Allergic bronchopulmonary disease caused by Bipolaris hawaiiensis presenting as a necrotizing pneumonia: case report and review of literature.

We report a case of allergic bronchopulmonary disease caused by Bipolaris hawaiisensis in an immunocompetent host, presenting with symptoms and radiographic findings suggestive of necrotizing pneumonia. Cultures of the plugs and bronchial washing yielded the pathogenic fungi. Laboratory tests revealed eosinophilia and elevation of serum IgE. This patient was successfully treated with steroids, amphotericin B lipid complex, and itraconazole. Review of 10 previously reported cases and their clinical manifestations and treatment are presented.

Tolerability of oral dextromethorphan in patients with a history of brain ischemia.

Twelve patients with a history of cerebral ischemia were randomized to treatment with the N-methyl-D-aspartate antagonist dextromethorphan (60 or 90 mg p.o. q.i.d.) or placebo for 2 weeks in a randomized, safety study. Neuropsychological testing did not detect evidence of cognitive dysfunction; however, side effects including lightheadedness, drowsiness, nausea, decreased coordination, and unsteady gait were reported by several patients while taking dextromethorphan.

Treatment of tardive dyskinesia with vitamin E.

OBJECTIVE: Vitamin E (alpha-tocopherol), a free-radical scavenger, has been reported to improve symptoms of tardive dyskinesia. The authors attempted to replicate this finding under more controlled conditions in a larger study group. METHOD: Fifteen inpatients and six outpatients with tardive dyskinesia received up to 1600 IU/day of vitamin E for 6 weeks in a double-blind, placebo-controlled crossover study. Abnormal Involuntary Movement Scale (AIMS) examinations of these patients were videotaped and rated independently by two trained raters. Levels of neuroleptic medication and vitamin E were measured during both treatment periods. Eighteen patients who demonstrated high blood levels of vitamin E were included in the data analysis. RESULTS: Vitamin E levels were significantly higher while the patients were receiving vitamin E than while they were receiving placebo. For all 18 patients, there were no significant differences between AIMS scores after receiving vitamin E and AIMS scores after receiving placebo. In agreement with previous studies, however, the nine patients who had had tardive dyskinesia for 5 years or less had significantly lower AIMS scores after receiving vitamin E than after receiving placebo. There were no changes in neuroleptic levels during vitamin E treatment. CONCLUSIONS: Vitamin E had a minor beneficial effect on tardive dyskinesia ratings in a selected group of patients who had had tardive dyskinesia for 5 years or less. This effect was not due to an increase in blood levels of neuroleptic medications.

Safety and tolerance of oral dextromethorphan in patients at risk for brain ischemia.

Experimental ischemia models have shown the antitussive dextromethorphan to be an N-methyl-D-aspartate antagonist with neuroprotective properties. We treated 10 patients with a history of recent stroke or transient ischemic attack with oral dextromethorphan (60 mg q.i.d.) for 3 weeks in a placebo-controlled, double-blind, crossover tolerance study. We documented no clinical evidence of toxicity attributable to dextromethorphan in this preliminary study.

Efficacy and toxicity of pentostam against Panamanian mucosal leishmaniasis.

We tested the World Health Organization (WHO) recommended treatment for mucosal leishmaniasis in 16 Panamanians with disease due to Leishmania braziliensis panamensis. Disease was mild in this population because it was limited to the nasal mucosa and only one patient had septal perforation. The patients were administered 20 mg antimony (in the form of Pentostam) per kg intravenously each day for 28 days. Ten patients completed therapy and were cured at 12 month follow-up. Three patients completed therapy, healed their lesions, but relapsed at the six or 12 month follow-up. Three patients terminated therapy prematurely because of liver enzyme elevations in conjunction with either EKG abnormalities or musculoskeletal complaints; none of these patients were healed. This study indicates that in patients with mild mucosal leishmaniasis, the WHO regimen is curative in 77% patients who complete treatment and in 63% of all patients.

Leishmania mexicana complex: human infections in the Republic of Panama.

Parasites of the genus Leishmania responsible for human cutaneous leishmaniasis in the New World form 2 major taxonomic divisions: the Leishmania braziliensis and the L. mexicana complexes. We report the isolation and characterization of the L. mexicana complex among humans in the Republic of Panama. Characterization was based on parasite morphology, pathogenesis in infected golden hamsters, cellulose acetate isoenzyme electrophoretic mobilities, and membrane-specific monoclonal antibodies using the radioimmune binding assay technique.

Efficacy of ketoconazole against Leishmania braziliensis panamensis cutaneous leishmaniasis.

PURPOSE, PATIENTS, AND METHODS: The classic agent for cutaneous leishmaniasis is pentavalent antimony. However, there are no reports of the efficacy of antimony versus placebo or of the efficacy of any alternative therapy versus either antimony or placebo. In the present report, the oral antifungal agent ketoconazole (600 mg/day for 28 days) was compared to a recommended regimen of intramuscular Pentostam (20 mg antimony/kg, with a maximum of 850 mg antimony/day, for 20 days) in a randomized study of the treatment of Panamanian cutaneous leishmaniasis due to Leishmania braziliensis panamensis. A separate group of patients with this disease was administered placebo. RESULTS: Ketoconazole clinically cured 16 of 21 (76%) patients. The lesions on nine patients healed by 1 month after therapy, and the lesions healed by 3 months after therapy on the other seven patients. Side effects were limited to a 27% incidence of mild, reversible hepatocellular enzyme elevation and an asymptomatic, reversible, approximately 70% decrease in serum testosterone in all patients. Pentostam cured 13 of 19 (68%) patients; the lesions on seven patients healed by the end of therapy, and the lesions on four other patients healed by 1 month after the end of therapy. Side effects were a 47% incidence of mild, reversible hepatocellular enzyme elevation and the morbidity due to 20 intramuscular injections in almost all patients. The placebo group of 11 patients had a 0% cure rate. By 1 month after therapy, all placebo-treated patients demonstrated new lesions or one lesion that was 23% to 875% larger than before therapy. CONCLUSION: Both ketoconazole and Pentostam were more effective than placebo against L. braziliensis panamensis cutaneous leishmaniasis. Oral ketoconazole is comparable in efficacy to this parenteral Pentostam regimen and can be recommended as initial treatment for this disease.

