RESUMO
Histoplasmosis is a progressive granulomatous disease caused by the intracellular dimorphic fungus Histoplasma capsulatum. We report a rare case of esophageal histoplasmosis in a renal allograft recipient. A 55-year-old male who received a live, unrelated renal allograft 20 years ago presented with complaints of recurrent fever for ten to 12 months, weight loss over six months, progressive dysphagia more for solids for five to six months and joint pain and swelling involving the bilateral metacarpo-phalangeal and proximal interphalangeal joints. Biopsy from the esophageal ulcers revealed dense inflammation infiltrated with lymphocytes and macrophages with clusters of strongly positive intracellular fungal spores with a clear area or "halo-like" zone suggestive of Histoplasma capsulatum invasion. The patient was treated with intravenous liposomal amphotericin B for ten days and later switched over to oral itraconazole. Repeated endoscopy revealed significant improvement of the lesions.
Assuntos
Doenças do Esôfago/etiologia , Doenças do Esôfago/microbiologia , Histoplasmose/etiologia , Transplante de Rim/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Anticorpos Monoclonais/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Terapia de Imunossupressão , Transplante de Rim/imunologia , Animais , Creatinina/sangue , Seguimentos , Humanos , Transplante de Rim/fisiologia , Camundongos , Muromonab-CD3/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Fatores de TempoRESUMO
Nine patients of acute falciparum malaria with severe hyperbilirubinemia developed acute renal failure (ARF). All of them had evidence of intrahepatic cholestasis and needed hemodialysis for several weeks; 7 survived and 2 died, one due to cerebral malaria, the other multiple organ failure. Interestingly, referal diagnosis did not include malaria as a cause of ARF in 8 out of 9 patients.
Assuntos
Injúria Renal Aguda/etiologia , Hepatopatias Parasitárias/diagnóstico , Malária Falciparum/diagnóstico , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/patologia , Adolescente , Adulto , Colestase Intra-Hepática/diagnóstico , Colestase Intra-Hepática/etiologia , Colestase Intra-Hepática/patologia , Diagnóstico Diferencial , Feminino , Humanos , Rim/patologia , Fígado/patologia , Hepatopatias Parasitárias/patologia , Malária Falciparum/complicações , Malária Falciparum/patologia , MasculinoAssuntos
Diabetes Mellitus/etiologia , Obesidade/complicações , Adolescente , Diabetes Mellitus/epidemiologia , Humanos , Índia , RiscoRESUMO
PIP: The author examines the relationship between population increase, economic growth, and economic development in India and considers different theoretical conceptions relating to underdevelopment. Economic indicators are analyzed with respect to their effects on development in developing countries. The effect of population growth on labor supply and on the industrial occupational structure is investigated.^ieng
