Involvement Of Other Organs Research Articles

LONG-TERM FOLLOW UP OF ACUTE HEART FAILURE PATIENTS UNDERWENT LEVOSIMENDAN INFUSION: IDENTIFICATION OF RESPONDERS AND NON-RESPONDERS BY USING HLM CLASSIFICATION

Levosimendan (Levo) reduces mortality in Acute Heart Failure (AHF) that determines involvement of other organs beyond heart; similar to TNM used in oncology, we proposed HLM staging system to assess prognosis of HF patients evaluating heart damage (H), lung involvement (L) and malfunction (M) of

Relapse rate and predictors of relapse in a large single center cohort of type 1 autoimmune pancreatitis: long-term follow-up results after steroid therapy with short-duration maintenance treatment.

Type 1 autoimmune pancreatitis (AIP), as a pancreatic manifestation of IgG4-related disease, shows a favorable prognosis in the short term. However, disease relapse is common in long-term follow-up, despite a successful initial treatment response. This study aimed to identify the predictors of relapse and long-term outcomes in patients with type 1 AIP. Patients with more than 2years of follow-up who met the International Consensus Diagnostic Criteria for type 1 AIP were included. Patients who had undergone pancreatic operations associated with AIP or who lacked sufficient clinical data were excluded. All 138 patients achieved clinical remission with initial steroid therapy, and 66 (47.8%) experienced relapse during a median 60 (range 24-197) months follow-up. Among the relapsed patients, about 74% (49/66) relapsed within 3years. About 60% (82/138) had other organ involvement (OOI), most commonly in the proximal bile duct (26.8%). At first diagnosis, OOI, and especially OOI of the proximal bile duct, was a significant independent predictor of relapse (hazard ratio 2.65; 95% confidence interval 1.44-4.89; p=0.002), according to multivariate analysis. During the follow-up period, 16 (11.6%) patients experienced endocrine/exocrine dysfunction and 32 (23.2%) patients developed de novo pancreatic calcifications/stones. No pancreatic cancer occurred in any patients. Type 1 AIP has common relapses, and patients with OOI, especially OOI of the proximal bile duct, appear to be at increased risk for relapse. Long-term sequelae, including pancreatic insufficiency and pancreatic calcifications/stones, are common in patients with relapse. To reduce the relapse, longer maintenance treatment may be needed especially for patients at high risk for relapse.

Isolated Retrobulbar Hydatid Cyst: A Case Report

Background: Hydatid cyst is caused by Echinococcus granulosus and human is the accidental host. The most common sites of involvement are the liver and lungs, and involvement of other organs is less common. Ocular involvement of hydatid cyst is one of the most uncommon manifestations of hydatid cyst. Cases Report : The case was a 40-year-old woman with a retrobulbar cystic lesion who was examined for the left eye pain and then proptosis. With the initial diagnosis of retrobulbar tumor, the patient underwent surgery and the removed mass was sent to the pathology laboratory. Since the result indicated the existence of a hydatid cyst, the patient was referred to the infectious service and was treated with albendazole. C onclusion: Although the ocular involvement of hydatid cyst is uncommon, it should be considered as a differential diagnosis in patients with proptosis in the endemic areas.

Left Side Spigelian Hernia Containing Tuberculous Ovary with Abscess Formation - Case Report

Spigelian hernia is a rare entity, representing about 0.12% of all abdominal wall hernias.The causes of Spigelian hernias are, involving both congenital and acquired factors and up to 50% of these hernias occur in patients with a history of previous abdominal surgery, it is slightly more common in females, usually on left side and the median age of presentation is 50 years. The most common content of the Spigelian hernia sac is the greater omentum; but, an involvement of other organs has been reported. A few cases of spigelian hernia containing ovary have been reported in the literatures. Isolated tuberculous salpingo- oophoritis is a rare female genital tract tuberculosis. Her we presented a 51 years old female with Left side Spigelian hernia containing tuberculous ovary with abscess formation. Up to our Knowledge; there was no reported case of spigelian hernia that contained a tuberculous ovary; Thus, our patient may be the first case in this topic.

