Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease but developed an ultimately lethal T. asahii systemic infection. There is a strong possibility that our patient had been colonized at the site infection as part of the normal skin flora. After a period of one month bed rest due to an accidental fall and fracture of the right shoulder-blade, a 61-year old woman experienced severe oedema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphoedema. Samples collected from affected areas revealed T. asahii and the patient was referred to a hospital for infection diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted in our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the outcome. Nowadays physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.</p

False increase of serum cancer risk markers in a case of benign uterine bleeding

Co-infection by specific Chlamydia species and Human Papilloma Virus has been associated with genital carcinogenesis. Additionally, modern serum biomarkers and risk algorithms for diagnosis and prognosis have proven their efficacy in patients with ovarian cancer although data on endometrial or cervical malignancies are still sparse. We aim to present an unusual case of serum cancer biomarkers increase in a premenopausal female suffering from recurrent uterine bleeding and genital infection by several pathogens. We further discuss proper utilization of these diagnostic tools in such unusual cases

Low-Grade Systemic Inflammation Profile, Unrelated to Homocysteinemia, in Obese Children

To investigate in prepubertal obese children (POC) the profile of chronic low-grade systemic inflammation (CLGSI) and its relation to homocysteinemia, 72 POC were evaluated for serum C-reactive protein (CRP) and amyloid A (SAA) levels, both markers of CLGSI, and plasma levels of total homocysteine (tHcy), an independent risk factor for adult atherosclerosis, in comparison to 42 prepubertal lean children (PLC). The main observations in POC were higher CRP levels compared to PLC, positive association of SAA levels to CRP levels, no association of CRP or SAA levels to tHcy levels. Thus, in POC, positively interrelated to each other, elevated CRP and unaltered SAA levels reveal a unique profile of the CLGSI, not explaining homocysteinemia-induced risk for future atherosclerosis

Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease but developed an ultimately lethal T. asahii systemic infection. There is a strong possibility that our patient had been colonized at the site infection as part of the normal skin flora. After a period of one month bed rest due to an accidental fall and fracture of the right shoulder-blade, a 61-year old woman experienced severe oedema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphoedema. Samples collected from affected areas revealed T. asahii and the patient was referred to a hospital for infection diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted in our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the outcome. Nowadays physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.</p

Immunohistochemical study of p185 HER2 and DF3 in primary breast cancer and correlation with CA-15-3 serum tumor marker

Human epidermal growth factor receptor 2 (p185 HER2) oncoprotein immunohistochemical expression and DF3 antigen distribution were evaluated in 129 patients with primary breast cancer. p185 HER2 overexpession was positively correlated with the degree of differentiation, metastatic disease, progesterone receptors, and cytoplasmic distribution of DF3 antigen. p185 HER2 overexpression had prognostic significance for the disease-free interval

Management of the airway without the use of neuromuscular blocking agents: The use of remifentanil

Remifentanil belongs to opioid drugs, and its pharmacokinetic characteristics make it unique in this class of drugs and appropriate for use during intubation without neuromuscular blockage. This up-to-date review aims to summarize the findings of recent studies regarding remifentanil and intubation. Remifentanil combined either with propofol or with inhaled anesthetic agents has been proved to provide acceptable intubating conditions. Regarding children patients, remifentanil can be used safely, and as far as intubating conditions are concerned, its effectiveness is as excellent as with neuromuscular blockage. Strong evidence exists that illuminates the usefulness of the drug in cases of difficult airway as well as in neuromuscular diseases. Beyond all these favorable characteristics, anesthesiologists must be conscious with the use of remifentanil. © 2011 The Authors Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique