Extrapulmonary Tuberculosis
Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies in Clinical Tuberculosis, 2020
Disseminated, or miliary TB, occurs when tubercle bacilli spread through the bloodstream resulting in small (approximately 1–2 mm) granulomatous lesions. The term “miliary” was proposed by John Jacob Manget to describe the gross appearance of pathological findings that were similar in size and appearance to millet seeds.87 Disseminated disease is defined as involvement of two or more noncontiguous sites or the presence of bacteremia. Disseminated TB has been reported to occur in approximately 1% of TB patients from Europe,9 but has been reported to account for 6%–8% of extrapulmonary TB in England and Wales88 and 11.2%–12.2% of cases in the United States.89 Historically, disseminated TB has been seen more commonly in infants and children <4 years old,90,91 however, disease also occurs in older individuals. There are now two peaks, one involving adolescents and young adults and the other among elderly individuals.90 In fact, the “cryptic” variety typically occurs in individuals older than 60 years of age.92 Males are more frequently affected in some series and females in others. Medical risk factors for disseminated TB include malnutrition, immunosuppression, alcoholism, diabetes mellitus, and chronic hemodialysis.93,94 Disease can result from early dissemination after infection or later after reactivation.95,96 Factors associated with an increased mortality include older age, lymphopenia, hypoalbuminemia, elevated transaminases, altered mental status, HIV infection, and delay in therapy.95
Amphotericin B Deoxycholate
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Mucormycosis (previously referred to as zygomycosis) encompasses fungal infections by the order Mucorales and Cunninghamellaceae, most commonly Rhizopus, Absidia, Lichtheimia, Mucor, Rhizomucor, Saksenaea, and Cunninghamella spp. (Roden et al., 2005). Mucormycosis is a severe disease, usually occurring in immunocompromised or diabetic hosts, and is characterized by angioinvasion, principally affecting rhinocerebral, pulmonary, or gastrointestinal blood vessels. Disseminated disease usually results from progression of infection from the lungs to multiple organs, occurs in the severely immunocompromised patient, such as those with acute leukemia, bone marrow transplantation, or diabetes, and is associated with an extremely high mortality rate. A cutaneous form is usually associated with minor trauma and diabetes.
Viral infections
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Herpes zoster usually manifests as an eruption of grouped vesicles in a dermatomal distribution (Figure 28.2). Lesions can become pustular (Figure 28.3) or hemorrhagic. In immunosuppressed patients, disseminated disease may occur, defined as more than 20 vesicles outside the area of the primary or adjacent dermatome. Common complications of disseminated disease include pneumonia, encephalitis, and hepatitis. VZV encephalitis may occur months after an episode of herpes zoster. Patients have a subacute clinical presentation with headache, fever, mental status changes, seizures, and focal neurologic defects. Cerebrospinal fluid analysis reveals VZV DNA by PCR. Death often results, although case reports have shown that high-dose IV acyclovir therapy may be efficacious [11].
Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging
Published in Expert Review of Respiratory Medicine, 2019
Ana Luiza Di Mango, Gláucia Zanetti, Diana Penha, Miriam Menna Barreto, Edson Marchiori
Clinical manifestations of pulmonary coccidioidomycosis can often be mistaken with those of other causes of pneumonia. Three clinical categories are described: acute, disseminated and chronic [25]. Approximately two-thirds of infected persons remain asymptomatic or develop self-limiting respiratory symptoms. When symptomatic, pulmonary involvement is common and most patients develop a mild flu-like illness (‘valley fever’) which is self-limited, presenting with cough, fever, chills, headache and chest pain. The classical triad of desert rheumatism, characterized by fever, arthralgia and erythema nodosum, can help distinguish it from bacterial pneumonia [26,27]. Disseminated disease is characterized by the involvement of other organs, mainly the skin, joints, bones, and meninges. Risk factors for this presentation are patients with immunodeficiency syndrome (AIDS), immunosuppressed patients, pregnant women especially those in the third trimester and those with diabetes mellitus [24]. Chronic pulmonary coccidioidomycosis is defined as patients with the disease presenting symptoms that last for more than 6 weeks and/or persistent infiltrates, fibrotic or fibrocavitary disease on imaging studies [25,27].
Cutaneous coccidiomycosis presenting with a facial plaque
Published in Baylor University Medical Center Proceedings, 2019
Coccidiomycosis, or “valley fever,” is caused by the virulent, dimorphic, soil-dwelling fungus Coccidiodes immitis. Endemic areas include the southwestern USA, northern Mexico, and Central and South America. Infection typically occurs via inhalation of arthroconidia and most commonly results in pulmonary disease.1–6 Presenting symptoms can include cough, fever, and arthralgias, although up to 60% of patients are asymptomatic. Disseminated disease occurs in up to 5% of patients.5–7 Filipinos, blacks, pregnant women, and immunosuppressed patients are at increased risk for developing widespread disease.1–6 Skin involvement by coccidiomycosis can present as papules, pustules, plaques, nodules, abscesses, or ulcerations and is seen in up to 50% of symptomatic patients.2–4,6,8,9 In addition, coccidiomycosis can cause hypersensitivity reactions such as erythema nodosum and erythema multiforme.2–4,9 Though any anatomical site may be affected, the head and neck are most commonly affected.3,6 Cutaneous involvement most often results from disseminated disease. Here, we present a patient with coccidiomycosis presenting with a facial plaque.
Treatment of locally advanced pancreatic cancer with irreversible electroporation – a Danish single center study of safety and feasibility
Published in Scandinavian Journal of Gastroenterology, 2019
Rasmus Virenfeldt Flak, Mogens Tornby Stender, Thomas Mandøe Jensen, Kasper Lenni Andersen, Stine Dam Henriksen, Peter Brøndum Mortensen, Mogens Sall, Ole Thorlacius-Ussing
Hypothetically, our inclusion of patients with large tumors (>3.5 cm), repeat IREs and locally progressive disease on pre-procedure chemotherapy contributed to the higher complication rate in our study, as a large proportion of the observed complications seems attributable to the natural history of pancreatic cancer itself. Additionally, we retrospectively found signs of disseminated disease in four patients at the time of treatment. Two had signs of disseminated disease, which was thought to be benign changes at inclusion. One had a single liver metastasis which had shown complete response on chemotherapy, but rapidly progressed during treatment pause. The second patient had resection of a large Krukenberg metastasis prior to IRE but was included because she had no other signs of dissemination at the time. All four patients quickly deteriorated after the IRE procedure.
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