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Fresh examination of usefulness associated with crops as bio-filter of particulate matters from the urban environment.
© 2019 The Authors.Antiviral therapy against cytomegalovirus (CMV) infection is indicated for symptomatic infection in the fetus and premature neonates. In mature neonates, the benefit of antiviral therapy for severe CMV infection remains controversial. Additionally, when diagnosing symptomatic CMV disease occurring during the early neonatal period, it is difficult to differentiate between congenital and acquired infections. We herein report a neonatal case of CMV infection complicated with severe thrombocytopenia that was successfully managed with antiviral treatment. A 21-day-old male infant presented with low-grade fever and erythema on his extremities. During outpatient follow-up, he developed petechiae and thrombocytopenia (platelet count 17,000/μL). Subsequent serological examination and molecular detection of CMV confirmed the diagnosis of CMV infection. In consideration of the severe thrombocytopenia, antiviral therapy with valganciclovir 32 mg/kg/day was initiated. The platelet counts increased with decreasing CMV loads. After excluding congenital CMV infection, we discontinued antiviral therapy without relapse of the disease. The present case suggests that neonatal cases of severe symptomatic CMV infection may require antiviral therapy while excluding the possibility of congenital infection. © 2019 The Authors.Mycobacterium haemophilum is a slow growing acid-fast bacillus (AFB) in the nontuberculous mycobacteria (NTM) group. M. haemophilum typically causes cervicofacial lymphadenitis in children, cutaneous diseases, septic arthritis and osteomyelitis. However, it rarely causes isolated spinal cord disease. We report the first case, to our knowledge, of isolated intramedullary spinal lesions secondary to M. haemophilum. This case involved a patient with newly diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). He developed significant immune reconstitution inflammatory syndrome (IRIS) during his treatment. selleckchem M. haemophilum should be on the differential for isolated intramedullary spinal lesions, particularly in immunocompromised patients. Given our patient's severe IRIS, patients with HIV and M. haemophilum infection should be closely monitored for IRIS and treated aggressively. In high risk circumstances such as M. haemophilum spinal disease in patients with HIV, clinicians should consider pre-emptive treatment for IRIS. © 2019 The Authors.Approximately 300 million people worldwide were living with chronic hepatitis B virus infection as of 2016, however, this number does not account for those who might be living with occult hepatitis B virus infection due to difficulty diagnosing this condition. The multiple genotypes and the ability of the hepatitis B virus to acquire mutations that down-regulate its expression make occult hepatitis B virus infection a very elusive diagnosis. This is especially worrisome when there is a need to start immunosuppressive therapies, since there is a risk of reactivation in undiagnosed patients. We present a case of female patient who was referred to the consultation because she was about to start chemotherapy with an anti-CD20 agent and had a positive anti-HBc and anti-HBs. During routine workup an occult hepatitis B virus infection was diagnosed. Upon further study mutations in the PreCore and Basal Core Promoter regions were identified, as well as, a double genotype D/C. Therapy with tenofovir was initiated before the patient was started on chemotherapy. This case highlights the importance of comprehensive studying of patients who present with apparently resolved chronic hepatitis B virus infection, especially when they are about to start immunosuppressive therapies. © 2019 The Author(s).Introduction Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre's syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. Case presentation A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. Conclusion As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan. © 2019 The Authors.Acute varicella zoster virus (VZV) infection is a common condition in children, which is considered a mild, self-limited disease with diffuse skin vesicular rash. However, disseminated VZV infection with multiple organ involvement can occur in immunocompromised patients with impaired T cell immunity including solid or hematopoietic stem cell transplant recipients, receiving immunosuppressive therapy, leukemia, lymphoma, and HIV infection. Prompt antiviral therapy is mandatory in those immunocompromised persons. A 52 year-old man receiving chronic immunosuppressive drugs for his underlying leukocytoclastic vasculitis visited emergency department for diffuse skin vesicular rash that developed 4 days after contact with varicella zoster patients at his office. Despite prompt initiation of oral antiviral agents had been prescribed, rapid progression with septic shock, lactate acidosis, and disseminated intravascular coagulopathy occurred. The patient died within 24 h of intensive care unit admission. Varicella zoster infection commonly causes severe complications in adults receiving chronic immunosuppressive therapy. Post exposure prophylaxis varicella zoster immune globulin and early parenteral antiviral agents use after acute varicella virus infection may be mandatory in immunocompromised patients. © 2019 Published by Elsevier Ltd.Histoplasmosis of the gallbladder is an extremely rare condition. We present the case of cholecystitis due to progressive, disseminated histoplasmosis in an immunocompetent woman. © 2019 The Authors.Klebsiella pneumoniae is an extremely rare case of the Lemierre syndrome, which is characterized as septic thrombophlebitis of the jugular vein as a consequence of oropharyngeal infection. link2 We present a unique case of Lemierre syndrome caused by Klebsiella pneumoniae, complicated by epidural abscess. The patient presented with fever, severe nuchal pain and stiffness and mild sore throat and headache. Computed tomography revealed a neck abscess localized dorsally to a left mandibular ramus and continuing caudally along the sternocleidomastoid muscle, thrombosis of the left internal jugular vein and fluid collection in the epidural space. Viewed under magnetic resonance imagining, the effusion had the character of an epidural abscess. Cultivation of oropharyngeal swab and blood cultures revealed Klebsiella pneumoniae. The neck abscess was surgically drained, and the patient was treated with a combination of parenteral antimicrobials until complete clinical and radiologic remission. This case highlights the importance of also covering the gram-negative facultative anaerobic rod spectrum in the empiric antimicrobial treatment of Lemierre syndrome. © 2019 The Author(s).We describe the case of a 13-year-old girl with atopic dermatitis (AD) and severe asthma that presented to the Dermatology clinic with a pruritic skin rash, which appeared concomitantly to common cold symptoms. On examination, there are erythematous, umbilicated papules and vesicles, some with erosions and crusting, surrounding the mouth and areolas; a few lesions are visible on the forearms. link3 The mucous membranes were unaffected, the patient was afebrile, and no lymphadenopathies were present. A diagnosis of eczema herpeticum (HE) was suspected, and a direct fluorescent antibody test was positive for herpes simplex virus. Even when the clinical presentation is characteristic, the eruption might be confused with other infections like impetigo and primary varicella infection. Misdiagnosis can lead to severe complications, including bacteremia and death. EH is considered a medical emergency, and the index of suspicion for this infection should be high among clinicians. Prompt treatment with oral acyclovir should be initiated; in cases of severe disease or immunocompromised patients, hospitalization for systemic antivirals is required. If EH is recognized early it is easily and effectively treated. Any patient with pre-existing skin disease and acute "blistering" should be examined to rule out EH. © 2019 The Authors.Influenza virus primarily affects the respiratory system. It rarely causes extrapulmonary complications, with otitis media and febrile seizures being the most common in children. Acute glomerulonephritis as a complication of H1N1 influenza virus infection has been described only sporadically. Herein we present a case of acute glomerulonephritis in a previously healthy adolescent, in the context of infection with influenza A H1N1 virus. A 15-year old adolescent was admitted to our pediatric department due to fever, pharyngitis, cough, vomit, dizziness and fatigue. Based on his symptoms and the seasonal epidemiology, empiric treatment with oseltamivir was initiated while waiting for RT-PCR for influenza virus in pharyngeal swab, which was positive for A H1N1 influenza virus. In the first 24 h of admission, the patient presented macroscopic haematuria, which completely subsided in the following days, along with fever recession. The urine microscopic analysis showed findings compatible with acute glomerulonephritis. The patient remained normotasic while his biochemical profile including renal function, as well as further investigation of hematuria (immunoglobulins, C3, C4, ANA, anti-DNA, U/S) were all normal. ASTO levels, which were initially above normal (562 IU/ml), did not increase significantly in the following days, and given the fact that C3 levels were constantly within normal limits and pharyngeal culture was negative for pyogenic streptococcus, they were not considered sufficient for poststreptococcal glomerulonephritis diagnosis. Physicians should be suspicious and include influenza in the differential diagnosis when children present with uncommon symptoms such as hematuria along with even mild respiratory symptoms, during seasonal influenza period. © 2019 The Authors.
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