African Histoplasmosis in a Guinea Bissau Patient with HIV-2: Case Report and Review

We present the case of a 30-year-old Bissau-Guinean man with HIV-2 infection known for 16 years, irregularly treated, admitted with two weeks of fever, diarrhoea and cutaneous lesions. Examination revealed multiple subcutaneous nodes, Molluscum contagiosum-like lesions, generalized lymphadenopathy and painful palpation of the left iliac fossa. Laboratory tests showed severe nonhaemolytic anaemia and CD4+ count of 9/mm3, with normal creatinine and hepatic enzymes. Chest roentgenogram was unremarkable and a research for Mycobacterium tuberculosis by GeneXpert® was negative. Nonetheless, given the lack of further diagnostic tools, a presumptive diagnosis of disseminated tuberculosis was made, and the patient was started on tuberculostatic and antiretroviral drugs. Despite initial improvement, a national shortage of antiretrovirals precluded further treatment, with worsening of the clinical picture, namely an increase in the number and dimensions of the skin lesions. An excisional biopsy of a subcutaneous nodule revealed Histoplasma capsulatum var. duboisii. Unfortunately, due to the unavailability of antifungals, the patient died one week later.To our best knowledge, this is the first confirmed case of an HIV infected patient with African histoplasmosis in Guinea-Bissau.RésuméHistoplasmose africaine est une infection est endémique en Afrique Centrale et Ouste, qui attend la peau avec un potentielle infection systémique et elle a été ...
Source: Journal of Medical Mycology - Category: Biology Source Type: research

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ConclusionPathological fracture in young adult should always be properly investigated. A high index of suspicion is necessary to diagnose unusual presentation of Primary Hyperparathyrodism.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
This study is registered with ClinicalTrials.gov (NCT02108964); enrolment to phase 1 is complete and the study is ongoing.FindingsBy Aug 31, 2017, 180 patients (116 [64%] women; median age 60 years (52–69); 116 [64%] with ECOG performance status 1) received nazartinib across seven dose levels: 75 mg (n=17), 100 mg (n=38), 150 mg (n=73), 200 mg (n=8), 225 mg (n=28), 300 mg (n=5), and 350 mg (n=11). Seven dose-limiting toxicities were observed in six (3%) patients who received 150 mg, 225 mg, or 350 mg nazartinib once daily. Although the maximum tolerated dose was not met, the recommended phase 2 dose was declared as 1...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
AbstractPurpose of reviewHigh resolution esophageal manometry (HRM) has expanded understanding of esophageal motor function. The Chicago Classification scheme has allowed systematic categorization of the myriad of manometric parameters identified during HRM. Multichannel intraluminal impedance pH has enhanced ambulatory reflux monitoring through complete assessment of esophageal content transit. However, the clinical implications of identified minor esophageal functional disorders remain unclear.Recent findingsEsophagogastric junction outlet obstruction is defined by esophagogastric junction obstruction with preserved peri...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research
Source: CardioVascular and Interventional Radiology - Category: Radiology Source Type: research
CONCLUSIONS AND PRACTICAL IMPLICATIONS: If appropriate sterility of the working field is maintained during surgery and a tight apical seal is achieved during the extraoral treatment, orthograde endodontic treatment should be delayed or avoided. PMID: 31937403 [PubMed - as supplied by publisher]
Source: Journal of the American Dental Association - Category: Dentistry Tags: J Am Dent Assoc Source Type: research
In conclusion, although the incidence of heterotopic ossification after TAA is considerable, there is insufficient literature to suggest that heterotopic ossification after TAA impacts range of motion or functional outcome.
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
We report one case of a recent renal transplant recipient, who presented with gastrointestinal and respiratory symptoms, evolving into shock. The identification of Strongyloides stercoralis in the bronchoalveolar lavage (BAL) lead us to the diagnosis of SHS. Treatment with subcutaneous ivermectin was started, however the patient did not survive. Retrospective serum donor analysis allowed us to identify the donor as the source of infection.
Source: IDCases - Category: Infectious Diseases Source Type: research
Authors: Abuaisha M, El Masri R, Itani H, Antoun J Abstract Objectives: There are no evidence-based recommendations to screen for iron deficiency in non-anemic patients, even though symptoms may be present. The aim of this study is to measure the prevalence of iron deficiency (ID) without anemia in the general population aged 18-50 presenting to primary care along with the incidence and time to develop anemia in the iron-deficient population.Methods: A single-center retrospective chart review of patients who presented to family medicine clinics between June 2010 and March 2018 at the American University of Beirut M...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1&ndas...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Conclusion: The combined picture of 'low IPT initiation and high completion' seen in our study mirrors findings from other countries. Drug stock-out was the key challenge, which obliged health-care providers to prioritize 'IPT completion' over 'IPT initiation'. There is an urgent need to improve the procurement and supply chain management of isoniazid. PMID: 31937200 [PubMed - in process]
Source: Global Health Action - Category: International Medicine & Public Health Tags: Glob Health Action Source Type: research
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