Omar Palmieri

Disseminated paracoccidioidomycosis with peripleuritis in an AIDS patient

Paracoccidioidomycosis is one of the most frequent systemic and endemic mycoses of Latin America caused by a dimorphic fungus. In AIDS patients, paracoccidioidomycosis appears as a severe and disseminated disease with a wide spectrum of clinical findings. The CD4 counts are usually less than 200 cell/mu L. We present a case of disseminated paracoccidioidomycosis with peripleuritis and subcutaneous abscesses on the chest wall as initial manifestation of AIDS. In endemic countries, paracoccidioidomycosis should be included as an opportunistic infection in AIDS.

Infección por Strongyloides stercoralis: estudio epidemiológico, clínico, diagnóstico y terapéutico en 30 pacientes

BACKGROUND Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts severe and life-threatening manifestations such as hyperinfection syndrome and disseminated disease might occur. METHODS We retrospectively analyzed the epidemiological and clinical characteristics, including HIV co-infection, microbiological findings, and outcome in 30 patients with strongyloidiasis, who attended in the Infectious Diseases F. J. Muñiz Hospital in Buenos Aires from January 2004 to December 2008. RESULTS The study included 20 men and 10 women with an average age of 33 years. HIV co-infection was present in 21 patients (70%) with a median CD4 T cell count of 50 cells/mm³ (range 7-355) (average 56 cells/mm³). Among HIV negative patients the following comorbidities were detected: tuberculosis (n = 3) and chronic alcoholism, leprosy treated with corticosteroids, immunosuppressive treatment for psoriasis, and diabetes mellitus (each in one patient). Two patients did not have any predisposing diseases or immunosuppressive treatments. Seventeen patients presented with diarrhea and were classified as chronic intestinal strongyloidiasis (57%), asymptomatic infection with peripheral eosinophilia was diagnosed in 7 (23%), and 6 patients (20%) developed hyperinfection syndrome. Seventeen patients (57%) presented peripheral eosinophilia. Diagnosis was achieved by direct visualization of larvae in feces by Baermann technique (n = 20), by multiple stool smears examinations (n = 2), by combination of both (n = 1), by visualization of the filariform larvae in duodenal fluid and stool (n = 1), and in fecal and bronchoalveolar lavage specimens (n = 6). Overall mortality in this series was 20% (6/30). There was no significant correlation between age and mortality. A significant inverse correlation between the survival rate and CD4 T-cell count as well as eosinophilia was observed. There was also a significant correlation between HIV co-infection and mortality. Twenty-two patients responded favorably to treatment with ivermectin.

Bacteriemia por Kocuria rosea en un paciente con SIDA

: Kocuria rosea is an uncommon pathogen may cause opportunistic infections in immunocompromised patient. We report a HIV patient, who presented bacteremia caused by Kocuria rosea. He was successfully treated with vancomycin and by catheter removal.

Lesión eritematocostrosa de cara en un paciente con sida

Paciente de 39 anos con serologia reactiva para el virusde la inmunodeficiencia humana (VIH) y el virus de la he-patitis C (VHC), heterosexual y adicto a drogas intrave-nosas (ADIV). Sin antecedentes de enfermedades marca-doras de sida ni terapia antirretroviral de gran actividad(TARGA). Ingreso en la Unidad 10 del Hospital de En-fermedades Infecciosas Francisco J. Muniz por fiebre(38,5 °C), perdida de peso (15 kg en los ultimos 3 meses) yuna placa eritematocostrosa en mejilla izquierda y ala na-sal homolateral de un mes de evolucion. El examen der-matologico comprueba la presencia de una placa eritema-toedematosa en la region malar y el ala nasal izquierda,infiltrada en sus bordes, con temperatura local aumenta-da, cubierta de escamocostras, que le provoca asimetria fa-cial (fig. 1) y ademas, compromiso de la mucosa nasal ho-molateral que se observa cubierta de costras. En la zonainferior de la comisura bucal derecha tiene una lesion pe-quena de similares caracteristicas. El resto del examen fi-sico mostro adelgazamiento, hipotonia e hipotrofia muscu-lar generalizada, estertores crepitantes diseminados enambos pulmones y hepatoesplenomegalia.Los examenes de laboratorio arrojaron los siguientes re-sultados: hematocrito 35%; hematies 3.710.000/ l; leuco-citos 5.800/ l; plaquetas 166.000/ l; velocidad de sedi-mentacion globular 107 mm en la primera hora; fosfatasaalcalina 766 U/l. El resto de la quimica sanguinea regis-tro valores normales. La serologia fue negativa para sifi-lis, toxoplasmosis y Chagas. El recuento de linfocitos TCD4+ fue de 57 cel./ l (3%). La radiografia de torax mos-tro un infiltrado intersticial hiliofugal bilateral y la eco-grafia abdominal evidencio una hepatomegalia con au-mento de la ecogenicidad compatible con esteatosis,fibrosis o granulomatosis y esplenomegalia con varias le-siones hipoecoicas, la mayor de 5,4 mm.

Rupioid histoplasmosis: first case reported in an AIDS patient in Argentina.

Disseminated histoplasmosis is a relatively common AIDS-defining illness, occurring in almost 4% of patients living in endemic areas and it may be the first clinical expression of the HIV infection. A broad spectrum of clinical skin lesions associated with Histoplasma capsulatum infection have been described in AIDS patients, such as erythematous macules, papules, nodules, and pustules. Herpetic, acneiform, erythema multiforme-like, molluscum contagiosum-like, vasculitic, and exfoliative forms have also been reported. To our knowledge, this is the first case of disseminated histoplasmosis in an AIDS patient presented as a rupioid eruption.