Prevalence and Associated Epidemiological Factors of Hydatidosis in Buffaloes in and Around Bareilly, Uttar Pradesh, India

The present study was undertaken for determination of prevalence of hydatidosis and some of the epidemiological factors like seasonal effect, organs involved, age, sex of the animal, status of the cysts etc in buffaloes. Prevalence was determined by examining 1046 buffaloes in Bareilly slaughter house. In the present study, the overall prevalence rate of hydatidosis in buffaloÂ’s was14.82%. Younger age group has lesser infection rate than older age group, (6.8%, 14.97% and 17.46% in below 3 years, 3 -5 years and above 5 year age group respectively). However, sex of the animal and season has no significant effect on the incidence rate. Amongst the predilection sites, hydatid cysts were observed mostly in lungs (83.2%), followed by liver (34.8%) whereas, involvement of other organs (1.29%) is rare. 63.87% of animals had cysts only in lungs and 15.48% had cysts in liver only while as 19.35% of animals had cysts in both lungs and liver. Only 2 cysts were found in other organs in which one was found in spleen and other in kidney. Majority of the cysts were confirmed as fertile (55.48) and sterile (41.93%) by both macroscopical and microscopical examination, while as 2.58% were determined as calcified. Based on these epidemiological factors, steps towards the control of this economical and zoonotic infection are discussed.

Gastrointestinal manifestation of immunoglobulin G4-related disease: clarification through a multicenter survey.

Several reports on immunoglobulin (Ig)G4-related disease (IgG4-RD) with gastrointestinal involvement (IgG4-related gastrointestinal disease; IgG4-GID) have been published, although this entity has not been fully established clinicopathologically. Thus, we carried out a multicenter survey. Patients with possible IgG4-GID who underwent resection were collected. Histologic slides were reevaluated, and eight cases with diffuse lymphoplasmacytic infiltration but without numerous neutrophils, granulations or epithelioid granulomas were further analyzed. Overall, the IgG4 counts (87-345/high-power field) and IgG4/IgG-positive ratio were high (44-115%). The demographic findings included advanced age among the patients (55-80years) and male preponderance (six cases). Six lesions (five gastric, one esophageal), consisting of lymphoplasmacytic infiltration with neural involvement in the muscularis propria and/or bottom-heavy plasmacytosis in the gastric mucosa, were histologically regarded as highly suggestive of IgG4-RD. Storiform fibrosis and obliterative phlebitis were found in two cases, and the former gave rise to a 7-cm-sized inflammatory pseudotumor (IPT) in one case. Ulceration and carcinoma co-existed in three and two lesions, respectively. All the patients had other organ involvement (OOI), and serum IgG4 levels were markedly elevated (four of five patients). The remaining two cases with gastric IPTs featuring reactive nodular fibrous pseudotumor or nodular lymphoid hyperplasia were regarded as possible cases of IgG4-RD because of the histologic findings and lack of OOI. IgG4-GID is found in the setting of IgG4-RD, often with ulceration or cancer. Characteristic histologic findings are observed in the muscularis propria and gastric mucosa. Cases with IPT may be heterogeneous, and there may be mimickers of IgG4-GID.

An overview of the cutaneous porphyrias.

This is an overview of the cutaneous porphyrias. It is a narrative review based on the published literature and my personal experience; it is not based on a formal systematic search of the literature. The cutaneous porphyrias are a diverse group of conditions due to inherited or acquired enzyme defects in the porphyrin–haem biosynthetic pathway. All the cutaneous porphyrias can have (either as a consequence of the porphyria or as part of the cause of the porphyria) involvement of other organs as well as the skin. The single commonest cutaneous porphyria in most parts of the world is acquired porphyria cutanea tarda, which is usually due to chronic liver disease and liver iron overload. The next most common cutaneous porphyria, erythropoietic protoporphyria, is an inherited disorder in which the accumulation of bile-excreted protoporphyrin can cause gallstones and, rarely, liver disease. Some of the porphyrias that cause blistering (usually bullae) and fragility (clinically and histologically identical to porphyria cutanea tarda) can also be associated with acute neurovisceral porphyria attacks, particularly variegate porphyria and hereditary coproporphyria. Management of porphyria cutanea tarda mainly consists of visible-light photoprotection measures while awaiting the effects of treating the underlying liver disease (if possible) and treatments to reduce serum iron and porphyrin levels. In erythropoietic protoporphyria, the underlying cause can be resolved only with a bone marrow transplant (which is rarely justifiable in this condition), so management consists particularly of visible-light photoprotection and, in some countries, narrowband ultraviolet B phototherapy. Afamelanotide is a promising and newly available treatment for erythropoietic protoporphyria and has been approved in Europe since 2014.

