RESUMEN
Tuberculosis remains a major cause of morbidity and mortality worldwide, and the extrapulmonary presentation represents up to 20% of this disease. The pericardial compromise of this disease has been estimated between 1% and 4% of diagnosed patients. This presentation may have a mortality rate as high as 90% without proper treatment and diagnosis, dropping to 12% with timely diagnosis and treatment. We present the case of a 55 year-old female patient hospitalized for two weeks with constitutional symptoms, intermittent fever, dry cough, pleuritic pain and some symptoms of heart failure. The imaging studies (chest x-rays and ultrasound), revealed bilateral pleural effusion: 300 cc on the right side, 1,000 cc on the left side, and 500 cc of pericardial effusion. Direct bacilloscopy of the pleural fluid, the pericardial fluid and the sputum were negative, as well as the C-reactive protein (CRP); however, the Löwenstein-Jensen culture of the pericardial fluid was positive for Mycobacterium tuberculosis . The result of the purified protein derivative (PPD) test showed a 23 mm swelling, and after quadruple therapy her clinical condition rapidly improved until final discharge. Tuberculous pericarditis can be considered as a rare manifestation of tuberculosis, with high morbidity and significant mortality which decrease with effective early diagnosis and treatment. Although several diagnostic criteria for tuberculous pericarditis have been suggested, a definitive diagnosis may suppose several technical challenges.
Asunto(s)
Errores Diagnósticos , Enfermería , Enfermedades Profesionales/diagnóstico , Pericarditis Tuberculosa/diagnóstico , Antituberculosos/uso terapéutico , Cardiomegalia/etiología , Femenino , Humanos , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Enfermedades Profesionales/tratamiento farmacológico , Derrame Pericárdico/etiología , Derrame Pericárdico/microbiología , Pericarditis Tuberculosa/tratamiento farmacológico , Derrame Pleural/etiología , Neumonía Bacteriana/diagnóstico , Prueba de Tuberculina , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
We report the case of a 36-year-old man who had acquired immune deficiency syndrome and developed suppurative mediastinitis extending over the left lung and anterior thoracic wall around the sternum, pericardial effusions, splenomegaly, and mesenteric and periaortic lymphadenomegaly due to Mycobacterium avium (genotype I). The organism was isolated from an axillary lymph node and the bone marrow. Mediastinitis associated with disseminated M. avium complex infection is uncommon and, to the best of our knowledge, this manifestation has not reported before.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Mediastinitis/microbiología , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/complicaciones , Derrame Pericárdico/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino , Mediastinitis/diagnóstico , Infección por Mycobacterium avium-intracellulare/diagnóstico , Derrame Pericárdico/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a 36-year-old man who had acquired immune deficiency syndrome and developed suppurative mediastinitis extending over the left lung and anterior thoracic wall around the sternum, pericardial effusions, splenomegaly, and mesenteric and periaortic lymphadenomegaly due to Mycobacterium avium (genotype I). The organism was isolated from an axillary lymph node and the bone marrow. Mediastinitis associated with disseminated M. avium complex infection is uncommon and, to the best of our knowledge, this manifestation has not reported before.
Relatamos o caso de um paciente de 36 anos vivendo com AIDS que desenvolveu mediastinite supurativa com extensão ao pulmão esquerdo e à parede anterior do tórax ao redor do esterno, derrame pericárdico, esplenomegalia e adenomegalia mesentérica e periaórtica, devido ao Mycobacterium avium genótipo I, isolado de linfonodo axilar e da medula óssea. A mediastinite associada à infecção pelo Mycobacterium avium é rara e, até onde conhecemos na literatura publicada, esta forma de apresentação ainda no foi relatada.
