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Sample records for system paracoccidioidomycosis case

  1. Central nervous system paracoccidioidomycosis in an AIDS patient: case report.

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    Silva-Vergara, Mario León; Rocha, Ivonete Helena; Vasconcelos, Rakel Rocha; Maltos, André Luiz; Neves, Fernando de Freitas; Teixeira, Luciana de Almeida Silva; Mora, Delio José

    2014-02-01

    Up to now, over 200 patients with paracoccidioidomycosis (PCM) associated to HIV infection have already been reported; however, the central nervous system involvement in this coinfection was rarely reported. This paper presents a 35-year-old Brazilian male AIDS patient who developed pulmonary PCM successfully treated with itraconazole. At the antiretroviral therapy starting, he had 32 CD4(+) T cells baseline count and high viral load levels. After 9 months, he presented severe fungal meningoencephalitis diagnosed by sublenticular enhanced nodular lesion at computerized tomography and magnetic resonance brain imaging and a positive Paracoccidiodes brasiliensis smear and culture from cerebrospinal fluid. At the time, a sixfold increase in CD4(+) T cell count and undetectable viral load level were evidenced. The patient received amphotericin B during 1 year presenting slow but progressive clinical improvement, and he is currently asymptomatic and without neurological disabilities. To our knowledge, this is the second case report of a patient with neuroparacoccidioidomycosis associated to HIV infection.

  2. Paracoccidioidomycosis case series with and without central nervous system involvement

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    Vinicius Sousa Pietra Pedroso

    2012-10-01

    Full Text Available INTRODUCTION: Paracoccidioidomycosis (PCM is the most important systemic mycosis in South America. Central nervous system involvement is potentially fatal and can occur in 12.5% of cases. This paper aims to contribute to the literature describing eight cases of neuroparacoccidioidomycosis (NPMC and compare their characteristics with patients without neurological involvement, to identify unique characteristics of NPCM. METHODS: A cohort of 213 PCM cases was evaluated at the Infectious Diseases Clinic of the University Hospital, Federal University of Minas Gerais, Brazil, from October 1976 to August 2008. Epidemiological, clinical, laboratory, therapeutic and follow-up data were registered. RESULTS: Eight patients presented NPCM. The observed NPCM prevalence was 3.8%. One patient presented the subacute form of PCM and the other seven presented the chronic form of the disease. The parenchymatous form of NPCM occurred in all patients. 60% of the patients who proceeded from the north/ northeast region of Minas Gerais State developed NPCM. The neurological involvement of a mother and her son was observed. NPCM patients exhibited demographical and clinical profiles similar to what is described in the literature. When NPCM cases were compared to PCM patients, there were differences in relation to origin and positive PCM family history. CONCLUSIONS: The results corroborate the clinical view that the neurological findings are extremely important in the evaluation of PCM patients. Despite the limitations of this study, the differences in relation to patient's origins and family history point to the need of further studies to determine the susceptibility factors involved in the neurological compromise.

  3. Isolated adrenal paracoccidioidomycosis: Case report

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    Uribe Castro, Jorge Ricardo; Quintana, Humberto; Puentes, Alix Sofia and others

    2011-01-01

    Even though paracoccidioidomycosis has a relatively high prevalence in Latin America in a systemic form, isolated cases, especially compromising the adrenal glands, are uncommon, with only two reported cases. In this article, we report the case of a 55 year-old male with clinical manifestations of adrenal insufficiency. The only imaging finding was the presence of bilateral adrenal masses. The biopsy showed Paracoccidioides brasiliensis infection.

  4. Paracoccidioidomycosis.

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    Marques, Sílvio Alencar

    2012-01-01

    Paracoccidioidomycosis is an endemic systemic mycosis that predominates in southern Mexico, parts of Central America, and South America. It is caused by a dimorphic fungus and is generally acquired through the lungs, from where it disseminates. Paracoccidioidomycosis has different clinical manifestations that require differentiation with tuberculosis, Hodgkin disease, several systemic and subcutaneous mycoses, and squamous cell carcinoma. Diagnosis is made by finding the organism in a biopsy specimen and isolating it in fungal culture. Treatment includes sulfamethoxazole-trimethoprim for mild forms and itraconazole for moderate cases. Fluconazole and voriconazole can be used for meningeal involvement, and amphotericin B is indicated for severe disease. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. [Paracoccidioidomycosis in pediatric patients: a description of 4 cases].

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    Taicz, Moira; Rosanova, Maria Teresa; Bes, David; Lisdero, Maria Laura; Iglesias, Viviana; Santos, Patricia; Berberian, Griselda

    2014-01-01

    Paracoccidioidomycosis is the most frequent systemic mycosis in Latin America, caused by the dimorphic fungus Paracoccidioides. Paracoccidioidomycosis in children is uncommon. Our aim is to describe clinical features of patients who had a confirmed diagnosis of paracoccidioidomycosis in our hospital in the last 10 years. We describe 4 cases of paracoccidioidomycosis in previously healthy children from the north of our country. Diagnoses were made by biopsy or culture. The diagnosis of paracoccidioidomycosis should be considered in a patient coming from regions where Paracoccidioides is endemic, and presenting with a lymphoproliferative syndrome, anemia, eosinophilia and hypergammaglobulinemia. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  6. Pancreatic paracoccidioidomycosis simulating malignant neoplasia: case report.

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    Lima, Talles Bazeia; Domingues, Maria Aparecida Custódio; Caramori, Carlos Antonio; Silva, Giovanni Faria; de Oliveira, Cássio Vieira; Yamashiro, Fábio da Silva; Franzoni, Letícia de Campos; Sassaki, Lígia Yukie; Romeiro, Fernando Gomes

    2013-09-14

    Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus, and must be considered in the differential diagnosis of intra-abdominal tumors in endemic areas. We report a rare case of paracoccidioidomycosis in the pancreas. A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related, with night sweating, inappetence, weight loss, jaundice, pruritus, choluria, and acholic feces, without signs of sepsis or palpable tumors. Abdominal ultrasonography (US) showed a solid mass of approximately 7 cm × 5.5 cm on the pancreas head. Abdominal computerized tomography showed dilation of the biliary tract, an enlarged pancreas (up to 4.5 in the head region), with dilation of the major pancreatic duct. The patient underwent exploratory laparotomy, and the surgical description consisted of a tumor, measuring 7 to 8 cm with a poorly-defined margin, adhering to posterior planes and mesenteric vessels, showing an enlarged bile duct. External drainage of the biliary tract, Roux-en-Y gastroenteroanastomosis, lymph node excision, and biopsies were performed, but malignant neoplasia was not found. Microscopic analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph node. Acid-alcohol resistant bacillus and fungus screening were negative. Fine-needle aspiration of the pancreas was performed under US guidance. The smear was compatible with infection by Paracoccidioides brasiliensis. We report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.

  7. Photodynamic inactivation of oral paracoccidioidomycosis affecting woman with systemic lupus erythematosus: An unusual case report.

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    Ribeiro, Cínthia Magalhães; Caixeta, Clenivaldo Alves; de Carli, Marina Lara; Sperandio, Felipe Fornias; de Sá Magalhães, Evandro Monteiro; Costa Pereira, Alessandro Antônio; Costa Hanemann, João Adolfo

    2017-03-01

    Paracoccidioidomycosis (PCM) is a systemic disease caused by the dimorphic fungus Paracocdioides brasiliensis. The infection primarily reaches the lungs by the inhalation of fungi spores and later can disseminate to other organs causing secondary oral lesions. Systemic lupus erythematosus (SLE), on the other hand, is an autoimmune chronic inflammatory disease that affects various organ systems, including skin and oral cavity. Here we report a 39-year-old female patient bearing SLE and presenting an ulcerated lesion on the hard palate extending to the superior alveolar ridge, diagnosed as PCM. Itraconazole 200mg was prescribed and photodynamic therapy (PDT) was also instituted in a way to help dealing with the PCM infection while assisting such an immunocompromised patient to heal. PDT consisted of topically placing toluidine blue dye at 37.5mg/L for 5min, followed by low-level laser irradiation (660nm; 100J/cm 2 ; 40mW of power; 100s per point). Forty days after beginning the treatment, the patient showed total regression of the oral lesion and absence of painful symptoms. The serologic test was performed again after six months of therapy and was negative; the patient continues to be followed periodically. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Form spleenic cystic of systemic paracoccidioidomycosis - communication of inedit case; Forma cistica esplenica da paracoccidioidomicose sistemica - comunicacao de caso inedito

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    Trad, Clovis Simao [Sao Paulo Univ., Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias de Imagem e Fisica Medica; Feltrin, Leonir T. [Hospital das Clinicas de Ribeirao Preto, SP (Brazil). Servico de Radiologia; Ramalho, Leandra N. Zambelli [Hospital das Clinicas de Ribeirao Preto, SP (Brazil). Servico de Patologia; Araujo Filho, Antonio de Barros [Hospital das Clinicas de Ribeirao Preto, SP (Brazil). Dept. de Clinica Medica

    1999-04-01

    The authors describe a clinical case of a 30-year-old female, with a previous history of paracoccidioidomycosis, manifested by cutaneous lesions, adenomegaly and further spleen enlargement. During clinical-radiological follow-up, splenic cystic image with peripheral calcifications was detected, which after had been punctured, discovered fungus agents suggestive of Paracoccidioides brasiliensis. (author)

  9. Paracoccidioidomycosis

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    ... Abbreviations Weights & Measures ENGLISH View Professional English Deutsch Japanese Espaniol Find information on medical topics, symptoms, drugs, ... spleen enlarge, and anemia develops. Diagnosis Examination and culture of samples of infected tissue Doctors suspect paracoccidioidomycosis ...

  10. Paracoccidioidomicose do sistema nervoso central: análise de 13 casos Central nervous system paracoccidioidomycosis: analysis os 13 cases

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    Walter J. Fagundes-Pereyra

    2006-06-01

    Full Text Available A paracoccidioidomicose (PCM é infecção granulomatosa sistêmica, causada pelo fungo Paracoccidioides brasiliensis, prevalente na América Latina, particularmente no Brasil. Acomete o sistema nervoso central (SNC em 10% dos casos. Foram estudados 13 pacientes com paracoccidioidomicose no SNC, entre 1991 e 2001, com ênfase para os aspectos clínicos, neuroradiológicos e terapêuticos. Onze pacientes eram do sexo masculino (84,6% e dois do feminino (15,4%, com idade entre 30 e 71 anos (M= 47,1 ± 11,6 Me= 46. Os sintomas mais freqüentes foram déficits motores (53,8%, alterações cognitivas (53,8%, emagrecimento (46,1%, cefaléia (46,1% e crises convulsivas (46,1%. O diagnóstico foi confirmado pela detecção do P. brasiliensis no SNC. Todos os pacientes apresentavam a forma granulomatosa e quatro (30,8% tinham a forma meningoencefalítica associada. Todos foram estudados com tomografia computadorizada (TC de crânio e um caso com ressonância magnética (RM encefálica. Dez pacientes (76,9% realizaram sorologia para o HIV, todos com resultados negativos. A anfotericina B foi utilizada em 12 casos (92,3%, em um deles por via intratecal. Em oito casos (61,5% o sulfametoxazol-trimetropim foi utilizado; em dois (15,4% a sulfadiazina e pirimetamina, e o fluconazol, cetoconazol e itraconazol, cada um deles em um paciente. Seis pacientes (46,1% morreram e sete evoluíram satisfatoriamente. O tempo de seguimento variou de 2 a 74 meses (M=30,9. Conclui-se que as manifestações clínicas assim como os exames de imagem na PCM do SNC são inespecíficos.Paracoccidioidomycosis (PCM is a systemic granulomatous disease caused by Paracoccidioides brasiliensis, prevalent in Latin America, particularly in Brazil. Central nervous system (CNS involvement occur in about 10% of cases. Thirteen patients with PCM involving CNS were studied considering clinical manifestation, neuroradiology and treatment modalities. Age ranged from 30 to 71 years-old (M= 47.1

  11. Head and neck manifestations of paracoccidioidomycosis: an epidemiological study of 36 cases in Brazil.

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    Girardi, F M; Scroferneker, M L; Gava, V; Pruinelli, R

