Recurrent Peri-Clitoral Abscess with Positive Actinomyces turicensis Culture.

A peri-clitoral abscess is a condition that is seldom encountered in practice and is found scarcely in the literature. The cause of spontaneous peri-clitoral abscess not associated with female circumcision/genital mutilation is generally unknown. Additionally, there have been no case reports of positive Actinomyces culture at the time of drainage of a peri-clitoral abscess. This case outlines a 42-year-old female with a spontaneous peri-clitoral abscess. The abscess was initially treated with incision and drainage (I&D) and antibiotics, but it later reoccurred necessitating a second I&D with bedside marsupialization and antibiotics targeted at Actinomyces, which grew on the culture after primary I&D.

A Suicide Attempt: Deltamethrin Intoxication.

Poisoning is a frequent cause of emergency department visits, with attempted suicide accounting for up to two-thirds of all fatalities from pesticide poisoning. Despite extensive pyrethroid use worldwide, relatively few cases of human poisoning have been reported in the literature. Although most pesticide use occurs in the developed world, 99% of all acute pesticide poisoning occurs in developing countries. Deltamethrin poisoning is uncommon, with fewer than 10 deaths reported following ingestion or occupational exposure. The present case report describes deltamethrin intoxication due to intentional oral ingestion in a suicide attempt, resulting in a life-threatening combination of seizures and coma due to non-convulsive status epilepticus. LEARNING POINTS: Up to two-thirds of all fatalities from pesticide poisoning are due to suicide.Organophosphate or organochloride poisoning can mimic pyrethroid poisoning.Poisoning with deltamethrin, which belongs to the pyrethroid family, is uncommon; there is no antidote, with supportive and symptom-directed treatment being the gold standard.

Tuberculosis among health care workers treated at a university hospital in Bogotá D.C., Colombia. 2008-2018 / Tuberculosis en trabajadores de la salud atendidos en un hospital universitario de Bogotá D.C., Colombia. 2008-2018

Abstract Introduction: Worldwide, three people die of tuberculosis (TB) every minute. The risk of TB transmission among healthcare workers is up to 40 times higher than in the general population. Nevertheless, in Colombia, little importance has been given to this situation. Objective: To describe the demographic and clinical characteristics of healthcare workers with TB treated in a university hospital from Bogotá D.C. (Colombia), as well as their laboratory, histologic, and imaging findings, and the main criteria for their TB diagnosis. Materials and methods: Case series study. The medical records of 24 healthcare workers with TB who were treated in a quaternary care university hospital in Bogotá D.C. between January 2008 and December 2018 were reviewed. Sociodemographic and clinical data, as well as imaging and laboratory findings data, were collected. Results: There was no predominant sex (50% women and 50% men). The median age was 33.5 years (IQR: 24-52.7). Pulmonary TB was the most frequent form of TB (62.50%); in addition, acid-fast bacillus sputum stain was positive in 2 patients (8.33%). The histopathology report was useful for diagnosing TB in 66.66% of cases, and mycobacterial culture was positive in 75% of patients. Most of them were physicians (41.66%) and medical students (16.66%). Conclusions: A high proportion of women was found in the study population (1:1 ratio), and the histopathology report was useful for reaching a rapid TB diagnosis in most cases. In addition, physicians and medical students were the healthcare workers most affected by TB. In this sense, health institutions in the country should pay greater attention to biosafety measures among these workers; also, occupational epidemiological surveillance programs enhancing TB-transmission control are necessary.

