Refractory mucocutaneous leishmaniasis resolved with combination treatment based on intravenous pentamidine, oral azole, aerosolized liposomal amphotericin B, and intralesional meglumine antimoniate

Introduction: Mucocutaneous leishmaniasis (MCL) is a complication of tegumentary leishmaniasis, causing potentially life-threatening lesions in the ear, nose, and throat (ENT) region, and most commonly due to Leishmania (Viannia) braziliensis. We report a case of relapsing MCL in an Italian traveler returning from Argentina. Case description: A 65-year-old Italian male patient with chronic kidney disease, arterial hypertension, prostatic hypertrophy, and type-2 diabetes mellitus was referred for severe relapsing MCL acquired in Argentina. ENT examination showed severe diffuse pharyngolaryngeal edema and erythema, partially obstructing the airways. A nasopharyngeal biopsy revealed a lymphoplasmacytic inflammation and presence of Leishmania amastigotes, subsequently identified as L. (V.) braziliensis by hsp70 PCR-RFLP analysis and sequencing. Despite receiving four courses of liposomal amphotericine B (L-AmB) and two courses of miltefosine over a 2-year period, the patient presented recurrence of symptoms a few months after the end of each course.After the patient was referred to us, a combined treatment was started with intravenous pentamidine 4 mg/kg on alternate days for 10 doses, followed by one dose per week for an additional seven doses, intralesional meglumine antimoniate on the nasal lesion once per week for six doses, oral azoles for three months, and aerosolized L-AmB on alternate days for three months.The treatment led to regression of mucosal lesions and respiratory symptoms. Renal function temporarily worsened, and the addition of insulin was required to maintain glycemic compensation after pentamidine discontinuation. Conclusions: This case highlights the difficulties in managing a life-threatening refractory case of MCL in an Italian traveler with multiple comorbidities. Even though parenteral antimonial derivatives are traditionally considered the treatment of choice for MCL, they are relatively contraindicated in cases of chronic kidney disease.The required dose adjustment in cases of impaired renal function is unknown, therefore the use of alternative drugs is recommended. This case was resolved with combination treatment, including aerosolized L-AmB, which had never been used before for MCL

Application of AI in cardiovascular multimodality imaging

Technical advances in artificial intelligence (AI) in cardiac imaging are rapidly improving the reproducibility of this approach and the possibility to reduce time necessary to generate a report. In cardiac computed tomography angiography (CCTA) the main application of AI in clinical practice is focused on detection of stenosis, characterization of coronary plaques, and detection of myocardial ischemia. In cardiac magnetic resonance (CMR) the application of AI is focused on post-processing and particularly on the segmentation of cardiac chambers during late gadolinium enhancement. In echocardiography, the application of AI is focused on segmentation of cardiac chambers and is helpful for valvular function and wall motion abnormalities. The common thread represented by all of these techniques aims to shorten the time of interpretation without loss of information compared to the standard approach. In this review we provide an overview of AI applications in multimodality cardiac imaging

Alcaloides e infección fúngica en festuca : estados fenológicos y posibilidad de contaminación

p.147-154Se ha estudiado la concentración de alcaloides en los distintos estados de desarrollo de una festuca tóxica en comparación con otra innocua, y la posibilidad de que la infección con Epichloe typhina pueda ser transmitida hacia plantas próximas sanas. Los resultados indican: a) Festuca tóxica En el estado vegetativo de las plantas jóvenes, tanto los alcaloides pirrolizidínicos (Jolinas), como perlolina, se encuentran en concentraciones pequeñas, aum entando luego durante la encañazón y floración. Los niveles de infección fúngica y de alcaloides pirrolizidínicos fueron medianos o elevados en los estados vegetativos siguientes, aún durante los meses fríos. b) Festuca innocua Si bien la perlolina aum entó marcadamente desde el estado vegetativo a la floración, no fue posible detectar, en ese lapso, alcaloides pirrolizidínicos. En los estados vegetativos siguientes, durante dos años, tanto el contenido de estos alcaloides como la infección con Epichloe typhina fueron prácticamente nulos

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Pulmonary Arteriovenous Malformations (PAVMs) and Pregnancy: A Rare Case of Hemothorax and Review of the Literature

Pulmonary arteriovenous malformations (PAVMs) are anatomical abnormalities consisting in a direct connection between pulmonary arteries and veins. Most of PAVMs are related to Hereditary Hemorrhagic Teleangiectasia, whereas only 10 to 20% are isolated sporadic cases. PAVMs tend to increase in size naturally; however, several factors can influence their growth such as pulmonary arterial hypertension, puberty, and pregnancy. Clinical manifestations are related to the right-to-left shunting and include dyspnoea, hypoxia, and pulmonary hypertension. The presence of PAVMs during pregnancy is associated with an increased risk of complications such as their rupture, haemothorax, and hypovolemic shock. The treatment reserved to PAVMs was the surgical resection of the lung lobe involving the malformation. Due to the worldwide acceptance of endovascular technique, the transcatheter embolization (TCE) is today considered as the mainstay of treatment. Recent studies reported the safeness of the TCE during pregnancy if performed by an experienced radiologist, at second or third trimesters when radiation exposure is believed to have minimal effect on the foetus. However, although the TCE during pregnancy represents an option, the treatment prior to pregnancy has to be considered the auspicial solution. Our study reports the case of a dyspnoeic pregnant woman with unknown pAVM causing hemothorax and simultaneously treated for pAVM reparation, left lower lobe resection, and hysterectomy. Postoperative treatment of embolization was performed to definitively close the pAVM

