Concomitant Cytomegalovirus Viraemia in Multisystem Inflammatory Syndrome in Adults (MIS-A) following COVID-19.

Multisystem inflammatory syndrome in adults (MIS-A) is recognised as an infrequent complication of coronavirus disease 2019 (COVID-19). This syndrome occurs following COVID-19 infection in some individuals and is characterised by inflammation of multiple organ systems, such as the heart, liver, bowel, and lymph nodes. Cytomegalovirus (CMV) viraemia is associated primarily with immunosuppression. In COVID-19 patients, it has been reported in severe and critical cases. We present a case of an adult patient diagnosed with MIS-A and concomitant CMV viraemia.

A Man in His Forties with Recurrent Cat-Scratch Disease.

Cat-scratch disease (CSD) is a self-limited zoonotic infection transmitted by felines caused by the Gram-negative bacillus Bartonella henselae. It usually presents with lymphadenopathy and constitutional symptoms that resolve within eight weeks, with, or without antibiotic treatment. The diagnosis is made by serology, molecular diagnosis in a biopsy, or a positive culture. The recurrence or reactivation of B. henselae has rarely been reported. We present the case of a 45-year-old man with a history of CSD two years before who presented to the clinic with groin lymphadenopathy. The patient had a history of close contact with felines though no known risk exposure was reported. The diagnosis was made with a positive serology suggestive of recent infection along with histopathological changes suggestive of CSD. Subsequently, azithromycin was administered with complete resolution of symptoms.

Antibiotic Management of Patients with Hematologic Malignancies: From Prophylaxis to Unusual Infections.

PURPOSE OF REVIEW: Patients with hematological malignancies are recognized for their high susceptibility and increased risk of developing infections associated with immunosuppression that can be caused by the infection itself or by the treatments that condition a decrease in the humoral and T lymphocyte response, so this review attempts to gather the main bacterial, viral, parasitic, and fungal agents that affect them and give recommendations for their approach and diagnosis. RECENT FINDINGS: In recent years, with the discovery and use of new therapies including immunological and targeted treatments, it has been possible to improve the survival and response of patients with hematological malignancies; however, antimicrobial resistance has also increased; we have faced new and unknown microorganisms, such as the SARS-CoV-2 that caused the COVID-19 pandemic in the past year, and therefore, new risks and more severe infections are presented. We present a review of the different circumstances where hematological malignancies increased the risk of infections and which microorganisms affect these patients, their characteristics, and the suggested prophylaxis.

Rhabdomyolysis as an initial presentation in a patient diagnosed with COVID-19.

The presence of rhabdomyolysis secondary to multiple infections has been reported, predominantly viral, but also bacterial and fungal. It is well known that COVID-19 can present a wide variety of complications during the course of infection; however, the presence of rhabdomyolysis as an initial condition has not been reported so far. We report a case of rhabdomyolysis as an initial presentation in a patient diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection.

Trypanosoma cruzi infection associated with atypical clinical manifestation during the acute phase of the Chagas disease.

BACKGROUND: Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and is transmitted by triatomine insects. Clinical manifestations vary according to the phase of the disease. Cutaneous manifestations are usually observed in the acute phase (chagoma and Romaña's sign) or after reactivation of the chronic phase by immunosuppression; however, a disseminated infection in the acute phase without immunosuppression has not been reported for CD. Here, we report an unusual case of disseminated cutaneous infection during the acute phase of CD in a Mexican woman. METHODS: Evaluation of the patient included a complete clinical history, a physical exam, and an exhaustive evaluation by laboratory tests, including ELISA, Western blot and PCR. RESULTS: Skin biopsies of a 50-year-old female revealed intracellular parasites affecting the lower extremities with lymphangitic spread in both legs. The PCR tests evaluated biopsy samples obtained from the lesions and blood samples, which showed a positive diagnosis for T. cruzi. Partial sequencing of the small subunit ribosomal DNA correlated with the genetic variant DTU II; however, serological tests were negative. CONCLUSIONS: We present a case of CD with disseminated skin lesions that was detected by PCR and showed negative serological results. In Mexico, an endemic CD area, there are no records of this type of manifestation, which demonstrates the ability of the parasite to initiate and maintain infections in atypical tissues .

Osteomielitis secundaria a Pasteurella canis / Osteomyelitis due to Pasteurella canis

Resumen Se comunica el caso de una paciente que sufrió mordedura de perro. Solicitó atención médica inmediatamente en donde realizaron asepsia y antisepsia de la herida para posteriormente tratar la lesión. A las 12 horas la paciente comenzó a mostrar cambios de la coloración, aumento de temperatura, volumen y dolor de severa intensidad, por lo que acudió a nuestro hospital para valoración. Se tomaron cultivos y se realizó resonancia magnética, que mostró datos compatibles con infección de tejidos blandos y osteomielitis. En los cultivos se aisló Pasteurella canis. Se dio tratamiento con antibióticos orales con lo que se logró un desenlace favorable. El género Pasteurella lo constituyen cocobacilos gramnegativos, inmóviles, anaerobios facultativos. La cepa más aislada es P. canis posterior a mordeduras de perro y P. multocida y P. septicum en mordeduras de gato. La manifestación más frecuente es celulitis en el sitio de mordedura o arañazo. El diagnóstico se establece mediante métodos microbiológicos. El tratamiento de elección es la penicilina.