    2012-03-01

    Paracoccidioidomycosis is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis. It is the principal systemic mycosis in Brazil, with higher incidence rates in the southern, southeastern, and midwestern regions. It primarily involves the lungs, but head and neck manifestations are common, and differential diagnosis with granulomatous and neoplastic diseases should therefore be considered. We conducted a retrospective analysis of medical records of paracoccidioidomycosis cases with head and neck manifestations in southern Brazil over a 10-year period, from 1998 to 2008. A total of 36 cases of paracoccidioidomycosis were confirmed by histopathological examination, fungal investigation, or culture. Most cases consisted of men with smoking and/or chronic drinking habits and with poor hygiene and nutrition. Paracoccidioidomycosis is endemic to southern Brazil. Most cases with mucocutaneous manifestations affect the head and neck region. Given that risk factors and clinical manifestations are similar to those of head and neck carcinomas, a differential diagnosis has to be done.

  12. Complex nasal reconstruction after paracoccidioidomycosis infection - Case report*

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    Ribeiro, Emilie Barreto; de Pochat, Victor Diniz; de Magaldi, Eduarda Nilo; Figueiredo, Bruno Suffredini; Alonso, Nivaldo; Meneses, José Valber de Lima

    2015-01-01

    Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles. PMID:26312717

  13. Complex nasal reconstruction after paracoccidioidomycosis infection--Case report.

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    Ribeiro, Emilie Barreto; Pochat, Victor Diniz de; Magaldi, Eduarda Nilo de; Figueiredo, Bruno Suffredini; Alonso, Nivaldo; Meneses, José Valber de Lima

    2015-01-01

    Paracoccidioidomycosis is an infectious disease whose etiological agent belongs to the Paracoccidioides genus. Although it affects primarily the lungs, it can spread to other tissues, including the skin and mucous membranes. Despite the clinical treatment for this disease, scarring can produce sequelae, manifesting as anatomical and functional deformities of the face. We present a case of extensive, nasal unaesthetic and functional sequelae resulting from paracoccidioidomycosis, reconstructed using the paramedian forehead flap in three stages, through the regional unit principles.

  14. Paracoccidioidomycosis of external genitalia: report of six new cases and review of the literature.

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    Marques, Silvio Alencar; Tangoda, Lilian Kanawa; Camargo, Rosangela Maria Pires de; Stolf, Hamilton Ometto; Marques, Mariangela Esther Alencar

    2012-01-01

    Paracoccidioidomycosis is a systemic mycosis of dermatological interest due to the frequency of cutaneous and mucosal lesions. The involvement of the external genitalia is extremely rare and few cases have been reported. To study the prevalence of external genitalia lesions in paracoccidioidomycosis patients, identify clinical characteristics and compare with what is observed in the specific literature. This is a cross-sectional, descriptive study, with focus on paracoccidioiodomycosis patients with external genitalia lesions. The demographic and clinical aspects of cases were compared with what has been reported so far on LILACS, SciELO e MEDLINE data bases. Data of 483 cases of paracoccidioidomycosis were studied in a 42-year period. Six (1.2%) patients showed specific lesions on external genitalia. Five patients were male with mean age of 47.2 years and all of them presented with the chronic multifocal clinical form. Only one, a 15-year-old female patient was observed who showed a subacute clinical form, juvenile type. Compromise of the genitourinary tract among paracoccidioidomycosis patients is rare and even rarer when only the external genitalia are considered. As observed in the classical picture of paracoccidioidomycosis patients, the male gender and the chronic multifocal clinical form prevailed in the present study.

  15. A CASE REPORT OF INTRASPINAL PARACOCCIDIOIDOMYCOSIS

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    Antonio Carlos Francesconi do Valle

    1998-05-01

    Full Text Available The authors report a case of paraplegia caused by a lumbar intraspinal paracoccidioidomycosis (PCM granuloma. Clinical neurological diagnosis of a compressive spinal cord lesion was confirmed by spinal magnetic resonance imaging (MRI. Patient was submitted to surgery with total excision of the lesion. Histopathological analysis confirmed the diagnosis of PCM. Patient is on sulfamethoxazole/trimethoprim combined with fluconazole and is experiencing positive neurological recovery.Registro de um caso de paracoccidioidomicose intra-medular. Os autores registram um caso de paraplegia causada por uma lesão granulomatosa de PCM intramedular. O diagnóstico clínico neurológico de uma lesão compressiva intramedular foi confirmado pelo exame de ressonância nuclear magnética da coluna, que mostrou lesão captante de contraste a nível de T12. O paciente foi operado e a lesão totalmente retirada. O exame histopatológico da peça operatória confirmou o diagnóstico de PCM. O doente está em uso de SMZ/TMP e fluconazol com boa recuperação neurológica.

