Gastric Adenomyoma in adult a case report / Adenomioma Gástrico en adulto reporte de caso

Objective: Report the clinical case of Gastric Adenomyoma as etiology of pyloric syndrome. Clinical case: We present a 52 years old man who attended the emergency room due pyloric syndrome and who underwent a distal gastrectomy. The pathological report revealed a gastric adenomyoma with ulcerative lesion. Discussion: This pathology is an unusual finding, and the literature describe it with extremely low rate of malignant transformation. Conclusion: Gastric adenomyoma is a infrequent pathology and should be taken into account when endoscopic studies are not enough to determine the etiology of a pyloric syndrome.

Objetivo: Reportar el caso clínico de Adenomioma gástrico como etiología de un síndrome pilórico. Caso Clínico: Presentamos el caso de un varón de 52 años que acudió a emergencia por un síndrome pilórico quien fue sometido a una gastrectomía distal. El reporte de anatomía patológica revelo un Adenomioma gástrico con lesión ulcerativa múltiple. Discusión: Esta patología es un hallazgo inusual, siendo extremadamente baja su tasa de transformación maligna. Conclusiones: El Adenomioma gástrico es una patología infrecuente que debe ser tenida en cuenta cuando los estudios endoscópicos no logran definir la etiología de un síndrome pilórico.

Conocimientos, actitudes y prácticas sobre prevención y control de infecciones (PCI) en alumnos de Estomatología de la UAM-Xochimilco / Knowledge, attitudes and practices on infection prevention and control in Stomatology students UAM-Xochimilco

Introducción: la prevención y control de infecciones (PCI) pretenden prevenir, detener y propagar enfermedades infecciosas en pacientes y trabajadores de la salud. Este enfoque debe comenzar con la formación y capacitación del profesional de la salud, inmunizaciones recomendadas y ejecución de medidas universales de protección. Objetivos: evaluar conocimientos, actitudes y prácticas en la prevención y control de infec- ciones de los estudiantes y pasantes de servicio social de la licenciatura en Estomatología de la UAM-X. Material y métodos: se realizó un estudio descriptivo, transversal y observacional mediante una encuesta anónima como instrumento para recolección de datos a una muestra de 108 alumnos y pasantes. Resultados: se encontró que al contestar el interrogatorio sobre «prevención y control de infecciones¼, 59.3% tuvo un nivel de conocimientos aceptable y 40.7% tuvo un nivel muy bueno. De los encuestados, 87% desinfecta y cambia las barreras de protección entre cada paciente, 9.3% al comenzar y finalizar el día; el restante 3.7%, cuando está visiblemente sucio o cuando hay derrame de sustancias de líquidos corporales. Conclusión: los encuestados tienen adecuados conocimientos y prácticas, lo que infiere que tienen el sustento teórico y habilidades para enfrentarse a la etapa postpandemia para la atención de pacientes (AU)

ntroduction: infection prevention and control (IPC) efforts to prevent, stopping and spreading infectious diseases in patients and healthcare workers. This approach should begin with education and training of the health professional, recommended immunizations and implementation of universal protective measures. Objectives: to evaluate knowledge, attitudes and practices in infection prevention and control stomatology career's students and social service interns UAM-X. Material and methods: a descriptive, cross-sectional and observational study was carried out using an anonymous survey as an instrument for data collection from a sample of 108 students and interns. Results: it was found that when answering the questionnaire on «infection prevention and control¼, 59.3% had an acceptable level of knowledge and 40.7% had a very good level. 87% of the respondents disinfect and change the protective barriers between each patient, 9.3% at the beginning and end of the day; the remaining 3.7% when visibly dirty or when there is spillage of body fluids. Conclusion: respondents have adequate knowledge and practices, inferring that they have the theoretical support and skills to face the post-pandemic stage of patient care (AU)

Carcinoma de paratiroides en un paciente con hiperparatiroidismo terciario / Parathyroid carcinoma in a patient with tertiary hyperparathyroidism

