Strongyloides hyperinfection syndrome and cytomegalovirus infection in a patient with type II diabetes mellitus.

Strongyloidiasis is a gastrointestinal parasitic infection caused by percutaneous infection with Strongyloides stercoralis, which is mainly distributed in the tropics and subtropics worldwide. Digestive symptoms like diarrhea and abdominal pain are the main manifestation, but serious infections such as bacterial pneumonia, purulent meningitis and sepsis also occur in immunocompromised individuals. Herein, we present a rare case of a type II diabetes mellitus (T2DM) patient presented with gastrointestinal hemorrhage and sepsis caused by concomitant Strongyloides stercoralis and cytomegalovirus (CMV) infection. This 51-year-old male patient presented to the hospital with vomiting, diarrhea, dyspnea, palpitation and weakness. Examination revealed skin soft-tissue infection with T2DM, and upper endoscopy revealed gastric mucosal erosion and hemorrhage. Radiology revealed bilateral diffuse interstitial infiltrates and thickened walls of the colon. Importantly, stool and vomitus examination showed numerous larvae of Strongyloides stercoralis. Then the diagnosis of Strongyloides hyperinfection syndrome was made. But antibiotics and albendazole treatment did not improve the patient's symptoms of gastrointestinal bleeding and sepsis. Subsequently, other pathogens were screened by sequence and a positive CMV gene was found in the peripheral blood. Thus, antibiotics, albendazole and ganciclovir were all used which ultimately resolved the infection in this patient. Therefore, this case indicated CMV could also by co-infected with Strongyloides stercoralis in the immunocompromised patient, which remind us that an CMV test should also be performed when encountered in severe strongyloidiasis infection, which could improve the prognosis of the patient.

[Correlation between Dynamic Change of IL-32 Level and Disease Development in Acute Leukemia Patients].

OBJECTIVE: To investigate the correlation between dynamic change of IL-32 level and disease development in the patients with acute leukemia(AL) and to explore its clinical significance. METHODS: The serum IL-32 levels and IL-32 mRNA expression in 82 cases of AL and 30 healthy persons were measured by ELISA and real-time PCR. RESULTS: Compared with healthy persons, the serum IL-32 protein level and IL-32 mRNA expression in AL, acute lymphoblastic leukemia(ALL) and acute non-lymphocytic leukemia(ANLL) groups all were significantly higher(P<0.05). The serum level of IL-32 protein and mRNA expression in newly diagnosed, PR and relapsed ALL and ANLL groups were all higher than those in the control group(P<0.05), and the serum protein level of IL-32 in relapsed ALL and ANLL groups were higher than that in other stage group(P<0.05). The serum levels of IL-32 protein and mRNA were not significantly different between CR and control group(P>0.05). CONCLUSION: The IL-32 in the peripheral blood of patients with AL has been found to be closely related with the occurrence and development of disease, therefore, monitoring the dynamic changes of serum IL-32 level would contribute to the clinical judgment of the severity, the IL-32 levels can be used as indicators for the therapeutic efficacy for AL.

[Clinical application of abductor digiti minimi muscle flap].

OBJECTIVE: To discuss the surgery procedure and the clinical effectiveness of repairing skin and soft tissue defects in the lateral foot and the heel with the abductor digiti minimi muscle flap. METHODS: Between July 2002 and October 2010, 8 patients with skin and soft tissue defects in the lateral foot and the heel were treated. There were 6 males and 2 females with an average age of 42 years (range, 28-65 years). The locations were the left foot in 5 cases and the right foot in 3 cases. Defects were caused by ulcer of the heel in 2 cases, by poor healing of incision after calcaneus fracture surgery in 1 case, and by crushing in 5 cases. The defect size ranged from 1.5 cmx 1.0 cm x 8.0 cm x 2.6 cm. The disease duration was 30 minutes to 26 months. The result of bacterial culture was positive in 2 cases. After 9 to 15 days of debridement and dressing change, defects were repaired with the abductor digiti minimi muscle flap of 5.6 cm x 1.5 cm to 7.6 cm x 1.8 cm at size. The donor site were sutured directly. RESULTS: Partial necrosis of muscle flap occurred in 1 case at 4 days after operation, which was cured by symptomatic treatment, and the other muscle flaps survived. All incisions of the donor sites healed by first intention. The muscle flaps survived and the granulation grew well at 9-21 days after operation, and the muscle flap wounds were repaired by free leg edge thickness skin grafting. Wounds were repaired by one-stage free skin grafting in 1 case and by two-stage free skin grafting in 7 cases; all skin flaps survived and wounds healed by first intention. Seven patients were followed up 9-18 months (mean, 11 months). The appearance, texture, and sensation were satisfactory. The two-point discrimination was 16-23 mm (mean, 19.5 mm). Epidermal abrasion occurred in 1 case of heel ulcer after weigt-bearing walking. Hallux valgus and muscle weakness occurred in 1 case of necrosis of the peroneus length tendons; and the satisfactory results were achieved in the other patients. CONCLUSION: It has satisfactory effectiveness to use the abductor digiti minimi muscle flap for repairing skin and soft tissue defects in the lateral foot and the heel, which has the advantages of easy-to-operate, safe, less injury at donor site, good appearance and texture, and good recovery of sensation.