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Cholecystitis as the initial manifestation of disseminated cryptococcosis.

AIDS (Impact Factor: 6.56). 11/2007; 21(15):2111-2. DOI: 10.1097/QAD.0b013e32801424e3
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    • "Disseminated cryptococcosis in HIV patients can be an AIDS defining illness and can also present as disseminated cutaneous lesions [6] . There are some reports of rare manifestations of disseminated cryptococcosis in AIDS patients presenting as multifocal choroiditis [7] , cholecystitis [8] , co-infection with disseminated histoplasmosis [9] . Among HIV negative patients with disseminated disease, Cirrhosis was the most frequent predisposing condition and was associated with grave prognosis [10] . "
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    ABSTRACT: Objective: To study disseminated cryptococcal infection in a tertiary care hospital in Southern India. Methods: The clinical profile of 12 disseminated cryptococcosis patients with the age group of 28-52 years was retrospectively analyzed. Results: 7(58.3%) presented with fever < 30 days and 3(25%) > 30 days whereas 2(16.7%) did not have fever. All the 12(100%) had headache, 2(16.7%) had altered sensorium, one (8%) seizure. 5(41.7%) had diarrhea and vomiting. 6(50%) had oral candidiasis, and anemia. 9(75%) had elevated erythrocyte sedimentation rate (ESR). 6(50%) had neck stiffness. Cerebrospinal fluid (CSF) pressure was elevated in all 12(100%) patients. Blood culture positive for Cryptococcus neoformans(C. neoformans) in 11(91.7%) and CSF culture positive in all 12 (100%), one (8%) had urine culture positive. India ink preparation was positive in 10(83.3%). CD4 count was less than 50/microl in 4 (33.3%), between 50-100 in 6(50%) and 2(16.7%) in the range of 100-200. 6(50%) were treated with parenteral amphotericin B (0.7 mg/kg/d) during intensive phase followed by oral fluconazole 400 mg/d for 8 weeks then maintenance oral fluconazole 200 mg/d. 5(41.6%) were treated with fluconazole alone. 8(66.7%) improved and 4(33.3%) patients died. Among those who succumbed to the illness, 2(16.7%) received amphotericin and fluconazole, 2(16.7%) patients received fluconazole alone. Conclusions: Disseminated cryptococcosis can cause considerable mortality in HIV patients and immunocompromised non-HIV individuals. At times, its presentation closely mimics that of Tuberculosis. Early diagnosis and appropriate treatment should be started as early as possible.
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    ABSTRACT: Time change of water properties in the upper layer associated with development of the Halmahera eddy, and water mass front between the northern and southern hemispheres water in their confluence region are investigated using the TRITON buoy data and hydrographic survey in the western equatorial Pacific conducted by JAMSTEC and jointly with BPPT Indonesia. Observation period of TRITON buoy in the Halmahera eddy region (2°N, 130°E) is from October 2001 to November 2002, while two hydrographic surveys data carried out by the R/V MIRAI in October 2001 and July 2002 are used to complement the TRITON data. It is shown that the Southern Pacific Tropical Water (SPTW) with salinity above 35.0 psu and occupied between 22.5 and 26.0 sigma-theta was clearly observed almost during the observation period. However, an anomalous intrusion of the North Pacific Tropical Water (NPTW) with salinity less than 34.85 psu and centered at 23.5 sigma-theta into the SPTW's dominated region was found during October 2001. It is considered that during this period part of strong southward flowing of the Mindanao Current which supplied the NPTW was observed further to south of 2°N, as confirmed by hydrographic survey data. It is concluded that during this observation period the front between the southern and northern hemispheres water was taken place around 2°N. However, in summer monsoon (July 2002) when the northwestward flowing of the New Guinea Coastal Current and Undercurrent which supplied high salinity water of the SPTW were fully developed, the front was shifted to near 5°N. The variability of surface current, dynamic height, and 20°C isotherm depth from the TRITON buoy indicated the dominant oscillation around 35-65 days period which may link to the Halmahera eddy activities because the time series of salinity on the surface of 24.5 sigma-theta changed at the similar time period.
    OCEANS '04. MTTS/IEEE TECHNO-OCEAN '04; 12/2004
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    ABSTRACT: The ability of tumor necrosis factor (TNF)-alpha inhibitors to impair pivotal pro-inflammatory host defenses may facilitate the development of disseminated cryptococcosis. Gastrointestinal (GI) tract disease is an unusual presentation of this yeast infection. We describe a unique case of disseminated cryptococcosis presenting as colitis that mimicked an exacerbation of Crohn's disease in a TNF-alpha inhibitor recipient. Review of existing literature shows that in immunocompromised patients, GI cryptococcosis invariably coexists with disseminated cryptococcosis, often lacks prominent GI symptomatology, and is primarily diagnosed postmortem. In cases with opportunistic infections, discontinuation of TNF-alpha inhibitors is a common practice, however rapid rebound of inflammatory responses may incur the risk of immune reconstitution syndrome.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 09/2009; 14(5):e436-40. DOI:10.1016/j.ijid.2009.05.019 · 2.33 Impact Factor
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