Phaeohyphomycosis in renal transplantation: report of two cases

Abstract Phaeohyphomycosis is an infection caused by a filamentous fungus that contains pigment melanin in its cell wall. We report two cases caused by Exophiala sp. emphasizing the clinical variability of the disease, as well as diagnostic and therapeutic difficulties of this opportunistic infection in immunosuppressed patients (kidney transplant).

Enfermedad de whipple en paciente HIV positivo / Whipple disease in an HIV patient

La enfermedad de Whipple es una enfermedad crónica sistématica de infrecuente presentación, causada por una bacteria, Tropheryma Whipplei, del orden Actinomycetales. Existen cerca de 1.000 casos reportados en la actualidad. Presentamos un caso de enfermedad de Whipple en un paciente HIV (+).

Hallazgos patológicos en cerdos afectados con el síndrome del desmedro multisistémico postdestete de la República Argentina / Pathological findings in pigs affected by the postweaning multisystemic wasting syndrome in Argentina

El síndrome del desmedro multisistémico postdestete (PMWS) fue descrito por primera vez en Canadá en el año 1991 y desde entonces un número creciente de casos han sido diagnosticados en todo el mundo. En la Argentina, el PMWS fue reportado por primera vez recientemente. Se estudiaron 48 cerdos de 5 a 12 semanas de edad con signos característicos de PMWS procedentes de 19 granjas. Si bien se desconoce la distribución real del virus en nuestro país se observó desde el año 2001 un número creciente de granjas con PMWS y distribuidas en las principales provincias productoras. La histopatología fue una herramienta diagnóstica importante en casos sospechosos de PMWS con la observación de diferentes grados de lesión. En los animales estudiados las infecciones secundarias pudieron ser importantes, ya sea por patógenos oportunistas o por complicaciones bacterianas.

Postweaning multisystemic wasting syndrome was first described in Canada in 1991 and at present an increasing number of cases has been diagnosed worldwide. In Argentina the first cases of PMWS were reported recently. Forty eight 5 to 12 week old pigs with signs characteristic of PMWS from 19 farms were studied. Although the real distribution of the virus in our country is not known it was observed an increasing number of farms with PMWS distributed in the major producing provinces. The histopathology was an important tool in diagnosis of suspicious cases of PMWS with the observation of different degrees of lesion. In the studied animals, the secondary infections, either by opportunistic pathogens or secondary bacteria could be important.

The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation

Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4 per cent is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35 per cent presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50 per cent), positivity to M. tuberculosis in the sputum (30 per cent) and spinal cerebral fluid analysis (7 per cent). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.

Inmunodiagnóstico de micosis sistémicas en pacientes con infección por el virus de inmunodeficiencia humana en Venezuela / Immunodiagnosis of systemic fungal infection in patients infected with Human Immunodeficiency virus in Venezuela

Se discute la casuística de las micosis sistémicas en pacientes con SIDA diagnosticadas por métodos inmulogógicos desde 1986 hasta 1997. En 12 años se procesaron 590 serologías para el inmunodiagnóstico de micosis sistémicas en pacientes con infección por el virus de inmunodeficiencia humana (VIH). Doscientas veinte (37,3 por ciento) serologías procedían de pacientes con SIDA y 370 (62,7 por ciento) de pacientes asintomáticos portadores del VIH. El inmunodiagnóstico se realizó por las pruebas de inmunodifusión doble en gel de agarosa y aglutinación de latex para Crytococcus neoformans. De 220 muestras procedentes de pacientes con SIDA 46 (20,9 por ciento) resultaron positivas. La distribución por micosis fué: histoplasmosis 34 (73,9 por ciento), criptococcosis 6 (13 por ciento), paracoccidioidomicosis 5 (10,9 por ciento) Y coccidioidomicosis 1 (2,2 por ciento). En 370 muestras procedentes de pacientes portadores del virus de inmunodeficiencia humana (VIH) asintomáticos no se detectó ninguna de las patologías antes mencionadas. Se demostró que la micosis sistémica más frecuente en pacientes con SIDA fue la micosis, cuyo agente etiológico Histoplasma capsulatum es de distribución mundial y frecuente en nuestro medio. Se recomienda el uso de la prueba de inmunodifusión doble en gel (serología para hongos) como alternativa en el diagnóstico de micosis sistémicas por su sensibilidad y especificidad.

