Antifungal therapy of experimental cerebral phaeohyphomycosis due to Cladophialophora bantiana

Cladophialophora bantiana is associated with central nervous system infection and a poor outcome. C. bantiana tends to be resistant to amphotericin B. Accordingly, we evaluated amphotericin B and three triazoles--posaconazole, itraconazole, and fluconazole--for treatment of C. bantiana infection in mice. In immunosuppressed ICR mice infected intravenously, posaconazole, itraconazole, and amphotericin B prolonged survival. This improvement in survival corresponded with a reduction in brain fungal concentrations for mice which were given itraconazole and posaconazole, but not amphotericin B. In nonimmunosuppressed BALB/c mice infected intracerebrally, posaconazole showed dose-dependent responses in survival and reduction of brain tissue counts. These responses were observed for short, delayed, and prolonged therapy. Although posaconazole prolonged the survival of mice with reductions in brain fungal counts, it did not sterilize brain tissue with continuous therapy for 8 weeks. We concluded that posaconazole shows promise for the treatment of C. bantiana brain infections.     

Central nervous system infections in transplant recipients by Cladophialophora bantiana

Cladophialophora bantiana, a dematiaceous fungus, is an uncommon pathogenic organism originally thought to more commonly affect immunocompetent patients. Increasing numbers of reports, however, describe the organism affecting immunocompromised patients. Like all dematiaceous fungi, Cladophialophora can be recognized in histopathologic sections by the golden-brown coloration in the walls of the hyphae. Of all the dematiaceous fungi, Cladophialophora bantiana demonstrates the most neurotropism, which is responsible for increasing recognition of this fungus as the causative agent in brain abscesses in transplant patients. We describe one patient with a liver transplant and another with a double lung transplant, both of whom developed cerebral abscesses caused by this organism, and review the reported literature.     

Gd-BOPTA致过敏性休克及时抢救成功一例

<正>磁共振成像已经成为临床诊疗活动中非常重要的一种检查手段,磁共振增强技术是磁共振检查的重要组成部分,随其广泛地开展,钆对比剂的使用也越来越多,其安全性问题也受到关注。钆对比剂不良反应发生率不高,文献报道其总发生率仅为0.58%~([1]),但是,近年来已有钆对比剂过敏休克致死亡的报道~([2]),应受到高度重视。通常钆对比剂均以轻中度不良反应为主,可以自行缓解。严重过敏反应(如:腹痛、超敏反应、意识障     

A case report of a hemolytic transfusion reaction caused by anti-Holley

Clinical and laboratory investigation of a black male patient, who received emergency transfusion of blood incompatible for a high incidence antigen, provided evidence for the pathogenetic importance of high titer anti-Holley antibodies with poor avidity. The red blood cells of the patient and two siblings were remarkable in being negative for two high incidence antigens, Hy and hrS, and weak for a third, Gy.     

A case report of generalized pustulosis with systemic manifestations requiring burn intensive care unit admission

Not infrequently patients are transferred to a burn center with the diagnosis of toxic epidermal necrolysis (TEN). Not all cases of generalized erythema and skin sloughing represent TEN. Acute generalized pustular psoriasis (AGPP) of the von Zumbusch type and acute generalized exanthematic pustulosis (AGEP) are two rare skin diseases that can also present with widespread erythema and skin sloughing. We present the case of a 55 year old morbidly obese woman with a history of severe psoriatic arthritis treated in our burn unit for generalized pustulosis, erythema, and skin sloughing. This was accompanied by respiratory failure, hypotension, acute renal failure, and elevated direct bilirubin. Skin biopsy narrowed the differential diagnosis to AGPP and AGEP. Her skin sloughing was treated as second degree burns with petrolatum gauze and mupirocin ointment. She required intubation, aggressive fluid resuscitation and inotropic support. She recovered with these measures over the course of 1 week. Like TEN, AGPP, and AGEP can involve the skin to an extent requiring burn intensive care admission. Patients can present on rare occasions with multi-system failure. We would like to raise the awareness of burn specialists regarding these rare diseases. They should be distinguished from TEN, as they tend to have better prognosis than TEN and their management can be different.     

