766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine

Abstract Background Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL). Methods Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture. Results Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic. Conclusion We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear. Disclosures All Authors: No reported disclosures

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Skin manifestation in COVID-19 infection: a thousand appearances (immune response perspective)

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20204566 ◽

2020 ◽

Vol 6 (6) ◽

pp. 776

Author(s):

Yohanes Firmansyah ◽

Jessica Elizabeth ◽

Sukmawati Tansil Tan

Keyword(s):

Clinical Symptoms ◽

Close Contact ◽

Clinical Manifestations ◽

Case Series ◽

Absolute Lymphocyte Count ◽

Skin Lesions ◽

Blood Parameters ◽

Skin Manifestation ◽

Skin Manifestations ◽

Initial Symptoms

The clinical manifestations of COVID-19 infection are still unclear. The spectrum of the disease is very broad, with many target organs; one of them is skin. Various skin manifestations have been observed in COVID-19 patients. However, the observed skin manifestation was not specific. This following case series aims to provide an overview of skin manifestations in COVID-19 to help recognize the initial symptoms of COVID-19 infection. This case series also compares cases with and without skin manifestations. This case series discusses seven cases, which the patient had close contact, who had been diagnosed with confirmed COVID-19 by polymerise chain reaction (PCR) examination. The clinical symptoms were mild, such as fever, cough, sore throat, myalgia, malaise, headache, and skin lesions. There are few differences in in complete blood laboratories. Radiology features within normal limits. All patients were given a treatment regimen according to the Indonesian lung association recommendations and symptomatic drugs. Three of seven cases had skin manifestation, which two of them had a maculopapular lesion, and the other one had urticaria lesions. Subjective symptoms, such as itching and burning sensation, were reported. The majority of lesions were localized on the upper and lower limb. Also, in this following case series, there is a tendency for complete blood parameters, neutrophil-to-lymphocyte ratio (NLR), and absolute lymphocyte count (ALC) to be lower in mild cases of confirmed COVID-19 with skin manifestations. It can be concluded that COVID-19 infection may result in skin manifestation with various clinical presentations. This important manifestation may help in diagnosing and treating COVID-19 and prevent further transmission.

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Characterization of a case series of Mastocytosis in a health care center in Cali, Colombia

10.21203/rs.3.rs-939459/v1 ◽

2021 ◽

Author(s):

Daniela Marulanda Sandoval ◽

Oscar Felipe Borja Montes ◽

Jose Leonel Zambrano Urbano ◽

Rigoberto Gomez Gutierrez

Keyword(s):

World Literature ◽

Case Reports ◽

Care Center ◽

Clinical Manifestations ◽

Case Series ◽

Poor Response ◽

Skin Lesions ◽

Serum Tryptase ◽

Health Care Center

Abstract Mastocytosis is a group of rare diseases, which correspond to neoplasms of the myeloid lineage. In Colombia there are only case reports and so far there are no studies of greater extension. We conducted a case series in which an active search was made for patients with a diagnosis of mastocytosis, either cutaneous (CM) or systemic (SM), from the total number of consultations between June 2004 and June 2019 in the reference hemato-oncologic center ("mastocytosis"). A total of 4 cases of CM and 3 cases of SM were identified. The most frequent clinical manifestations were skin lesions, which were present in 100% of patients; of these hyperpigmented macules were the most frequent findings. Serum tryptase (TS) levels were found to be elevated in 67% (2/3) of patients with DM. Both TS levels and mean absolute eosinophils were higher in patients with MS. In this case series we found a higher frequency of extracutaneous involvement, and in general a very poor response to the management. The findings of this series are comparable to those reported in world literature.

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Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients

Journal of Neurosurgery ◽

10.3171/2020.4.jns20476 ◽

2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Michael B. Keough ◽

Albert M. Isaacs ◽

Geberth Urbaneja ◽

Jarred Dronyk ◽

Andrew P. Lapointe ◽

...

Keyword(s):