Asunto(s)
Adulto , Humanos , Masculino , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Mediastinitis/microbiología , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/complicaciones , Derrame Pericárdico/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Imagen por Resonancia Magnética , Mediastinitis/diagnóstico , Infección por Mycobacterium avium-intracellulare/diagnóstico , Derrame Pericárdico/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Actinomycosis is a rare, chronic disease caused by a group of anaerobic Gram-positive bacteria that normally colonize the mouth, colon, and urogenital tract. Infection involving the cervicofacial area is the most common clinical presentation, followed by pelvic region and thoracic involvement. Due to its propensity to mimic many other diseases and its wide variety of symptoms, clinicians should be aware of its multiple presentations and its ability to be a 'great pretender'. We describe herein three cases of unusual presentation: an inferior caval vein syndrome, an acute cholecystitis, and an acute cardiac tamponade. We review the literature on its epidemiology, clinical presentation, diagnosis, treatment, and prognosis.
Asunto(s)
Actinomicosis/diagnóstico , Enfermedades de la Vesícula Biliar/fisiopatología , Derrame Pericárdico/fisiopatología , Actinomicosis/fisiopatología , Adulto , Femenino , Enfermedades de la Vesícula Biliar/microbiología , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/microbiologíaRESUMEN
O sistema BacT/Alert (Organon-Teknika) é um sistema automatizado para a detecçäo de microrganismos presentes no sangue. Neste estudo, o referido sistema foi avaliado quanto à possibilidade de sua utilizaçäo para o cultivo de fluidos biológicos näo sanguíneos, comparando-se com cultivos tradicionais. Ambos procedimentos mostraram resultados equivalentes quanto ao isolamento de microrganismos, porém o tempo de detecçäo foi sensivelmente menor no sistema BacT/Alert, variando de 6 a 34 horas. Na metodologia tradicional, o tempo de detecçäo de positividade variou de 24 a 72 horas. Os resultados obtidos demonstraram que o sistema automatizado BacT/Alert pode também ser utilizado para a detecçäo de microrganismos em outros fluidos biológicos que näo o sangue, com importante reduçäo no tempo de detecçäo da positividade
Asunto(s)
Humanos , Espacio Extracelular/microbiología , Líquido Cefalorraquídeo/microbiología , Colorimetría , Derrame Pericárdico/microbiología , Líquido Ascítico/microbiologíaRESUMEN
Se reporta un caso de actinomicosis con compromiso pulmonar, pericárdico y de la pared torácica. el compromiso pericárdico estuvo asociado a un exudado hemorrágico de gran cuantía con celularidad aumentada, de predominio polimorfonuclear. El caso fue adecuadamente documentado por la demostración bacteriológica de actinomyces isrraelli desde una muestra obtenida de una tumoración inflamatoria paraesternal. El paciente respondió favorablemente al uso prolongado de bencilpenicilina sódica en altas dosis por vía intravenosa y a tetraciclina oral subsecuentemente
Asunto(s)
Humanos , Masculino , Adolescente , Actinomicosis/complicaciones , Enfermedades Pulmonares/microbiología , Pericarditis/microbiología , Actinomyces/patogenicidad , Derrame Pericárdico/microbiología , Penicilina G/administración & dosificación , Tetraciclina/administración & dosificaciónAsunto(s)
Antiinflamatorios/efectos adversos , Varicela/fisiopatología , Pericarditis/microbiología , Infecciones Estafilocócicas/fisiopatología , Triamcinolona Acetonida/efectos adversos , Administración Tópica , Taponamiento Cardíaco/microbiología , Femenino , Glucocorticoides , Humanos , Lactante , Derrame Pericárdico/microbiología , Pericarditis/fisiopatologíaRESUMEN
Transient cardiac constriction is an unusual complication of purulent pericarditis. It should be suspected in the presence of clinical and haemodynamic deterioration when signs of activity have abated. Features of cardiac constriction were observed in a 4-year-old boy 2 weeks after surgical drainage. The patient was managed conservatively without surgery and the outcome was good. Follow up 2 years later showed a healthy boy with a normal cardiological examination.