ABSTRACT
Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequently implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.
Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Acquired Immunodeficiency Syndrome/diagnosis , Candidiasis/complications , Meningitis/complications , Tuberculosis, Meningeal/complications , AIDS-Related Opportunistic Infections/complications , Adult , Candidiasis/diagnosis , Humans , Male , Meningitis/microbiology , Meningitis, Fungal/complications , Meningitis, Fungal/diagnosis , Tuberculosis, Meningeal/diagnosisABSTRACT
Las meningoencefalitis por gérmenes oportunistas ocupan un lugar importante dentro de la patología neurológica del sida. Treponema palli dum y Mycobacterium tuberculosis dentro de las baceterias, Crytptococ cus neoformans dentro de los hongos, Toxoplasma gondii dentro de los protozoos y el Papovavirus JC dentro de los virus, son los gérmenes más frecuentes dentro de cada grupo. Con cierta frecuencia las infecciones son mixtas, tal como ocurrió en el caso que se presenta de meningitis simultánea por Candida albicans y Mycobacterium tuberculosis, que cursó con pleocitosis neutrófila y normoglucorraquia, constituyendo la primera manifestación de un sida. El estudio secuencial del LCR es clave para el diagnóstico de estos casos, que, pese a su gravedad, pueden tener un tratamiento efectivo, tal como ocurrió en el que se describe. Es el primer caso descrito de meningitis simultánea candidiásica y tuberculosa en paciente portador de VIH (AU)
Subject(s)
Adult , Male , Humans , Tuberculosis, Meningeal , Meningitis, Fungal , AIDS-Related Opportunistic Infections , Meningitis , Candidiasis , Acquired Immunodeficiency SyndromeSubject(s)
Aortic Arch Syndromes/etiology , Giant Cell Arteritis/complications , Aged , Female , HumansABSTRACT
95 pleural effusions of different etiology were studied. 25 were transudate, 22 neoplastic, 28 caused by tuberculosis, and 20 miscellaneous. The Light parameters (pleural protein/plasma) (Prot LP/P), Pleural LDH (LDH LP) and LDH pleural/plasma quotient (LDH LP/P) were determined and compared with the efficacy of pleural cholesterol (Chol LP) and pleural cholesterol/plasma quotient (Chol LP/P) to differentiate the transudate from pleural exudate. With Prot LP/P quotient the sensitivity was of 85% and the specificity 91.6%; with LDH LP the sensitivity was of 74.6% and the specificity 97.6%. With the LDH LP/P quotient the sensitivity was of 89% and the specificity 87.8%. The sensitivity of each parameter was similar to that obtained by Light but less specific. All the transudates had levels of chol LP lower than 55 mq/dl (100% specificity) with a sensitivity of 84%. The Chol LP/P quotient had a limit of 0.3, this being its sensitivity of 91.3% and 93.1% its specificity. The presence of both parameters were necessary to the classification and the sensitivity obtained being of 80.3% and the specificity 100%. We concluded that the determinations of Chol LP and the Chol LP/P quotient are of great advantage in differentiating the pleural transudate from pleural exudate and the predictive value is, at least, similar to that obtained by Light.
Subject(s)
Cholesterol/analysis , Pleural Effusion, Malignant/chemistry , Pleural Effusion/chemistry , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Pleural Effusion, Malignant/diagnosis , Pleural Effusion, Malignant/etiology , Prognosis , Sensitivity and SpecificityABSTRACT
A case of hyperamylasemia produced outside the pancreas and of exceptional origin, is presented. The place of origin is an ovarian carcinoma whose first manifestation was acute abdominal pain. The blood level of amylase was slightly increased mainly in its salivary fraction detected by the chromogenic/inhibition technique. This level, followed the tumor evolution and decreased in parallel to the tumor's response treatment.
