Coinfección SIDA / Enfermedad de Chagas. Presentación de caso y revisión de la bibliografía / 9 CO-INFECTION AIDS / CHAGA'S DISEASE. REPORT OF A CASE AND LITERATURE REVISION

Chagas' disease caused by "Trypanosoma cruzi" (T. cruzi), is well recognized as an opportunistic infection in the setting of HIV / AIDS. More patients with Chagas' disease, live in countries of Central and South America, That's why, it is also called "American Trypanosomiasis ". T. cruzi is mainly transmitted by vectors ("Triatoma infestans" in Argentina) specially in the "endemic american area" and secondarily, by blood transfusion, not only in America, but also in the rest of the world. Many people have migrated from the endemic area of America to others countries around the world. Perhaps, some of them were asyntomatic "chagasic" patients and may have transmitted T. cruzi by blood transfusions in those non-endemic areas.. So that, Chagas' disease should be considered nowadays, as a "global pathology". In severely inmunocompromissed patients with AIDS, chronic Chagas' disease may have reactivated, affecting central nervous system (CNS) with brain mass lesions (called "chagomas"), similar to others necrotizing encephalitis like Toxoplasmosis.. We report a 32 year-old woman assisted in the Rawson Hospital of Córdoba City (Argentina), with AIDS and reactivation of Chagas' disease. Patient coming from Catamarca (north-western region of Argentina) with severe headache, unisocoria, desorientation in time and space, fine tremor, nistagmus, clonus, hiperreflexia and fascial-braquial-crural hemiparesia. Patient was afebrile and the rest of physical examination was normal. She had low count of CD4 cells and high HIV-viral load. Magnetic resonance imagin (MRI) showed: several enhanced rounded lesions surrounded by edema along the whole brain. Treatment with sulfadiacina + Pyrimethamine and Dexametasone, for a presuntive cerebral toxoplasmosis was implemented but, patient did not improve. So, cerebral biopsie was performed and it showed: intra and extracellular " AMASTIGOTES" of T. cruzi..Treatment with Benznidazol was prescribed, but in a few days, patient died.

Espondilitis tuberculosa ("Mal de Pott"): presentación de un caso y revisión bibliográfica / Tuberculous spondylitis (Pott's disease): case report and review of the literature

Tuberculosis of the spine (Pott' disease), is an uncommon evento of extrapulmonary tuberculosis and usually occurs in the absence of extraspinal infection. We report a 24 year-old-man assisted in Córdoba, City (Argentina). Patient arrived at the hospital with mild lumbar pain, thigh's hyperesthesia an patellar hyporreflexia, both in the right side, without general manifestations. X-ray and CT scanning showed severe structural domage of vertebral bodies of the fourth, an fifth lumbar (L4, L5) and first sacral (S1) vertebrae. In addition, paraspinal abscess with extension up to psoas muscle was observed. Mycobacterium tuberculosis was isolated by culture of specimens obtained by aspiration from affected area, fourty days after admission. Patient was treated for nine months with four drugs (Isoniazid, Rifampicine, Pyrazinamide and Ethambutol). Then, the spine was surgically stabilized. During a follw-up of ten years, patient improved progressively. We point out that Pott' disease should be suspected in all cases with vertebral osteomyelitis and negative bacteriological test for common bacteria.

Leucoencefalopatía multifocal progresiva en paciente con SIDA. Presentación de un caso / Progressive multifocal leucoencephalopaty in a patient with aids

Progressive Multifocal Leucoencephalopaty (PML) is an untreatable viral infection of the brain white matter, seen in persons with very advanced HIV infection.

Listeriosis: meningoencefalitis en adultos / Listeriosis: meningoencephalitis in adults

Se presentan 13 pacientes asistidos en el Hospital Rawson de Córdoba durante el período 1965-1985, con meningoencefalitis por Listeria monocytogenes. De acuerdo con nuestros resultados esta entidad no difiere de las causadas por otras etiologías en el aspecto clínico ni en las características físico-químicas y citológicas del líquido cefalorraquídeo; el diagnóstico se apoya en los exámenes bacteriológicos. Prácticamente en la mitad de los casos (53,8%) ocurrió como infección oportunista; sólo 39% correspondió a pacientes de zonas rurales. Se aplicó la asociación penicilina-cloranfenicol con resultados favorables

Tetanos por inyección intramuscular / Tetanus by intramuscular injection

Presentamos 28 pacientes asistidos en los últimos 6 años (1980-1986) en el Hospital Rawson de la ciudad de Córdoba, con tétanos con puerta de entrada inyectable. El diagnóstico como ocurre con otros tipos de tétanos, fue eminentemente clinico, no obstante, en algunos casos se aisló el Clostridium del sitio de la inyección. Se analizarón diversos tipos ítems: edad, sexo, tipo de inyectable, enfermedad previa que motivó el mismo, material utilizado, evolución, etc. De acuerdo a nuestro resultados, esta entidad posee, en nuestro medio, una importancia capital, por su incidencia, su rápida evolución y su elevado indice de mortalidad. Se enfatiza sobre las causas del mismo y se proponen medidas de prevención

Primer caso de enfermedad del suero por suero antiofidico en dosis mínima / First case of serum sichness by snake antivenins at minimun dosages

Presentamos un caso de "enfermedad del suero", por suero antifídico en dosis mínima de 1 frasco indicado para una forma clínica "leve", en un paciente picado por un ofidio Bothrops neuwiedri diporus, que no había sido tratado en ninguna oportunidad con sueros heterólogos, por lo que estamos ante el primer caso documentado de dicha patología