Introducción: La mayoría de los pacientes con enfermedad renal crónica terminal en hemodiálisis desarrollan hiperparatiroidismo secundario. Algunas veces este tipo de hiperparatiroidismo secundario suele ser severo y refractario al tratamiento médico, inclusive algunos desarrollarán hiperparatiroidismo terciario, el tratamiento de ambas situaciones suele ser la paratiroidectomía subtotal o total. Reporte de Caso: Presentamos el caso de un paciente de 29 años, con enfermedad renal terminal en hemodiálisis durante 13 años, quien desarrolló hiperparatiroidismo terciario por lo que fue sometido a paratiroidectomía subtotal con autotrasplante de media glándula; el estudio patológico informó la presencia de un carcinoma de paratiroides en una de las cuatro glándulas paratiroides extirpadas. Conclusión: El carcinoma de paratiroides es una neoplasia rara que causa hiperparatiroidismo primario en menos de 1% de todos los casos, y se ha reportado en algunos pacientes operados por hiperparatiroidismo terciario.

Background: Most patients with terminal chronic kidney disease on hemodialysis develop secondary hyperparathyroidism. Sometimes this type of secondary hyperparathyroidism becomes severe and refractory to medical treatment, some will even develop tertiary hyperparathyroidism, the treatment of both situations is usually subtotal or total parathyroidectomy. Case Report: We present the case of a 29-year-old patient with end-stage kidney disease on hemodialysis for 13 years, who developed tertiary hyperparathyroidism, for which he underwent subtotal parathyroidectomy with half gland autotransplantation; the pathological study reported the presence of a parathyroid carcinoma in one of the four excised parathyroid glands. Conclusion: Parathyroid carcinoma is a rare neoplasm that causes primary hyperparathyroidism in less than 1% of all cases, and has been reported in some patients operated on for the development of tertiary hyperparathyroidism.

Inicio / Archivos / Vol. 22 Núm. 2 (2022): Revista de la Facultad de Medicina Humana / Caso Clínico Páncreas Ectópico incidental en vesícula biliar: reporte de caso / Incidental Ectopic pancreas in gallbladder: a case report

El páncreas ectópico en vesícula biliar es un hallazgo poco frecuente, con una incidencia menor a 0.5% de los casos descritos en la literatura. Reportamos el caso de una mujer de 26 años que acude a emergencia por dolor abdominal quien fue sometida a una colecistectomía laparoscópica. El reporte anatomopatológico describió tejido pancreático ectópico en la pared de la vesícula biliar. Este hallazgo debe ser evaluado minuciosamente debido a la susceptibilidad del tejido pancreático a patologías como pancreatitis, lesiones quísticas y degeneración maligna, y debe ser considerado en el contexto de un pólipo vesicular asociado a sintomatología digestiva.

Ectopic pancreas is an unusual finding, with an incidence below 0.5% of all reports worldwide. We report a 26 years old woman who went to emergency room with abdominal pain and underwent laparoscopic cholecystectomy. The pathology report described pancreatic ectopic tissue in the wall of the gallbladder. This finding must be thoroughly evaluated because this tissue can suffer diseases like pancreatitis, cystic tumours and malign degeneration, and should be considerated in the context of gallbladder polips with digestive sintomatology.

Tratamiento del hiperaldosteronismo primario durante el embarazo: reporte de un caso / Management of primary hyperaldosteronism during pregnancy: Case report

Resumen ANTECEDENTES: El hiperaldosteronismo primario es la principal causa de hipertensión arterial de origen endocrino en la población general; su manifestación durante el embarazo es poco frecuente, casi siempre provocado por un adenoma adrenal productor de aldosterona. De 1962 a la fecha se han descrito alrededor de 50 casos. Objetivo: Reportar un caso de hiperaldosteronismo durante el embarazo y revisar la bibliografía relacionada. CASO CLÍNICO: Paciente de 39 años, con antecedente médico de hipertensión arterial, en curso del segundo trimestre del quinto embarazo, que acudió a consulta por hipertensión no controlada e hipocalemia. El tratamiento incluyó un antagonista del receptor de aldosterona, que permitió el control de la tensión arterial y la finalización del embarazo. Posteriormente se identificó un nódulo adrenal, cuya resección resultó en normalización de las concentraciones de aldosterona, la actividad de renina plasmática, calemia y remisión de la hipertensión hasta la actualidad. CONCLUSIÓN: Las recomendaciones para el tratamiento de pacientes con hiperaldosteronismo durante el embarazo se basan en los casos publicados y los datos de toxicidad generados de estudios en animales. De ahí la importancia de este caso, que aporta información importante y puede considerarse en situaciones similares.