Successful embolectomy of bilateral femoral artery thrombosis in neonate

In childhood, the incidence of thrombotic disease, both spontaneous and catheter-induced, is highest in the neonatal period. Depending on the thrombus location, degree of aortic occlusion and involvement of other organs, aortic thrombosis clinical signs range from a completely asymptomatic presentation to a life threatening neonatal emergency. We report a case of aortoiliac thrombosis in a 12 days old baby, who presented with complaints of bluish-black patches on right foot for 4 days. Lower limb CT (Computed Tomography) Angiography showed thrombus in abdominal aorta involving proximal part of right common iliac artery. The anticoagulant therapy was initiated and surgical embolectomy was performed with restoration of blood flow, but the patient developed gangrene of right foot during the follow up period.

Safety of avoiding systemic corticosteroid administration for grade II acute graft-versus-host disease limited to the skin.

We hypothesized that systemic corticosteroid administration would be safely avoided not only in grade I acute graft-versus-host disease (GVHD) but also in selected patients with grade II acute GVHD limited to the skin (grade IIs GVHD). We retrospectively evaluated risk factors for subsequent GVHD progression, defined as the involvement of other organs or progression to grade III to IV GVHD, in 50 patients with acute GVHD of grade IIs at its onset. Sixteen patients received systemic corticosteroid administration before GVHD progression. The cumulative incidence of GVHD progression at 28days from the onset of grade IIs GVHD was 24%. Twenty-five patients did not require systemic corticosteroid administration throughout the entire episode of acute GVHD. Systemic corticosteroid administration before GVHD progression did not affect GVHD progression, chronic GVHD, or non-relapse mortality. Early onset (less than 26days from transplantation) of grade IIs GVHD was identified as the only statistically significant risk factor for GVHD progression (hazard ratio 6.73, 95% confidence interval 1.5-31.1, P=0.01). In conclusion, avoiding systemic corticosteroid administration for selected patients with grade IIs GVHD before GVHD progression did not compromise the transplantation outcomes. Patients with early-onset grade IIs GVHD were at high risk for GVHD progression.

The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection.

Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra‐pulmonary complications of influenza infection, using organ‐specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra‐pulmonary complications is critical to determining the true burden of influenza infection and initiating organ‐specific supportive care.

Features of Autoimmune Pancreatitis Associated With Inflammatory Bowel Diseases

Few people know of autoimmune pancreatitis (AIP), a rare disorder associated with inflammatory bowel diseases (IBD). We aimed to describe phenotype and outcomes of IBD and AIP when associated. We performed a retrospective study of cases of AIP in IBD identified from the multicenter Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif in Belgium and France from July 2012 through July 2015. Patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria for AIP. A definitive AIP diagnosis was based on histological analysis of pancreatic resection specimens or samples collected by fine-needle aspiration during endoscopic ultrasound. Patients with probable type 1 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, level of serum immunoglobulin G4, and involvement of other organs. Patients with probable type 2 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, and association with IBD. The primary objective was to collect information on the characteristics of AIP in patients with IBD. We also compared features ofpatients with IBD with and without AIP in a case-control analysis, using multivariate analysis. We analyzed data from 91 individuals with AIP and IBD (47 women) seen at 23 centers (58 had ulcerative colitis [UC] and 33 Crohn's disease [CD]). Eighty-nine patients had type 2 AIP, and 2patients had type 1 AIP. The mean age at diagnosis of AIP was 35 ± 12 years, and for IBD it was 32 ± 12 years. AIP preceded IBD in 19 patients (21%). Over a mean follow-up period of 5.7± 4.9 years, 31 patients (34%) relapsed, 11 patients (12%) developed diabetes, and 17 patients (19%) developed exocrine pancreatic insufficiency. In patients with UC, factors independently associated with AIP included proctitis (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.3; P= .007) and colectomy (OR, 7.1; 95% CI, 2.5-20; P= .0003). In patients with CD, AIP was significantly associated with fewer perianal lesions (OR, 0.16; 95% CI, 0.03-0.77; P=.023), non-stricturing non-penetrating CD (OR, 6.7; 95% CI, 1.25-33.3; P= .0029), and higher rate of colectomy (OR, 27.8; 95% CI, 3.6-217; P= .0029). In a multicenter retrospective analysis of patients with AIP and IBD, followed for an average of 5.7 ± 4.9 years, we found most to have type 2 AIP. Two-thirds of patients have UC, often with proctitis. One-third of patients have CD, often with inflammatory features. Patients with IBD and AIP have higher rates of colectomy than patients with just IBD.