Hindfoot pain treated by a leg-hindfoot orthosis. A case report

This case report describes an orthotic management option for the treatment of persistent subtalar and ankle joint pain in a patient with rheumatoid arthritis. Orthotic design, principles of control, and methods of application are discussed in addition to the advantages and disadvantages of prefabricated and custom-formed orthotic devices.     

坏死梭杆菌脓毒症1例

坏死梭杆菌(Fusobacterium necrophorum)是严格厌氧的革兰阴性多形态杆菌,广泛分布于人和动物的口腔、胃肠道和泌尿生殖道 [1].该菌是条件致病菌,除了能引起动物的腐蹄病[2]、肝脓肿[3],还能引起人的急性咽炎综合征[4].     

布鲁菌病致颅内肉芽肿1例

病例资料患者男,18岁。以“间歇发热、乏力、多汗、头晕2个月,加重伴头痛1周”为主诉于2013年12月26日入院。患者入院前2个月无明确诱因出现发热,体温最高38.5℃,无畏冷寒战,伴乏力、多汗、头晕不适,食欲不振,于当地疾控中心化验布鲁菌病凝集试验1∶400,按“布鲁菌病”予阿米卡星静脉滴注,利福平口服治疗20 d(具体剂量不详),体温降至正常,但仍有乏力、头晕症状,体温平稳10 d后再次出现发热,体温达39.0℃,伴头痛,恶心、呕吐,呕吐物为胃内容物,非喷射性,于当地诊所静脉点滴药物治疗3 d(具体不详),症状无缓解。     

氨曲南致过敏性休克1例

患者,女,20岁。因＂咳嗽、咳痰5 d＂来急诊。既往有青霉素和头孢菌素类过敏史。体检：体温38.3℃,心率87次/min,呼吸16次/min,血压120/80mmHg（1mmHg=0.133kPa）,咽部充血,双肺呼吸音粗,可闻及湿啰音,心腹查体无明显异常,胸片示双肺中内带纹理增强紊乱,以右下肺明显。     

雷公藤制剂引起横纹肌溶解症一例

雷公藤具有抗炎、免疫调节、抗肿瘤及抗生育等作用,近年来临床应用日趋广泛;但同时其毒副作用报道也日益增多.笔者最近发现一例雷公藤制剂引起横纹肌溶解症的患者,现报道如下.     

Hydrofluoric acid burn: a case report

A case of occupational hydrofluoric acid exposure is presented, accentuating the importance of eliciting an occupational history during the initial emergency department evaluation. Patients who present with major hydrofluoric acid burns are at risk for systemic complications, including potentially fatal hypocalcemia. Information regarding the accident and workplace circumstances may well allow the physician to anticipate the exposed patient's course. These patients should be considered occupational index cases that will require follow up by government occupational health services. Identification of potential hazards, risk assessment and enforcement of recommendations for change (such as engineering controls, personal protective equipment, education) may be key to preventing similar injuries in the future.     

Sodium azide burn: a case report

Chemical burn injuries commonly occur at the workplace and can be caused by a variety of agents. Sodium azide is a volatile compound used in the industrial setting and it is also a constituent of car airbags. The known toxic effects of sodium azide include hypotension, bradycardia, and headaches. At the cellular level, it inhibits of ATP production by blocking the respiratory oxidation cascade. In the burn literature only one previous report documents a sodium azide hand burn caused by airbag malfunction. We report a case of massive exposure and resultant systemic toxicity from a sodium azide canister explosion.     

