Andrés F. Henao-Martínez

Chagasic cardiomyopathy, from acute to chronic: is this mediated by host susceptibility factors?

Chronic chagasic cardiomyopathy (CCC) is the main contributor to morbidity and mortality among individuals chronically infected with the protozoan parasite Trypanosoma cruzi. However, cardiomyopathy develops in fewer than one-third of these patients. Among the different mechanisms to explain this variability are environmental factors, T. cruzi genetic diversity, and host susceptibility. CCC is the culmination of a pathologic process with an onset during the acute infection phase. Previous studies of host genetic factors have been limited to a few candidate genes. This review describes the pathologic features of acute and chronic myocarditis and the host susceptibility factors that may contribute to the development of chagasic cardiomyopathy.

Cryptococcosis in solid organ transplant recipients.

Purpose of review Cryptococcosis among solid organ transplant (SOT) recipients is a source of significant morbidity. Its pathogenesis, the etiology of immune reconstitution syndrome, and the optimal therapy in this setting are still not well defined. Herein, we review the epidemiology, the latest findings on pathogenesis, unique clinical manifestations, and the treatment of Cryptococcosis in this specific vulnerable population. Recent findings Cryptococcosis is a common fungal complication among SOT recipients. It follows in frequency only to aspergillosis and candidiasis. Cryptococcal infection carries a high mortality, up to 27% during the first year posttransplantation. Host factors, environmental factors, medications, and the type of transplant all play a role in the clinical presentation and severity of infection. Clinical manifestations can be atypical among SOT recipients, and therefore, clinical suspicion and diagnostic evaluation must consider cryptococcal central nervous system disease. During meningitis treatment, measurement of Flucytosine levels is recommended to increase safety and optimize the therapeutic effect. Summary Cryptococcosis among SOT recipients is an evolving field. Increased recognition and understanding of the disease pathogenesis, its uncommon clinical manifestations, complications and particular therapeutic strategies are the cornerstone for the optimal outcome of this often fatal condition. Video abstract http://links.lww.com/COID/A11

Dengue hemorrhagic fever complicated by pancreatitis

Acute pancreatitis is an atypical complication of dengue fever and is rarely described. We are reporting a case of dengue hemorrhagic fever complicated by acute pancreatitis in a patient with history of diabetes mellitus type 1 and end stage renal disease on hemodialysis.

Mycoplasma hominis brain abscess presenting after a head trauma: a case report

IntroductionMycoplasma hominis brain abscess is a rare occurrence, and treatment is not well defined. The mechanism by which M. hominis infects sites outside the genitourinary tract, including the central nervous system, is unclear.Case presentationWe report the case of a 40-year-old Somali man who sustained a traumatic brain injury that required initial neurosurgical hematoma evacuation and that subsequently was complicated by a hospital-acquired M. hominis brain abscess. Our patient was successfully treated with neurosurgical debridement and an antibiotic course of intravenous doxycycline.ConclusionsHead trauma or neurosurgical procedures or both might be a predisposing factor for this type of infection.

Photo Quiz: A 28-Year-Old Hispanic Woman with a History of Lupus Presenting with an Acute Onset of Thrombocytosis

A 28-year-old Colombian woman with a past medical history significant for systemic lupus erythematosus (SLE), who was receiving treatment with chloroquine and prednisone and had been complicated in the past with episodes of lupus-induced thrombocytopenia (baseline platelet count, 87 × 109 platelets

Combination Antifungal Therapy in the Treatment of Scedosporium apiospermum Central Nervous System Infections

Treatment of Scedosporium apiospermum central nervous system (CNS) infection typically consists of an azole in combination with surgical debridement. This approach requires prolonged treatment and carries a high associated mortality. We present two cases of the successful treatment of S. apiospermum CNS infections with the combination of voriconazole and terbinafine.

Successful treatment of acyclovir-resistant herpes simplex virus type 2 proctitis with leflunomide in an HIV-infected man

Human herpes simplex virus infections are very common and represent significant morbidity in the immunocompromised host. Patients with acyclovir resistant strains of HSV based on viral thymidine kinase gene mutations need alternative therapeutic approaches. Leflunomide has been shown to possess antiviral activity against several viruses. Herein we describe a case of acyclovir resistant HSV-2 proctitis in an HIV patient successfully treated with leflunomide without significant side effects.