English

A cross sectional study was conducted to assess the prevalence and economic significance of bovine hydatidosis at Adama municipal abattoir. A total of 500 cattle were examined and 191 (38.2%) of them were found infected. Also, 253 visceral organs were found harboring one or more hydatid cyst. Prevalence of lung and liver cyst accounted for 94.5% and the involvement of other organs as many as 20 cysts were recovered from a single lung. Proportionally 35.7, 34.6, 20.8 and 8.82% of the cysts were calcified, small, medium and large sized, respectively. In addition, sterile and fertile cysts represent 46.2 and 18.1%, respectively. The rate of calcification is higher in liver than lungs, while that of most fertile cysts were recovered from lungs. The annual economic loss due to bovine hydatidosis at Adama abattoir is estimated to be about 171,436.36 Eth Birr (ETB). This information shows the risk of hydatid cyst distribution and economic significance in the study area. Therefore, appropriate control measures should be undertaken which include public awareness education program and a more aggressive effort that should include a reduction of stray dog population. Key words: Adama abattoir, economic significance, hydatid cyst, fertility, prevalence.

Primary sarcoidosis of the breast, a case study in connection with Propionibacterium acnes infection

A 77-year-old female underwent screening mammography with abnormal results. Core needle biopsy revealed a granulomatous lesion without necrosis, and sarcoidosis was considered although tuberculosis and granulomatous mastitis could not be ruled out. Three months later, the patient detected breast and axillary masses. Malignancy was suspected and both lesions were excised. The specimens contained epithelioid cell granulomas with no necrosis. Her angiotensin-converting enzyme level was normal, and radiographic examination revealed no evidence of involvement of other organs, including the lungs and mediastinal lymph nodes. Although sarcoidosis was highly suspected, it was not definitive. Immunohistochemistry with the PAB antibody, which specifically reacts with Propionibacterium acnes, the most commonly implicated causative agent of sarcoidosis, showed positive signals in granulomatous inflammation of the breast and within granulomas of the sentinel lymph node. This is the first case report of primary sarcoidosis of the breast involving the draining lymph node with confirmed P. acnes infection.

The frequency of ophthalmologic manifestations of granulomatosis with polyangiitis (Wegener's) and their relationship to systemic diseases

To estimate the frequency of lesions in the organ of vision in granulomatosis with polyangiitis (GPA) (Wegener's) and to determine their relationship to systemic diseases. The retrospective study enrolled 218 patients followed up at the E.M. Tareyev Clinic of Nephrology, Internal and Occupational Diseases, with a diagnosis of GPA. The frequency and association of ophthalmic manifestations with systemic involvement were statistically analyzed using PASW Statistics 18. The organ of vision was impaired in 48.1% of the patients with GPA. The most common manifestations were orbital space-occupying lesion (22.9%), conjunctivitis/episcleritis (14.7%), dacryocystitis (6.0%), and scleritis (4.6%). Orbital space-occupying lesions occurred more frequently in the local type of the disease (p=0.0003), and, on the contrary, the involvement of the conjunctiva and eyeball was seen in patients with the systemic types of GPA (p=0.02). The findings may suggest that the orbital lesion is an independent manifestation of GPA, which develops more commonly in its local type. Conjunctivitis/episcleritis is, on the contrary, more frequently seen in the active phase of the disease and generally in the involvement of other organs and systems.

Sarcoidosis in Israel: Clinical Outcome Status, Organ Involvement, and Long-Term Follow-Up.

Sarcoidosis is a chronic granulomatous inflammatory disease of unknown etiology with heterogeneous outcomes. This study reviewed the clinical outcome status (COS) and organ involvement of Israeli sarcoidosis patients during a five-year period. Further, we compared our results to the 'World Association of Sarcoidosis and Other Granulomatous Disease' (WASOG) COS and the 'A Case Control Etiologic Study of Sarcoidosis' (ACCESS) instruments in order to evaluate their relevance to the Israeli population. The retrospective study group consisted of 166 sarcoidosis patients for the period of 2010-2015. Data on demographic characteristics, presenting symptoms, co-morbidities, disease duration, lung function tests, treatment program, chest X-ray, and chest high-resolution computed tomography were collected. The median patient age was 62±14, which was significantly higher than the WASOG and ACCESS cohorts (p<0.0001), and the average disease duration was 9.8±7.5years. Resembling the ACCESS cohort, most patients were women (67.5%). The majority of patients suffered from constitutional symptoms (86%), as well as from respiratory symptoms (38.5%). Similarly to the ACCESS cohort, 91% of patients presented with lung involvement. However, significant differences in the involvement of other organs were noted, including lymph nodes (3 vs. 15.2%), liver (3.6 vs. 11.5%), CNS (7.2 vs. 4.6%), and joints (3.6 vs. 0.5%). In addition, significant differences were observed in the COS of the Israeli population in comparison to the WASOG data (p<0.01). Sarcoidosis in Israel is a unique and challenging disease with its clinical presentations that differ from previously reported studies.

