Cutaneous leishmaniasis is caused by different species of
theLeishmania genus.
Leishmania(Leishmania)
infantum, causing cutaneous leishmaniasis, has been described in
patients living in areas where visceral leishmaniasis is endemic. In this study, it
was possible to characterize this species in seven slides from cutaneous tissue
imprints from patients with cutaneous leishmaniasis in the State of Mato
Grosso do Sul, Brazil.
Atypical mycobacteria are saprophytic organisms not transmitted from person to
person, which affect mainly immunosuppressed but also immunocompetent individuals. We
present a case of atypical mycobacteriosis after a vascular procedure, with
widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae
was identified by the polymerase chain reaction (PCR) method. The patient showed
improvement after treatment with three antibiotics. Mycobacterium chelonae causes
skin lesions after invasive procedures. The clinical form depends on the immune state
of the host and on the entry points. The diagnosis is based essentially on culture
and the mycobacteria is identified by PCR. We highlight the importance of
investigating atypical mycobacteriosis when faced with granulomatous lesions
associated with a history of invasive procedures.
The purpose of this study was to estimate the prevalence of intestinal parasites in both cooperative-affiliated and independent waste pickers operating at the municipal sanitary landfill in Campo Grande, Mato Grosso do Sul, Brazil, and associate these findings with hemoglobin, eosinophils, vitamin A and C levels and interleukin 5 and 10 (IL-5 and IL-10) production. Biological samples were collected, in addition to clinical, epidemiological, and sociodemographic data. Stool analyzes were based on sedimentation by centrifugation and on spontaneous sedimentation. High-performance liquid chromatography was used to determine vitamin A and C levels. ELISA was employed to quantify interleukins. Intestinal parasites were found in 29 of the 66 subjects assessed (43.9%). Endolimax nana (22.7%), Entamoeba coli (21.1%), Giardia lamblia (6.1%), Entamoeba histolytica/E. dispar (4.5%), and Ascaris lumbricoides (4.5%) were the most prevalent species. Pathogenic parasites were detected in 11 individuals (16.7%). Hypovitaminoses A and C were detected in 19.6% (13/66) and 98.4% (65/66) of subjects, respectively. IL-5 and IL-10 production was observed in 21 (31.8%) and 32 (48.4%) subjects, respectively. Infection with pathogenic intestinal parasites was not a cause of vitamin A and C deficiency or IL-5 and IL-10 production among these workers.
Patient: Male, 74-year-old
Final Diagnosis: Aspergillus fumigatus infection
Symptoms: Anemia • elevated inflammatory marker • fever • mediastinal fluid collection • sternal disruptation
Medication: —
Clinical Procedure: —
Specialty: Cardiac Surgery • Infectious Diseases
Objective:
Rare disease
Background:
Mediastinitis is a serious complication after cardiac surgery; it is a deep sternal wound infection following sternotomy, with clinical evidence and/or microbiological involvement and sternal osteomyelitis. The most common pathogens are
Staphylococcus
spp (
S. aureus
), followed by gram-negative organisms. Establishing an etiological diagnosis of fungal mediastinitis is often a challenging issue, given the nonspecific clinical presentation.
Case Report:
A 74-year-old man was diagnosed with a three-vessel coronary artery disease in a university hospital. The patient had as clinical background hypertension, a body mass index (BMI) of 29.78 kg/m
2
, and no diabetes mellitus. After an uneventful coronary artery bypass surgery, he presented clinical and radiological mediastinitis manifestations on the 9
th
postoperative day. He was treated with a range of antibiotics, with no clinical improvement until the 33
rd
postoperative day. Then, mediastinal fluid and biopsied tissue were collected and he was started on voriconazole due to growing
Aspergillus
spp. On the 93rd postoperative day, he had clinical improvement and, after several exams, was released from the hospital. We present the first report of
Aspergillus fumigatus
mediastinitis after cardiac surgery in Brazil, successfully treated with voriconazole.
Conclusions:
Aspergillus
infection should be considered in the differential diagnosis of mediastinitis after coronary surgery, especially in a clinical case of unexplained sepsis, negative blood culture, and no clinical improvement despite antibiotic therapy. This case report highlights that the mediastinal fluid and biopsy tissue culture can be useful for the diagnosis of fungal mediastinitis.
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