HIV adult with fever and shortness of breath: Influenza B misdiagnosed as Pneumocystis (carinii) jiroveci pneumonia (PCP).

Clinical correlation is essential in assessing the relevance of the patient's history and physical findings in making a clinical presumptive diagnosis. False diagnostic associations may result in misdiagnosis. We present a case of an elderly female with HIV on HAART who presented with shortness of breath assumed to have Pneumocystis (carinii) jiroveci pneumonia (PCP) even though she had a clinical diagnosis of influenza B. She was thought to have PCP only because she had HIV. Tests for PCP were negative including BAL staining. Influenza B present in her respiratory secretions by PCR and was also cultured from BAL fluid. Diagnostic associations are helpful in suggesting diagnostic possibilities but must be supported by clinical correlation of characteristic clinical features.

Intracranial complications of acute bacterial endocarditis.

BACKGROUND: Infectious endocarditis (IE) clinically manifests as either subacute bacterial endocarditis (SBE) or acute bacterial endocarditis (ABE). Neurologic manifestations are markedly different for these two entities. ABE is caused by invasive, highly virulent pathogens (e.g., Staphylococcus aureus), whereas SBE is attributed to relatively avirulent, non-invasive organisms (e.g., viridans streptococci). METHODS: Here, we reviewed the clinical and radiographic presentations of a patient with cranial complications attributed to ABE. Such patients typically develop central nervous system (CNS) septic emboli resulting in stroke (with/without intracranial hemorrhage (ICH)) and/or mycotic aneurysms resulting in ICH bleeds. RESULTS: With ABE, cerebrospinal fluid (CSF) seeding may result in acute bacterial meningitis (ABM), documented by positive Gram stain and/or culture for S. aureus, decreased glucose, highly elevated lactose acid levels, or ICH. Alternatively, in SBE, the CSF profile reflects an aseptic (viral) meningitis (i.e., Gram stain and culture negative, a normal glucose, and lymphocytic pleocytosis), while septic microemboli to the vasa vasorum contribute to an inflammatory reaction in the adventitia/muscle layer that weakens the vessel wall and results in mycotic aneurysms that may leak but often do not rupture causing ICH. CONCLUSION: Here, we reviewed the literature for intracranial pathology accompanying ABE versus SBE. ABE typically results in acute ischemia, septic emboli, stroke/hemorrhagic infarcts, or ICH. SBE more classically produces septic microemboli and mycotic aneurysms that may leak, but rarely producing ICH. We also presented a patient with ABE attributed to S. aureus whose septic emboli/stroke was accompanied by a mycotic aneurysm; the ruptured resulting in a large right occipital ICH.

Study of the radiologic features of Legionnaires' disease with mediastinal adenopathy: Legionella or lymphoma?

An index case of Legionnaires's disease with mediastinal adenopathy prompted us to review our recent experience with Legionnaires' disease to determine the incidence of mediastinal adenopathy of this finding in Legionnaires' disease. We reviewed the radiographic findings of 90 hospitalized adults with Legionnaires' disease from 2015 to 2017. Excluded were 11 patients with mediastinal adenopathy due to non-Legionnaires' disease causes, e.g., lymphoma. Thirty-seven of the remaining patients had both chest films and chest computed tomography (CT) scans. Of the 37 Legionnaires' disease cases, 13/37 (35%) had mediastinal adenopathy and 8/27 (24%) also had unilateral hilar adenopathy. These chest CT findings were not seen on chest films. Chest CT scans are needed to detect mediastinal adenopathy in Legionnaires' disease. Mediastinal adenopathy may be due to Legionnaires' disease or a malignancy. Some findings in Legionnaires' disease are also present in mediastinal adenopathy due to lymphomas, e.g., highly elevated erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and ferritin. Hospitalized adults with Legionnaires' disease and mediastinal adenopathy should have serial chest CT scans to monitor resolution of the mediastinal adenopathy. In hospitalized adults with otherwise unexplained persistent mediastinal adenopathy, they should be considered as being due to another etiology, e.g., lymphoma, until proven otherwise.

Lyme carditis with isolated left bundle branch block and myocarditis successfully treated with oral doxycycline.

Lyme disease may present with a variety of cardiac manifestations ranging from first degree to third degree heart block. Cardiac involvement with Lyme disease may be asymptomatic, or symptomatic. Atrioventrical conduction abnormalities are the most common manifestation of Lyme carditis. Less common, are alternating right bundle branch block (RBBB) and left bundle branch block (LBBB). We present an interesting case of a young male whose main manifestation of Lyme carditis was isolated LBBB. He also had mild Lyme myocarditis. The patient was successfully treated with oral doxycycline, and his isolated LBBB and myocarditis rapidly resolved.

Recurrent FUO due to intermittent Enterobacter cloacae bacteremias from an infected pacemaker lead diagnosed by gallium scan.

Fever of unknown origin (FUO) refers to fevers of ≥101° F that persist for ≥3 weeks and remain undiagnosed after a focused inpatient or outpatient workup. FUO may be due to infectious, malignant/neoplastic, rheumatic/inflammatory, or miscellaneous disorders. Recurrent FUOs are due to the same causes of classical FUOs. Recurrent FUOs may have continuous or intermittent fevers and are particularly difficult to diagnose. With intermittent fever, recurrent FUO diagnostic tests are best obtained during fever episodes. With recurrent FUOs, the periodicity of febrile episodes is unpredictable. We present a case of a 70-year-old male who presented with recurrent FUO. Multiple extensive FUO workups failed to determine the source of his fever. During his last two episodes of fever/chills, blood cultures were positive for Enterobacter cloacae. Episodic E. cloacae bacteremias suggested a device-related infection, and the patient had a penile implant and permanent pacemaker (PPM). Following febrile episodes, he was treated with multiple courses of appropriate antibiotics, but subsequently fever/chills recurred. Since a device-associated infection was suspected, indium and PET scans were done, but were negative. The source of his intermittent E. cloacae bacteremias was finally demonstrated by gallium scan showing enhanced uptake on a cardiac lead, but not the penile implant or PPM. Gallium scanning remains useful in workup of FUOs, particularly when false-negative indium or PET scans are suspected. The involved pacemaker lead was explanted, grew E. cloacae and the patient has since remained fever free.

Sarcoidosis with fever and a splenic infarct due to CMV or lymphoma?

We present a case of an adult female with a past history of pulmonary sarcoidosis who presented with fever, night sweats, profound fatigue, and LUQ abdominal pain. Sarcoidosis is an afebrile disorder (excluding Lofgren's syndrome, Heerfordt's syndrome or neurosarcoidosis). Therefore, the presence of fever with sarcoidosis should suggest infection, usually viral, or lymphoma. Sarcoidosis-lymphoma syndrome describes the evolution of a lymphoma in long standing sarcoidosis. Fever aside, possible lymphoma is suggested by otherwise unexplained fever, pleural unilateral effusion, highly elevated ESR or ferritin levels. In this case, a viral etiology was suggested because of atypical lymphocytosis and mildly elevated transaminases. In this patient, CMV IgM titers and elevated CMV PCR viral load confirmed the diagnosis of CMV infectious mononucleosis with lung and liver involvement. In this case CMV infectious mononucleosis was accompanied by procoagulant activity which resulted a DVT, pulmonary emboli and splenic infarct. We believe this to be the first reported case of CMV infectious mononucleosis splenic infarct in a patient with a history of sarcoidosis.

Riesgo cardiovascular global consultorio 3: Área de salud de Guanabo 2008 / Global cardiovascular risk. Consulting 3: Guanabo health locality 2008