  16. Disseminated Paracoccidioidomycosis juvenile type with intestinal compromise. Case report

    International Nuclear Information System (INIS)

    Bedoya, Ana M; Velez, Alejandro; Tobon, Angela M; Juliao, Fabian; Ruiz, Mario; Arango, Myrtha; Restrepo, Angela

    2002-01-01

    We present a case of juvenile paracoccidioidomycosis in a man of 24 years of age with a clinical case of four months evolution of abdominal pain associated with diarrhea and weight loss. Retroperitoneal adenopathies. Ileus, colon and cervical ganglia biopsies revealed multibudding Paracoccidiodes brasiliensis yeasts. Serum tests supported this diagnosis

  17. DIFFERENTIAL DIAGNOSIS OF CUTANEOUS LEISHMANIAS IS AND PARACOCCIDIOIDOMYCOSIS: CASE REPORT

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    Thaísa da Silva Vieira

    2017-01-01

    Full Text Available The polymorphism of the clinical presentation of paracoccidioidomycosis allows it to be included in the differential diagnosis of various clinical conditions, including cutaneous leishmaniasis. This study aims to discuss the difficulty of establishing the differential diagnosis between paracoccidioidomycosis and american cutaneous leishmaniasis in the case of patients from rural areas with chronic ulcerative lesion in the oral and nasal mucosa. This is a case report of an adult patient, coming from rural Itagi, Bahia, admitted to the public Hospital Prado Valadares (HGPV, in Jequié-BA. Thus, the case report aims to contribute to the medical and scientific community in the description of the clinical aspects of the lesions for the early diagnosis and prevention of the impacts of disabilities and injuries

  18. Cytological diagnosis of paracoccidioidomycosis: a report of four cases.

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    de Souza Vianna, Leonora Maciel; Pirani Carneiro, Fabiana; Calvalca Tavares, Alexandre; Soares Takano, Gustavo Henrique; Silva Guerra, Eliete Neves; de Melo, Nilce Santos

    2013-04-01

    Paracoccidioidomycosis (PCM) is a common deep mycosis in South America caused by Paracoccidioides brasiliensis, a dimorphic fungus. Biopsy is the most frequent diagnostic method. The aim of this article is reporting four cases of PCM, in which intraoral involvement simulated squamous-cell carcinoma and was diagnosed by exfoliative cytology. We highlight this diagnostic tool as a simple, low cost, painless, noninvasive, and fast diagnostic method for PCM. Copyright © 2012 Wiley Periodicals, Inc.

  19. Single oral paracoccidioidomycosis mimicking other lesions: report of eight cases.

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    de Oliveira Gondak, Rogério; Mariano, Fernanda Viviane; dos Santos Silva, Alan Roger; Vargas, Pablo Agustin; Lopes, Márcio Ajudarte

    2012-01-01

    Paracoccidioidomycosis is a fungal infection caused by Paracoccidioides brasiliensis. It is an endemic disease, representing a serious health problem in Latin American countries. This infection primarily affects the lungs and is acquired by inhalation of the fungus. It can spread to other organs and tissues, mainly the oral cavity affecting more adult men from 30 to 50 years of age. On clinical presentation, several signs associated with impaired general and nutritional conditions can be noted. Oral manifestation is more common in the soft palate, gingiva, lower lip, buccal mucosa, and tongue. The classical clinical presentation is a superficial ulcer with granular appearance and hemorrhagic points. Usually, the oral lesion is extensive and generalized. Although uncommon, when the oral manifestation is single, others lesions, particularly squamous cell carcinoma, must be included in the differential diagnosis. In this article, the authors discuss the unusual presentation of eight cases of single oral paracoccidioidomycosis and its diagnostic importance.

  20. Pulmonary paracoccidioidomycosis.

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    Queiroz-Telles, Flavio; Escuissato, Dante L

    2011-12-01

    Paracoccidioidomycosis is a subacute or chronic systemic mycosis caused by Paracoccidioides brasiliensis, a soil saprophyte and thermally dimorphic fungus. The disease occurs mainly in rural workers in Latin America and is the most frequent endemic systemic mycosis in many countries of South America, where almost 10 million people are believed to be infected. Paracoccidioidomycosis should be regarded as a disease of travelers outside the endemic area. The primary pulmonary infection is subclinical in most cases, and individuals may remain infected throughout life without ever developing clinical signs. A small proportion of patients present with clinical disease. The lungs are frequently involved, and the pulmonary clinical manifestations must be differentiated from many other infectious and noninfectious conditions. Diagnosis should be based on epidemiological, clinical, and microbiological data. Effective treatment regimens are available to control the fungal infection, but most patients develop fibrotic sequelae that may severely hamper respiratory and adrenal function and the patient's well-being. © Thieme Medical Publishers.

  1. A case of paracoccidioidomycosis due to Paracoccidioides lutzii presenting sarcoid-like form

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    Luiza Sarmento Tatagiba

    2018-03-01

    Full Text Available Paracoccidioidomycosis (PCM is a fungal disease caused by Paracoccidioides spp., which can cause a systemic granulomatous infection with tegumentary and visceral involvement. Sarcoid-like skin lesions are uncommon and can be misdiagnosed due to similarities with other granulomatous diseases. We report a case of a women presenting with erythematous infiltrated plaques on her face that was treated for leprosy and rosacea with no response and was later diagnosed with PCM, presenting positive serology for Paracoccidioides lutzii.

  2. Unusual Otolaryngologic Manifestations of Paracoccidioidomycosis: A Case Report and Review of Literature.

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    Lucinda, Lucas Resende; Polanski, José Fernando

    2017-05-01

    AbstractParacoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis . It occurs more frequently in its chronic form, which particularly affects male adults from rural areas. These patients present with pulmonary involvement and systemic symptoms. Skin and mucosal lesions are rather typical and might suggest the diagnosis. The involvement of the upper airway mucosa is common and the patients usually complain of dysphagia and dysphonia. Nonetheless, in endemic areas, physicians should maintain a high level of suspicion even when faced with some atypical symptoms. We present the case of an adult diagnosed with nasopharyngeal paracoccidioidomycosis after presenting with an unusual otolaryngologic syndrome including unilateral soft palate paralysis with velopharyngeal insufficiency and hearing loss secondary to middle ear effusion.

  3. Meningite paracoccidioidomicótica: relato de caso Paracoccidioidomycosis meningitis: case report

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    Paulo José Lorenzoni

    2002-12-01

    Full Text Available O envolvimento do sistema nervoso central na paracoccidioidomicose tem sido pouco descrito na literatura, sendo rara sua apresentação sob a forma meníngea. Descreve-se o caso de um paciente de 23 anos que desenvolveu meningite paracoccidioidomicótica comprovada pela positividade do fungo na pesquisa direta e cultura do líquido cefaloraquidiano. Discute-se a apresentação da forma meníngea da paracoccidioidomicose, seu diagnóstico laboratorial e neurorradiológico. Destaca-se a importância da investigação rotineira do fungo.The involvement of the central nervous system in paracoccidioidomycosis and its meningeal form of clinical presentation have rarely been described. This is a case report of a 23 years old man who developed paracoccidioidomycosis meningitis achieved by fungus' presence in direct research and culture of cerebrospinal fluid. The meningeal form of paracoccidioidomycosis, its laboratorial and imaging diagnostic are discussed, and the importance of the routine investigation of the fungus is emphasized.

