A case of imported paracoccidioidomycosis in a German legionnaire.

We report on a case of the chronic form of paracoccidioidomycosis with swelling and ulcerations of the mouth in a German legionnaire who also suffered from a chronic bronchitis. The patient had worked for many years in Brazil, an area endemic for the disease. Infection due to Paracoccidioides brasiliensis was diagnosed in Germany, more than 10 years after the patient's return. Diagnosis was established by the presence of yeast cells with multipolar budding in the tissue of the oral lesion. Furthermore, the fungus was grown in a liquid Leishmania culture medium. Identification of the fungus was based on morphology and genetic sequencing. Furthermore, IgG antibodies against a 43-kDa antigen of P. brasiliensis were detected in a western blot. After itraconazole therapy (400 mg day(-1)) for 4 weeks, the lesions had disappeared almost completely, but the therapy was continued for further 5 months to avoid relapse of the infection.     

A case of Mayaro virus infection imported from French Guiana

Emergence of arboviruses is a rising problem in several areas in the world. Here we report a case of Mayaro virus infection that was diagnosed in a French citizen presenting a dengue-like syndrome with prolonged arthralgia following a travel in French Guiana. Diagnosis was based on serological testing, a newly developed specific RT–PCR and sequencing.The real incidence of this viral infection among travelers is poorly known but this case is the first reported in a European area where Aedes albopictus mosquitoes are established, which underscores the necessity to determine the vector competence of the European strain of this mosquito species for Mayaro virus.     

Canine Leishmania infantum infection: an imported case in UK after staying in the Canary Islands

Parasitology Research - Leishmaniosis is reported in the Iberian Peninsula and the Balearic Islands, but the Canary Islands are deemed free. In the present communication, we report a clinical...     

A fluffy white traveller: imported Coccidiodes immitis infection in an Australian tourist

Pulmonary coccidioidomycosis is a rare cause of pulmonary nodules and respiratory infection in travellers to endemic areas. An Australian tourist suffered an acute respiratory illness while on holiday in Mexico. She subsequently developed erythema nodosum and was noted to have a left pulmonary nodule on chest X-ray after return to Australia. The diagnosis of Coccidioides immitis infection was established by histology and culture of the resected lung lesion. The patient made an uneventful recovery and received one month of therapy with ketoconazole. Culture of the fungus took place under controlled Class 3 conditions. An unusual fungal infection in Australia, coccidioidomycosis poses special risks to staff of microbiology laboratories.     

The first imported case of pulmonary coccidioidomycosis in Korea.

Coccidioidomycosis is an endemic disease found in the southwestern part of North America. Travellers who visit the endemic area may carry the infection. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman. She was healthy before visiting Arizona, U.S.A twice. After returning home, she began to complain of intermittent dry coughing. The symptom was mild, however, and she was treated symptomatically. Later a chest radiograph, which was taken 4 years after the onset of the symptom, showed a solitary pulmonary nodule in the right upper lobe. By percutaneous needle aspiration, a few clusters of atypical cells were noted in the necrotic background. A right upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nodule was present in otherwise normal lung parenchyma. Microscopically, the nodule consisted of aggregates of multiple solid granulomas inside of which was mostly necrotic. Neutrophils and nuclear debris were scattered along the periphery of the necrotic foci. Numerous multinucleated giant cells were associated with the granulomas. In the necrotic area, mature spherules of Coccidioides immitis, which were 30-100 microm in diameter, were present. They contained numerous endospores which ranged from 5 to 15 microm and were also noted in multinucleated giant cells. The diagnosis of coccidioidomycosis was made. She is doing well after the resection.     

A case of Penicillium marneffei infection in an AIDS patient: the first case in Japan.

A 38-year-old Japanese AIDS patient developed papular lesions which rapidly increased in number, eroded and crusted, and spread over not only skin but also the mucosal surface. High fever, sore throat, malaise and hepatosplenomegaly were also noted, and he died despite 2 months of intensive treatment. An autopsy revealed numerous histiocytes infected with Penicillium marneffei in the lymph nodes, liver, spleen, bone marrow, skin, and mucosal surface of the oral cavity to the pharynx. This case is thought to be the first Japanese case of penicilliosis marneffei.     

