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Brucellosis is an anthropozoonotic infectious disease in which infected animals pose a threat to humans. This disease has considerable social, economic and international trade importance. Despite past and current efforts to eradicate brucellosis, a large number of new human cases are reported annually worldwide. In this study, patho-physiological response to Brucella abortus S19Δper infection in BALB/c mice was assessed in comparison to its parent strain, B. abortus S19 and virulent strain, B. abortus 544. Immunohistochemical analysis confirmed the presence of bacteria in liver and spleen. Comparatively lower serum Aspartate aminotranferase (AST) level and observation of less number of microgranulomas in liver indicated that B. abortus S19 Δper was less infectious and failed to cause active infection unlike S19 and 544 strain. S19Δper, thus could be a safer vaccine candidate as an alternate to the S19 vaccine strain. Hematological studies indicated clinical manifestation of thrombocytopenia in different Brucella infected mice including S19Δper. Therefore, measurement of platelets count and serum AST level may offer as reliable indicators of brucellosis in clinical cases
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RESUMEN Introducción Rhodococcus equi, patógeno intracelular, afecta a pacientes inmunodeprimidos, en ellos la infección pulmonar es la forma más frecuente de presentación. La Histoplasmosis, micosis profunda, habitualmente diseminada en pacientes con SIDA, relacionada al CD4 bajo. Caso Clínico Varón de 43 años, HIV+, con WB: 08/04/15, CD4: 13, CV: 92.076, TARV con Tenofovir + Lamivudina + Efavirenz, cuadro de 5 días de sensación febril, tos con expectoración amarillenta y dolor tipo puntada en hemitórax izquierdo. Examen físico MV disminuido en hemitórax izquierdo, crepitantes en campo medio. Hepatoesplenomegalia leve. Lesiones papulares violáceas indoloras en tórax y miembro superior derecho. Hemocultivo: Rhodococcus equi. TAC de tórax: imagen hiperdensa con cavitaciones en campo medio del parénquima pulmonar izquierdo. Biopsia de piel, anatomía patológica: SK en estadio de mácula. Fibrobroncoscopía + Bx transbronquial: BAL (-), anatomía patológica: proceso inflamatorio granulomatoso severo. Pancitopenia durante internación. PAMO: (-). BxMO: microgranuloma de etiología a determinar. Cultivo de MO: Histoplasma capsulatum. Recibió tratamiento con Levofloxacina 750mg/d + Azitromicina 500mg/d + Rifampicina 900 mg/d y Anfotercina B desoxicolato con buena evolución clínica. Discución La persistencia de picos febriles obligó a la realización de procedimientos invasivos para diagnosticar una coinfección oculta. Es bien conocida la afección de inmunodeprimidos por estos patógenos.
ABSTRACT Introduction Rhodococcus equi, an intracellular pathogen, affects immunecompromised patients, where lung infection is the most frequent form of presentation. Histoplasmosis, deep mycosis, usually disseminated in patients with AIDS, is related to low CD4. Clinical Case Male, 43 years, HIV +, with WB: 08/04/15, CD4: 13, CV: 92.076, ART with Tenofovir + Lamivudine + Efavirenz, 5-day fever, cough with yellowish expectoration and type pain Stitch in left hemithorax. MV physical examination decreased in left hemithorax, crackling in midfield. Mild hepatosplenomegaly. Painless violaceous papular lesions in the thorax and right upper limb. Hemoculture: Rhodococcus equi. Chest CT: hyperdense image with cavitations in the middle field of the left lung parenchyma. Skin biopsy, pathological anatomy: SK at macula stage. Fibrobronchoscopy + transbronchial Bx: BAL (-), pathological anatomy: severe granulomatous inflammatory process. Pancytopenia during hospitalization. PAMO (-). BxMO: microgranuloma of aetiology to be determined. Culture of MO: Histoplasma capsulatum. Received treatment with Levofloxacin 750mg / d + Azithromycin 500mg / d + Rifampicin 900mg / d and amphotericin B deoxycholate with good clinical evolution. Discussion The persistence of febrile spikes forced invasive procedures to diagnose occult coinfection. It is well known the condition of immunosuppressed by these pathogens.