Resumen Introducción. Cada minuto tres personas mueren de tuberculosis (TB) en el mundo. El riesgo de transmisión en trabajadores de la salud es hasta 40 veces mayor que en población general. Sin embargo, en Colombia se ha dado poca importancia a esta situación. Objetivo. Describir las características demográficas y clínicas de trabajadores de la salud con TB atendidos en un hospital universitario de Bogotá D.C., Colombia, así como los hallazgos paraclínicos (de laboratorio, histológicos y radiológicos) y los principales criterios de diagnóstico de TB en estos pacientes. Materiales y métodos. Estudio de serie de casos. Se revisaron las historias clínicas de 24 trabajadores de la salud con TB atendidos en un hospital universitario de cuarto nivel de Bogotá D.C. entre enero de 2008 y diciembre de 2018. Se recolectó información sociodemográfica y sobre las características clínicas de estos pacientes, así como sobre hallazgos radiológicos y de laboratorio. Resultados. No hubo un género predominante (50% mujeres y 50% hombres). La mediana de edad fue 33.5 años (RIQ: 24-52.7). La TB más frecuente fue la TB pulmonar (62.50%); además, en 2 pacientes (8.33%) la baciloscopia de esputo fue positiva. El estudio histopatológico fue útil en el diagnóstico del 66.66% de los casos, y el cultivo de micobacterias fue positivo en el 75% de los casos. La mayoría de los pacientes eran médicos (41.66%), seguidos de estudiantes de medicina (16.66%). Conclusión. Se encontró una alta proporción de mujeres (relación 1:1), y el estudio histopatológico permitió el diagnóstico rápido de TB en la mayoría de los casos. Además, los trabajadores de la salud más afectados fueron los médicos y los estudiantes de medicina. En este sentido, las instituciones de salud del país deben prestar mayor atención a las prácticas de bioseguridad de esta población, y se debe contar con programas de vigilancia epidemiológica ocupacional que favorezcan un mejor control de la transmisión.

Within patient genetic diversity of blaKPC harboring Klebsiella pneumoniae in a Colombian hospital and identification of a new NTEKPC platform.

Resistance to carbapenems in Klebsiella pneumoniae has been mostly related with the worldwide dissemination of KPC, largely due to the pandemic clones belonging to the complex clonal (CC) 258. To unravel blaKPC post-endemic clinical impact, here we describe clinical characteristics of 68 patients from a high complexity hospital, and the molecular and genetic characteristics of their 139 blaKPC-K. pneumoniae (KPC-Kp) isolates. Of the 26 patients that presented relapses or reinfections, 16 had changes in the resistance profiles of the isolates recovered from the recurrent episodes. In respect to the genetic diversity of KPC-Kp isolates, PFGE revealed 45 different clonal complexes (CC). MLST for 12 representative clones showed ST258 was present in the most frequent CC (23.0%), however, remaining 11 representative clones belonged to non-CC258 STs (77.0%). Interestingly, 16 patients presented within-patient genetic diversity of KPC-Kp clones. In one of these, three unrelated KPC-Kp clones (ST258, ST504, and ST846) and a blaKPC-K. variicola isolate (ST182) were identified. For this patient, complete genome sequence of one representative isolate of each clone was determined. In K. pneumoniae isolates blaKPC was mobilized by two Tn3-like unrelated platforms: Tn4401b (ST258) and Tn6454 (ST504 and ST846), a new NTEKPC-IIe transposon for first time characterized also determined in the K. variicola isolate of this study. Genome analysis showed these transposons were harbored in different unrelated but previously reported plasmids and in the chromosome of a K. pneumoniae (for Tn4401b). In conclusion, in the blaKPC post-endemic dissemination in Colombia, different KPC-Kp clones (mostly non-CC258) have emerged due to integration of the single blaKPC gene in new genetic platforms. This work also shows the intra-patient resistant and genetic diversity of KPC-Kp isolates. This circulation dynamic could impact the effectiveness of long-term treatments.

Comparison of the QuantiFERON-TB and tuberculin skin test for detection of latent tuberculosis infection in cancer patients in a developing country.

Cancer patients have an increased risk of reactivation of latent tuberculosis infection. It is unknown which strategy on screening should be used in this population in developing countries. We aimed to determine the concordance between the tuberculin skin test (TST) and QuantiFERON®-TB (QFT) assay in order to diagnose latent tuberculosis infection in cancer patients. We conducted a cross-sectional study of the agreement of diagnostic tests. Prevalence and agreement between tests were calculated. A logistic regression to assess predictors of discordance was performed. The accuracy of the TST to predict QFT results by a receiver operating characteristic (ROC) curve was evaluated. We included 149 adults with cancer without active tuberculosis. Prevalence of latent tuberculosis infection was 21.5% (n=32), defined as positive results on either test. Test agreement was moderate for the diagnosis of latent tuberculosis infection (κ=0.43, 90% CI 0.26-0.6). No predictor was associated with the chance of discordant results. Agreement improved slightly using a cut-off point ≥8 mm (κ=0.5, 90% CI 0.35-0.66). In a moderate-incidence setting, a moderate agreement was found between tests in cancer patients. Modification of the cut-off points of test results achieved marginally better agreement between the TST and QFT.