Se realizó un estudio descriptivo de corte transversal con el objetivo de determinar algunos factores de riesgo aterogénicos en la población perteneciente al consultorio médico 3 del Policlínico Docente Dr. Mario Muñoz Monroy, situado en la localidad de Guanabo, municipio Habana del Este, durante el período comprendido entre el 2 de marzo al 1ro de diciembre del año 2008, cuyo propósito general fue realizar un enfoque de riesgo individual (Riesgo Cardiovascular Global) en esta comunidad a partir de algunos factores de riesgo aterogénico identificados, tales como Hipertensión Arterial, Obesidad, Diabetes Mellitus y Tabaquismo, entre otros. La muestra estuvo conformada por los adultos mayores de 20 años que ascendieron a 325 personas. Los principales resultados obtenidos muestran mayor frecuencia de hábito de fumar, hipertensión arterial y Diabetes mellitus, predominaron los hábitos alimentarios inadecuados,sobre todo, en el sexo masculino. Se pudo determinar que 22.8 por ciento de los pacientes presentan riesgos alto y muy alto de morbimortalidad cardiovascular en los próximos 5 a 10 años y que una gran parte de las personas necesita intervención sanitaria para evitar o disminuir riesgos cardiovasculares en el futuro((AU)

A descriptive study of transverse estructure was carried out with the objective of determining some atherogenic risk factors in the particular population of the consulting # 3 of the Dr. Mario Munoz Monroy Teaching Policlinic, situated in the Guanabo health locality of the Habana del Este Municipality, during the period between the 2nd of March to the 1st of December, 2008, with a general proposition to carry out a focus on individual risk (Global Cardiovascular Risk) in this community with respect to some identified atherogenic risk factors such as Arterial Hypertension, Obesity, Diabetes Mellitus and Tabaquism among others. The sample was made up of adults above the age 20 years which came to about 325 persons. The principal results obtained show a higher rate of smoking habit, arterial hipertensión and diabetes mellitus. Inadequate eating habits predominated especially in the masculine sex. It was deduced that 22.8 percent of the patients present high and very high risk of cardiovascular morbimortality in the next 5 to 10 years and that a very large part of the petients need health intervention so that they can avoid or reduce cardiovascular risks in the future(AU)

Riesgo cardiovascular global consultorio 3: área de salud de Guanabo 2008 / Global cardiovascular riskconsulting 3: Guanabo health locality 2008

Se realizó un estudio descriptivo de corte transversal con el objetivo de determinar algunos factores de riesgo aterogénicos en la población perteneciente al consultorio médico 3 del Policlínico Docente Mario Muñoz Monroy, situado en la localidad de Guanabo, municipio Habana del Este, durante el período comprendido entre el 2 de marzo al 1ro de diciembre del año 2008, cuyo propósito general fue realizar un enfoque de riesgo individual Riesgo Cardiovascular Global en esta comunidad a partir de algunos factores de riesgo aterogénico identificados, tales como Hipertensión Arterial, Obesidad, Diabetes Mellitus y Tabaquismo, entre otros. La muestra estuvo conformada por los adultos mayores de 20 años que ascendieron a 325 personas. Los principales resultados obtenidos muestran mayor frecuencia de hábito de fumar, hipertensión arterial y Diabetes mellitus, predominaron los hábitos alimentarios inadecuados, sobre todo, en el sexo masculino. Se pudo determinar que 22.8 por ciento de los pacientes presentan riesgos alto y muy alto de morbimortalidad cardiovascular en los próximos 5 a 10 años y que una gran parte de las personas necesita intervención sanitaria para evitar o disminuir riesgos cardiovasculares en el futuro(AU)

A descriptive study of transverse estructure was carried out with the objective of determining some atherogenic risk factors in the particular population of the consulting número 3 of the Dr Mario Munoz Monroy Teaching Policlinic, situated in the Guanabo health locality of the Habana del Este Municipality, during the period between the 2nd of March to the 1st of December, 2008, with a general proposition to carry out a focus on individual risk Global Cardiovascular Risk in this community with respect to some identified atherogenic risk factors such as Arterial Hypertension, Obesity, Diabetes Mellitus and Tabaquism among others. The sample was made up of adults above the age 20 years which came to about 325 persons. The principal results obtained show a higher rate of smoking habit, arterial hipertensión and diabetes mellitus. Inadequate eating habits predominated especially in the masculine sex. It was deduced that 22.8 percent of the patients present high and very high risk of cardiovascular morbimortality in the next 5 to 10 years and that a very large part of the petients need health intervention so that they can avoid or reduce cardiovascular risks in the future(AU)