The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Jul 2013
Case ReportsDrug-resistant tuberculosis treatment complicated by antiretroviral resistance in HIV coinfected patients: a report of six cases in Lesotho.
Treating drug-resistant tuberculosis (DR-TB) is particularly challenging in high human immunodeficiency virus (HIV) prevalence settings. Neither antiretroviral resistance testing nor viral load monitoring is widely available in sub-Saharan Africa, and antiretroviral resistance can complicate the clinical management for DR-TB/HIV coinfected patients. ⋯ Favorable DR-TB treatment outcomes in coinfected patients require successful management of their HIV infection, including treatment with an effective ART regimen. Coinfected patients undergoing DR-TB treatment may require closer monitoring of their response to ART, including routine viral load testing, to ensure that they receive an effective ART regimen concurrent with DR-TB treatment.
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A 53-year-old malnourished man, presented to the emergency room with 2 months of poor appetite, malaise, high spiking fevers, 10 Kg weight loss and night sweats; he also noted progressive exertional dyspnea and anterior chest pain developing over the last 2 days. On physical examination he was afebrile, had 90/60 arterial pressure, 100 × min heart rate, pulsus paradoxus, jugular vein engorgement, sudden inspiratory splitting of the second heart sound, and soft heart sounds on auscultation. A contrasted tomography of the thorax showed a large pericardial effusion with pericardial contrast enhancing and no pulmonary opacities. Histologic examination of pericardial tissue showed multinucleated giant cells with scarce acid-fast bacillae, and on pericardial culture grew Mycobacterium tuberculosis.
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Am. J. Trop. Med. Hyg. · Jul 2013
Case ReportsRare case of disseminated cysticercosis and taeniasis in a Japanese traveler after returning from India.
We report disseminated cysticercosis concurrent with taeniasis in a 31-year-old male Japanese, who had visited India three times and stayed for 1 month each time during the previous 1 year. The patient presented increasing numbers of subcutaneous nodules and expelled proglottids, although numerous cysts were also found in the brain in imaging findings, though no neurological symptoms were observed. Histopathological and serological findings strongly indicated cysticercosis. ⋯ We concluded that disseminated cysticercosis was caused by the secondary autoinfection with eggs released from the tapeworm carrier himself. After confirming the absence of adult worms in the intestine by copro-polymerase chain reaction, the patient was successfully treated with albendazole at a dose of 15 mg/kg/day for 28 days. Subcutaneous and intracranial lesions had completely disappeared by the end of the treatment period.