and associated risk factors related to HIV, syphilis, herpes simplex virus-2 among female sex workers in Jiaozhou, Shandong province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the prevalence rates and associated risk factors on HIV, syphilis, herpes simplex virus-2 (HSV-2) among female sex workers (FSWs) in Jiaozhou, Shandong province.</p><p><b>METHODS</b>Through convenient sampling, an anonymous questionnaire survey was conducted on female sex workers to collect related information. Blood specimens were drawn for serological tests on HIV, syphilis and HSV-2 antibodies, respectively. Patients with positive results from both treponema pallidum and HSV-2 tested by ELISA method, were defined as being superinfected.</p><p><b>RESULTS</b>A total of 460 FSWs were recruited in this study. The prevalence rates of HIV, syphilis, HSV-2, and syphilis/HSV-2 superinfection were 0.22% , 5.9% , 43.0% , and 11.7% , respectively. Among the methamphetamine users, the prevalence rates of syphilis, HSV-2, and syphilis/HSV-2 superinfection were 12.4%, 55.2%, and 22.9%, respectively. Results from multivariate analysis showed that factors that significantly associated with syphilis infection would include: methamphetamine use (OR = 3.61, 95% CI:1.62-8.06), having first commercial sex intercourse at under 20 years of age (OR = 2.80, 95% CI:1.15-6.85), more than 2 establishments that the FSWs worked in the last month (OR = 4.37, 95%CI:0.83-22.83). Factors associated with HSV-2 infection were methamphetamine use (OR = 2.30, 95%CI:1.43-3.70), having first commercial sex intercourse at under 20 years of age (OR = 1.77, 95% CI:1.16-2.69), working at low-end establishments (OR = 2.61, 95%CI:1.66-4.10), working at the local sex-work venues for more than one year (OR = 2.01, 95% CI:1.28-3.14), with low education backgrounds (OR = 2.27, 95% CI:1.18-4.36), using methamphetamine (OR = 3.95, 95% CI:2.09-7.44), low education background (OR = 2.43, 95% CI: 1.10-5.36), 21-30 year-olds (OR = 2.95, 95%CI:1.08-8.03), older than 31 years of age (OR = 7.05, 95% CI:2.48-20.01) etc., were independent risk factors associated with the superinfection of syphilis and HSV-2.</p><p><b>CONCLUSION</b>The prevalence rates of syphilis, HSV-2 and syphilis/HSV-2 superinfection were relatively high among FSWs in Jiaozhou, especially among the FSWs who were methamphetamine users.</p>

A Case of Infective Endocarditis with Cytomegalovirus Infection after Kidney Transplantation / 대한내과학회지

Advances in immunosuppressive therapy have increased the survival of kidney transplant recipients, yet suppression of the immune system after transplantation can promote infectious complications. Cytomegalovirus (CMV) infection remains one of the most important complications following kidney transplantation and it is a risk factor for developing superinfections with other organisms. Aspergillus endocarditis is a rare life-threatening complication in kidney transplantation. Coinfection of CMV and Aspergillus endocarditis is rare worldwide and has not been reported in Korea. We report a case of Aspergillus endocarditis that developed in a patient with CMV infection after kidney transplantation. His clinical condition did not improve despite mitral valve replacement and empirical antibiotic treatment, but he was eventually treated successfully with antifungal agents for 6 weeks.

Riesgo de reinfección después de primera infección del tracto urinario en el período neonatal / Risk of reinfection after the first infection of the urinary tract in the neonatal period

Introducción: no se tiene constancia de la frecuencia con que ocurren reinfecciones después de la primera infección del tracto urinario en el período neonatal, ni cuáles son los factores que se asocian a estas. Objetivo: determinar la frecuencia y factores asociados con la ocurrencia de reinfecciones en pacientes que sufrieron la primera infección del tracto urinario en el período neonatal. Métodos: estudio observacional, analítico, longitudinal, desde 1992 hasta 2009, de 399 recién nacidos con la primera infección del tracto urinario, y que se le realizaron ultrasonido renal y uretrocistografía miccional. Los pacientes tuvieron seguimiento por consulta externa y se analizaron la frecuencia y factores clínicos, demográficos y de evaluación de radioimagen, asociados con la ocurrencia de reinfecciones...