Neumonía cavitada por Cryptococcus neoformans en un paciente con sida

Pulmonary cryptococcosis is an unusual fungal infection that is most often found in AIDS or in organ transplant recipients. Although in immunocompromised patients, cryptococcal infection often causes pulmonary infections, the diagnosis of lung involvement is generally difficult. The presentation of pulmonary cryptoccosis in HIV-infected patients appears to be more acute and severe than in other immunocompromised patients, probably related with the severe immunosuppression. Diffuse infiltrates, mediastinal and hilar lymph nodes enlargement are the most common radiological findings in AIDS-associated pulmonary cryptococcosis. Cavitation is a rare form of and includes only 10% to 15% of all cases. Only a few case reports or studies with small number of patients of pulmonary cryptococcosis have been published over the past two decades. We report a case of an AIDS patient who developed cavitary pneumonia as the only clinical expression of cryptococcosis.

Tumoración de la pared anterior del tórax en un paciente con sida

que demostro una radiopacidad difusa en los lobulos superiores y bases de ambos pulmones en relacion con probable proceso inflamatorio activo, mediastino normal, imagenes hiperdensas (calcicas) a nivel de la pleura parietal del hemitorax izquierdo (paquipleuritis) con imagenes nodulares subpleurales homolaterales, atelectasia laminar bibasal, adenopatias axilares bilaterales y sinequias pleurofrenicas bibasales. En las partes blandas y sobre la cara anterior del hemitorax izquierdo se observo extensa formacion hipodensa de 82,7 × 49,2 mm de diametro, con densitometria heterogenea (solida y liquida) y paredes gruesas (fig. 3). De la puncion aspirativa con aguja fina de la tumoracion se obtiene material purulento cuyo examen directo demostro cinco BAAR por campo y, de la biopsia quirurgica practicada por incision submamaria, material de aspecto caseosopurulento situado por debajo del pectoral mayor. La histopatologia demostro granulomas compatibles con tuberculosis. Se inicio tratamiento Caso clinico

Infección por Rhodococcus equi en pacientes con SIDA: Análisis retrospectivo de 13 pacientes en Argentina

INTRODUCTION Rhodococcus equi is a gram positive coccoid rod that causes pulmonary infections in immunosuppressed patients. METHODS We retrospectively analyzed epidemiological, clinical, microbiological, radiological, and immunological features as well as the outcomes of 13 AIDS patients with R. equi infection. RESULTS Between January 1994 and December 2012, 13 patients attending the AIDS department of the Infectious Diseases reference hospital in Buenos Aires were diagnosed with R. equi infection. All were men, the median age was 27 years. At the time of diagnosis, the median of CD4+ T cell counts was 11 cells/μl Twelve patients presented pulmonary disease with isolation of the microorganism from sputum or bronchoalveolar lavage; in the other patient the diagnosis was postmortem with positive culture of cerebrospinal fluid. The most frequent clinical manifestations were fever, haemoptysis, and weight loss. The predominant radiological finding was lobe consolidation with cavitation. Nine patients died after a median survival of 5.5 months. In all of them, cultures persisted positive until the last admission. The other 4 patients did continue clinical follow-ups. CONCLUSION The insidious course of R. equi disease and the difficulties in the isolation of the microorganism contribute to the delay in the diagnosis and to the high mortality rate of this opportunistic infection.

Hip tuberculosis. Case report and literature review

Osteoarticular tuberculosis is a rare complication of the disseminated disease and appears, in different series, between 10% to 20%, trough hematogenous spread. Tuberculosis hip involvement is less than 10% of all the cases of osteoarticular tuberculosis. The diagnosis is confirmed by the detection of Mycobacterium tuberculosis in samples obtained from joint fluid or synovial membrane biopsy by direct examination and culture, in order to perform antimicrobial susceptibility testing. Here, we present a patient infected with the human immunodeficiency virus (HIV) who developed a disseminated tuberculosis with affection of the hip in the context of the immunodeficiency related with the retrovirus.

Lesión ulcerocostrosa en el brazo derecho en paciente VIH positivo

Evolucion Los examenes directos del esputo y lavado broncoalveolar fueron negativos para bacilos acido-alcohol resistentes (BAAR), bacterias comunes, hongos y parasitos. Se efectuo biopsia de la lesion cutanea, cuyo examen histopatologico mostro epidermis adelgazada, con ulceracion por despegamiento dermoepidermico y perdida de las crestas interpapilares. En la dermis, se observo incremento de los haces de fibras colagenas, escasos macrofagos con citoplasma claro y fibroblastos dispuestos en fasciculos paralelos a la epidermis (fig. 2). Con la coloracion de Ziehl-Neelsen se observaron abundantes bacilos aislados y agrupados, alargados y sin fragmentacion (fig. 3). Las coloraciones de acido peryodico de Schiff (PAS) y Grocott no revelaron otros microorganismos. Los cultivos de esputo, el lavado broncoalveolar y la biopsia cutanea mostraron el desarrollo de Mycobacterium tuberculosis sensible a todos los farmacos antituberculosos. Se realizo tratamiento con isoniacida, rifampicina, etambutol y pirazinamida por via oral durante 2 meses, profilaxis con cotrimoxazol en dosis de 160 mg de trimetoprima y 800 mg de sulfametoxazol 3 veces por semana y suplementos vitaminicos. Evoluciono con excelente respuesta clinica. Al mes de tratamiento, la bacteriologia del esputo fue negativa y la lesion cutanea habia cicatrizado; la radiografia de torax fue normal y la ecografia abdominal mostro la desaparicion de las imagenes hipoecoicas del bazo. Caso clinico