Endobronchitis by Scedosporium apiospermum in a child with cystic fibrosis

Presentamos un caso de endobronquitis por Scedosporium apiospermum en una niña con fibrosis quística. El diagnótico se confirmó mediante laboratorio. La citología del aspirado bronquial mostró la presencia de grandes cantidades de micelio dicotomizado septado. El cultivo del aspirado bronquial en tres muestras consecutivas, mostró la presencia de Scedosporium apiospermum en cultivo puro. El estudio de la superficie de la mucosa, mediante microscopia electrónica de barrido, reveló la presencia de micelio escaso, contrastando con la presencia de una gran cantidad de conidias. La microscopia electrónica de transmisión realizada en los cortes de la mucosa bronquial, reveló la presencia de infiltrado inflamatorio constituido por macrófagos, leucocitos polimorfonucleares y una gran cantidad de micelio dicotomizado y macrófagos con micelio y conidis en el interior de fagosomas. La paciente fue tratada con anfotericina B e itraconazol(AU)

A case of endobronchitis by Scedosporium apiospermum in a child with cystic fibrosis is presented. The bronchial aspirate's cytology showed the presence of a large amount of septated-dichotomized hyphae. The bronchial aspirate's culture showed the presence of Scedosporium apiospermum in a pure culture of three consecutive samples. The scanning electron microscopy study of the mucosal surface revealed scarce mycelia with the presence of abundant conidiae. The transmission electron microscopy of the mucosa revealed inflammatory infiltrates constituted by macrophages, polymorphonuclear leukocytes, a lot of dichotomized mycelia and macrophages with hyphae and conidiae within the phagosomes. The patient was treated with amphotericin B and itraconazole(AU)

Treatment of a scalp arteriovenous malformation by a combination of embolization and surgical removal.

SUMMARY: The authors describe a 21-year-old man in whom a large arteriovenous malformation of the scalp was eliminated using a combined interventional, neuroradiological and neurosurgical approach. Embolization was utilized to reduce arterial blood supply to the malformation. Eudragit- E, as a liquid embolic material from a cationic polymer, methyl and butyl methacrylate, and dimethylaminoethyl methacrylate copolymer, was injected through the transarterial route and then by direct percutaneous puncture of the nidus. One week after embolization, the nidus was easily resected with minimal blood loss. A postoperative angiogram showed nearly total extirpation of the nidus as well as complete clinical recovery. Preoperative embolization in this case was a safe and effective ablative technique.

[Generalized microsporidiosis caused by Encephalitozoon sp. in a pediatric patient with Bruton's disease]. / Microsporidiosis generalizada por Encephalitozoon sp. en un paciente pediátrico con enfermedad de Bruton.

We present the case of a four-year-old boy with a history of repeated upper respiratory tract infections and pyoderma. He presented fever, seizures, inability to talk, loss of swallowing, fine tremor in the upper extremities; positive bilateral Babinski reflex and quadriparesis. The diagnosis of Bruton's disease and generalized microporidiosis was based on immunologic analysis, smear tests with chromotrope R2 stain and indirect immunofluorescense with monoclonal 3B6 antibody for Encephalitozoon species in samples of spinal fluid, bronchial and paranasal sinus aspirates and stool, which were all positive. The patient was treated with albendazol during 72 days; he left the hospital in a good condition, walking, talking and able to swallow. His laboratory test controls were negative; he is followed up in the outpatient department.

Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients.

OBJECT: The pathogenesis of traumatic brain swelling remains unclear. The generally held view is that brain swelling is caused primarily by vascular engorgement and that edema plays a relatively minor role in the swelling process. The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling. METHODS: Both brain-tissue water and CBV were measured in 76 head-injured patients, and the relative contribution of edema and blood to total brain swelling was determined. Comparable measures of brain-tissue water were obtained in 30 healthy volunteers and CBV in seven volunteers. Brain edema was measured using magnetic resonance imaging, implementing a new technique for accurate measurement of total tissue water. Measurements of CBV in a subgroup of 31 head-injured patients were based on consecutive measures of cerebral blood flow (CBF) obtained using stable xenon and calculation of mean transit time by dynamic computerized tomography scanning after a rapid bolus injection of iodinated contrast material. The mean (+/- standard deviation) percentage of swelling due to water was 9.37+/-8.7%, whereas that due to blood was -0.8+/-1.32%. CONCLUSIONS: The results of this study showed that brain edema is the major fluid component contributing to traumatic brain swelling. Moreover, CBV is reduced in proportion to CBF reduction following severe brain injury.