Coccidioidomycosis in India: report of a second imported case.

We describe a fatal case of imported coccidioidomycosis in India in a 22-year-old male who worked in Tucson, Arizona, approximately four years prior to his illness. The diagnosis was based on the presence of characteristic spherules with endospores in biopsy tissue of lymph nodes, bone and pus from a chronic discharging sinus in the left gluteal region and isolation of Coccidioides immitis in culture. C. immitis is one of the most infectious and virulent fungal pathogens and poses a serious occupational hazard for laboratory personnel, especially in areas where the disease is not endemic. To reduce the role of laboratory-acquired infection, all procedures that involve manipulation of cultures of C. immitis should, whenever possible, be conducted in a biological safety cabinet.     

A case of oral paracoccidioidomycosis suspected to be pharyngeal cancer

Paracoccidioidomycosis is a fungal infection endemic to South American countries that affects the lungs, skin, and mucosae. Reports from Japan are limited by a long-term resident in South America. Some cases are incorrectly diagnosed because of a refractory buccal ulcer that resembles a malignant tumor. This is a disease that may not be correctly examined if we cannot suspect by a case history. We report the case of a Brazilian man who had a buccal ulcer with lung involvement, which mimicked pharyngeal cancer.     

Antigenemia in paracoccidioidomycosis.

Severe forms of paracoccidioidomycosis (Pcm) are accompanied by intense immunological involvement characterized by depression of the cell-mediated immune response and by high levels of antibodies in serum with no protective function. These changes can be reversed by antifungal treatment. It has been suggested that antigens of Paracoccidioides brasiliensis released into the circulation during the active phase of the disease may be involved in the genesis of the changes in the immune response. In the present study, we evaluated the antigenemia of patients with Pcm using a competitive enzyme-linked immunosorbent assay (ELISA-c) capable of detecting 6 ng of antigen per ml of serum. Twenty-seven of 88 serum samples tested gave positive results, with the highest frequency of positivity being detected in patients with the severe acute form of the disease; these patients had the highest antigen levels (0.03 to 3.4 micrograms/ml). Follow-up of one case showed a correlation between antigen levels in serum and evolution of the disease. False-positive reactions were observed in sera from patients with histoplasmosis, aspergillosis, and cryptococcosis. The results indicate that the described method has potential for clinical application, especially with respect to the evaluation of disease activity. Quantification of fungal antigens in the serum of patients with active Pcm represents an objective parameter for the study of the physiopathology of the disease.     

The first case of imported dermatobiasis in Czechoslovakia

Dermatobiasis, a tropical furuculoid myiasis caused by the larvae of Dermatobia hominis (family Cuterebridae) was manifested in a Czech expert already within several days of field work in the state Minas Gerais, Brasil. Due to the localization at the root of the nose above the left eye vision was impaired and the patient developed a general reaction. As loss of the eye was feared, the patient returned to his homeland. The recorded case draws attention to the fact that several days in an endemic area suffice to contract this serious parasitosis and that the latter may then be introduced also into Central Europe.     

Evolution of an integrated HIS in The Netherlands.

This article considers the 26 years history of an integrated hospital information system (HIS). The system emerged from an experimental government sponsored project in the Leiden University Hospital and is now the leading HIS in The Netherlands. The evolution during these 26 years is presented and discussed in this article with an emphasis on the organisational setting and financing besides the aspects functionality, technology/architecture and evaluation aspects. Recently HISCOM was acquired by the BAAN-group completing the evolution and bringing the HIS to the international health care IT market.     

A case of imported Plasmodium ovale malaria

There have been reports in Korea of imported malaria cases of four Plasmodium species, but there has been no report of imported Plasmodium ovale malaria confirmed by molecular biological methods. We report an imported case of that was confirmed by Wright-Giemsa-stained peripheral blood smear and nested polymerase chain reaction targeting the small subunit ribosomal RNA gene. The amplified DNA was sequenced and compared with other registered P. ovale isolates. The isolate in this study was a member of the classic type group. The patient was a 44-yr-old male who had worked as a woodcutter in Côte d''Ivoire in tropical West Africa. He was treated with hydroxychloroquine and primaquine and discharged following improvement. In conclusion, P. ovale should be considered as an etiology in the imported malaria in Korea, because the number of travelers to P. ovale endemic regions has recently increased.     

