Rafael Jurado

Iron, Infections, and Anemia of Inflammation

Iron is essential to all microorganisms. To obtain iron from the very low concentrations present in their environment, microorganisms have developed sophisticated mechanisms such as the siderophore system. As a primitive defense mechanism, humans have developed mechanisms to withhold iron from microorganisms. Iron-binding proteins such as transferrin, ferritin, and lactoferrin have a central role in human ferrokinetics. These iron-binding proteins also participate in the process of decreasing iron availability for the microorganisms. They do so by decreasing iron reutilization. Anemia of inflammation (previously called anemia of chronic disease) is seen in the setting of infectious, inflammatory, and neoplastic diseases. It results, in part, from changes in the intracellular metabolism of iron. Alterations of iron physiology seen in many clinical circumstances make excess iron available to microorganisms, thus enhancing their pathogenicity. Understanding the molecular basis of iron withholding by the human host, both in the absence of and during infection, and that of iron acquisition by microorganisms may provide us with new and innovative antimicrobial agents and vaccines.

Musculoskeletal infections in patients with human immunodeficiency virus infection.

&NA; Abbreviations used in this article: AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; IVDA, intravenous drug abuse; WBC, white blood cell count.

Tuberculosis of the Pancreas: Report of Two Cases and Review of the Literature

Tuberculosis of the pancreas is a clinical entity rarely described in the literature. The pancreas is biologically protected from infection by Mycobacterium tuberculosis, probably because of the presence of pancreatic enzymes that interfere with the seeding of M. tuberculosis. However, when pathogens are able to overcome the resistance, they can have diverse presentations, such as pancreatic masses that can mimic carcinoma, obstructive jaundice, pancreatitis, and gastrointestinal bleeding. Herein we describe 2 cases of pancreatic tuberculosis that presented as multicystic masses, and we review the literature to describe the diverse clinical manifestations of this condition.

Tuberculosis in the transplant candidate: importance of early diagnosis and treatment.

Background. Transplantation is contraindicated in candidates with active tuberculosis. The present study was undertaken to determine the clinical manifestations of tuberculosis in the transplant candidate and the prognosis of cases that inadvertently undergo transplantation. Methods. This study was a retrospective study of tuberculosis cases diagnosed among 3,889 transplant candidates. All cases were diagnosed from respiratory or tissue samples obtained in the pretransplant period or during transplantation. Results. We observed 7 cases (0.18%) of active tuberculosis among 3,889 candidates. Two patients had a history of tuberculosis. Tuberculosis was frequently asymptomatic. Three patients had extrapulmonary tuberculosis. Chest radiographs showed residual fibrotic lesions in three patients and noncavitated consolidation in two patients. All of the patients in which the purified protein derivative test was performed were anergic. All patients that inadvertently underwent transplantation were cured. Conclusions. Aggressive management is required to prevent tuberculosis in transplant candidates. Patients that inadvertently undergo transplantation can be effectively treated when diagnosed early.

Systemic inflammatory response syndrome caused by chronic salicylate intoxication

Systemic inflammatory response syndrome (SIRS) is characterized by body temperature abnormalities, tachypnea or hyperventilation, tachycardia, and leukocytosis or leukopenia. Although it is typically associated with a serious infection and referred to as sepsis, SIRS can stem from noninfectious causes, as well. We report the cases of four patients with toxic serum levels of salicylate (33.5 to 67.6 mg/dL) and SIRS, and we discuss mechanisms responsible for SIRS. Our patients showed temperature disturbances (35.5°C to 39.8°C), noncardiogenic pulmonary edema, and mixed acid base disturbances. Other abnormalities included coagulopathy (disseminated intravascular coagulation), encephalopathy, and hypotension. All four patients recovered from SIRS, probably due to early recognition and treatment; only one patient did not survive the hospitalization. Chronic salicylate toxicity should be considered as a cause of SIRS in the absence of a source of infection, since survival appears to be dependent on prompt diagnosis and management.

Why Shouldn't We Determine the Erythrocyte Sedimentation Rate?

A test that is meant to measure a given parameter is more likely to detect changes in that parameter if it is not affected by factors other than those which it is intended to quantitate. The clinical use of the laboratory test for determining the erythrocyte sedimentation rate is backed by nearly a century of experience. Although its nonspecificity is acknowledged, it has been used to quantitate the inflammatory process that underlies infectious, inflammatory, and neoplastic disorders. I believe that this venerable test is affected by too many factors in addition to that which we think we are measuring, to the point that its clinical usefulness is severely compromised.

Trimethoprim-Sulfamethoxazole–Induced Meningitis in Patients With HIV Infection

ABSTRACT: Meningitis is a frequent complication of the human immunodeficiency infection. Possible causes include bacterial, fungal, mycobacterial, syphilitic, and vital pathogens (including the human immunodeficiency virus). Drugs must also be considered in the differential diagnosis. Two patients with probable trimethoprim-sulfamethoxazole–induced meningitis are described in the setting of human immunodeficiency virus infection.

Salicylate toxicity in the older patient.

Nonacetylated salicylates are frequently used in the treatment of musculoskeletal complaints and pain management in older patients because of their possible lower gastrointestinal and renal toxicity as compared with other nonsteroidal anti-inflammatory agents. We report five patients with chronic salicylate intoxication seen at the Atlanta VA Medical Center. All charts of patients diagnosed with salicylate toxicity were reviewed, and cases with acute, intentional intoxication were excluded. In the study group, three patients took a nonacetylated salicylate, the other two took an acetylated salicylate. Our patients ranged in age from 51 to 78 years old. One patient died of respiratory failure and “sepsis-like syndrome,” a potentially lethal complication of salicylate toxicity. Four of the patients had altered mental status as a presenting complaint. The presence of a combined respiratory alkalosis and metabolic acidosis, present in all five patients, was the clue for diagnosis in three of the cases. Tinnitus was reported in only one patient. A significantly decreased urate level and a wide anion gap were consistent findings as well. Two of the patients improved after hydration and discontinuation of use of the drug, two required alkalinization of the urine, and one required dialysis. Clinicians need to be more aware of the potential toxicity, including life-threatening complications, with the use of salicylates, particularly in high risk populations such as elderly patients and patients with multiple medical problems.

Foliculitis del jacuzzi : descripción de un brote de 6 casos

8. Moraga Llop FA, Martı́nez Roig A. Enfermedades bacterianas de la piel. Pediatr Integral. 2012;16:235–43. 9. Berrouane YF, McNutt LA, Buschelman BJ, Rhomberg PR, Sanford MD, Hollis RJ, et al. Outbreak of severe Pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31:1331–7. 10. Lutz JK, Lee J. Prevalence and antimicrobial-resistance of Pseudomonas aeruginosa in swimming pools and hot tubs. Int J Environ Res Public Health. 2011;8:554–64.

Of skin and bones.

1-9 Side, behind, side, cross rock, 1/4, 1/4, 1/2 with sweep, behind, side, cross 1-2& (1) Step R to R, (2) cross L behind R, (&) step R to R 12.00 3-4& (3) Rock L across R, (4) recover onto R, (&) turn 1/4 L stepping fwd. on L 9.00 5-6 (5-6) Turn 1/4 L stepping R to R turning your body towards L diagonal prepping to turn R (this is a slow move). As you do this swivel L toes to the side and look over your L shoulder 6.00