[Cyclospora cayetanensis infection. Laboratory diagnosis]. / Infección por Cyclospora cayetanensis. Diagnóstico de laboratorio.

Cyclospora cayetanensis is an Apicomplexa protozoa which was found to cause gastroenteritis in humans in 1979. This paper reviews the laboratory diagnosis of the disease. The usefulness of direct examination of fresh fecal matter with special acid-fast stains is emphasized as well as the morphometric differentiation between this organism and other similar coccidia. The paper reviews the sporulation technique of Cyclospora cayetanensis for the recognition and differentiation of artifacts and green-blue algae. Another aspect discussed is the morphology of the parasite in histological sections and with electromicroscopic examination whereby tissue morphology changes caused by the microorganism can be identified. The experience of the Service and Laboratory of Parasitology of the Instituto Nacional de Pediatría of Mexico in the laboratory diagnosis of this protozoosis is described. The paper is oriented towards the inclussion of Cyclospora cayetanensis in the diagnostic protocols for the study of diarrheas in our health Institutions.

[Anthelmintics as a risk factor in intestinal obstruction by Ascaris lumbricoides in children]. / Antihelmínticos como factor de riesgo en la obstrucción intestinal por Ascaris lumbricoides en niños.

In a retrospective study the authors analyzed the clinical records of 199 children ages one month to 16 years hospitalized, with the diagnosis of intestinal ascariasis, in the Instituto Nacional de Pediatria of Mexico from 1984 to 1999. The purpose of the study was to evaluate the use of anthelmintics drugs as a risk factor of intestinal obstruction by A. lumbricoides. Two groups were made for the study: Group A (n = 66) of children who presented intestinal obstruction, Group B (n = 133) children with no complications. A comparative analysis of clinical data of both groups was made by means of chi square with Yates correction and a stratified analysis by means of chi square. Possible confusing elements were overcrowding, age and the use of antiparasitic drugs. The calculus of risk factors for intestinal obstruction by A. lumbricoides was done by means of contingency tables of 2 x 2 and odds ratio with an IC of 95%. The significant risk factors were included in a model of logistics regression with an impact variable consting in the presence or absence of intestinal obstruction in order to establish a multivariate model of predictive risk at level of significance of p < 0.05. Twenty-seven patients (40.90%) in group A (n = 66) were given anthelmintics medications prior to the intestinal obstruction: mebendazol, 14 (51-85%); two, albedazol (7.4%); eight, a non-specified anthelmintic (29.6%). In addition, an anthelmintic medication without a specified time of ingestion: two with mebendazol and one with piperazine (11.3%). In the case of mebendazol, the drug most frequently associated with intestinal obstruction, seven patients received it on the same day of the obstruction; five patients received it between one and seven days prior to the obstruction; two received it seven days prior to the complication. In the control group, only 7% had taken the anthelmintic one to seven days before the diagnosis of uncomplicated intestinal ascariasis diagnosis was made. With the step by step (Backward) logistic regression conditioned by the treatment variable with an anthelmintic, an X2 = 38.15 gl, p < 0.000 was obtained for which reason it was considered by A. lumbricoides. Of the probable risk factors analyzed in this study, the only one capable of influencing and predicting the presentation of intestinal obstruction by A. lumbricoides in children, was the prior anthelmintic treatment particularly with mebendazol.

CSF dynamics in a patient with a programmable shunt.

The Codman-Medos programmable shunt system was designed by Drs. Hakim to relieve under and over drainage problems. The system allows for non-invasive post-implantation adjustment of the opening pressure of the valve through a range of 30 to 200 mmH2O in 10 mm differentials. However, its wide adjustability does not simplify determination of the optimal pressure setting. The bolus injection method was used to study the intracranial pressure environment of nine adult hydrocephalic patients treated with the Codman-Medos programmable shunt. Changes in CSF hydrodynamics with manipulation of the pressure valve setting, and the effectiveness of the bolus injection method to determine the optimum valve pressure setting were investigated. Initial valve pressure setting at shunt implantation was determined on the basis of preoperative CSF dynamics test. Another CSF dynamics test was carried out after surgery, and the pressure setting was revised in necessary. The new setting was the maximum obtained within normal CSF hydrodynamics. If shunt overflow was suspected, pressure was set at a higher level. After resetting of the shunt, no patient encountered serious shunt-related problems in the follow-up period. This method was considerably useful for understanding of the intracranial pressure environment of patients with a programmable shunt, and determination of a better shunt setting.

