PDF | A c r i p t o c o c o s e é u m a d o e n ç a c a u s a d a p o r Cryptococcus Download full-text PDF A criptococose é micose oportunista causada por. Download scientific diagram | Criptococose em caninos e felinos. (A) Leveduras de Cryptococcus sp. arredondadas com célula central circundada por uma. Download PDF. 1 / Pages. Previous article. Go back to website. Next article.
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A Criptococose é uma infecção relativamente rara causada por um fungo, o Cripwcoccus neofornrans, que se encontra largamente distribuido por todo o. Guia de Criptococose da OMS, março On 6 de março de 6 de março de por infectotropicalem Education, . Arquivos para Download. GDrive. Project terney.info has many thousands of free and legal books to download in PDF as well as many other formats. Open library is a high.
The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C.
Keywords: Fungemia; Cryptococcosis; Cryptococcus gattii. We describe a case of Cryptococcus gattii infection in a patient without evidence of immunosuppression including HIV infection with fungemia, an unusual manifestation of this species of Cryptococcus, in whom lung and brain lesions of disseminated cryptococcosis mimicked bronchogenic carcinoma with brain metastases.
CASE REPORT A year-old apparently immunocompentent white man was admitted to the hospital complaining of fever, weakness, anorexia, headache, dyspnea, cough, purulent sputum production, and disorientation one week duration.
It was noted that he had lost 20 kg in weigh during the previous three months. He had smoked one pack of cigarettes daily for the past 50 years.
One year prior to admission arterial hypertension was found. On physical examination he was a thin man who was confused and mumbling. The patient had a stiff neck, positive Lasegue's, and Kerning's signs.
Bilateral Brudzinski signs were present. Ophthalmologic examination revealed pupils non reactive and bilateral papilledema.
Chest roentgenogram revealed overinflation of both lungs and a spherical mass lesion, 5 cm in diameter, in the superior segment of the right lower lobe Fig. Contrast-enhanced axial cranial computed tomographic CT scan showed nonenhancing cystic large mass within the right temporal lobe, hydrocephalus Fig.
Cytomegalovirus CMV is the most frequent pathogenic agent in viral infections in transplant recipients. No case of CMV disease was detected in the series presented, which could be directly related to the small size of the sample.
In the series presented there was a case of varicella with pulmonary involvement. The patient's symptoms included fever, lumbar pain and maculopapular exanthema with two days' evolution. Lung imaging showed diffuse accentuation of the bronchovascular markings.
The patient was prescribed acyclovir, initially intravenously 8 days and after orally with good clinical and radiological response. Lung abscesses are characterised as acute or chronic, depending on length of symptoms. Aerobic agents are more frequently involved in acute infection, unlike chronic disease A doente foi medicada com This is generally detected at a pneumonitis stage, with posterior development of cavita-tion as pulmonary parenchyma necrosis progresses until it establishes communication with the bronchi, with consequent air-fluid level formation.
Imagiology is necessary to diagnosis this entity.
There is no consensus as to length of treatment. Bartlett is in favour of a conservative strategy which maintains antibiotic treatment until imagi-ology shows total resolution or the residual lesion is stable and small Many patients require weeks of treatment in these cases; the treatment strategy currently used in the majority of clinical situations. In the series presented there was a case of methicillin-sensitive Staphylococcus aureus MSSA lung abscesses. The patient had been admitted to hospital once before with left CAP MSSA , whose aetiological confirmation was only possible using microbiology exam of the product obtained by computed tomograhy-guided transthoracic needle aspiration biopsy of a lung nodule.
The histology exam was compatible with AFOP The patient underwent 14 days of antibiotherapy with vancomycin and piperacillin-tazobactam, with good clinical and analytic improvement. Around two weeks later the patient developed a constitutional and respiratory clinical picture, presenting two cavitation images with air-fluid level in the left pulmonary field on the chest teleradiography compatible with pulmonary abscesses Fig.
Identification of the aetiological agent was possible through microbiological exam of traqueo-bronchial secretions, BL and BAL. The patient was prescribed flucloxacillin and clin-damycin, with favourable clinical and radiological evolution, the latter more evident after the 4th week of treatment. O estudo celular nos casos descritos de toxicidade pul- Rapamycin was the agent responsible for the five cases of iatrogenic, or drug-induced, pulmonary pathology.
Around 80 cases of rapamycin-induced pulmonary toxicity have been described in solid organ transplant recipients In the majority of cases, patients present respiratory and systemic symptoms, associated to radiologic images of pulmonary infiltrates, mimicking respiratory infection in the immuno-compromised patient.
These abnormalities characteristically regress with the suspension of the drug, usually in a three-month period9. In the five cases studied, the lack of isolation of any microorganism and the observation of lymphocytosis in the BAL in four was indicative of pneumonitis.
Here some authors defend the anatomo-pathological confirmation of pneumonitis diagnosis9, Clinical presentation, BAL result and favourable clinical and radiological evolution following drug suspension question the need for a more invasive diagnostic approach.
The rare occurrence led, however, to performing a surgical lung biopsy in the patient with alveolar haemorrhage. This was compatible with AFOP, an anatomo-pathological entity associated to acute or subacute onset pulmonary pathology which can occur in an idiopathic form, associated to infection or following exposure to drugs such as rapamycin9, There was no case of malignant pulmonary pathology seen in the series presented, partly explained by the small sample size and also by the low risk in this type of patient of solid lung cancer compared with other types of cancers In terms of the cases of infections it was not possible to correlate the type of pulmonary abnormality with the immunosuppression scheme, a situation which was not confirmed with the toxicity associated to rapamycin.
Further, it was impossible to correlate the degree and length of immunosuppressive therapy with the type of pulmonary manifestations and their severity such as, for example, in the case of pneumocystosis described which occurred in a late posttransplant stage , as in the population studied the most severe cases were not associated with the immediate posttransplant period, the time in which the degree of immunosuppression is greater.
Conclusion Similarly to that described in the literature, infection was the main pulmonary complication in the patients group studied, with bacterial and opportunistic agents the most frequent. Rapamycin-induced pulmonary toxicity is being described more and more, underlining the importance of regular monitoring of rapamycin serum levels, or the serum levels of other potentially toxic drugs.
The need for an invasive diagnostic approach in some cases is highlighted, determining the early institution of a specific treatment. Despite the sample's small size, the lack of deaths is in line with the gradual drop in mortality by infection in immunocompro-mised patients, given the advances in diagnosis, treatment, prevention and immuno-suppressive therapy.
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