Gnatostomiasis cutánea, primer caso confirmado en Colombia / Cutaneous gnathostomiasis, first confirmed case in Colombia

La gnatostomiasis es una zoonosis parasitaria causada por algunas especies del género de helmintos Gnathostoma . La presentación clínica es muy variada y su diagnóstico constituye un desafío; es endémica en países tropicales y subtropicales, y la transmisión se asocia con el consumo de carne de animales acuáticos, cruda o mal cocida. En las últimas décadas, el creciente turismo internacional y el consumo de alimentos exóticos, han provocado un notable aumento de casos de la enfermedad. En nuestro país no se ha reportado ningún caso confirmado de gnatostomiasis. Se presenta el caso de un hombre colombiano de 63 años de edad, viajero frecuente al exterior, que consultó por presentar síntomas gastrointestinales. Durante la hospitalización desarrolló una lesión cutánea en el flanco abdominal derecho, de la cual se extrajo una larva cuya descripción morfológica permitió clasificarla como Gnathostoma spinigerum . Se trata de la primera confirmación de un caso importado de gnatostomiasis en Colombia. En este artículo se discuten las generalidades, la etiología, la patogenia y el tratamiento de la enfermedad, con especial énfasis en las características particulares de este paciente.

Gnathostomiasis is a parasitic zoonosis caused by some species of helminthes belonging to the genus Gnathostoma . It has a wide clinical presentation and its diagnosis is a challenge. Tropical and subtropical countries are endemic, and its transmission is associated with eating raw or undercooked meat from fresh water animals. Increasing global tourism and consuming exotic foods have produced a noticeable rise in cases of the disease in the last decades. However, in our country, there has not been any confirmed case of gnathostomiasis previously reported. We present the case of a 63-year-old Colombian man with an international travel history, who presented with gastrointestinal symptoms. During the hospital stay, he developed a cutaneous lesion on the upper right abdominal quadrant, where later, a larva was found. A morphological study allowed us to identify it as Gnathostoma spinigerum . As such, this is the first report of an imported case of gnathostomiasis confirmed in Colombia. This article describes the principles, etiology, pathogenic cycle and treatment of this disease with special considerations to our patient´s particular features.

[Cutaneous gnathostomiasis, first confirmed case in Colombia]. / Gnatostomiasis cutánea, primer caso confirmado en Colombia.

Gnathostomiasis is a parasitic zoonosis caused by some species of helminthes belonging to the genus Gnathostoma . It has a wide clinical presentation and its diagnosis is a challenge. Tropical and subtropical countries are endemic, and its transmission is associated with eating raw or undercooked meat from fresh water animals. Increasing global tourism and consuming exotic foods have produced a noticeable rise in cases of the disease in the last decades. However, in our country, there has not been any confirmed case of gnathostomiasis previously reported. We present the case of a 63-year-old Colombian man with an international travel history, who presented with gastrointestinal symptoms. During the hospital stay, he developed a cutaneous lesion on the upper right abdominal quadrant, where later, a larva was found. A morphological study allowed us to identify it as Gnathostoma spinigerum . As such, this is the first report of an imported case of gnathostomiasis confirmed in Colombia. This article describes the principles, etiology, pathogenic cycle and treatment of this disease with special considerations to our patient´s particular features.

[Pathological and molecular diagnosis in a case of primary laryngeal tuberculosis in a physician]. / Diagnóstico patológico y molecular de un caso de tuberculosis laríngea primaria en un médico.

Primary laryngeal tuberculosis is a rare disease with a wide variety of clinical manifestations. We report the case of an ear-nose and throat diabetic physician with primary laryngeal tuberculosis. The diagnosis of laryngeal cancer had been considered before in another institution, and at the patient's admission, he only presented dysphonia with a six-month evolution. The vocal cord histological examination showed granulomas, giant cells, fibrosis and necrosis, and the Ziehl-Neelsen staining showed acid-alcohol resistant bacilli. The culture from vocal cord tissue was positive for mycobacteria, and IS 6110 -PCR was positive too. The Mycobacterium tuberculosis strain was sensitive to first line drugs. Treatment using directly observed therapy short-course (DOTS) was initiated. Clinical presentation, differential diagnosis, diagnostic workup, associated risk factors and a brief literature revision are discussed in this article.