[Vegetables for human consumption as probable source of Toxocara sp. infection in man]. / Verduras de consumo humano como probable fuente de infección de Toxocara sp. para el hombre.

Although Toxocara canis life cycle is known, other possible mechanisms dynamically involved in its transmission to man are still ignored. The object of the present investigation was to search the occurrence of Toxocara sp. eggs in vegetables which humans consume. Five hundred and thirty six vegetables from a supply distribution center in Mexico City (Distrito Federal) were examined. Those included 212 carrots, 76 potatoes, 31 radishes, 22 mushrooms, 27 lettuces, 20 sweet potatoes and 66 bundles of spinaches, 32 bundles of salt-worts, 29 bundles of coriander, and 21 bundles of purslane. Each unit or bundle was washed with 50 ml of sterilized water, allowing sedimentation at room temperature for 8 hours. Five ml of sediment were centrifugated at 3,000 r.p.m. for 5 minutes. Sediment was examined in lugol stained fresh plates through light microscopy, which turned to be Toxocara sp. eggs were found only in two vegetables: 1.9% of carrots and 6.5% of radishes. Toxocara sp. eggs were: 66.7% recently emitted and 33.3% embryonated. Other parasite elements were: Ascaris lumbricoides eggs 1.9% in carrots, 2.6% in potatoes, 9.1% in mushrooms, 6.9% in corianders, 20.0% in sweet potatoes and 6.1% in spinachs. Entamoeba histolytica cyts were found in 0.9% of carrots. Soil contamination with Toxocara sp. eggs from parasitized dogs or cats, or with either sewage systems or contaminated water where vegetables for human consumption are grown, play a role as a transmission mechanism must be deeperly studied since 33.3% of Toxocara sp. eggs found contained larvae, potentially infective to man.

[Frequency of Toxocara cati eggs in domestic cats in Mexico City and the State of Mexico]. / Frecuencia de hallazgo de huevos de Toxocara cati en gatos domésticos de la Ciudad de México y el Estado de México.

Toxocariosis is a zoonosis which has been widely studied in dogs. However, not much is known about this parasitosis in cats. The aim of the present work was to determine the frequency of Toxocara cati in domestic cats in Mexico City and the State of Mexico. Feces of 660 domestic cats were studied by the Faust concentration-floating test; 401 samples were from cats living in Mexico City of which 308 lived in houses and 93 in apartments; 231 were from urban areas of the State of Mexico and 28 from a rural area of the same state. The total frequency of T. cati eggs obtained from domestic cats in Mexico City was 42.9%; in cats living in apartments it was 18.3% and in cats living in houses it was 50.3%. In domestic cats from the State of Mexico, T. cati frequency was 36.4% in the urban and 21.4% in the rural areas. We consider that toxocariosis frequency observed at the two studied sites is high and that the need to prevent dissemination of the infectious forms of T. cati is urgent, as is the necessity of informing the population of the risk of living with T. cati parasited animals and of the anatomopathological alterations caused by T. cati in man.

Evaluation of homeostatic changes in CSF circulation: in vivo analysis of the effect of neurotransmitter accumulation in the extracellular space following transient global ischemia.

Accumulation of potassium and excitatory amino acids (EAA) in the extracellular space (ECS) following ischemia has been well documented. Careful monitoring of these transients is crucial to gain a better understanding of CNS pathophysiology. This study was initiated to determine if CSF concentrations of EAAs reflect those measured in the ECS. Transient global ischemia, 20 minutes in duration, was produced by clamping the left subclavian and innominate arteries combined with hemorrhagic hypotension. The accumulation of glutamate and electrolytes were measured in CSF and the extracellular fluid (ECF) of cerebral cortex. Microdialysis (MD) was utilized to measure the extracellular concentrations while direct sampling of CSF was provided via cannulation of the cisterna magna. Hydrogen clearance and laser doppler methods were used to monitor regional cortical CBF. Our results show that extracellular concentrations of potassium ([K+]ECF) and glutamate significantly increased following the initiation of ischemia (p < 0.05). The extracellular concentration of these substances decreased with the restoration of CBF. In CSF, a similar trend was observed following re-circulation (p < 0.05). However, CSF glutamate levels did not return to pre-ischemic values.

Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics.

Cerebrospinal fluid (CSF) dynamics were correlated to the changes in ventricular size during the first 3 months posttrauma in patients with severe head injury (Glasgow Coma Scale score < or = 8, 75 patients) to distinguish between atrophy and hydrocephalus as the two possible causes of posttraumatic ventriculomegaly. Using the bolus injection technique, the baseline intracranial pressure (ICP), pressure volume index, and resistance for CSF absorption (R0) provided a three-dimensional profile of CSF dynamics that was correlated with ventricular size and Glasgow Outcome Scale (GOS) score at 3, 6, and 12 months posttrauma. Patients were separated into five different groups based on changes in ventricular size, presence of atrophy, and CSF dynamics. Group 1 (normal group, 41.3%) demonstrated normal ventricular size and normal ICP. Group 2 (benign intracranial hypertension group, 14.7%) showed normal ventricular size and elevated ICP. Group 3 (atrophy group, 24%) displayed ventriculomegaly, normal ICP, and normal R0. Group 4 (normal-pressure hydrocephalus group, 9.3%) had ventriculomegaly, normal ICP, and high R0. Group 5 (high-pressure hydrocephalus group, 10.7%) showed ventriculomegaly and elevated ICP with or without high R0. The GOS score in the nonhydrocephalic groups (Groups 1, 2, and 3) was better than in the hydrocephalic groups (Groups 4 and 5). It is concluded from these results that 44% of head injury survivors may develop posttraumatic ventriculomegaly. Posttraumatic hydrocephalus, as identified by abnormal CSF dynamics, was diagnosed in 20% of survivors and their outcome was significantly worse. This study demonstrates the importance of using CSF dynamics as an aid in diagnosis of posttraumatic hydrocephalus and identifying those patients who may benefit from shunt placement.

[Soil contamination with Toxocara sp. eggs in public parks and home gardens from Mexico City]. / Contaminación de suelos por huevos de Toxocara sp. en parques públicos y jardines de casas-habitación de la ciudad de México.

Due to de high number of stray dogs and cats which defecate in public places in Mexico City (3 millions approximately), in addition to domestic dogs and cats, exists the potential risk to man of infection by Toxocara sp. eggs. A study to determine the contamination frequency by Toxocara sp. eggs in public parks, public flower beds, and home gardens in Mexico City, Distrito Federal, was carried out in the 1995 first semester. Fourteen hundred and five soil samples were collected from 156 public parks, 83 public flower beds and 42 home gardens across the 16 delegations in Mexico City, Distrito Federal. Samples were processed by the zinc sulfate centrifugal flotation method, and supernatants read by microscopy. Out of the whole 281 sampled sites, 12.5% were found contaminated with Toxocara sp. eggs. Positivity found was: 10.9% in public parks, 13.3% in public flower beds and 16.7% in home gardens. Ninety percent of the eggs were embryonated or larvaeted measuring 60 to 90 micrometers. The high contamination frequencies found make necessary to prompt for Public Health measures granted the risk of infection acquisition spread on the most exposed population (children) provided that it is acquired via geophagia.

Seasonal development of Leptotrombidium akamushi (Acari: Trombiculidae) under field temperatures.

Engorged larvae of Leptotrombidium akamushi (Brumpt), a vector of scrub typhus, were reared in small plastic containers placed on the ground and fed fresh eggs of the collembolan Sinella curviseta Brook. Engorged larvae obtained in October developed into deutonymphs through protonymphs approximately 1 mo before winter and became dormant in the cold winter season (approximately 3 mo). Most deutonymphs developed into tritonymphs in April and adults in May. Females began laying eggs in mid-June and the numbers of unfed larvae showed a peak in August. The mites reared from July rapidly developed into adults by August, and laid eggs in September. Larvae were most abundant in October, and adults became dormant in the winter. The same adults laid eggs from early May to late June and, upon hatching, the larval population peaked in early July of the 2nd summer. Most larvae died before the 2nd winter. Eggs hatched approximately 3 wk after oviposition and longevity of unfed larvae was 2 mo. Because of this very short incubation period, L. akamushi larvae occur in the summer, whereas L. pallidum Nagayo, Miyagawa, Mitamura & Tamiya, and L. scutellare Nagayo, Miyagawa, Mitamura, Tamiya & Tenjin occur in the autumn, although 3 species lay eggs from May to August.