A rare case of imported diphyllobothriasis]

The author describes a case of imported diphylobothriosis in a Czechoslovak citizen who returned after a 6-month stay from Finland. The tapeworm Diphylobothrium latum is bound in its life cycle to aqueous crustaceans and fish. Man is infected by ingestion of inadequately thermally processed fish. The author draws attention to the possible import of this uncommon parasitosis.     

Intraepithelial parasitism as an infection mechanism in human paracoccidioidomycosis (South American blastomycosis)

Summary Eight typical clinical and laboratory proved human cases of Paracoccidioidomycosis, presenting lip lesions rich in parasites, were studied by light and electron microscopy. Besides producing a typical pathological picture in the corium,Paracoccidioides brasiliensis was seen parasitizing epithelial cells of the lip mucosa. Intraepithelial abcess formation was established through the detachment of the parasitized epithelial cells from their connections with the neighbouring cells and a further local invasion of inflammatory cells, mainly granulocytes and large mononuclears.In few instances, structures with no wall, tentatively inter preted as spheroplasts ofParacoccidioides brasiliensis were also present inside the epithelial cells cytoplasm.Intraepithelial parasitism is regarded as an important mechanism of penetration and spread of the parasite. The possible relation of this phenomena to immunogenic defects is discussed.     

Central nervous system paracoccidioidomycosis: case report and review

Paracoccidioidomycosis is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). The most common lesions frequently occur in the bucopharinx mucosa. Other lesions occur in the adrenal glands, liver, bone, gastrointestinal tract, lungs and nervous system. We report here a case of neuroparacoccidioidomycosis. The patient was a 49 year-old male, who consulted due to neurological symptoms (cephalalgia, speech difficulty and one tonic clonic seizure with urinary incontinence) of eight months duration. Upon physical examination it was observed an emaciated male with nail clubbing, a skin ulcer with raised edges and a crusted bottom of 4 x 2 cm in diameter located in the right supraclavicular region and an ulcerated lesion in the left tonsil with edema. The rest of the physical examination reveled a discrete left side hemiparesis and pulmonary rales in the left hemitorax. The fungus was identified through direct examination of cerebrospinal fluid (CSF). The histopathology of suprarenal, lungs, brain and skin showed multiple paracoccidioidal granulomas. To the best of our knowledge, this is the third case reported in the literature. We review the literature on the pathogenesis and prevalence of neuroparacoccidioidomycosis.     

Experimental paracoccidioidomycosis in dogs.

The aim of this study was to evaluate the susceptibility of dogs to develop paracoccidioidomycosis by experimental infection. Puppies were inoculated with Paracoccidioides brasiliensis by an intravenous route and two out of four died 1 week postinoculation, showing, at histopathological analysis, granulomas in the lungs, spleen and liver. P. brasiliensis was isolated from these organs. The animals that survived the infection showed a strong reaction when skin was tested with gp43, a specific antigen of P. brasiliensis. These animals were killed at 1 and 5 months after infection, and no lesions, macroscopic or microscopic, were observed in the lungs, spleen or liver; furthermore no P. brasiliensis culture was obtained from these organs. These results suggest that dogs can develop paracoccidioidomycosis and reinforces the importance of this animal as a sensitive indicator of P. brasiliensis in the environment.     

Mixed pulmonary infection in an immunocompromised patient: A rare case report

Patients who are immunocompromised are predisposed to a variety of common and uncommon pulmonary infections. We report a case of mixed pulmonary infection by drug resistant tuberculosis with a nocardiosis in a 49-year-old man who was a known case of chronic obstructive pulmonary disease, on prolonged corticosteroid use with diabetes mellitus. Chronic use of corticosteroids is a predisposing factor for opportunistic infections, such as nocardiosis or tuberculosis. Since such a mixed infection is rare, maybe a combined approach to therapy early in the course of disease would be effective in such cases.