Abdominal complications following hematopoietic stem cell transplantation.

Abdominal complications affect more than 80% of patients who undergo hematopoietic stem cell transplantation (HSCT) for treatment of benign or malignant hematologic disease and some solid tumors. HSCT can be performed using cells from bone marrow, peripheral blood, or umbilical cord blood. These stem cells may be from the patient him- or herself (autologous transplant), from relatives or nonrelatives with very similar human leukocyte antigen (allogeneic transplant), or from an identical twin (syngeneic transplant). Posttransplantation complications are classified according to the amount of time elapsed between transplantation and onset. Complications that occur during the first 100 days are divided into preengraftment phase complications (≤30 days after transplantation) and early posttransplantation phase complications (31-100 days after transplantation) and include infectious and noninfectious conditions such as hepatic veno-occlusive disease (VOD), hemorrhagic cystitis, neutropenic colitis, benign pneumatosis, and acute graft-versus-host disease (GVHD). Hepatic VOD, neutropenic colitis, and acute hemorrhagic cystitis are associated with the pretransplantation conditioning regimen. After the first 100 days, chronic GVHD and lymphoproliferative disease are the main complications. Computed tomography and ultrasonography are the primary imaging techniques used in HSCT patients and can help make an early diagnosis, grade the severity of impact, and (if necessary) recommend further investigations to confirm the diagnosis.

Diagnóstico patológico y molecular de un caso de tuberculosis laríngea primaria en un médico / Pathological and molecular diagnosis in a case of primary laryngeal tuberculosis in a physician

La tuberculosis laríngea primaria es una enfermedad rara con una amplia gama de manifestaciones clínicas. Se reporta el caso de un médico otorrinolaringólogo con diabetes de tipo II y con diagnóstico de tuberculosis laríngea primaria. El diagnóstico de cáncer de cuerda vocal se había considerado en otra institución, y al ingreso el paciente sólo presentaba disfonía de seis meses de evolución. En el estudio histopatológico se encontraron granulomas, células gigantes multinucleadas, fibrosis y necrosis, y en la tinción de Ziehl-Neelsen, bacilos ácido-alcohol resistentes. El cultivo del tejido de cuerda vocal para micobacterias y la PCR-IS6110 fueron positivos. La cepa de Mycobacterium tuberculosis demostró sensibilidad a todos los medicamentos de primera línea. Se inició tratamiento según la estrategia DOTS ( Directly Observed Treatment, Short -course ). Se discute la presentación clínica, los diagnósticos diferenciales, el abordaje diagnóstico y los factores de riesgo asociados y se hace una breve revisión de la literatura.

Primary laryngeal tuberculosis is a rare disease with a wide variety of clinical manifestations. We report the case of an ear-nose and throat diabetic physician with primary laryngeal tuberculosis. The diagnosis of laryngeal cancer had been considered before in another institution, and at the patient´s admission, he only presented dysphonia with a six-month evolution. The vocal cord histological examination showed granulomas, giant cells, fibrosis and necrosis, and the Ziehl-Neelsen staining showed acid-alcohol resistant bacilli. The culture from vocal cord tissue was positive for mycobacteria, and IS 6110 -PCR was positive too. The Mycobacterium tuberculosis strain was sensitive to first line drugs. Treatment using directly observed therapy short-course (DOTS) was initiated. Clinical presentation, differential diagnosis, diagnostic workup, associated risk factors and a brief literature revision are discussed in this article.

Altered HLA class I and HLA-G expression is associated with IL-10 expression in patients with cervical cancer.