  4. Bone paracoccidioidomycosis associated with acquired immunodeficiency syndrome: evaluation by radiological methods - a case report; Paracoccidioidomicose ossea associada a sindrome da imunodeficiencia adquirida - relato de um caso

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    Maeda, Lucimara; Hara, Monica Hiromi; Sabedotti, Ismail Fernando; Montandon, Cristiano; Torriani, Martin; Nanni, Livio [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Radiologia

    1999-03-01

    Paracoccidioidomycosis is a chronic granulomatous disease, caused by the Paracoccidioides brasiliensis fungus. This disease involves primarily the lungs, although disseminated forms may occur. Bone involvement is rare, and is associated to systemic disease or may present as a focal lesion. An association between paracoccidioidomycosis and the acquired immunodeficiency syndrome (AIDS) was first established in 1989. There are only a few reports on this association, and none of them was the fungus isolated from bone lesions. This is the first case report on the paracoccidioidomycosis-AIDS association in which bone lesions demonstrated infection by P. brasiliensis. The authors propose the inclusion of paracoccidioidomycosis in the differential diagnosis of lytic bone lesions in patients with AIDS and discuss the role of radiological diagnostic in this case. (author)

  5. HIV Immune Recovery Inflammatory Syndrome and Central Nervous System Paracoccidioidomycosis.

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    de Almeida, Sérgio Monteiro; Roza, Thiago Henrique

    2017-04-01

    The immune reconstitution inflammatory syndrome (IRIS) is a deregulated inflammatory response to invading microorganisms. It is manifested when there is an abrupt change in host immunity from an anti-inflammatory and immunosuppressive state to a pro-inflammatory state as a result of rapid depletion or removal of factors that promote immune suppression or inhibition of inflammation. The aim of this paper is to discuss and re-interpret the possibility of association of paracoccidioidomycosis (PCM) with IRIS in the central nervous system (CNS) in a case from Brazil published by Silva-Vergara ML. et al. (Mycopathologia 177:137-141, 6). An AIDS patient who was not receiving medical care developed pulmonary PCM successfully treated with itraconazole. The patient developed central nervous system PCM (NPCM) after starting the ARV therapy with recovery of immunity and control of HIV viral load, although it was not interpreted as IRIS by the authors, it fulfills the criteria for CNS IRIS. This could be the first case of NPCM associated with IRIS described. Although not frequent, IRIS must be considered in PCM patients and HIV, from endemic areas or patients that traveled to endemic areas, receiving ARV treatment and with worsening symptoms.

  6. PARACOCCIDIOIDOMYCOSIS AND AIDS: REPORT OF THE FIRST TWO COLOMBIAN CASES

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    Angela M. TOBON

    1998-11-01

    Full Text Available The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients´ improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.Relato dos dois primeiros casos de pacientes colombianos com AIDS e paracoccidioidomicose. Os pacientes, ambos masculinos, não tinham conhecimento do fator de risco por HIV, embora tivessem no passado trabalhado no campo onde poderíam ter sido infectados por fungos. Eles tiveram o tipo juvenil da doença em vários orgãos com sintomas de curta duração. Eles estavam profundamente

  7. Paracoccidioidomycosis of the central nervous system: CT findings

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    Rodacki, M.A. [Section of Neuroradiology, Service of Radiology, Sta Isabel Hospital, Sta Catarina (Brazil); Toni, G. de [University Hospital, Medical School of Curitiba, Parana (Brazil); Borba, L.A. [Division of Neurosurgery, Sta Isabel Hospital, Blumenau, Sta Catarina (Brazil); Oliveira, G.G. [Division of Pathology, Sta Isabel Hospital, Blumenau, Sta Catarina (Brazil)

    1995-11-01

    A retrospective analisis of six cases of central nervous system paracoccidioidomycosis, all but one proven by biopsy and surgery, was carried out to study the CT and clinical data and pathological correlation. Most of the patients were from the country. Headache, vomiting, seizures and hemiparesis were the most frequent symptoms. Papilloedema was present in four patients with raised intracranial pressure. Five patients had chronic lung disease and two with advanced systemic disease, skin and mucous membrane lesions were also observed. The neurological disturbance was sometimes the presenting features and the diagnosis was discovered incidentally after surgery. Both solitary and multiple parenchymal lesions were observed and the cerebral hemispheres were more commonly involved in four patients. Local meningeal involvement was observed in one with a single cortical granuloma. We enphasise the usefulness of CT, showing a rounded or lobulated mass with an isodense or radiolucent centre after contrast enhancement, surrounded by an irregular wall of varying thickness. There was always moderate oedema, extending peripherally. Other infections or neoplastic diseases may present similar findings. Preoperative diagnosis should rest on integration of clinical data, chest films, laboratory and neuroimaging studies. (orig.). With 4 figs., 2 tabs.