Abstract BACKGROUND: Primary hyperaldosteronism is the main cause of arterial hypertension of endocrine origin in the general population; its presentation during pregnancy is infrequent; having described about 50 cases since 1962, the most common cause is the presence of an adrenal adenoma. OBJECTIVE: To report the first case of hyperaldosteronism treated during pregnancy in Peru and reviews the literature. CLINICAL CASE: A 39-year-old patient with a history of arterial hypertension and poor obstetric history, who was referred to our center in the second trimester of the 5th pregnancy due to uncontrolled hypertension and symptomatic hypokalemia. Management included an aldosterone receptor antagonist, allowing the control of blood pressure and the culmination of the pregnancy with the delivery of a healthy girl. Subsequently, the presence of an adrenal nodule was confirmed, the resection of which resulted in normalization of aldosterone concentration, plasma renin activity, kalemia, and remission of hypertension to date. CONCLUSION: Recommendations on the management of hyperaldosteronism during pregnancy are based only on published cases and drug toxicity data were generated in animal studies. Hence the importance of this report, which provides information that can be considered in similar situations.

Prevalence of human cryptosporidiosis in the Americas: systematic review and meta-analysis

ABSTRACT Cryptosporidiosis is a disease caused by the Cryptosporidium spp parasite. As some species of Cryptosporidium have a wide host spectrum, the characterization of the pathogen at the species or genotype level is of great importance to define the sources of infection for humans and the potential for public health. This study investigated the diversity of the genus Cryptosporidium spp. in humans from all over the American continent and observed whether the method used to search for the parasite influenced the prevalence found in the Americas. This systematic review was carried out using the Pubmed, Science direct, Lilacs, Scielo, and Scopus databases with publications from January 1, 2010, to December 31, 2020. For data synthesis, the PRISMA flowchart was used and for the meta-analysis we used the MetaXL program. Of the selected publications, 57, 9 and 16 belonged to the region of South, Central and North America, respectively. The prevalence found for South, Central, and North America was 7%, 7%, and 8%, respectively, when analyzing publications that used only the microscopy method. When we analyzed the publications that used immunological and molecular methods, we found prevalences of 10%, 9%, and 21% for South, Central, and North America, respectively. The C. hominis subtype IbA10G2 was the most reported in the American continent, followed by subtype IeA11G3T3 and, for C. parvum, subtype IIaA15G2RI was the most reported. In conclusion, Cryptosporidium spp. is present throughout the American continent and its prevalence is higher when immunological and/or molecular methods are used, in addition to direct microscopic examination.

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Abstract INTRODUCTION: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. METHODS: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. RESULTS: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). CONCLUSIONS: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

Mediastinitis necrotizante descendente de origen dental: revisión de la literatura y presentación de un caso / Descending necrotizing mediastinitis of dental origin: a case study and review of the literature

La mediastinitis se define como una inflamación aguda severa de los tejidos conectivos ubicados en la cavidad torácica media, en la que 20% de los casos puede implicar una infección difusa y polimicrobiana del mediastino denominada mediastinitis necrotizante descendente (MND), secundaria a la propagación de una infección grave desde los tejidos bucofaríngeos o cervicales tales como infecciones odontogénicas (de 36 a 47%), faríngeas (de 33 a 45%), cervicales (15%) y otras infecciones de cabeza y cuello (5%). Clínicamente, los pacientes presentan aumento de volumen, temblores, trismus, odinofagia con disnea, disfagia, hipotensión, dolor de cuerpo y del ángulo de la mandíbula. Puede observarse signo de Hamman (crepitación mediastinal con el latido cardiaco) y enfisema subcutáneo. El manejo quirúrgico de las infecciones odontogénicas, sin importar su severidad, consta de dos principios: eliminar el foco etiológico y el vaciamiento quirúrgico de los espacios anatómicos comprometidos con la instalación de un drenaje adecuado. Se presenta el caso de un masculino de 60 años con diagnóstico de mediastinitis necrotizante descendente de origen dental (AU)

Mediastinitis is defined as a severe acute inflammation of the connective tissues affected in the middle thoracic cavity, in which 20% of cases may involve a diffuse and polymicrobial infection of the mediastinum, descending necrotizing mediastinitis (MND), secondary to the spread of a serious infection from the oropharyngeal or cervical tissues, stories such as odontogenic infections (36 to 47%), pharyngeal (33 to 45%), cervical (15%) and other head and neck infections (5%). Clinically, patients present with increased volume, tremors, trismus, odynophagia with dyspnea, dysphagia, hypotension, pain in the body and in the angle of the jaw. Hamman sign (mediastinal crepitus with heartbeat) and subcutaneous emphysema may be observed. The surgical management of odontogenic infections, regardless of their severity, consists of two principles: eliminate the etiological focus and the surgical emptying of the anatomical spaces compromised with the installation of adequate drainage. We present the case of a 60-year-old man diagnosed with descending necrotizing (AU)

Cerebrospinal fluid challenges for the diagnosis of herpes simplex infection in the central nervous system / Desafios do exame do líquido cefalorraquidiano para o diagnóstico de infecção por herpes simplex no sistema nervoso central

Abstract Herpes simplex virus (HSV) is a cause of a severe disease of the central nervous system (CNS) in humans. The demonstration of specific antibodies in the cerebrospinal fluid (CSF) may contribute to the retrospective neurological diagnosis. However, the commercial immunological tests for HSV infection are for use in serum samples. Objective: The aim of the present study was to adapt a commercial kit anti-HSV IgG used for serum samples to be performed with a CSF sample. Methods: Forty CSF specimens from 38 patients with suspected CNS HSV infection were serially diluted for detecting anti-HSV IgG by enzyme immunoassay (EIA). The same samples were also analyzed with the polymerase chain reaction (PCR). Results: The sensitivity of EIA test for HSV was 5% (dilution 1:40) and 65% (dilution 1:2) in CSF, and HSV DNA PCR was 15%. The combined analysis of EIA (dilution 1:2) and PCR increased the sensitivity up to 72.5%. The inflammatory CSF was associated with positive HSV PCR. Conclusions: We demonstrated the importance to adapt serological anti-HSV IgG EIA test for CSF assays to increase the accuracy of the analysis, considering the low concentration of specific antibodies in CSF.

Resumo O vírus herpes simples (HSV) é um dos agentes causadores de uma doença grave no sistema nervoso central (SNC) em humanos. A detecção de anticorpos específicos no líquido cefalorraquidiano (LCR) pode contribuir para o diagnóstico neurológico retrospectivo. Entretanto, os testes imunológicos comerciais são para uso em amostras de soro. Objetivo: Adaptar um kit comercial sorológico anti-HSV IgG para ser utilizado no de LCR. Metodos: Quarenta amostras de LCR de 38 pacientes com suspeita de infecção por HSV no SNC foram diluídas pesquisa de anticorpos anti-HSV IgG pelo método imunoenzimático (EIA). Além disso, as mesmas amostras também foram analisadas por reação em cadeia da polimerase (PCR). Resultados: A sensibilidade do teste EIA para o HSV consistiu em 5% (diluição 1:40) e 65% (diluição 1:2) no LCR, e o PCR do DNA do HSV, 15%. A análise combinada de EIA (diluição 1:2) e PCR aumentou a sensibilidade para 72,5%. Houve associação entre presença do LCR inflamatório e PCR positiva para HSV. Conclusões: Demonstramos a importância na adaptação previa do teste sorológico anti-HSV IgG EIA para ensaios do no LCR, a fim de aumentar a acuracia da análise, considerando a baixa concentração de anticorpos específicos no LCR.

Plasmocitoma solitario intracraneal: una presentación inusual / Intracranial solitary plasmacytoma: an unusual presentation

Background: Intracranial solitary plasmacytoma is extremely rare and its location in the clivus is unusual; its clinical presentation is very varied and the diagnostic images are similar to the other tumors in skull-base. Case presentation: 47-year-old woman with initial diagnosis of pituitary macroadenoma, attended with headache, nausea, vomiting, diplopia in the right eye and paralysis of her abducent nerve. She was reoperated by transsphenoidal endoscopic approach, concluding in solitary clivus plasmacytoma by biopsy and immunohistochemistry. Conclusions: Clivus is an unusual location for intracranial plasmacytoma. Early diagnosis, complete study and careful follow-up are required due to its high progression to multiple myeloma(AU)

Introducción: El plasmocitoma solitario intracraneal es extremadamente raro y su localización en el clivus es inusual; su presentación clínica es muy variada y las imágenes diagnósticas son similares a las de otros tumores de la base del cráneo. Reporte de caso: Se presenta el caso de una mujer de 47 años con diagnóstico inicial de macroadenoma hipofisiario, que cursó con cefalea, náuseas, vómitos, diplopía en ojo derecho y parálisis de su nervio abducente. Fue reintervenida por vía transesfenoidal endoscópica, concluyendo en plasmocitoma solitario del clivus por biopsia e inmunohistoquímica. Conclusiones: El clivus es una localización inusual para plasmocitoma intracraneal, se requiere un diagnóstico precoz, estudio completo y seguimiento cuidadoso por su alta progresión a mieloma múltiple(AU)

Coexistencia de Aspergilosis e Hidatidosis Pulmonar. Reporte de un caso / Coexistence of Pulmonary Aspergillosis and Hydatidosis. Case report

RESUMEN La hidatidosis es una zoonosis causada por el parásito Echinococcus granulosus. Perú es una zona endémica para esta infección, presentamos el caso de una mujer de 33 años, procedente de la región de Ica; que durante la gestación se le diagnosticó hidatidosis hepática y pulmonar y posterior al término de la gestación fue referida con tubo de drenaje torácico, disnea y dolor torácico en hemitórax derecho, de curso progresivo e imagen tomográfica de tórax que mostró quiste pulmonar basal posterior derecho. Los exámenes serológicos fueron positivos, la paciente fue sometida a resección quirúrgica con resultado histopatológico de quiste hidatídico pulmonar complicado no viable y estructura micótica consistente con aspergiloma. La coexistencia de estas dos entidades es rara y pueden ser amenazas potenciales para los pacientes. El diagnóstico y tratamiento tempranos son vitales para prevenir posibles complicaciones como la hemoptisis masiva o incluso enfermedad invasiva.

ABSTRACT Hydatidosis is a zoonosis caused by the parasite Echinococcus granulosus and Peru is an endemic zone for this infection. We present the case of a 33-year old woman from the region of Ica who, during gestation, was diagnosed with liver and pulmonary hydatidosis. After gestation was terminated, she was referred with thoracic drainage tube, dyspnea, and thoracic pain in right hemithorax, with progressive course and tomographic image of thorax showing right posterior basal pulmonary cyst. The serological analysis was positive, the patient underwent surgical resection with histopathologic result as complex non-viable pulmonary hydatidic cyst and mycotic structure consistent with aspergilloma. The coexistence of these two diseases is rare and can mean potential threats for patients. The early diagnosis and treatment are vital to prevent possible complications such as massive hemoptysis or even invasive disease.

Tumor abdominopélvico por actinomicosis en gestante / Abdominopelvic tumor due to actinomycosis in a pregnant woman

La actinomicosis es una infección poco frecuente causada por el Actinomyces spp, germen grampositivo, de naturaleza saprofita, ubicado en la boca, tracto genital y el tracto digestivo inferior. Su diagnóstico resulta difícil por la poca frecuencia y clínica muy variable. Se presenta el caso de una mujer de 28 años, de 34½ semanas de gestación, con masa pélvica y abdominal hipogástrica acompañada de dolor abdominal. Un día antes de su ingreso, se intensificó el dolor en fosa ilíaca derecha tipo contracción. Sometida a cesárea se obtuvo producto a término; de inmediato se realizó histerectomía y resección de tumor de pared abdominal más resección en bloque de la cúpula vesical más apendicectomía. La anatomía patológica informó actinomicosis. Se incide en la forma de presentación, en una paciente gestante con producto pretérmino y vivo, así como los signos y síntomas que ayudan a considerar este diagnóstico.

Actinomycosis is a rare infection caused by Actinomyces spp, a gram-positive germ of saprophytic nature, located in the mouth, genital tract and lower gastrointestinal tract. Its diagnosis is difficult because of its low frequency and variable clinical presentation. We report the case of a 28-year-old female, 34½ weeks pregnant, who presented a pelvic and hypogastric mass accompanied by abdominal pain. One day before admission, the contraction-like pain in the right iliac fossa intensified. The patient underwent a cesarean section and a full-term product was obtained. This surgery was followed by hysterectomy and resection of an abdominal wall tumor as well as en bloc resection of the vesical dome plus appendectomy. The pathology report informed actinomycosis. We focus on the presentation in a pregnant woman with a preterm and live product, as well as the signs and symptoms that help consider this diagnosis.

Dengue infection in the nervous system: lessons learned for Zika and Chikungunya / Infecção por dengue no sistema nervoso: lições para Zika e Chikungunya

ABSTRACT Dengue, Zika and Chikungunya are emerging arboviruses and important causes of acute febrile disease in tropical areas. Although dengue does not represent a new condition, a geographic expansion over time has occurred with the appearance of severe neurological complications. Neglect has allowed the propagation of the vector (Aedes spp), which is also responsible for the transmission of other infections such as Zika and Chikungunya throughout the world. The increased number of infected individuals has contributed to the rise of neurological manifestations including encephalitis, myelitis, meningitis, Guillain-Barré syndrome and congenital malformations such as microcephaly. In this narrative review, we characterize the impact of the geographic expansion of the vector on the appearance of neurological complications, and highlight the lack of highly accurate laboratory tests for nervous system infections. This represents a challenge for public health in the world, considering the high number of travelers and people living in endemic areas.

RESUMO Dengue, Zika e Chikungunya são arbovírus emergentes e importante causa de doença febril aguda em áreas tropicais. Embora a dengue não represente uma doença nova, houve uma expansão geográfica ao longo do tempo, com o aparecimento de complicações neurológicas graves. A negligência desta situação permitiu a propagação do vetor (Aedes spp) em todo o mundo, que também é responsável pela transmissão de outras infecções pelos vírus Zika e Chikungunya. O grande número de casos infectados contribui para o aumento de manifestações neurológicas incluindo encefalite, mielite, meningite, síndrome de Guillain-Barré e má formações congênitas, como microcefalia. Nesta revisão narrativa, destaca-se o impacto da expansão geográfica do vetor no aparecimento de complicações neurológicas e a falta de testes laboratoriais de elevada acurácia para o diagnóstico da infecção neurológica. Estes aspectos representam desafio para a saúde pública mundial, considerando o grande número de indivíduos que moram ou viajam para áreas endêmicas.

Genetic diversity of Cryptosporidium identified in clinical samples from cities in Brazil and Argentina

The identification and characterisation of Cryptosporidiumgenotypes and subtypes are fundamental to the study of cryptosporidiosis epidemiology, aiding in prevention and control strategies. The objective was to determine the genetic diversity ofCryptosporidium in samples obtained from hospitals of Rio de Janeiro, Brazil, and Buenos Aires, Argentina. Samples were analysed by microscopy and TaqMan polymerase chain reaction (PCR) assays forCryptosporidium detection, genotyped by nested-PCR-restriction fragment length polymorphism (RFLP) analysis of the 18S rRNA gene and subtyped by DNA sequencing of the gp60 gene. Among the 89 samples from Rio de Janeiro, Cryptosporidium spp were detected in 26 by microscopy/TaqMan PCR. In samples from Buenos Aires,Cryptosporidium was diagnosed in 15 patients of the 132 studied. The TaqMan PCR and the nested-PCR-RFLP detected Cryptosporidium parvum, Cryptosporidium hominis, and co-infections of both species. In Brazilian samples, the subtypes IbA10G2 and IIcA5G3 were observed. The subtypes found in Argentinean samples were IbA10G2, IaA10G1R4, IaA11G1R4, and IeA11G3T3, and mixed subtypes of Ia and IIa families were detected in the co-infections. C. hominis was the species more frequently detected, and subtype family Ib was reported in both countries. Subtype diversity was higher in Buenos Aires than in Rio de Janeiro and two new subtypes were described for the first time.

Carcinoma papilar y medular de tiroides simultáneo / Medullary carcinoma thyroid papillary and simultaneous

El sincronismo del Carcinoma Papilar y Medular es infrecuente. No se sabe la etiología clara sobre esta patología. El pronóstico está dado por el Carcinoma Medular ya que este es el más agresivo. A continuación se presenta el caso de una paciente mujer de 76 años con Carcinoma Medular y focos de Carcinoma y microcarcinoma Papilar de Tiroides.

Nefropatía asociada a poliomavirus BK en trasplante renal / BK polyomavirus-associated nephropathy in kidney transplant

El objetivo del presente reporte es dar a conocer los dos primeros casos de nefropatía del injerto asociada a poliomavirus BK (NPBK) ocurridos en el Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Perú. El diagnóstico definitivo de la NPBK se corroboró mediante biopsia renal y estudio de microscopia electrónica. En el caso 1, el deterioro funcional renal no se controló a pesar de reducir la inmunosupresión y añadir drogas antivirales (leflunamide y ciprofloxacina), evolucionando a falla renal y su posterior acceso a retrasplante renal. En el caso 2, la alternativa terapéutica se basó en infusión de inmunoglobulina endovenosa asociada a reducción de la inmunosupresión, resultando en moderada mejora histológica y estabilización de la función renal. En ambos injertos renales hubo concomitantemente NPBK y lesiones histológicas compatibles con rechazo agudo celular pendientes de interpretar. En conclusión, la presencia del poliomavirus BK representa serio problema en el riñón trasplantado. La mejor conducta terapéutica se basa en el diagnóstico precoz y subsecuente reducción de la inmunosupresión. Es imprescindible disponer de metodología apropiada que posibilite un diagnóstico preciso. Se utiliza tamizaje de células señuelo o marcadoras (decoy cells) en orina, reacción de cadena polimerasa (PCR), biopsia renal o la microscopia electrónica como método valioso de ayuda en el diagnóstico etiológico viral. Se considera el retrasplante como opción ante la pérdida del injerto por NPBK (caso 1)...

Two documented cases of BK polyomavirus-associated nephropathy (BKVN) seen at Hospital Edgardo Rebagliati Martins, EsSalud, Lima, Peru are reported. Final BKVN diagnosis was confirmed by renal biopsy and electron microscopy study. Case 1: Renal functional deterioration was not controlled despite reduction of immunosuppression and addition of antiviral drugs (leflunomide and ciprofloxacin), evolving to renal failure and subsequent kidney retransplantation. Case 2: The therapeutical management consisted in intravenous immunoglobulin infusion linked to reduction of immunosuppression; this resulted in modest histological improvement and stabilization of renal function. Both renal grafts concomitantly presented BKVN and histological lesions consistent with acute rejection, pending interpretation. In conclusion presence of BK polyomavirus is a serious problem for transplanted kidneys. The best treatment is based on early diagnosis and subsequent reduction of immunosuppression. It is essential to have an appropriate methodology for precise diagnosis. Early electron microscopy is a valuable method for viral etiologic diagnosis. Retransplantation is considered a treatment option when faced with possible BKVN-related graft loss (Case 1)...

Infestación ocular por plerocercoide de Spirometra mansonoides: primer reporte en el Perú / Ocular infestation by plerocercoid of Spirometra mansonoides: first case report in Perú

La plerocercoidiosis es una zoonosis parasitaria producida por la larva plerocercoide de Spirometra. Esta larva migra por el tejido de la pared intestinal, mediante la ruta subcutánea y puede llegar a diferentes áreas del cuerpo humano como la cabeza, el cerebro y la órbita ocular. Se reporta el caso de un varón de 45 años procedente de la Amazonía peruana, quien presentó ardor asociado con edema y hemorragia conjuntival en el borde ocular externo del ojo derecho, durante once meses. Se observó un helminto localizado en la cavidad orbitaria derecha, el cual se extrajo y por estudios morfológicos e histopatológicos se identificó como Spirometra mansonoides de localización ocular el que se reporta por primera vez en el Perú.

