scholarly journals Comprehensive Analysis and Risk Identification of Pulmonary Cryptococcosis in Non-HIV Patients

2021 ◽  
Vol 7 (8) ◽  
pp. 657
Author(s):  
Chun Lin ◽  
Tsung-Ying Yang ◽  
Ming-Cheng Chan ◽  
Kuo-Hsuan Hsu ◽  
Yen-Hsiang Huang ◽  
...  
Keyword(s):  
Disease Recurrence ◽  
Risk Identification ◽  
Comprehensive Analysis ◽  
Outcome Predictors ◽  
Pulmonary Cryptococcosis ◽  
Radiological Findings ◽  
Clinical Presentations ◽  
Immunodeficiency Virus ◽  
Malignant Solid Tumor ◽  
Extent Of Disease

Pulmonary cryptococcosis in the non-human immunodeficiency virus-infected population is uncommon. We aimed to explore the relevance between clinical presentations, radiological findings, and comorbidities and identify the outcome predictors. A total of 321 patients at Taichung Veterans General Hospital between 2005 and 2019 were included; of them, 204 (63.6%) had at least one comorbidity, while 67 (20.9%) had two or more. The most common comorbidities were diabetes mellitus (27.4%), malignant solid tumor (19.6%), autoimmune disease (15.6%), and chronic kidney disease (8.4%). Patients experiencing comorbidity, particularly those with multiple comorbidities, had a higher multilobar and extrapulmonary involvement, which could explain these patients being more symptomatic. In the overall population, extrapulmonary involvement independently predicted disease recurrence and death. Amongst patients with isolated pulmonary cryptococcosis, age, cryptococcal antigen (CrAg) titer in blood, and comorbidities not only predicted the extent of disease, but also its outcome. Of note, patients simultaneously with age ≥ 65 years, CrAg test ≥ 1:128, and multiple comorbidities had the lowest disease control of antifungal treatment (76.9%) and the highest rate of disease recurrence or death from any cause (40.0%). In conclusion, approximately two-thirds of patients had at least one underlying comorbidity. In addition to extrapulmonary involvement, old age, high CrAg titer in blood, and multiple comorbidities could act as risk factors for predicting the extent of disease and outcome.

Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent

2021 ◽  
Author(s):  
Keely Johnson ◽  
Umaima Dhamrah ◽  
Aisha Amin ◽  
Joseph Masci
Keyword(s):  
New York ◽  
High Altitude ◽  
Acid Fast Bacillus ◽  
Chest Imaging ◽  
Immunocompetent Host ◽  
Pleuritic Chest Pain ◽  
Pulmonary Cryptococcosis ◽  
Radiological Findings ◽  
Travel History ◽  
Fluconazole Therapy

Cryptococcus exposure in certain global regions is common and yet virulence in the immunocompetent host remains rare. Radiological findings of pulmonary cryptococcosis may include nonspecific lung nodules or masses indistinguishable from lung cancer or pulmonary tuberculosis. We present a case of an immunocompetent diabetic female who presented with progressively worsening pleuritic chest pain and cough with travel between Tibet and New York 2 months earlier. Chest imaging demonstrated a large lobulated mass, acid-fast bacillus smears were negative, and our patient underwent pulmonary biopsy, which grew rare budding yeast later confirmed by mucicarmine staining as Cryptococcus. Our patient was successfully treated with fluconazole therapy. We hypothesize that the high altitude of Tibet may allow for clinical latency followed by symptomatic reactivation on descent. A raised index of suspicion for pulmonary cryptococcosis with careful attention to travel history is expected to facilitate timely diagnosis.

scholarly journals Primary hyperparathyroidism with water clear cell content: the impact of histological diagnosis on clinical management and outcome

2013 ◽  
Vol 95 (3) ◽  
pp. e6-e8 ◽  
Author(s):  
T Ezzat ◽  
GM Maclean ◽  
R Parameswaran ◽  
B Phillips ◽  
V Komar ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Clear Cell ◽  
Disease Recurrence ◽  
Cell Hyperplasia ◽  
Cell Content ◽  
Clinical Presentations ◽  
Increased Risk ◽  
Cellular Water ◽  
The Impact ◽  
Unilateral Neck Exploration

Water clear cell hyperplasia (WCCH) and water clear cell adenomas (WCCA) of the parathyroid glands are rare causes of primary hyperparathyroidism. We report in this series one case of WCCH and two cases of WCCA representing 0.3% of patients with primary hyperparathyroidism presenting to our institution. Increased parathyroid cellular water content was responsible for relatively larger parathyroid gland sizes. However, this was not associated with higher biochemical markers or more severe clinical presentations. Histological distinction between WCCH and WCCA is difficult but important since patients with WCCH who have had a parathyroidectomy via a unilateral neck exploration may carry an increased risk of future disease recurrence.