Pediatric Patients ◽

Early Recognition ◽

Delayed Diagnosis ◽

Clinical Manifestations ◽

Case Series ◽

Low Pressure ◽

Adult Patients ◽

Definitive Treatment ◽

Third Ventriculostomy ◽

Shunt Insertion

OBJECTIVEAcute low-pressure hydrocephalus (ALPH) is characterized by clinical manifestations of an apparent raised intracranial pressure (ICP) and ventriculomegaly despite measured ICP that is below the expected range (i.e., typically ≤ 5 cm H2O). ALPH is often refractory to standard hydrocephalus intervention protocols and the ICP paradox commonly leads to delayed diagnosis. The aim of this study was to characterize ALPH and develop an algorithm to facilitate diagnosis and management for patients with ALPH.METHODSEMBASE, MEDLINE, and Google Scholar databases were searched for ALPH cases from its first description in 1994 until 2019. Cases that met inclusion criteria were pooled with cases managed at the authors’ institution. Patient characteristics, presenting signs/symptoms, precipitating factors, temporizing interventions, definitive treatment, and patient outcomes were recorded.RESULTSThere were 195 patients identified, with 42 local and 153 from the literature review (53 pediatric patients and 142 adults). Decreased level of consciousness was the predominant clinical sign. The most common etiologies of hydrocephalus were neoplasm and hemorrhage. While the majority of ALPH occurred spontaneously, 39% of pediatric patients had previously undergone a lumbar puncture. Prior to ALPH diagnosis, 92% of pediatric and 39% of adult patients had a ventricular shunt in situ. The most common temporizing intervention was subatmospheric CSF drainage. The majority of patients underwent a shunt insertion/revision or endoscopic third ventriculostomy as definitive ALPH treatment. Although the mortality rate was 11%, 83% of pediatric and 49% of adult patients returned to their pre-ALPH neurological functional status after definitive treatment. Outcomes were related to both the severity of the underlying neurosurgical disease causing the hydrocephalus and the efficacy of ALPH treatment.CONCLUSIONSALPH is an underrecognized variant phenotype of hydrocephalus that is associated with multiple etiologies and can be challenging to treat as it frequently does not initially respond to standard strategies of CSF shunting. With early recognition, ALPH can be effectively managed. A management algorithm is provided as a guide for this purpose.

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Ectopic Cervical Thymus: A Common, yet Rarely Symptomatic Pediatric Neck Mass

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616999201027214101 ◽

2020 ◽

Vol 16 ◽

Author(s):

Lee Rousslang ◽

Jaren Meldrum ◽

Rooks Veronica ◽

Augustah Poutre ◽

Timothy Biega

Keyword(s):

Differential Diagnosis ◽

Pediatric Patients ◽

Incidental Finding ◽

Case Series ◽

Surgical Excision ◽

Neck Mass ◽

Thymic Tissue ◽

Ectopic Thymus ◽

Unusual Finding

Abstract:: Ectopic thymic tissue is an unusual finding that is generally asymptomatic. We present a case series of five pediatric patients with cervical ectopic thymuses. In two patients, the ectopic thymic tissue was symptomatic, and in three patients it was an incidental finding. We highlight the need to include this anomaly on the differential diagnosis for a pediatric neck mass. We also propose observation, rather than surgical excision, as the treatment of choice for asymptomatic cervical ectopic thymus.

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Allergy to Gibberellin-Regulated Proteins (Peamaclein) in Children

International Archives of Allergy and Immunology ◽

10.1159/000517413 ◽

2021 ◽

pp. 1-6

Author(s):

Benedetta Biagioni ◽

Leonardo Tomei ◽

Claudia Valleriani ◽

Giulia Liccioli ◽

Simona Barni ◽

...

Keyword(s):

Pediatric Patients ◽

Immunoglobulin E ◽

Clinical Manifestations ◽

Case Series ◽

In Vitro Test ◽

Eligibility Criteria ◽

Positive Skin ◽

Vitro Test ◽

Pru P 3

Background: Gibberellin-regulated proteins (GRPs, Peamaclein) are allergens recently identified in plant-derived food allergy (FA), and little is known about the clinical manifestations of this allergic condition in the European population, especially in children. Objective: Our study aimed to identify and characterize pediatric patients with pollen-FA due to GRP sensitization. Methods: We retrospectively analyzed the charts of patients referred to the Allergy Unit of the Meyer Children’s Hospital in Florence for suspected FA. Three main eligibility criteria based on the actual knowledge of GRP allergy were used to select patients deserving further investigations: (1) systemic reactions after consumption of fruit or an unknown culprit food, (2) positive skin prick tests to both cypress pollen and Pru p 3-enriched peach peel extracts, (3) negative in vitro test results for Pru p 3 serum-specific Immunoglobulin E (sIgE). We performed the in vitro test to determine the anti-rPru p 7 (Peamaclein) sIgE levels in the selected patients. Results: We identified 10 pediatric patients with Pru p 7 allergy and described their characteristics. The use of our eligibility criteria showed a high accuracy in identifying these patients: 100% of the selected patients had positive in vitro results for Pru p 7. We therefore proposed a diagnostic algorithm for Pru p 7 allergy. Conclusion: This is the first case series of European pediatric patients with a demonstrated Peamaclein allergy. These findings broaden our knowledge on GRP allergy in pediatric populations and could help clinicians to suspect, diagnose, and manage this recently discovered plant-derived FA.

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Clinical Manifestations and Distribution of Cutaneous Leishmaniasis in Pakistan

Journal of Tropical Medicine ◽

10.1155/2011/359145 ◽

2011 ◽

Vol 2011 ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

Abaseen Khan Afghan ◽

Masoom Kassi ◽

Pashtoon Murtaza Kasi ◽

Adil Ayub ◽

Niamatullah Kakar ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Cutaneous Leishmaniasis ◽

Primary Care Physicians ◽

Health Workers ◽

Clinical Manifestations ◽

Public Health Problem ◽

Skin Lesions ◽

Major Public Health Problem ◽

Local Health

Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected, where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region. The increased clinical diversity and the spectrum of phenotypic manifestations noted underscore the fact that the diagnosis of CL should be not only considered when dealing with common skin lesions, but also highly suspected by dermatologists and even primary care physicians even when encountering uncommon pathologies. Hence, we would strongly advocate that since most of these patients present to local health care centers and hospitals, primary care practitioners and even lady health workers (LHWs) should be trained in identification of at least the common presentations of CL.