Abstract This paper reports a case of osteomyelitis due to Pasteurella canis after a dog bite. The patient requested medical care immediately after the bite, there were performed asepsis and antisepsis of the wound to later close the injury. After 12 hours, the patient's wound started changing colour with increase in temperature, volume and severe pain, so patient went to our hospital for evaluation. Cultures were taken, and magnetic resonance imaging showed images related to soft tissue infection and osteomyelitis. In cultures, Pasteurella canis was isolated. Treatment was given with oral antibiotics, achieving a favourable outcome. The genus Pasteurella are gram-negative, immobile, anaerobic facultative coccobacilli. The most isolated strain is P. canis after dog bites, and P. multocida and P. septicum in cat bites. The most frequent manifestation is cellulitis at the site of a bite or scratch. The diagnosis is made by microbiological methods. The treatment of choice is penicillin.

Not everything is as it seems: neurosarcoidosis presenting as leptomeningitis.

Involvement of the central nervous system in sarcoidosis is rare; neurosarcoidosis, although unusual, can present as leptomeningitis. The diagnosis is usually difficult because of the vague and broad symptomatology; therefore, a prompt diagnosis should be made, and adequate treatment should be administered to reduce morbidity and mortality.

[Primary bone anaplastic large cell lymphoma]. / Linfoma anaplásico de células grandes. Primario de hueso.

INTRODUCTION: Anaplastic large cell lymphoma (ALCL) is a neoplasia of T-cell or null-cell origin accounting for approximately 3% of non-Hodgkin lymphomas in adults and 10-30% of lymphomas in children. It involves the lymph nodes as well as various extranodal sites, but the involvement of bone as either the primary or secondary site of spread, is rare. CASE REPORT: A 47-year-old male presented with an ALCL and multiple bone lesions involving the vertebrae, ribs, and iliac bone, with no other site of involvement. Histologic findings included interstitial and focal bone infiltrate consisting of large pleomorphic cells with an inflammatory background and marked fibrosis. There was immunohistochemical expression of CD30, EMA, CD45RO, CD43, CD8, Glut-1 and ALK-1. DISCUSSION: There are 20 reported cases of ALCL (T/null cell) arising from the bone. To diagnose primary bone lymphoma it is necessary to first exclude systemic lymphoma of the lymph nodes or the skin with bone spread. The differential diagnoses include osteomyelitis, small round cell tumors, mainly Ewing sarcoma/PNET, metastatic carcinoma, melanoma, Hodgkin lymphoma and Langerhans' cell histiocytosis. In this case, the differential FDG accumulation in the lesions observed in the PET-CT was associated with the degree of Glut-1 expression.

Factores pronóstico y mortalidad asociada a bacteremias por bacilos gramnegativos / Mortality and prognostic factors associated to gramnegative bacillus bacteremia

La frecuencia de bacteremia por bacilos gramnegativos ha aumentado en forma importante en este siglo. La mortalidad asociada a este tipo de infecciones es alta y los factores asociados a éstas son múltiples. Realizamos un estudio retrospectivo, en el que se analizan diferentes factores relacionados con el huésped, el bacilo y el hospital que pudieran afectar la evolución del paciente. Se mostro que las bacteremias por Stenotrophomona maltophilia, el antecedente de neoplasia, el uso previo de carbapenémicos y el uso de nutrición parenteral total se asociaron a mayor mortalidad

Síndrome retroviral agudo asociado con angiomatosis bacilar: presentación de un caso y revisión de la literatura / Acute retroviral syndrome associated to bacilar angiomatosis: report of a case and bibliographic review

La angiomatosis bacilar asociada con infección por virus de la inmunodeficiencia adquirida ha sido ampliamente descrita; sin embargo esta presentación se había mencionado siempre en pacientes con cuentas de linfocitos CD4 menores a 200. Presentamos el primer caso de angiomatosis bacilar con peliosis hepática en un paciente con síndrome retroviral agudo confirmado por anticuerpos antivirus de la inmunodeficiencia humana negativos, títulos de antígeno P-24 elevados y serología para Bartonella quintana positiva

Ascitis: Diagnóstico, análisis del líquido, tratamiento y complicaciones / Ascites: Diagnosis, fluid analysis, treatment and complications

Un problema común en la gastroenterología y en otras áreas de la medicina interna es la ascitis. Esta entidad puede ser la manifestación de diversas patologías. Por esta razón, es necesario conocer el abordaje inicial de estos pacientes, así como sus complicaciones y tratamiento

Endocarditis infecciosa en el Hospital ABC / Infectious endocarditis at the ABC Hospital

En los últimos años, el diagnóstico de la endocarditis infecciosa ha cambiado significativamente, tomando encuenta aspectos clínicos, ecocardiográficos y microbiológicos. Presentamos el primer estudio epidemiológico de endocarditis infecciosa realizado en Latinoamérica en un hospital de asistencia privada. El estudio incluyó 15 pacientes con diagnóstico de endocarditis infecciosa establecido según los criterios de Duke; estos enfermos fueron admitidos en el Hospital ABC en un periodo de 18 meses. Se analizó prevalencia, frecuencia, características epidemiológicas, etiología, evolución y tratamiento recibido. La mayoría de los resultados obtenidos en el estudio correlacionan con lo publicado en la literatura mundial