Although high-risk human papillomaviruses (HPVs) are an important risk factor in the etiopathogenesis of cervical cancer, increasing evidence suggests that the ability to avoid immune surveillance seems to be linked to the transforming potential of HPV and a rapid progression to cancer. In other cancer models, IL-10 contributes to impair anti-tumor immune response either by downregulating human leukocyte antigen Class I (HLA-I) expression or by increasing HLA-G expression. To comprehend how these alterations could contribute to evasion of immune surveillance in cervical cancer, we analyzed HLA-I, HLA-G and IL-10 expressions by immunohistochemistry in 63 biopsies from patients with cervical intraepithelial neoplasia III (CIN-III) and cervical cancer. Immunohistochemistry showed absent or weak HLA-I expression in 50/59 cases. In these cases, a high percentage had loss of heterozygosis. IL-10 and HLA-G expression were observed in 46.6 and 27.6% of cases, respectively. Concurrent upregulation of IL-10 was found in 87.5% of HLA-G positive cases (p = 0.000). Similarly, a significant association between IL-10 expression and HLA-I downregulation was found (p = 0.028). Finally, we observed higher HLA-G expression in patients with HLA-I downregulation than in those with normal HLA-I expression (p = 0.004). Our results suggest that, in cervical cancer, the IL-10 expression may induce an immunosuppressive environment by upregulating HLA-G expression and downregulating HLA class I expression.

Frecuencias de las perdidas de heterocigocidad en la regi¨®n que codifica para HLA en biopsias de pacientes con c¨¢ncer de cuello uterino / Frequency of Heterozygosity Loss in the Region to be Encoded by HLA in Biopsies of Patients with Cervical Cancer

Objetivo: Determinar las frecuencias de p¨¦rdidas de heterocigocidad de LOH en las regiones 6p21.3 y 15q21 que codifican para HLA y ¦Â2 microglobulina, para establecer su correlaci¨®n con el estadio tumoral, teniendo en cuenta que las LOH en HLA I ocurren como un evento gen¨¦tico temprano del c¨¢ncer y pueden contribuir a su desarrollo. M¨¦todos: Se tomaron muestras de sangre perif¨¦rica (SP) y biopsias de cuello uterino de pacientes con NICIII y CCU. Se amplificaron 11 microsat¨¦lites relacionados con el sistema HLA en pares normal-tumor a partir de ADN purificado de c¨¦lulas de SP y c¨¦lulas tumorales microdisectadas. Las LOH fueron determinadas por electroforesis capilar y analizadas mediante los programas GeneScan y Genotyper. Resultado: Todas las muestras amplificaron m¨¢s de 7 microsat¨¦lites (promedio 9,5). El porcentaje de heterocigocidad para los marcadores de microsat¨¦lites utilizados en las muestras de cuello uterino vari¨® entre 51,8% y 95%, y la LOH, entre 17,4% y 50,0%. Las frecuencias observadas para LOH en los diferentes estadios tumorales fueron: 42,9% en el grupo de NIC-III; 57% en CCU en estadio I; 63,6% en CCU en estadio II y 92,85% en pacientes con estadios m¨¢s avanzados (III-IV). Conclusi¨®n: Se observ¨® una mayor frecuencia de LOH en los grupos de pacientes con estadios avanzados de CCU, al comparar con pacientes con NIC-III.

Objective: To determine the frequency of LOH heterozygosity in the regions 6p21.3 and 15q21 which encode for HLA and ¦Â2microglobulina in order to establish their correlation with tumoral stage, taking into account that LOH and HLA I occur as an early genetic event in cancer and can contribute to its development. Methods: Peripheral blood (PB) samples and cervical biopsies were taken from patients with CIN III and invasive cancer. Amplification was made of eleven microsatellites related to the HLA system, in normal-tumor pairs, based on purified DNA PB cells and micro-dissected tumor cells. LOH were determined through capillary electrophoresis and analyzed with GeneScan and Genotyper programs. Results: All samples amplified at more than 7 microsatellites (average 9.5). The percentage of heterozygosity for microsatellite markers used in the cervical samples varied between 51.8% and 95%; the LOH, between 17.4% and 50.0%. The frequencies observed for LOH in the different tumoral stages were: 42.9% in the CIN III group; 57% in invasive cancer Stage I; 63.6% in Stage II, and 92.85% in patients in the most advanced stages (III-IV). Conclusion: Greater frequency of LOH was observed in groups of patients with advanced stages of invasive cancer in comparison with patients with CIN III.