[Blister dermatitis caused by Epicauta flagellaria (Erichson) (Coleoptera: Meloidae) species]. / Dermatitis ampollar causada por la especie Epicauta flagellaria (Erichson) (Coleoptera: Meloidae).

This paper is the first published report of vesicular dermatitis due to blister beetles of the family Meloidae in Panamá. A familial outbreak of bullous dermatitis caused by Epicauta flagellaria (Erichson) is described. All previous cases known in the Gorgas Memorial Laboratory were associated with E. isthmica Werner. Bullous lesions are produced when cantharidin, a vesicating toxin contained in the beetle's body, is released at the time the insect is crushed or rubbed upon the exposed skin. Rules for the treatment and prevention of this disease are indicated.

Treatment of American cutaneous leishmaniasis with orally administered allopurinol riboside.

Eighteen patients received 1,250 mg of allopurinol riboside (AR) four times daily for 28 d. Nine of the patients concurrently received 500 mg probenecid (PB) four times daily. Cure was assessed clinically and parasitologically. Patients who had culture-positive and nonhealing lesions 3 mo after therapy received pentavalent antimony. Of the nine patients who received AR alone, four (44%) had clinical improvement at the end of therapy and two (22%) were culture-negative. A third patient became culture negative at 2 mo after therapy. The culture-negative patients were completely healed at 1 mo and remained so at 1 y after therapy. Of the nine patients who received AR plus PB, four had complete healing and two had clinical improvement at the end of therapy; however, all patients remained culture-positive. At 2-3 mo after therapy, six (67%) of the patients were completely healed, and of these, five (56%) were culture-negative. The drug was well-tolerated.

[Mucocutaneous leishmaniasis in Panama. Etiologic agent, epidemiologic and clinical aspects]. / Leishmaniasis mucocutánea en Panamá. Agente etiológico, aspectos epidemiológicos y clínicos.

From November 1985 to December 1988, 33 patients were enrolled at Santo Tomas Hospital and Gorgas Memorial Laboratory to study the etiology, epidemiology and clinical characteristics of mucocutaneous leishmaniasis. Seventeen were males and 16 females, 14 to 80 years old from the endemic rural areas of the provinces of Panama, Colón, Coclé, Darién, Veraguas, Bocas del Toro and San Blas. In 8 patients the respiratory mucosa involvement occurred at the time of the primary infection and 25 had the involvement after an incubation period of 2 to 30 years. Twenty one of these 25 patients had a clear history of cutaneous leishmaniasis and the characteristic depressed and hyperpigmented scar of a previous leishmanial infection. The Montenegro skin test was positive in all the patients, serology in 84%, direct smear in 47%, histopathology in 37% and culture in 26%. The strains were characterized as L. braziliensis panamensis by electrophoresis of isoenzymes. Possible risk factors in development of MCL were found to be female sex and the lack of past treatment of CL. The mucosal involvement was mild in the majority of the patients, the infection was localized in the nasal mucosal (nasal septum and inferior turbinate) in 91% of the patients, and the most common symptoms were epistaxis, nasal obstruction and rhinorrhea.

Toxoplasmosis in Panama: a 10-year study.

We studied the prevalence of Toxoplasma antibody over a 10-year period in a rural population of 326 people in Chorrera Province of Panama using the dye test. Fifty-five seroconversions were found in 108 people at risk, and 48 (87%) in children between 2 and 13 years with a mean incidence rate of 8.6% per year. Antibody prevalence rose from 25% at 5 years to 50% at 10 years of age, and increased gradually, reaching 90% by 60 years. Mean antibody levels after seroconversion were 1:6,000 in the dye test; they fell to 1:1,000 after 1 year, 1:800 after 2 years, 1:200 after 3 years, and 1:333 after 7-9 years. About 10% of antibody titers ranged between 1:4 and 1:32. Toxoplasma antibody prevalence was also studied in the metropolitan Panama City population using 590 sera collected in the fall of 1981. Age-specific incidence rates were similar in the urban and rural setting (correlation coefficient 0.71). The number of cats observed in the rural area and in the city and the degree of soil contact appeared compatible with a hypothesis of transmission by oocysts.

Radiculomielitis post-conjuntivitis hemorrágica aguda por enetrovireus 70: informe del primer caso comprobado en America / Radiculomyelitis following acute hemorrhagic conjunctivitis due to Enterovirus 70: report of a first confirmed case in America

Se informa el primer caso confirmado de radiculomielitis post-conjuntivitis hemorrágica aguda (CHA) ocurrido en Panamá y probablemente en el continente americano. Se describen sus características epidemiológicas, las manifestaciones clínicas y su diagnóstico virológico

La epidemia de meningitis viral por Echo 4 ocurrida em Panamá durante 1981 / Viral meningitis outbreack caused by Echo 4 ocurred in Panama during 1981

Se informa la epidemia de meningitis viral por ECHO 4 ocurrida en la ciudad capital durante 1981, la cual resultó la más grande ocurrida en la historia de Panamá y una de las más grandes epidemias comprobadas en la literatura. Se describen sus características clínicas y epidemiológicas, y se analizan las interrogantes que surgieron en la comunidad durante el desarrollo de las mismas