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Surgical Experiences of Pediatric Cervical Bronchogenic Cysts: A Case Series of 6 Patients

Ear Nose & Throat Journal ◽

10.1177/0145561320982194 ◽

2021 ◽

pp. 014556132098219

Author(s):

Yanzhen Li ◽

Shengcai Wang ◽

Jun Tai ◽

Jie Zhang ◽

Lejian He ◽

...

Keyword(s):

Pediatric Patients ◽

Bronchogenic Cyst ◽

Case Series ◽

Side Wall ◽

Neck Region ◽

Surgical Excision ◽

Complete Resection ◽

Congenital Disease ◽

Surgical Experience ◽

Bronchogenic Cysts

Objectives: Bronchogenic cyst is a rare congenital disease which occurs especially in the neck region. This report presents 6 cases of bronchogenic cysts and discusses the diagnosis and surgical experience of this anomaly. Methods: A retrospective study of 6 pediatric patients with cervical bronchogenic cysts treated in our hospital during 2016 to 2019 was performed. We recorded and analyzed the clinical data of the patients, including age, symptoms, imaging findings, surgical procedure, and complications. Results: All patients underwent surgical excision. The chondroid tissues were found at the base of cysts which clung to the trachea in 5 patients and completely removed by surgery without recurrence. One patient showed recurrence due to residual cartilage after the first surgery, and the second surgery was required to resect the remaining cartilage. During the surgery, the recurrent laryngeal nerve (RLN) detector was used, which confirmed that all the RLNs clung to the side wall of cysts. All cases were cured without complications. Conclusions: Although rare, bronchogenic cysts should be considered in the differential diagnosis of peritracheal masses in children. Complete resection of the bronchogenic cysts, including the cartilages at the base, is vital in preventing recurrence. The RLN must be protected during the surgery.

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Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v19i2.8477 ◽

2021 ◽

Author(s):

Elham Askary ◽

Poordast Tahereh ◽

Zahra Shiravani ◽

Mohammad Ali Ashraf ◽

Atefeh Hashemi ◽

...

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Skin Diseases ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Case Series ◽

Skin Lesions ◽

Labor Pain ◽

Neonatal Outcomes ◽

Vaginal Deliveries

Background: Coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes. Case presentation: This case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results. Conclusion: Clinical manifestations and paraclinical results were similar to nonpregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually. Key words: Pregnancy, COVID-19, Maternal-fetal infection transmission, Vertical transmission of infectious disease, Papulosquamous skin diseases.

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The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review

Lupus ◽

10.1177/0961203320958141 ◽

2020 ◽

Vol 30 (1) ◽

pp. 125-133

Author(s):

Sara Mazzilli ◽

Laura Vollono ◽

Laura Diluvio ◽

Elisabetta Botti ◽

Gaetana Costanza ◽

...

Keyword(s):

Confocal Microscopy ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Clinical Manifestations ◽

Case Series ◽

Skin Lesions ◽

Reflectance Confocal Microscopy ◽

Discoid Lupus Erythematosus ◽

Cutaneous Lupus

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.

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Human myiasis caused by the reindeer warble fly, Hypoderma tarandi, case series from Norway, 2011 to 2016

Eurosurveillance ◽

10.2807/1560-7917.es.2017.22.29.30576 ◽

2017 ◽

Vol 22 (29) ◽

Cited By ~ 6

Author(s):

Jörgen Landehag ◽

Andreas Skogen ◽

Kjetil Åsbakk ◽

Boris Kan

Keyword(s):

Rangifer Tarandus ◽

Clinical Manifestations ◽

Case Series ◽

Regional Lymph Nodes ◽

Travel History ◽

Prevention Measure ◽

Periorbital Oedema ◽

The Face ◽

Returning Travellers ◽

Hypoderma Tarandi

Hypoderma tarandi causes myiasis in reindeer and caribou (Rangifer tarandus spp.) in most northern hemisphere regions where these animals live. We report a series of 39 human myiasis cases caused by H. tarandi in Norway from 2011 to 2016. Thirty-two were residents of Finnmark, the northernmost county of Norway, one a visitor to Finnmark, and six lived in other counties of Norway where reindeer live. Clinical manifestations involved migratory dermal swellings of the face and head, enlargement of regional lymph nodes, and periorbital oedema, with or without eosinophilia. Most cases of human myiasis are seen in tropical and subtropical countries, and in tourists returning from such areas. Our findings demonstrate that myiasis caused by H. tarandi is more common than previously thought. Healthcare professionals in regions where there is a likelihood of human infestation with H. tarandi (regions populated by reindeer), or treating returning travellers, should be aware of the condition. All clinicians are advised to obtain a detailed travel history when assessing patients with migratory dermal swellings. On clinical suspicion, ivermectin should be given to prevent larval invasion of the eye (ophthalmomyiasis). Since H. tarandi oviposits on hair, we suggest wearing a hat as a prevention measure.

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