Oncogene amplification as tumor marker in a group of Colombian lung cancer patients / Amplificación oncogénica como marcador tumoral en un grupo de pacientes con cáncer pulmonar

Introduction: In spite of recent treatment advances, lung cancer continues to be the first world cancer related death cause; its mortality associated occupied the fifth place in Colombia in 2004. Complete surgical resection is the therapeutic option with the greatest cure probability, however it results frequently ineffective given the current incapacity in Colombia to an early detection of the disease. This study reports the characterization of a group of 30 lung cancer patients regarding the gene dose (gene copy number) found at the loci corresponding to genes EGFR (erb B1), PIK3CA and C-myc in tumor samples, and compares the results with the dose found in adjacent lung from the same patients. Methods: The gene dose of EGFR (erbB1), PIK3CA, and C-myc were measured by real time PCR in matched tumor and normal lung tissue samples. Results are expressed as the multiplicity of each gene dose with respect to a single copy reference gene. In this case the gene HHB (human hemoglobin). Antiquity of the cases ranged from 5 to 10 years. Results: An increased gene dose for EGFR and PIK3CA was a feature clearly associated to the tumor phenotype of the sample (found in 96 and 100% of the tumors respectively). Quantitative measure of this feature demonstrated for both genes a high sensitivity and specificity for tumor/normal discrimination as confirmed by the ROC analysis. On the other hand, the Spearman test showed a great correlation between EGFR and PIK3CA doses (r=0.75). C-myc was the gene whose dose was less consistently correlated to the tumor phenotype, however most of the patients with amplified C-myc presented distant spread of tumor cells (metastasis) at diagnosis. Conclusion: Quantitative measurement of EGFR, PIK3CA, and C-myc gene dose by real time PCR provides a method for tumor phenotype recognition in DNA samples from lung tissue.

Introducción: A pesar de los avances terapéuticos actuales, el cáncer de pulmón sigue como la primera causa de muerte por cáncer en el mundo, ocupando Colombia el quinto lugar en mortalidad por este tipo de afección en el 2004. La resección quirúrgica total es la alternativa terapéutica con mayores probabilidades de curaciones, pero resulta poco efectiva en el país por la incapacidad actual para detectar tempranamente la enfermedad. Este trabajo informa la caracterización de un grupo de 30 pacientes con cáncer de pulmón con referencia a la dosis génica hallada en los loci correspondientes a los genes EGFR (erb B1), PIK3CA y C-myc en muestras tumorales, comparada con la dosis encontrada en el tejido normal adyacente de los mismos enfermos. Métodos: La dosis génica se midió en cada caso por PCR en tiempo real sobre ADN aislado de tejido tumoral y normal preservado en parafina de cada paciente. Los resultados se expresan como el número de veces que la dosis de cada gen sobrepasa la dosis de un gen de referencia, en este caso el HHB (hemoglobina humana b). El rango de antigüedad de los casos fue de 5 a 10 años. Resultados: Una dosis génica incrementada para los genes EGFR, PIK3CA demostró ser una característica claramente asociada con el fenotipo tumoral (96% y 100% de los tumores respectivamente). La medición cuantitativa de dicho fenómeno demostró en ambos casos gran sensibilidad y especificidad para la discriminación tumor/normal como lo confirma el análisis ROC. Por otro lado, la amplificación simultánea de ambos genes en el mismo paciente fue un hecho observado con alta frecuencia (Spearman=0.75). La dosis de C-myc mostró una asociación menos consistente con el carácter tumoral, sin embargo todos los pacientes con C-myc amplificado presentaron dispersión distante de células tumorales (metástasis).

Tumor carcinoide broncopulmunar / Bronchopulmonary carcinoid tumor

Los tumores carcinoides son tumores neuroendocrinos raros derivados de células enterocromafines. Han sido reportados en órganos como pulmón, bronquios y en el espacio tractogastrointestinal. La clasificación patológica de la Organización Mundial de la Salud (OMS) de 1999 los divide en tumores carcinoides típicos, tumores carcinoides atípicos y carcinoma de célula pequeña. Los hallazgos radiológicos incluyen masa hiliar o perihiliar, nódulos endobronquiales, hallazgos secundarios a obstrucción bronquial y nódulo solitario. Se presentan, así mismo, los hallazgos patológicos, clínicos, radiológicos y quirúrgicos del tumor carcinoide, y se revisan las características descritas en la literatura.