Azathioprine Maintenance Therapy to Prevent Relapses in Autoimmune Pancreatitis.

Objectives:Steroids are used to induce remission in autoimmune pancreatitis (AIP). Low-dosage steroid therapy or immunosuppressant (IMs) has been proposed as maintenance therapy to prevent AIP relapse. Few and conflicting data have been published on the efficacy of azathioprine (AZA) in preventing AIP relapse. The aim of this study was to evaluate the indication and efficacy of AZA as maintenance therapy to prevent disease relapse in AIP.Methods:Patients suffering from AIP diagnosed according to the ICDC in type 1, type 2, and not otherwise specified (NOS) were divided in those treated with AZA (AZA+ group) as maintenance therapy and not treated with maintenance therapy (AZA− group). Exclusion criteria were: previous pancreatic surgery, other autoimmune diseases as indication for AZA treatment, and use of IMs different from AZA. Drug safety, clinical and instrumental outcome of AZA+ patients were evaluated.Results:A total of 23 patients (18 Males and 5 Females, mean age 54±11 years) in AZA+ group and 97 (58 Males and 39 Females, mean age 45±18 years) in AZA− group were compared. In AZA+ group, patients were significantly older (P=0.043), type 1 AIP was more frequently diagnosed (87 vs. 51%, P=0.006), sIgG4 higher (758±625 vs. 311±409 mg/dl, P<0.001), other organ involvement (OOI) more frequently observed (83 vs. 48%, P=0.002), with higher frequency of relapse before AZA treatment (78 vs. 14%, P<0.001). Three patients in AZA+ group required drug discontinuation because of adverse events. Twenty patients were therefore evaluated for outcome. Six out of 20 patients (30%) relapsed after 24±15 months (5 in pancreas and 1 on biliary tract). They were retreated with steroids and continued AZA. Two out of 6 patients (33%) had a second relapse,after respectively 11 months (in pancreas and kidney) and 22 months (in kidney).Conclusions:AZA is an effective and safe treatment to prevent AIP relapses.

Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial

Although benefits of laparoscopic surgery compared with open surgery have been suggested, the long-term survival of patients undergoing laparoscopic surgery for colon cancer requiring Japanese D3 dissection remains unclear. We did a randomised controlled trial to establish non-inferiority of laparoscopic surgery to open surgery. We did an open-label, multi-institutional, randomised, two-arm phase 3 trial in 30 hospitals in Japan. Patients aged 20-75 years who had histologically proven colon cancer; tumours located in the caecum or ascending, sigmoid, or rectosigmoid colon; T3 or deeper lesions without involvement of other organs, node stages N0-2, and metastasis stage M0; and tumour size of 8 cm or smaller were included. Only accredited surgeons did surgery as an operator or instructor. Patients were randomly assigned (1:1) preoperatively to undergo D3 resection either by an open route or a laparoscopic route, via phone call or fax to the Japan Clinical Oncology Group (JCOG) Data Center. Randomisation used a minimisation method with a biased-coin assignment according to tumour location (caecum, ascending vs sigmoid, rectosigmoid) and institution. The primary endpoint was overall survival and was analysed by intention to treat. The non-inferiority margin for the hazard ratio (HR) was set at 1·366. This study is registered with UMIN Clinical Trials Registry, number C000000105, and ClinicalTrials.gov, number NCT00147134. Between Oct 1, 2004, and March 27, 2009, 1057 patients were randomly assigned to either open surgery (n=528) or laparoscopic surgery (n=529). 5-year overall survival was 90·4% (95% CI 87·5-92·6) for open surgery and 91·8% (89·1-93·8) for laparoscopic surgery. Laparoscopic D3 surgery was not non-inferior to open surgery for overall survival (HR 1·06, 90% CI 0·79-1·41; pnon-inferiority=0·073). 65 (13%) patients in the open surgery group and 53 (10%) patients in the laparoscopic surgery group had grade 2-4 adverse events. Grade 2-4 adverse events included diarrhoea (15 [3%] in the open surgery group vs 14 [3%] in the laparoscopic surgery group), paralytic ileus (six [1%] vs nine [2%]), and small intestine bowel obstruction (16 [3%] vs 11 [2%]). Two treatment-related deaths occurred in the open surgery group: one patient died 7 days after surgery (probably due to myocardial infarction), and one patient died from febrile neutropenia, pneumonia, diarrhoea, and gastrointestinal haemorrhage during postoperative chemotherapy. Laparoscopic D3 surgery was not non-inferior to open D3 surgery in terms of overall survival for patients with stage II or III colon cancer. However, because overall survival in both groups was similar and better than expected, laparoscopic D3 surgery could be an acceptable treatment option for patients with stage II or III colon cancer. National Cancer Center Research and Development Fund, Grant-in-Aid for Cancer Research, and Health and Labour Sciences Research Grant for Clinical Cancer Research from the Ministry of Health, Labour and Welfare of Japan.