Spondylodiscitis presenting as pleural effusion in a geriatric female: a case report

2020 ◽  
pp. 1-11
Author(s):  
Funda Secik Arkin ◽  
Gulfidan Aras
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Clinical Laboratory ◽  
Medical Problem ◽  
Pulmonary Diseases ◽  
Radiological Findings ◽  
Clinical Presentations ◽  
Low Incidence ◽  
Exudative Pleural Effusion

Abstract Pleural effusion is a frequently seen medical problem caused by pulmonary and non-pulmonary diseases. Spondylodiscitis is a very rare cause of pleural effusion and is typically diagnosed based on clinical, laboratory, microbiological and radiological findings. The low incidence and different clinical presentations of Spondylodiscitis make its diagnosis and treatment challenging. We present the case of a 78-year-old female who was initially admitted due to chest pain and, upon chest radiography, was found to have pleural effusion; and eventually diagnosed with spondylodiscitis. Keywords: Spondylodiscitis, exudative pleural effusion, geriatrics, vertebra, infection. Continuous...

scholarly journals Symptomatic large or giant capillary telangiectasias: management and outcome in 5 cases

2016 ◽  
Vol 125 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Tao Yu ◽  
Xingwen Sun ◽  
Yan You ◽  
Jie Chen ◽  
Jun-mei Wang ◽  
...  
Keyword(s):  
Vision Loss ◽  
Clinical Course ◽  
Complete Removal ◽  
Neurological Deficits ◽  
Radiological Findings ◽  
Brain Capillary ◽  
Generalized Seizures ◽  
Clinical Presentations ◽  
Uncontrolled Bleeding

Brain capillary telangiectasias (BCTs) are usually small and benign with a predilection in the pons and basal ganglion. Reports of large and symptomatic BCTs are rare. Large BCTs have a much higher risk of causing uncontrolled bleeding and severe neurological defects, and they can be fatal if left untreated. Therefore, large BCTs should be managed with special caution. Because of the lack of reports, diagnosis of large BCTs has been difficult. Strategies of management are undefined for large or giant BCTs. The current study presents 5 cases of giant and large BCTs. To the authors’ knowledge, this is the largest series of this disease ever reported. Radiological findings, histopathological characteristics, clinical presentations, and surgical management were analyzed in 5 symptomatic, unusually large BCTs (mean diameter 5.06 cm, range 1.8–8 cm). Four patients presented with focal or generalized seizures, and 1 patient presented with transient vision loss attributed to the lesions. Gross-total resection of the lesion was achieved in all patients. After surgery, the 4 patients with seizures were symptom free for follow-up periods varying from more than 1 to 5 years with no additional neurological deficits. The unique location, radiological characteristics, and clinical course suggest that giant BCTs could be a different entity from small BCTs. Surgery might be a good option for treatment of patients with intractable neurological symptoms, especially in those with surgically accessible locations. Complete removal would be anticipated to provide relief of the symptoms without causing new neurological deficits.

scholarly journals Evaluation of the Drug Treatment and Persistence of Onychomycosis

2004 ◽  
Vol 4 ◽  
pp. 760-777 ◽  
Author(s):  
Andrew W. Campbell ◽  
Ebere C. Anyanwu ◽  
Mohammed Morad
Keyword(s):  
Clinical Symptoms ◽  
The Elderly ◽  
Antifungal Drugs ◽  
Chemical Structures ◽  
Nail Lacquer ◽  
Clinical Presentations ◽  
Immunodeficiency Virus ◽  
Drug Treatments ◽  
Adults And Children ◽  
And Migration

Onychomycosis is a common nail disease responsible for approximately 50% of diseases of the nail. It occurs more in the elderly, though several cases have been reported among children. Several factors influence, such as climate, geography, and migration. The two dermatophytes most commonly implicated in onychomycosis are Trichophyton rubrum and T. mentagrophytes, accounting for more than 90% of onychomycoses. Nonetheless, several other toxigenic molds have been implicated. For convenience, onychomycosis is divided into four major clinical presentations: distal subungal, which is the most common form of the disease; proximal subungal, which is the most common form found in patients with human immunodeficiency virus infection; superficial; and total dystrophic onychomycosis. Epidemiology of onychomycosis in adults and children is evaluated and the most common clinical symptoms addressed. Although the risk factors are discussed, the multifactorial nature of onychomycosis makes this inexhaustible. The diagnosis and treatments are difficult and the choice of appropriate antifungal drugs complex and require the knowledge of the chemical structures of the metabolites of the molds that cause onychomycosis and their interaction with the antifungal drugs. This is true because most of the antifungal drugs are derived from mold/fungal metabolism. Treatment with griseofulvin and amphotericin is displaced by the use of newer drugs from azole compounds, pyrimidines, and allylamines derivatives. Amorolfine, itraconazole, and ciclopirox nail lacquer solution 8 have gained support globally, but the side effects, drug resistance, and persistence of the disease are still a serious concern to the patients, just as economics and quality of life. Hence, the search for safer and more efficacious drug treatments are continuing.

scholarly journals MELAS: A Multigenerational Impact of the MTTL1 A3243G MELAS Mutation

2014 ◽  
Vol 41 (2) ◽  
pp. 210-219 ◽  
Author(s):  
M. Prasad ◽  
B. Narayan ◽  
A.N. Prasad ◽  
C.A. Rupar ◽  
S. Levin ◽  
...  
Keyword(s):  
Maternal Inheritance ◽  
Extended Family ◽  
Family Members ◽  
Strong Support ◽  
Radiological Findings ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
The Family ◽  
Generation Family ◽  
Pathological Material

Background:the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized.Methods:retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members.Results:there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS.Conclusions:the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.

scholarly journals Elucidating the antiviral mechanism of different MARCH factors

2020 ◽  
Author(s):  
Supawadee Umthong ◽  
Brian Lynch ◽  
Uddhav Timilsina ◽  
Brandon Waxman ◽  
Emily B. Ivey ◽  
...  
Keyword(s):  
Transmembrane Proteins ◽  
Comprehensive Analysis ◽  
Envelope Glycoproteins ◽  
Main Function ◽  
Intrinsic Immunity ◽  
Immunodeficiency Virus ◽  
Antiviral Function ◽  
Antiviral Mechanism ◽  
Hiv 1 ◽  
Human Immunodeficiency Virus 1

ABSTRACTThe Membrane Associated RING-CH (MARCH) proteins belong to a family of E3 ubiquitin ligases, whose main function is to remove transmembrane proteins from the plasma membrane. Recent work has shown that the human MARCH1, 2 and 8 are antiretroviral factors that target the Human Immunodeficiency virus-1 (HIV-1) envelope glycoproteins by reducing their incorporation in the budding virions. Nevertheless, the dearth of information regarding the antiviral mechanism of this family of proteins necessitates further examination. In this study, using both the human MARCH proteins and their mouse homologues, we provide a comprehensive analysis of the antiretroviral mechanism of this family of proteins. Moreover, we show that human MARCH proteins restrict to varying degrees the envelope glycoproteins of a diverse number of viruses. This report sheds light on the important antiviral function of MARCH proteins and their significance in cell intrinsic immunity.

scholarly journals A 15-year pheochromocytoma and paraganglioma experience in a single centre: a Singapore perspective

2021 ◽  
Author(s):  
Y Lee ◽  
LYR Tan ◽  
SAKK Abdul Shakoor
Keyword(s):  
Positive Family History ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
Haemodynamic Instability ◽  
Preoperative Preparation ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
Wide Range

Introduction: Pheochromocytomas (PCC) and paragangliomas (PGL) are rare endocrine tumours. The objective of this study was to describe our experience with these two entities in a Singapore population. Methods: We identified patients with positive histopathological confirmations of PCC and PGL who were treated at a tertiary Singapore hospital between January 2000 and December 2015. The results were analysed for clinical presentations, treatment and long-term outcomes. Results: A total of 27 cases (20 PCC, 7 PGL) were identified over a 15-year period. One case of PGL developed bilateral disease on follow-up. There were 17 male and 10 female patients with a median age of 57 (range 24–77) years. A positive family history was uncommon and present in only 3.7% of patients. Uniquely, the top three presenting symptoms were abdominal discomfort, palpitations and diaphoresis. Despite adequate preoperative preparation, intraoperative haemodynamic instability occurred in 70.4% and early postoperative hypotension occurred in 11.1% of patients. After surgery, hypertension was resolved in 41.2% (7/17) and diabetes mellitus in 60% (3/5). Disease recurrence was reported in 22.2% and distant metastases in 14.8%. At the end of the follow-up period (median 35 [range 3–148] months), 70.4% were still alive. Conclusion: PCC and PGL can present with a wide range of symptoms. Intraoperative haemodynamic instability was frequent despite good preoperative preparation. Disease recurrences and metastasis occurred in up to one-fifth of the patients. Genetic screening should be offered to patients with PCC and PGL.

scholarly journals Myxoid chondrosarcoma of sphenoid bone

2012 ◽  
Vol 03 (03) ◽  
pp. 395-398 ◽  
Author(s):  
Amit K. Chowhan ◽  
Nandyala Rukmangadha ◽  
Rashmi Patnayak ◽  
Mandyam Kumaraswamy Reddy ◽  
Chandra Mouliswara Prasad Bodapati ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Treatment Protocol ◽  
Sphenoid Bone ◽  
Occipital Region ◽  
Radiological Findings ◽  
Diagnostic Dilemma ◽  
Histopathological Features ◽  
Myxoid Chondrosarcoma ◽  
Clinical Presentations ◽  
Prognostic Importance

ABSTRACTThe myxoid variant of chondrosarcoma is usually seen in soft tissues where it is known as chordoid sarcoma or parachordoma. Rarely, it involves bone and when it does, cranial bones are the preferred location. This tumor is frequently amalgamated with the chondroid variant of chordoma, especially when the lesion occurs in the sphenoid bone/spheno-occipital region, because of their similar clinical presentations, anatomical locations, radiological findings, and mistaken histopathological features. It is essential to distinguish myxoid chondrosarcoma from the chondroid variant of chordoma, because of the different treatment protocol and prognostic importance. We present such a location-based diagnostic dilemma, solved successfully with ancillary immunohistochemistry.

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