RESUMO
We report a case of pulmonary nocardiosis in an immunosuppressed patient having vasculitis who presented with fever, cough and chest pain. A suspicion of nocardiosis was made on auramine O staining of material procured by CT guided fine needle aspiration cytology right lung. Modified Ziehl-Neelsen staining was useful in confirming the diagnosis. The patient showed remarkable recovery after treatment with co-trimoxazole. Quick identification of this uncommon pathogen in the cytological material using special stains helped in timely diagnosis and successful treatment of the patient.
Assuntos
Benzofenoneídio , Biópsia por Agulha Fina , Feminino , Humanos , Hospedeiro Imunocomprometido , Pulmão/patologia , Pneumopatias Fúngicas/diagnóstico , Pessoa de Meia-Idade , Nocardia/citologia , Nocardiose/diagnóstico , Coloração e Rotulagem/métodosRESUMO
Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.
Assuntos
Adulto , Amebíase/diagnóstico , Anfotericina B/uso terapêutico , Animais , Ceftazidima/uso terapêutico , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Líquido Cefalorraquidiano/parasitologia , Quimioterapia Combinada , Evolução Fatal , Humanos , Masculino , Naegleria fowleri/isolamento & purificação , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X , Recusa do Paciente ao TratamentoRESUMO
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.