A case report of disseminated tuberculosis: an unsuspected uterine cervical mass in a young native american woman with new-onset seizure disorder.

Disseminated tuberculosis involving the uterine cervix and central nervous system is described in a 26-year-old Native American female with new-onset seizures. Her presenting complaint was generalized seizures with associated weight loss, chronic cough, global headache, and malaise. Pelvic examination revealed an exophytic cervical mass consistent with carcinoma. Laboratory results showed anemia, hypoalbuminemia, and radiodensities on chest radiography. Cultures of sputum and cervix were positive for Mycobacterium tuberculosis. Cervical biopsies revealed multiple acid-fast bacilli. Computed tomography of the head showed multiple tuberculomas. The patient was treated with multidrug antituberculous therapy for 6 months, with resolution of seizures and improvement in computed tomographic findings.

Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. The Hantavirus Study Group.

BACKGROUND: In May 1993 an outbreak of severe respiratory illness occurred in the southwestern United States. A previously unknown hantavirus was identified as the cause. In Asia hantaviruses are associated with hemorrhagic fever and renal disease. They have not been known as a cause of human disease in North America. METHODS: We analyzed clinical, laboratory, and autopsy data on the first 17 persons with confirmed infection from this newly recognized strain of hantavirus. RESULTS: The mean age of the patients was 32.2 years (range, 13 to 64); 61 percent were women, 72 percent were Native American, 22 percent white, and 6 percent Hispanic. The most common prodromal symptoms were fever and myalgia (100 percent), cough or dyspnea (76 percent), gastrointestinal symptoms (76 percent), and headache (71 percent). The most common physical findings were tachypnea (100 percent), tachycardia (94 percent), and hypotension (50 percent). The laboratory findings included leukocytosis (median peak cell count, 26,000 per cubic millimeter), often with myeloid precursors, an increased hematocrit, thrombocytopenia (median lowest platelet count, 64,000 per cubic millimeter), prolonged prothrombin and partial-thromboplastin times, an elevated serum lactate dehydrogenase concentration, decreased serum protein concentrations, and proteinuria. Rapidly progressive acute pulmonary edema developed in 15 of the 17 patients (88 percent), and 13 patients, all of whom had profound hypotension, died (case fatality rate, 76 percent). Increases in the hematocrit and partial-thromboplastin time were predictive of death. CONCLUSIONS: Infection with a newly described hantavirus causes the hantavirus pulmonary syndrome, which is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic pulmonary edema.

Plague. A clinical review of 27 cases.

We reviewed the medical records of 27 patients with plague seen at the Gallup (NM) Indian Medical Center between 1965 and 1989. Nineteen patients had bubonic plague and eight had septicemic plague. Three patients with septicemic plague and three with bubonic plague died. The patients presented with five different clinical pictures. Ten patients presented with classic signs of plague, five with the appearance of an upper respiratory tract infection, five with a nonspecific febrile syndrome, four with the appearance of a gastrointestinal or urinary tract infection, and three with the appearance of meningitis. Blood cultures were positive in 24 of 25 cases, and bubo aspirate cultures were positive in 10 of 13 cases. All six patients who died were under 30 years old, and all the deaths were related to a failure to treat initially with an antibiotic appropriate for plague. Plague is a treatable disease, but clinicians must have a high index of suspicion and give appropriate antibiotics at the earliest possible time to patients whose presentation suggests plague.

Pneumonia in a Navajo community: a two-year experience.

This report describes surveillance of pneumonia in an entire community during a 2-year interval. The study, which was performed on the Navajo reservation, included those who sought care for defined clinical manifestations and who showed pulmonary infiltrate(s) on roentogenographic examination. Approximately 10 bouts of pneumonia per 1,000 persons required hospitalization, and an equal number were treated at home each year. Rates were highest at the extremes of age and were higher among males. Multiple attacks were observed in 14.5 per cent of infants and children and in 7.6 per cent of adults. Most illnesses were associated with pneumococci. The proportions of these illnesses, however, were smaller among hospitalized children than among adults. Pneumococcal bacteremia was uncommon in infants and children. Most pneumococcal serotypes isolated are included in currently proposed antipneumococcal vaccines. The 2-year case fatality rate was 2.2 per cent. None of those who dided had been previously well. Factors associated with multiple occurrences need further study. Efforts at prevention should be directed to life's extremes, especially to those already infirm.

Diagnosis and thereapy of necrotizing soft tissue infections of the perineum.

Nine patients with necrotizing soft tissue infection of the perineum and adjacent areas developed following perirectal absecess, retroperitoneal infection, local trauma or apparently spontaneously. Skin changes and crepitus were often present but severe local pain was the only indication of infection in three patients. Repeated surgery or in one case, a necropsy, were required to uncover the extensive, dissecting, purulent and necrotizing subcutaneous process. Myonecrosis had occurred in three cases. Operation was often delayed for several days because of the difficulty in recognizing the presence of infection or because the urgency for treating an already apparent infection was not appreciated. The mortality was high (5/9 cases). The bacterial isolates were predominantly of a mixed aerobic-anaerobic nature. Needle aspiration of suspicious areas, even where classic signs of inflammation are lacking and Gram staining of exudate are valuable procedures for diagnosis and institution of appropriate presumptive antibiotic treatment. Thorough surgical exploration and debridement must be performed promptly to maximize chances for survival.

Epidemiologic and clinical features of an outbreak of bubonic plague in New Mexico.

An outbreak of seven cases of bubonic plague in New Mexico was investigated. Clinical features were studied and correlated with field studies in an attmept to determine the source of infection in patients with indefinite histories of exposure. Most patients presented with fever, malaise, and an acute painful lymphadenitis (bubo). One death occurred in a patient with bubonic-septicemic plague complicated by meningitis due to Yersinia pestis. All patients lived in rural or semirural areas, and most had been in the general vicinity of their usual residence during the six days prior to onset of symptoms. The outbreak was associated with probable epizootics in rodents in two different areas of the state. One case was traced to direct hand contact with plague-infected rabbits. One patient developed insect bites after sleeping in the same bed with a flea-infested cat. Three of the other five patients had insect bites, presumably flea bites, but none of the five recalled contact with rodents or rabbits. Four of the five, however, had been in contact with dogs or cats that were later shown to have titers of antibody to Y. pestis. These findings provide further support for the hypothesis that contact with domestic dogs and cats may result in direct or indirect transmission of Y. pestis to humans.