Successfully treated bronchopulmonary oxalosis caused by Aspergillus tubingensis in a non-neutropenic patient: A case report and review of the literature

Pulmonary oxalosis can be fatal, and Aspergillus tubingensis is commonly resistant to azoles in Japan. We report a case of bronchopulmonary oxalosis caused by A. tubingensis in a non-neutropenic patient who was successfully treated with voriconazole monotherapy. The susceptibility of the isolates to voriconazole and the effective elimination of contagious necrotic tissue by expectoration seemed to be two major factors contributing to the patient's survival. According to the literature review, pulmonary oxalosis is associated with a high mortality rate over a short term. An exploration of detailed information about the genomic characteristics and drug susceptibility of Aspergillus isolates is important for the development of treatment strategies for this life-threatening disease.     

Geleophysic dysplasia caused by a mutation in FBN1: A case report

BACKGROUNDGeleophysic dysplasia (GD) presents the characterized clinical manifestations of acromelic dysplasia, including extremely short stature, short limbs, small hands and feet, stubby fingers and toes, joint stiffness and others. It is clinically distinct from the other acromelic dysplasia in terms of symptoms such as cardiac valvular abnormalities, progressive hepatomegaly and tracheal stenosis.CASE SUMMARYWe report on a Chinese 9-year-old girl with GD with the c.5243G>T (p.C1748F) mutation in FBN1 (fibrillin 1, OMIM 134797). She was born in Guangxi Zhuang Autonomous Region of China. The patient presented with typical clinical features of GD and recurrent respiratory tract infections over 6 years. Laboratory studies and chest computed tomography (CT) scan indicated bronchopneumonia. Her echocardiography revealed mild mitral valve thickening with regurgitation. Laryngopharyngeal CT and electronic bronchoscopy revealed severe glottic stenosis. Echocardiography examination displayed mild mitral valve thickening and regurgitation. Ophthalmic examination did not reveal myopia or lens dislocation. Treated with ceftriaxone sodium and methylprednisolone sodium succinate for injection as well as methylprednisolone orally, patient’s symptoms had improved.CONCLUSIONGD is a rare genetic condition that can cause life-threatening cardiovascular and respiratory problems. This study also found that the identified genotype of GD could be related to different clinical phenotypes.     

Gastrointestinal bleeding caused by syphilis: A case report

BACKGROUNDSyphilis is a chronic, classic sexually transmitted disease caused by Treponema pallidum, which can invade almost all organs of the body and produce various symptoms and signs. Although there are some cases of colorectal bleeding caused by syphilis, small intestinal bleeding caused by syphilis is still rare.CASE SUMMARYA 58-year-old man had experienced recurrent abdominal pain and melena for 3 years. Repeated gastroenteroscopy and computed tomography angiography examinations failed to find bleeding lesions. During the same admission, multiple intestinal ulcers were found by capsule endoscopy, and syphilis was also diagnosed. With a history of atrial fibrillation and chronic pancreatitis, he had undergone mitral valve replacement and tricuspid valvuloplasty for valvular heart disease. After anti-syphilis treatment, the melena and abdominal pain disappeared and his hemoglobin gradually increased. It is considered that gastrointestinal bleeding, chronic pancreatitis, atrial fibrillation, and heart valvular disease may have been caused by syphilis.CONCLUSIONThis case report found that syphilis can mimic systemic disease and cause intestinal bleeding. In addition, treatment of the disease requires both sexual partners to be treated. Finally, although syphilis is easy to treat, it is more important to consider that bleeding could be caused by syphilis.     

Sepsis caused by Eggerthelle lenta: a case report

<正>Dear editor,Eggerthelle lenta (E. lenta) is a gram-positive nonspore-bearing anaerobic bacilli that was first isolated from human feces by Arnold Eggerth in 1935.^[1] It is classifiedasananaerobiceubacteriumthatcannot decompose glucose and tryptophan^[2] but can synthesize different kinds of steroid metabolism enzymes.^[3] On the basis of the high content of guanine+cytosine detected by 16S ribosomal RNA gene sequencing, its original nameEubacteriumlentumwa...