Ophthalmic manifestations in patients with inflammatory bowel disease: A review.

Clinical manifestations of inflammatory bowel disease (IBD) are not locally restricted to the gastrointestinal tract, and a significant portion of patients have involvement of other organs and systems. The visual system is one of the most frequently affected, mainly by inflammatory disorders such as episcleritis, uveitis and scleritis. A critical review of available literature concerning ocular involvement in IBD, as it appears in PubMed, was performed. Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity when compared with other ocular EIMs. In IBD patients, anterior uveitis has an insidious onset, it is longstanding and bilateral, and not related to the intestinal disease activity. Systemic steroids or immunosuppressants may be necessary in severe ocular inflammation cases, and control of the underlying bowel disease is important to prevent recurrence. Our review revealed that ocular involvement is more prevalent in Crohn’s disease than ulcerative colitis, in active IBD, mainly in the presence of other EIMs. The ophthalmic symptoms in IBD are mainly non-specific and their relevance may not be recognized by the clinician; most ophthalmic manifestations are treatable, and resolve without sequel upon prompt treatment. A collaborative clinical care team for management of IBD that includes ophthalmologists is central for improvement of quality care for these patients, and it is also cost-effective.

THE CASE OF SEROUS MENINGITIS ROTAVIRUS ETIOLOGY IN A FOUR-YEAR-OLD CHILD

Rotavirus infection is manifested, in some cases, not only by damage to the gastrointestinal tract, but also by the involvement of other organs and systems in the pathological process. A clinical case of rotavirus meningitis in a four-year-old girl was confirmed, which was confirmed by the detection of RNA virus by PCR in сerebrospinal fluid, while the virus was detected in the faeces by ELISA.

Clinical and morphological characteristics and outcomes of tuberculosis process in patients suffered from HIV infection

The purpose of research is to perform an analysis of features of the clinical course of comorbidity tuberculosis + HIV infection and proximate causes of death of patients. In the article there was performed a comparative analysis of the clinical and radiological, bacteriological and morphological data of 74 deceased patients, divided into two groups: main (cases with the presence of co-infection: tuberculosis associated with HIV infection) and a comparison group (TB mono-infected persons).The performed analysis of the clinical course, the data of microbiological examination and radiographic findings in 74 of the dead patients allowed to reveal features of the course of tuberculosis in HIV infection cases at the IV stage: acute onset of illness, debilitating fever, full-blown bronchopulmonary syndrome and intoxication, massive bacterial excretion. In co-infection patients at the advanced stages with a significant decrease in the level of CD4+ lymphocytes there was no tendency to develop of tuberculous granuloma. The evolution of the process was characterized by the acute generalized by lymphatic/hematogenous and hematogenous dissemination with combined lesions of the internal organs (meninges, lungs, liver, spleen, adrenal glands, pancreas, heart, mesenteric lymph nodes). Tuberculosis granulomatous response as a mode of specific antituberculosis protection failed to develop, the changes were mostly exudative-necrotic inflammation in character due to the presence of immunodeficient state. At the same time in patients without HIV infection the process was classic in character: there were developed isolated lung lesions without the involvement of other organs. Morphological changes were presented by formed tuberculous granulomas with epithelioid cell infiltration and pronounced caseous necrosis. The cause of death in the study group patients was generalized tuberculosis with simultaneous defeat of several vital organs.