Manifestaciones neurológicas asociadas a la infección por el virus de inmunodeficiencia humana / The neurological complications of HIV infection

El sistema nervioso central y periférico es frecuentemente afectado en el curso de la infección por HIV siendo las manifestaciones neurológicas asociadas a esta infección altamente estadío específico. En este artículo revisamos las características clínicas, paraclínicas, tratamiento y brevemente los mecanismos patogénicos de las manifestaciones neurológicas más comunmente asociadas a la infección por HIV/SIDA, en orden de importancia, aparición nacional y mundial. Se incluyeron en esta revisión las siguientes clínicas: el complejo demencia-SIDA; lesiones focales del sistema nervioso central como toxoplasmosis cerebral, linfoma primario del sistema nervioso central y leucoencefalopatía multifocal progresiva junto a las infecciones oportunistas de mayor incidencia en el paciente con HIV/SIDA. Además se estudia la asociación de enfermedades cerebrales vasculares, mielopatías y varias neuropatías periféricas al HIV

Feo-hifomicose subcutânea no estado do Pará: relato de três casos / Subcutaneous phaeohyphomycosis in the state of Pará: report of 3 cases

Sao descritos três casos de feo-hifomicose subcutânea, os primeiros encontrados no Estado do Pará, todos oriundos de localidades situadas a leste de Belém, nas microrregioes do Salgado e Bragantina. O diagnóstico teve por base o reconhecimento dos parasitos em cortes histológicos, sem identificaçao de espécie, uma vez que todo o material disponível para exame - compreendendo as lesoes completamente excisadas -, ao ser recebido, já estava fixado em formol e imprestável, portanto, para qualquer tentativa de estudo micológico. A abundância de elementos fúngicos verificada nos tecidos, após impregnaçao pela prata (métodos de Grocott e de Fontana-Masson), contrastava com a dificuldade para visualizá-los em cortes nao-corados ou corados por hematoxilina-eosina, fato devido certamente ao aspecto das hifas neles existentes: delgadas, de paredes finas e cor quase imperceptível.

Microflora in postirradiated cancer cervix.

Cases of cancer cervix receiving radiation therapy revealed more anaerobes (50%) in comparison to normal controls (44.6%). The aerobic organisms were suppressed in the former cases (63.6%) in contrast to the latter group (90.7%). Of the anaerobes, the Gram-negative bacilli were more notable (18.1%) in cancer cervix than the normal controls (4.6%). The anaerobes like Peptococcus prevotii (18.1%) and Bacteroides oralis (9%) and the aerobes, Staph aureus (13.6%) and klebsiella (13.6%) were prevalent in cancer cervix. The higher incidence of aerobic and anaerobic organisms in stage III elderly (> 45 years) patients of cancer cervix may necessitate antibacterial therapy.

Phaeohyphomycosis: first case in Puerto Rico

A 24 year-old woman with systemic lupus erythematosus developed a subcutaneous nodule on the back wich upon histopathological examination was found to be a case of phaeohyphomycosis. To our knowledge, this is the first case of the condition to be reported in Puerto Rico

Infecciones oportunistas en 5.612 necropsias. Santiago, Chile, 1960-1986

To help fill gaps in existing knowledge about opportunistic parasitic infections in Chile, histologic material from 5,612 autopsies performed from 1960 through mid-1986 was examined. This examination found 175 opportunistic agents in the tissues of 151 autopsy subjects- these agents including fungi (75 per cent), viruses (23 per cent), parasites (3 per cent), and Nocardia (2 per cent). Ordinary bacteria were disregarded because they are not sufficiently distinctive in histologic studies and cannot be classed as opportunistic on the basis of such studies alone. The most commonly found infections were candidiasis, aspergillosis, cytomegalovirus infection, herpesvirus infection, and zygomycosis. The most commonly compromised organs and tissues were the lungs, esophagus, kidneys, brain, intestines, stomach, myocardium, liver, trachea, and skin. The more frequent primary underlying conditions predisposing subjects to opportunistic infections were lymphohematologic disorders, solid tumors, diabetes mellitus, major abdominal surgery, diffuse diseases of the connective tissue, pulmonary tuberculosis, kidney transplants, prematurity, and senility. In 44 cases the subject had a history of immunodepressant chemotherapy. In general, the types of opportunistic infections, the clinical-anatomic forms of those infections, and the underlying conditions predisposing subjects to such infections appear to