Plerocercoidosis is a parasitic zoonosis caused by plerocercoid larvae of the genus Spirometra. The larvae migrate through the intestinal wall tissue, by subcutaneous route and can reach different areas of the body like the head, the brain and the eye socket. A case is reported of a 45 year-old man from the Peruvian Amazon with burning sensation associated with conjunctival edema and hemorrhage in the outer eye border of the right eye for eleven months. A localized worm in the right orbital cavity was observed, which was extracted. Morphological and histopathological studies identified it as Spirometra mansonoides localized in the eye, which is the first case reported in Perú.

Frequency of amoebiasis and other intestinal parasitoses in a settlement in Ilheus City, State of Bahia, Brazil

Introduction: This study evaluated the frequency of intestinal parasites, emphasizing the identification and differentiation of Entamoeba spp. Methods: Multiplex polymerase chain reaction (PCR), coproantigen tests and morphometric analysis were performed for Entamoeba spp. differentiation. Results: The overall frequency of intestinal parasites was 65%. Entamoeba histolytica was detected by the coproantigen test, and the PCR showed that Entamoeba dispar predominated in the population. In contrast, morphometric analysis was important for identifying Entamoeba hartmanni. Conclusions: It is possible to identify the causative agent of amoebiasis and to differentiate this agent from other species by combining techniques. .

A conventional polymerase chain reaction-based method for the diagnosis of human schistosomiasis in stool samples from individuals in a low-endemicity area

The aim of this study was to evaluate the efficacy of a polymerase chain reaction (PCR)-based method to detect Schistosoma mansoni DNA in stool samples from individuals living in a low-endemicity area in Brazil. Of the 125 initial stool samples, 80 were ELISA reactive and eggs were identified in 19 of the samples by parasitological examination. For the PCR evaluations, 56 stool samples were selected and divided into five groups. Groups I-IV were scored negative for S. mansoni eggs by parasitological examination. Groups I and II were ELISA reactive, whereas Groups III and IV were ELISA nonreactive. Groups II and III were positive for other intestinal parasites. PCR testing scored eight samples as positive from these four groups. Group V represented the S. mansoni -positive group and it included ELISA-reactive samples that were scored positive for S. mansoni by one or more parasitological examinations (6/19 were positive by Kato-Katz method, 9/17 by saline gradient and 10/13 by Helmintex®). PCR scored 13 of these 19 samples as positive for S. mansoni . We conclude that while none of these methods yielded 100% sensitivity, a combination of techniques should be effective for improving the detection of S. mansoni infection in low-endemicity areas.

Detection and differentiation of Cryptosporidium by real-time polymerase chain reaction in stool samples from patients in Rio de Janeiro, Brazil

This study reports the first genetic characterisation of Cryptosporidium isolates in Brazil using real-time polymerase chain reaction (RT-PCR). A total of 1,197 faecal specimens from children and 10 specimens from human immunodeficiency virus-infected patients were collected between 1999-2010 and screened using microscopy. Forty-eight Cryptosporidium oocyst-positive isolates were identified and analysed using a generic TaqMan assay targeting the 18S rRNA to detect Cryptosporidium species and two other TaqMan assays to identify Cryptosporidium hominis and Cryptosporidium parvum. The 18S rRNA assay detected Cryptosporidium species in all 48 of the stool specimens. The C. parvum TaqMan assay correctly identified five/48 stool samples, while 37/48 stool specimens were correctly amplified in the C. hominis TaqMan assay. The results obtained in this study support previous findings showing that C. hominis infections are more prevalent than C. parvum infections in Brazil and they demonstrate that the TaqMan RT-PCR procedure is a simple, fast and valuable tool for the detection and differentiation of Cryptosporidium species.