Introduction: there is not enough proof of either the frequency of re-infections after the first infection of the urinary tract in the neonatal period, or the factors associated to them. Objective: to determine the frequency and the factors associated to occurrence of re-infections in patients who suffered the first infection of the urinay tract in the neonatal period. Methods: a longitudinal, observational and analytic study of 399 newborns with first infection of the urinary tract was conducted from 1992 to 2009. These patients had been performed renal ultrasound and mictional cystourethrography and they were followed-up in the outpatient service. Frequency, clinical and demographic factors and imaging assessment associated to the occurrence of re-infections were analyzed...

Ectima gangrenoso en pediatría / Ecthyma gangrenosum in pediatrics

Resumen El ectima gangrenoso es una infección poco frecuente de la piel, conocida con una característica lesión causada principalmente por la Pseudomoma aeruginosa, pero que también se puede presentar por otro tipo de bacterias del tipo Staphylococcus aureus o el Streptococcus beta hemolítico del grupo A ( S. beta hemolítico del grupo A), entre otros. Esta entidad se asocia frecuentemente con inmunodeficiencias primarias y secundarias. Las lesiones, clínicamente, se presentan como máculas eritematovioláceas, descamativas que rápidamente evolucionan a papulovesículas, ampollas hemorrágicas y costrosas que dejan unas úlceras profundas en sacabocado con fondo necrótico. La mortalidad es alta, entre 40 y 75% de los individuos inmunológicamente comprometidos. Se describe el caso de una niña de 5 años que inicialmente presentó varicela y luego una sobreinfección por S. aureus ocasionando un cuadro clínico de un ectima gangrenoso; al diagnóstico se llega por la clínica, cultivos y biopsias de piel. Se realizó manejo con aciclovir, clindamicina y cefepime endovenoso, con buena y rápida respuesta de la paciente.

Abstract Ecthyma gangrenosum (EG) is a rare infection of the skin, known as a characteristic lesion caused by Pseudomoma aeruginosa , but also can occur from other types of bacteria like Staphylococcus aureus or beta hemolytic group, among others. This condition is often associated with primary and secondary immunodeficiencies. The lesions present clinically as scaly, erythematous violacious macules that rapidly evolve into papule-vesicles, bleeding and crusty blisters leaving a deep punch ulcer with a necrotic base. Mortality is high, between 40% and 75% of immunologically compromised individuals. We describe the case of a girl of 5 years of age who initially presented chickenpox and then superinfection with Staphylococcus aureus, causing a clinical picture of EG. The diagnosis was reached based on symptoms, cultures and skin biopsies. Management was achieved with acyclovir, intravenous clindamycin and cefepime, with a good and quick response by the patient.

Fulminant gastrointestinal hemorrhage due to Strongyloides stercoralis hyperinfection in an AIDS patient

Strongyloides stercoralis is an endemic nematode to tropical and subtropical regions of the globe. The parasite is capable of autoinfection, which is limited by an intact immune response. In immunocompromised hosts, hyperinfection and dissemination can occur and have a high index of mortality. A hyperinfection syndrome with dissemination is frequently associated with corticosteroid administration and other conditions (malignancies and organ transplantation). Interestingly, although strongyloidiasis is common among AIDS patients in endemic areas, the hyperinfection syndrome is rarely noted. We report here on a rare manifestation of fulminant gastrointestinal hemorrhage due to hyperinfection of strongyloidiasis in a female drug-abusing, alcoholic HIV/AIDS patient.

