Résumé
Central nervous system infection with free-living amoebae is rare. We present a fatal case of Acanthamoeba encephalitis in a 63-year-old female from India where acanthamoebae were demonstrated and cultured from CSF. In spite of treatment with amphotericin B, fluconazole and rifampicin the patient did not survive. Amoebic infection should be suspected in a patient of encephalitis of unexplained aetiology as timely diagnosis can lead to a favourable outcome.
Sujets)
Acanthamoeba/isolement et purification , Amibiase/diagnostic , Amphotéricine B/usage thérapeutique , Animaux , Antibactériens/usage thérapeutique , Antifongiques/usage thérapeutique , Liquide cérébrospinal/parasitologie , Encéphalite/parasitologie , Issue fatale , Femelle , Fluconazole/usage thérapeutique , Humains , Inde , Adulte d'âge moyen , Rifampicine/usage thérapeutiqueRésumé
Rheumatic fever is a multi system disease which occurs following infection with group A beta hemolytic streptococcus. It is commonest in the age group of 5-15 years but can occur in adults also. First degree atrioventricular block is a common manifestation of acute rheumatic fever and is included in the Jones criteria but Wenckebacks phenomena and complete heart block are relatively rare manifestations of rheumatic fever. Syncope occurring in acute rheumatic fever is also infrequently reported. We report the case of a 38-year-old male with rheumatic carditis who had advanced atrioventricular block which resulted in syncope and required a temporary pacemaker insertion.
Sujets)
Adulte , Diagnostic différentiel , Électrocardiographie , Fièvre/étiologie , Bloc cardiaque/complications , Humains , Mâle , Rhumatisme cardiaque/complications , Syncope/étiologieRésumé
BACKGROUND: Intrapulmonary vascular dilatation in patients with portal hypertension due to chronic liver disease has been reported mainly from Western countries. METHODS: Fifty in-patients with portal hypertension due to cirrhosis of the liver were subjected to contrast-enhanced two-dimensional echocardiography in order to detect the presence of intrapulmonary vascular dilatation. Their arterial blood oxygen saturation was measured. The patients, including 37 men, were aged mean 43.5 years; 30 had alcoholic cirrhosis and 20 postnecrotic cirrhosis. Twelve patients were in Child-Pugh, class B and 38 in class C. RESULTS: None of the 50 patients was cyanosed or had clubbing. Their mean pO2 was 83.2 mmHg. None had evidence of intrapulmonary vascular dilatations. CONCLUSION: Intrapulmonary vascular dilatation was not observed in our patients with liver cirrhosis. However, the sensitivity of contrast-enhanced echocardiography for this purpose needs to be reviewed.