Sustainable discoloration of textile chromo-baths by spent mushroom substrate from the industrial cultivation of Pleurotus ostreatus

Synthetic dyes are recalcitrant to degradation and toxic to different organisms. Physical-chemical treatments of textile wastewaters are not sustainable in terms of costs. Biological treatments can be more convenient and the lig-nin-degrading extracellular enzymatic battery of basidiomycetes are capable to discolor synthetic dyes. Many basidio-mycetes are edible mushrooms whose industrial production generates significant amount of spent mushroom substrate (SMS) with residual high levels of lignin-degrading extracellular enzymatic activities. We have demonstrated that the low cost organic substrate, the SMS deriving from the cultivation of the basidiomycetes Pleurotus ostreatus, is able to discolor anthraquinonic, diazo and monoazo-dyes when incubated in dying chromo-reactive and chromo-acid baths containing surfactants and anti-foams, where the concentrations of the different dyes are exceeding the one recovered in the corresponding wastewaters. Laccase was the lignin-degrading extracellular enzyme involved in the discolouring process. The exploitation of the low cost SMS in the treatment of textile wastewaters is proposed. Accordingly, a toxi-cological assessment, based on a cyto-toxicity test on a human amnion epithelial cell line (WISH) and the estimation of the germination index (GI%) of Lactuca sativa, Cucumis sativus and Sorghum bicolor, has been performed, showing the loss of toxicity of the chromo-baths after being discoloured by the SMS

Sustainable discoloration of textile Chromo-Baths by Spent Mushroom Substrate from the industrial production of Pleurotus ostreatus

Synthetic dyes are recalcitrant to degradation and toxic to different organisms. Physical-chemical treatments of textile wastewaters are not sustainable in terms of costs. Biological treatments can be more convenient and the lig-nin-degrading extracellular enzymatic battery of basidiomycetes are capable to discolor synthetic dyes. Many basidio-mycetes are edible mushrooms whose industrial production generates significant amount of spent mushroom substrate (SMS) with residual high levels of lignin-degrading extracellular enzymatic activities. We have demonstrated that the low cost organic substrate, the SMS deriving from the cultivation of the basidiomycetes Pleurotus ostreatus, is able to discolor anthraquinonic, diazo and monoazo-dyes when incubated in dying chromo-reactive and chromo-acid baths containing surfactants and anti-foams, where the concentrations of the different dyes are exceeding the one recovered in the corresponding wastewaters. Laccase was the lignin-degrading extracellular enzyme involved in the discolouring process. The exploitation of the low cost SMS in the treatment of textile wastewaters is proposed. Accordingly, a toxi-cological assessment, based on a cyto-toxicity test on a human amnion epithelial cell line (WISH) and the estimation of the germination index (GI%) of Lactuca sativa, Cucumis sativus and Sorghum bicolor, has been performed, showing the loss of toxicity of the chromo-baths after being discoloured by the SMS

Long-term SARS-CoV-2 Asymptomatic Carriage in an Immunocompromised Host: Clinical, Immunological, and Virological Implications

PURPOSE: SARS-CoV-2 infection in immunocompromised hosts is challenging, and prolonged viral shedding can be a common complication in these patients. We describe the clinical, immunological, and virological course of a patient with eosinophilic granulomatosis with polyangiitis, who developed the status of long-term asymptomatic SARS-CoV-2 carrier for more than 7 months. METHODS: Over the study period, the patient underwent 20 RT-PCR tests for SARS-CoV-2 detection on nasopharyngeal swabs. In addition, viral cultures and genetic investigation of SARS-CoV-2 were performed. As for immunological assessment, serological and specific T-cell testing was provided at different time points. RESULTS: Despite the patient showing a deep drug-induced B and T adaptive immunity impairment, he did not experience COVID-19 progression to severe complications, and the infection remained asymptomatic during the follow-up period, but he was not able to achieve viral clearance for more than 7 months. The infection was finally cleared by SARS-CoV-2-specific monoclonal antibody treatment, after that remdesivir and convalescent plasma failed in this scope. The genetic investigations evidenced that the infection was sustained by multiple viral subpopulations that had apparently evolved intra-host during the infection. CONCLUSION: Our case suggests that people with highly impaired B- and T-cell adaptive immunity can prevent COVID-19 progression to severe complications, but they may not be able to clear SARS-CoV-2 infection. Immunocompromised hosts with a long-term infection may play a role in the emergence of viral variants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10875-022-01313-6