Primary Extranodal, Extralymphatic Hodgkin Lymphoma of the Mandible

Primary extranodal, extralymphatic Hodgkin lymphomas (PEEHLs) are a rare occurrence. When they are encountered, they become diagnostic challenges. We are describing the uniqueness of a case of PEEHL affecting the mandible with his early response to the available chemotherapy.

The Hispanic HIV Epidemic

The Hispanic population in the U.S. has been dramatically affected by the HIV epidemic. The impact not only is related to the infection itself and its complications, but also is driven by social factors that lead to increased disparity in health-care access and cultural modeling and to increased social stigma, which leads to marginalization and exacerbates the existing gaps in medical care. Hispanics infected with HIV more frequently receive delayed diagnoses and more often present with AIDS, concomitant opportunistic infections, or coinfections related to their country of origin. The unique characteristics that define the HIV epidemic in Hispanics need further analysis in order to identify new opportunities to improve linkage to health care, increase efficacy in health-care provision, and decrease social disparities related to the Hispanic population.

A case of community-acquired Acinetobacter junii-johnsonii cellulitis.

INTRODUCTION Physiological resistance of natural population of Aedes aegypti to insecticides contribute to the decreased efficacy of chemical control as a main control strategy during dengue outbreaks. OBJECTIVE The susceptibility status of Ae. aegypti was assessed for the carbamate propoxur, the adulticide malathion and the larvicide temephos on 13 natural populations of Ae. aegypti immature forms were taken from 8 Colombian localities. These included the following: Bucaramanga (1), Sabana de Torres (2), Girardot (2), La Mesa (2), Villavicencio (2), Puerto López (2), San José del Guaviare (1) and Florencia (1). MATERIALS AND METHODS Susceptibility tests mainly consisted of the standardized bioassay outlined by WHO (1981) and CDC bottles (1998). Colorimetric tests were undertaken to determine enzyme levels possibly responsible for the reduction of susceptibility to organophosphate and carbamate insecticides. RESULTS All specimens demonstrated susceptibility to malathion and propoxur insecticides. Four of the 13 populations revealed susceptibility to the temephos larvicide. Seven of 11 populations showed a limited increase in values for nonspecific esterase enzymes. The Bucaramanga population was the only one which showed an increase in the cytochrome P450 monooxygenases enzymes. Neither population was found with modified acetilcolinesterase. CONCLUSIONS The widespread susceptibility to organophosphates used as adulticides indicated that malathion, the most used insecticide in Colombia, remains effective in interrupting the transmission of dengue. Physiological resistance to insecticides occurring in communities of a single township proved to be a localized phenomenon.INTRODUCTION Physiological resistance of natural population of Aedes aegypti to insecticides contribute to the decreased efficacy of chemical control as a main control strategy during dengue outbreaks. OBJECTIVE The susceptibility status of Ae. aegypti was assessed for the carbamate propoxur, the adulticide malathion and the larvicide temephos on 13 natural populations of Ae. aegypti immature forms were taken from 8 Colombian localities. These included the following: Bucaramanga (1), Sabana de Torres (2), Girardot (2), La Mesa (2), Villavicencio (2), Puerto López (2), San José del Guaviare (1) and Florencia (1). MATERIALS AND METHODS Susceptibility tests mainly consisted of the standardized bioassay outlined by WHO (1981) and CDC bottles (1998). Colorimetric tests were undertaken to determine enzyme levels possibly responsible for the reduction of susceptibility to organophosphate and carbamate insecticides. RESULTS All specimens demonstrated susceptibility to malathion and propoxur insecticides. Four of the 13 populations revealed susceptibility to the temephos larvicide. Seven of 11 populations showed a limited increase in values for nonspecific esterase enzymes. The Bucaramanga population was the only one which showed an increase in the cytochrome P450 monooxygenases enzymes. Neither population was found with modified acetilcolinesterase. CONCLUSIONS The widespread susceptibility to organophosphates used as adulticides indicated that malathion, the most used insecticide in Colombia, remains effective in interrupting the transmission of dengue. Physiological resistance to insecticides occurring in communities of a single township proved to be a localized phenomenon.Acinetobacter skin and soft tissue infection outside of the traumatic wound setting are rare occurrences. The majority of cases occur in the presence of significant comorbilities and by Acinetobacter baumanii. Herein a case is reported of community-onset, health-care-associated, non-traumatic cellulitis caused by Acinetobacter, species junii-johnsonii with bacteremia. This is the first reported case of Acinetobacter junii-johnsonii skin and soft tissue infection. Hemorrhagic bullae might be one of the clinical features of Acinetobacter cellulitis.