Multiple aneurysms associated with bilateral carotid occlusion and venous angioma: surgical management risk-case report.

A unique case of multiple aneurysms associated with bilateral carotid artery occlusion and venous angioma is described. A 42 year old female presented with subarachnoid haemorrhage. Cerebral angiograms demonstrated(1) a ruptured saccular aneurysm in the right posterior cerebral artery,(2) bilateral occlusion of internal carotid arteries,(3) a rete mirabile in the subtemporal fossa fed by left external carotid artery which connected with the internal carotid artery at the cavernous portion where a saccular aneurysm had formed, and(4) a venous angioma in the posterior fossa. The ruptured aneurysm of the posterior cerebral artery was obliterated preserving the anterior choroidal arteries. However, a left hemiparesis developed and CT scan revealed a small low density area in the right posterior limb of the internal capsule postoperatively. A ruptured aneurysm associated with bilateral extracranial carotid occlusion poses a clinical dilemma and treatment of such cases is challenging and difficult. The non-surgical and surgical outcomes of ruptured cerebral aneurysms associated with internal carotid occlusion are reviewed.

[Cefuzonam penetration into cerebrospinal fluid].

We studied the penetration of cefuzonam (CZON) into the cerebrospinal fluid (CSF) in 20 patients with neurosurgical diseases. Influences of the presence of meningeal reaction and the intensity of brain damage on CSF penetration of CZON were also examined. Concentrations of CZON in serum and CSF were determined using the thin-layer cup method before and 1, 2, 4, and 6 hours after 2 g of CZON was administered intravenously. The serum concentration at 1 hour was 60.4 +/- 31.3 (mean +/- S.D.) microgram/ml, then rapidly decreased to 2.1 +/- 2.3 micrograms/ml at 6 hours. In contrast, the CSF concentration gradually increased, reached a peak level of 0.319 +/- 0.313 micrograms/ml at 4 hours and then slowly decreased to 0.273 +/- 0.249 micrograms/ml at 6 hours. The CSF penetration ration: CZON ([CSF]/[serum]) was 5.6% at 4 hours. The peak CSF concentration in patients with meningeal reaction (0.465 +/- 0.364 micrograms/ml at 2 hours) was about 2-fold higher than that in those without the reaction (0.249 +/- 0.223 micrograms/ml at 4 hours). The peak CSF concentrations in patients with slight, moderate, and severe brain damage were 0.231 +/- 0.133 micrograms/ml at 4 hours, 0.270 +/- 0.232 micrograms/ml at 4 hours, and 0.680 +/- 0.467 micrograms/ml at 2 hours, respectively. CSF penetration of CZON was augmented in patients with meningeal reaction or severe brain damage. These findings indicate that the concentration of CZON in CSF after intravenous administration is sufficient for treatment of meningitis or infections after neurosurgical operations caused by such bacteria as Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae.

Measurement of vascular reactivity in head injured patients.

It is has been demonstrated that clinical outcome following head injury is correlated with the reactivity of the cerebrovasculature to carbon dioxide changes. Since CBF measurements are difficult to perform in these patients, a new technique is proposed utilizing the ICP response to capnic stimuli. In 40 head injured patients, the responses of ICP, pressure volume index (PVI) and middle cerebral artery velocities to hypocapnia and to hypercapnia were determined. Hypocapnia reduced ICP and MCA velocity while hypercapnia was followed by ICP and MCA velocity increases. Both changes were in the same magnitude supporting the concept the global ICP response reflects vascular reactivity. The fact that the velocity response to hypocapnia in lesioned hemispheres was less compared to the ICP response indicates the loss of ability to dilate in injured vessels and is consistent with earlier findings relating reduced reactivity to poor outcome.