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MELIOIDOSIS: An unusual case presentation

 

Author: Mary tambore

 

Introduction: It is essential to think of melioidosis as a part of the differential diagnosis in these cases as there is a very serious and fatal infection having acute and chronic presentation which involves different organ systems. If this is not detected and treated properly it can lead to death. Melioidosis is a rare and infectious disease caused by gram negative bacterium, Burkholderia pseudomallei. It is a disease mainly seen in the tropical climates and it has gained importance as emerging disease in India. The causative organism are found I contaminated water and soil and it is spread to humans and animals through direct contact with contaminated source.

 

History: A 51 year old patient who is a cook by occupation, complained of cough with sputum production and high grade fever for 3 months, which was insidious in onset, progressive in nature and got relieved on medications. Investigations: A cA chest X-ray was done which showed a mass in the left upper lobe of the lung. CECT thorax showed possibility of Koch’s disease with calcified aspergilloma in a pre-existing cavity.Sputum for acid-dast bacilli was negative and sputu, culture was negative. USG of the abdomen and pelvis showed grade 1 protamegaly. Later a bronchoscopy was done and bronchalveolar fluid lavage showed growth of Burkholderia pseudomallei.

 

Treatment: Meropenem for 14 days along with continuation of doxycycline showed improvement when repeat chest x-ray was taken.

 

Differential diagnosis: Aspergillosis, Pulmonary TB and COPD

 

Discussion: Aspergillosis is the common etiology associated with post-primary tubercular lesions. Melioidosis is presented with varied clinical presentation, however inhabitation of cavity lesions by Burkholderia pseudomallei is an unusual presentation. A high clinical index of suspicion is needed is essential for timely management to avoid further fatal outcomes.

 

Keywords: Melioidosis, Meropenem, Burholderia pseudomallei

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Low grade brain edema is not involved in the motor alterations observed during the early stages of encephalopathy in the hepatic devascularized rat

 

Nicolas Chatauret1, Marc Oria1 and Juan Cordoba1

 

Abstract:

Hepatic encephalopathy (HE) associated with liver failure includes neurological symptoms ranging from alterations of the motor function to coma. It has been demonstrated that cirrhotic patients present increased conduction time and decreased amplitude of the motor evoked potentials. These alterations were proposed to be the consequence of a low grade cellular edema along the cortico-spinal tract. In order to assess this hypothesis, we evaluated the motor function of rats with acute liver failure (ALF) induced by hepatic devascularization at different grades of HE and after mannitol injections at early stages of the encephalopathy.

Both latency and amplitude of the motor evoked potentials were respectively significantly increased and decreased (p<0.05) at early stages of the encephalopathy (after 6 hours of liver ischemia) when no neurological symptoms or brain edema were detectable. Mannitol injections performed 6 hours after liver ischemia significantly reduced brain water content but had no significant effect on the alterations of the motor function.

In conclusion, early stages of encephalopathy induced by ALF reproduced the motor alterations observed in cirrhotic patients. The absence of effect of decreasing brain water content after mannitol injections on motor evoked potentials suggest that low grade brain edema is not involved in the apparition of these motor alterations in hepatic devascularized rats. These results do not support the hypothesis that neuronal dysfunction in HE is secondary to astrocytic edema.

 

Keywords: Hepatic encephalopathy; Motor evoked potentials; Low grade cerebral edema; Acute liver failure; Mannito

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Seborrheic Dermatitis in Patients with Acquired Immunodeficiency Syndrome

 

Author: Barbara Mathes

 

Introduction: Several skin conditions are known to be associated with acquired immune deficiency syndrome (AIDS). Our clinical suggested the hypothesis that seborrheic dermatitis is an under-recognized but common skin manifestation of AIDS that ha important, short-term prognostic significance.

 

Methods: All patients with AIDS seen at Henry Ford Hospital, an urban hospital, during a one year period were enrolled in a cohort study. Each patient underwent a comprehensive skin examination. All skin conditions were noted, and the severity of seborrheic dermatitis was graded. A group of sex and age matched patients seen during the same time period served as a control group. In the second part of the study, AIDS or HIV patients with the most severe grades of seborrheic dermatitis were compared to patients with mild or no seborrheic dermatitis for short term mortality. Comparisons were analysed with chi-square and relative risk calculations.

 

Results: 18 patients with AIDS and 12 patients with HIV infection were enrolled (29 males and 1 female). 30 age and sex matched controls were randomly selected from the patient roster. The most common risk factors for the cases were homosexuality and IV drug abuse. Eighty percent of AIDS and fourty-two percent of HIV-infected patients had seborrheic dermatitis compared 10% of controls (P<0.001 AIDS vs. P=0.07 for HIV patients vs. controls and P=0.02 for AIDS vs HIV-infected). The severity of seborrheic dermatitis seemed to be associated with short-term prognosis. Of the patients who died during the study, 3 developed severe seborrheic dermatitis within six months and 2 developed moderate seborrheic dermatitis within a year of their deaths (relative risk=2.5, 95% CI=1.9-3.3) Of the HIV 5 HIV-infected patients with seborrheic dermatitis, 2 with moderate grade progressed to AIDS and one subsequently died during the study period.

 

Conclusion: There is a significant increase I seborrheic dermatitis in patients with AIDS, and the severity of seborrheic dermatitis may have short-term prognostic significance.

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