Archive | April 2010

Pulmonary cryptococcosis and Cryptococcus gattii

Etiology:

The fungus Cryptococcus gattii, contracted through inhalation of spores.

Commonly grows in tropical and subtropical climes, yet has appeared in  British Columbia, Canada and the Pacific Northwest as the climate warms.

Manifestations:

  1. Pulmonary cryptococcosis
  2. basal meningitis,
  3. cerebral cryptococcomas
  4. skin, soft tissue, lymph node, bone, and joint infections

Symptoms:

  • Prolonged cough (lasting weeks or months)
  • Sputum production
  • Sharp chest pain
  • Shortness of breath
  • Sinusitis (cottony drainage, soreness, pressure)
  • Severe headache (meningitis, encephalitis, meningoencephalitis)
  • Stiff neck (prolonged and severe nuchal rigidity)
  • Muscle soreness (mild to severe, local or diffuse)
  • Photophobia (excessive sensitivity to light)
  • Blurred or double vision
  • Eye irritation ( soreness, redness)
  • Focal neurological deficits
  • Fever (delirium, hallucinations)
  • Confusion (abnormal behavior changes, inappropriate mood swings)
  • Seizures
  • Dizziness
  • night sweats
  • Weight loss
  • Nausea (with or without vomiting)
  • Skin lesions (rashes, scaling, plaques, papules, nodules, blisters, subcutaneous tumors or ulcers)
  • Lethargy
  • Apathy

Treatment:

antimicrobials:

  1. the anti-fungal drug Amphotericin B in conjunction with IV or oral Flucytosine
  2. followed by oral Fluconazole for 6 months
  3. surgical excision of walled off sporomas in the lungs (may be mistaken for lung cancer on X-ray).

A) Chest radiograph and B) computed tomography scan of the patient showing 3 nodular Cryptococcus gattii infiltrates near pleura.

Figure retrieved from: http://images.google.ca/imgres?imgurl=http://www.cdc.gov/ncidod/EID/13/1/images/06-0945_b.jpg&imgrefurl=http://www.cdc.gov/ncidod/EID/13/1/178-G.htm&usg=__zwXn6_afr3ZwCP3kQHKddxwDIbU=&h=285&w=600&sz=26&hl=en&start=16&um=1&itbs=1&tbnid=CK9QajTlLYpAqM:&tbnh=64&tbnw=135&prev=/images%3Fq%3Dcryptococcus%2Bgattii%26um%3D1%26hl%3Den%26sa%3DN%26tbs%3Disch:1

Septotomy

incision into an anatomical partitions (a septum) to create passage between two adjacent cavities.

eg. atrial septotomy

procedure to allow oxygenated and non oxygenated blood mix in the heart atria to temporarily improve blood oxygen levels prior to repair of congenital pulmonary artery and vein heart defect  (oxygenated blood is not properly circulated past the lungs).

during heart surgery the septotomy will be repaired after the blood vessels are surgically placed in their correct anatomical positions.

below: a congenital septal defect.

Pulmonary artery banding

used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects.

objective:

reduce excessive pulmonary blood flow and protect the pulmonary vasculature from hypertrophy and irreversible pulmonary hypertension.

Binswanger’s disease or Binswager’s Dementia

a form of multi-infarct dementia caused by damage to the white brain matter.

Etiology:

White matter atrophy can be caused by:

  • chronic HTN
  • the aging process

Manifestations:

loss of memory and intellectual function ( collectively known as executive brain functioning)

changes in mood.

Normal Pressure Hydrocephalus (NPH)

A specific form of hydrocephalus in which the central cavities of the inner brain (the ventricles) enlarge at the expense of the substance of the brain, while the pressure of the CSF remains within normal range.

Etiology:

accumulation of excess of cerebrospinal fluid in the brain.

Manifestations:

neurologic symptoms

  1. dementia
  2. loss of bladder control
  3. difficulty walking

Treatment:

placement of a shunt to relieve excess fluid and decrease intra-cranial pressure.

Wilson’s Disease or Hepatolenticular degeneration

Etiology: 

a rare inherited disorder of copper metabolism.

copper accumulates in the liver and then in the red blood cells and in tissues;

Manifestations:

neurological or psychiatric symptoms and liver disease.

Treatment and Management:

  1. decrease dietary copper intake: low-containing foods such as mushrooms, nuts, chocolate, dried fruit, liver, and shellfish is recommended.
  2. increase the excretion of copper in urine and feces.

Agnosia

Inability to recognize objects by use of the senses (athough the sensory mechanism is intact).

A loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss.