结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

International Consensus Statement on an Update of the Classification Criteria for Definite Antiphospholipid Syndrome(APS)

Iconographies supplémentaires de l'article : Tuberculosis and diabetes mellitus: convergence of two epidemics

Outbreaks of disease attributable to human error or natural causes can provide unique opportunities to gain new information about host-pathogen interactions and new leads for pathogenesis research. Poststreptococcal glomerulonephritis (PSGN), a sequela of infection with pathogenic streptococci, is a common cause of preventable kidney disease worldwide. Although PSGN usually occurs after infection with group A streptococci, organisms of Lancefield group C and G also can be responsible. Despite decades of study, the molecular pathogenesis of PSGN is poorly understood. As a first step toward gaining new information about PSGN pathogenesis, we sequenced the genome of Streptococcus equi subsp. zooepidemicus strain MGCS10565, a group C organism that caused a very large and unusually severe epidemic of nephritis in Brazil. The genome is a circular chromosome of 2,024,171 bp. The genome shares extensive gene content, including many virulence factors, with genetically related group A streptococci, but unexpectedly lacks prophages. The genome contains many apparently foreign genes interspersed around the chromosome, consistent with the presence of a full array of genes required for natural competence. An inordinately large family of genes encodes secreted extracellular collagen-like proteins with multiple integrin-binding motifs. The absence of a gene related to speB rules out the long-held belief that streptococcal pyrogenic exotoxin B or antibodies reacting with it singularly cause PSGN. Many proteins previously implicated in GAS PSGN, such as streptokinase, are either highly divergent in strain MGCS10565 or are not more closely related between these species than to orthologs present in other streptococci that do not commonly cause PSGN. Our analysis provides a comparative genomics framework for renewed appraisal of molecular events underlying APSGN pathogenesis.

/pdf/genome-sequence-of-a-lancefield-group-c-streptococcus-ne0lv3lwd7.pdf

Genome Sequence of a Lancefield Group C Streptococcus zooepidemicus Strain Causing Epidemic Nephritis: New Information about an Old Disease

Diabetes mellitus (DM) is known as one of the factors that increases the risk of tuberculosis (TB). TB can also show atypical clinical presentation and localization in diabetics. The aim of the study was to evaluate the features of TB in diabetics in our region. Between 1997 and 2003, all cases of diabetic TB patients and an equal number of non-diabetics treated and followed at the Esrefpasa Tuberculosis Dispensary were analyzed retrospectively. A total of 78 (7.3%) TB cases in DM patients was encountered among 1,063 TB cases. Cavity formation and atypical localization were more often found in diabetics (P<0.05). Duration of treatment was longer in diabetics (P<0.05). The rate of drug resistance was higher in DM cases, but cure rates were similar between groups. A diagnosis of TB should be considered in diabetics with an abnormal chest radiograph, in the presence of absence of specific clinical symptoms, in endemic regions. Diabetic TB cases should be followed especially closely in terms of cure time and drug resistance.

Tuberculosis in diabetics: features in an endemic area.

Lower lung lobe tuberculosis is less common than the classical radiological forms of pulmonary tuberculosis. However this radiological presentation has a particular relevance in patients with some associated pathological conditions, such as diabetes mellitus, HIV infection and chronic alcoholism. We make a review of this entity in reference to an illustrative clinical case.

Lower lung field tuberculosis

A patient with sarcoidosis and antiphospholipid syndrome.

Objectives To report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone.Materials and methods: We describe a clinical case and present a review of the literature. Results A 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported. Conclusion Prosthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone. Learning points Brucella endocarditis is responsible for most fatal cases of brucellosis.Brucellosis relapse after treatment in patients with a cardiac valve prosthesis should arouse suspicion for endocarditis.Long-term medical treatment alone can be successful in selected patients with Brucella endocarditis, even in those with prosthetic valve endocarditis..

/pdf/successful-management-of-prosthetic-valve-brucella-4pn8gf61f3.pdf

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone.

Resumo A tuberculose do lobo pulmonar inferior e menos comum do que as apresentacoes radiologicas classicas da tuberculose pulmonar. Esta apresentacao radiologica assume particular relevância nos doentes com algumas comorbilidades, como a diabetes mellitus , a infeccao pelo VIH e o alcoolismo cronico. Fazemos uma revisao desta entidade a partir de um caso clinico ilustrativo. Rev Port Pneumol 2009; XV (1): 89-92

http://www.scielo.mec.pt/pdf/pne/v15n1/v15n1a08.pdf

Tuberculose do lobo pulmonar inferior

A 51-year-old man presented with a 3 month history of progressive right visual loss. On examination, the only abnormal findings were a right visual acuity of 4/10 and a swollen right optic disc. The patient had previously undergone MRI that had been reported as being normal and a trial of corticosteroids under the care of the referring ophthalmologist. An extensive battery of blood tests was normal apart from a rapid plasmatic reagin titre of 1:64. ELISA revealed elevated levels of total and immunoglobulin M antibodies against Treponema pallidum. Cerebrospinal fluid analysis revealed a mild leucocytosis and mildly elevated protein content. The patient was treated with a 5 week course of penicillin. Three months after starting treatment, his right visual acuity had improved to 8/10 and his right optic disc swelling had resolved.

/pdf/unilateral-swollen-optic-disc-do-not-forget-neurosyphilis-nb4y5lgrlv.pdf

Adelino Carragoso

Papers

Lower lung field tuberculosis

A patient with sarcoidosis and antiphospholipid syndrome.

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone.

Tuberculose do lobo pulmonar inferior

Unilateral swollen optic disc: do not forget neurosyphilis