A case of hemophagocytic syndrome in a patient with fulminant ulcerative colitis superinfected by cytomegalovirus

Hemophagocytic syndrome (HPS) is an uncommon hematological disorder that manifests as fever, splenomegaly, and jaundice, with hemophagocytosis in the bone marrow and other tissues pathologically. Secondary HPS is associated with malignancy and infection, especially viral infection. The prevalence of cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients is approximately 16%. Nevertheless, HPS in UC superinfected by CMV is very rare. A 52-year-old female visited the hospital complaining of abdominal pain and hematochezia for 6 days. She was diagnosed with UC 3 years earlier and had been treated with sulfasalazine, but had stopped her medication 4 months earlier. On admission, her spleen was enlarged. The peripheral blood count revealed pancytopenia and bone marrow aspiration smears showed hemophagocytosis. Viral studies revealed CMV infection. She was treated successfully with ganciclovir. We report this case with a review of the related literature.

Vitamin D, the Cutaneous Barrier, Antimicrobial Peptides and Allergies: Is There a Link?

Atopic diseases such as atopic dermatitis (AD) are very common in industrialized countries. Up to 15%-30% of all children and 2%-10% of all adults suffer from AD. Already in early disease stages, a defective epidermal barrier is known to contribute to the pathogenesis of AD. Central elements in the epidermal barrier are antimicrobial peptides (AMPs), which are secreted by keratinocytes, sweat gland cells but also infiltrating immune cells. AMPs function as endogenous antibiotics and are able to kill bacteria, viruses, and fungi. Furthermore AMPs act as immune modulators with effects on the innate and adaptive immune system. The probably best studied AMPs in human skin are the defensins and cathelicidin. In atopic diseases the functions of AMPs such as cathelicidin might be impaired and microbial superinfections could serve as cofactors for allergic sensitization. Hence, induction of AMPs could be beneficial in these patients. Cathelicidin which is often referred to its peptide form hCAP18 or LL-37 can be induced by ultraviolet light B (UVB) irradiation and is upregulated in infected and injured skin. The cathelicidin gene carries a vitamin D response element and the vitamin D pathway could therefore be targeted for cathelicidin regulation. As the development and course of atopic diseases might be influenced by vitamin D signaling these pathomechanisms could explain the growing evidence connecting vitamin D to allergic diseases, including AD, allergic rhinitis, food allergies and asthma. In this review the role of vitamin D and the AMP cathelicidin in the pathogenesis of atopic diseases with impaired barrier function will be discussed.

Maxillary Sinusitis Caused by Mucormycosis

Metaneumovirus humano en niños: primeros casos en Colombia / Human metapneumovirus in children: first cases in Colombia

El metaneumovirus humano es un nuevo patógeno asociado a infecciones respiratorias, principalmente en niños, que produce cuadros clínicos que van desde leves hasta graves, los cuales pueden incluso requerir tratamiento en unidades de cuidados intensivos. Hasta el momento, la reacción en cadena de la polimerasa con transcripción inversa y el cultivo celular son los métodos más usados para su diagnóstico. Se presentan los seis primeros casos de metapneumovirus humano en niños de Medellín, Colombia.

Human metapneumovirus is a newly discovered pathogen associated with respiratory disease and occurring mainly in children. It produces an acute viral respiratory disease picture that varies from mild disease to severe, and which can require strict surveillance in intensive care units. Currently, reverse transcriptase polymerase chain reaction and cell culture are the most common methods for its diagnosis. The first six cases of human metapneumovirus in Colombia are presented from Medellín.

Prolonged jaundice attributed to super infection of hepatitis E virus in a case of resolving leptospirosis.

India is endemic for both Leptospira and hepatitis E virus (HEV). The clinical presentations of these diseases have overlapping features. We report a case of superinfection of HEV in a patient with resolving leptospirosis with underlying Hodgkin lymphoma. The diagnosis of HEV in our case was established by HEV-RNA PCR as our patient was immunosuppressed. The present study highlights the need for molecular diagnosis in the case of HEV infection with strong clinical suspicion and negative serological results.