  8. Disseminated paracoccidioidomycosis with peripleuritis in an AIDS patient

    OpenAIRE

    Corti,Marcelo; Villafañe,María F.; Negroni,Ricardo; Palmieri,Omar

    2004-01-01

    Paracoccidioidomycosis is one of the most frequent systemic and endemic mycoses of Latin America caused by a dimorphic fungus. In AIDS patients, paracoccidioidomycosis appears as a severe and disseminated disease with a wide spectrum of clinical findings. The CD4 counts are usually less than 200 cell/mu L. We present a case of disseminated paracoccidioidomycosis with peripleuritis and subcutaneous abscesses on the chest wall as initial manifestation of AIDS. In endemic countries, paracoccidio...

  9. Paracoccidioidomycosis in the spine: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    José Alexandre Lopes da Silva Alvarenga

    Full Text Available ABSTRACT: CONTEXT: Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare. CASE REPORT: We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms. CONCLUSION: Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.

  10. Paracoccidioidomycosis in the spine: case report and review of the literature.

    Science.gov (United States)

    Alvarenga, José Alexandre Lopes da Silva; Martins, Délio Eulálio; Kanas, Michel; Elizeche, Hugo Gustavo Kunzle; Dell'Aquila, Adriana Macêdo; Fernandes, Eloy De Avila; Wajchenberg, Marcelo; Puertas, Eduardo Barros

    2016-01-01

    Paracoccidioidomycosis is a systemic form of mycosis that spreads hematogenously, secondarily to reactivation of lung infection or infection at another site or to new exposure to the causative agent. Few cases of bone involvement have been reported in the literature and involvement of the spine is extremely rare. We describe a case of a 68-year-old male patient with spondylodiscitis at the levels L4-L5 caused by presence of the fungus Paracoccidioides brasiliensis, which was diagnosed through percutaneous biopsy. The patient was treated with sulfamethoxazole and trimethoprim for 36 months, with complete resolution of the symptoms. Spondylodiscitis caused by the fungus Paracoccidioides brasiliensis is uncommon. However, in patients with chronic low-back pain who live or used to live in endemic regions, this infection should be considered as a possible differential diagnosis.

  11. [Paracoccidioidomycosis of the external ear].

    Science.gov (United States)

    Sambourg, E; Demar, M; Simon, S; Blanchet, D; Dufour, J; Sainte-Marie, D; Fior, A; Carme, B; Aznar, C; Couppié, P

    2014-01-01

    Paracoccidioidomycosis is a systemic fungal infection common in Latin America. Cutaneous involvement is frequent and usually affects multiple sites, being most frequently associated with lesions of the oropharyngeal mucosa. The cutaneous form on its own is rare. We report a case of paracoccidioidomycosis isolated from the ear of a 43-year-old immunocompetent man. The lesion consisted of a partially ulcerated plaque on the auricle of the left ear. Direct examination, histopathological examination and PCR revealed the presence in the skin lesion of yeasts identified as Paracoccidioides brasiliensis. The sites of paracoccidioidomycosis on the ear can be confused with other tropical diseases frequently found in the Amazon region such as leishmaniasis, leprosy and lobomycosis. The absence of any other cutaneous sites in this case raised the question of whether the lesion was of primary or secondary origin. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Pulmonary paracoccidioidomycosis: A case report with high-resolution computed tomography findings

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    M. Armas

    2012-07-01

    Full Text Available Paracoccidioidomycosis is a systemic mycosis which is endemic in rural areas of Latin America, an important European source of immigrants and a growing European touristic destination as well, with most cases occurring in Brazil, Argentina, Venezuela and Colombia. The authors report a case of a 43-year-old man who previously worked in Venezuela and is living in Portugal for 8 years, presenting with a single cutaneous lesion. Despite the absence of valuable respiratory complaints, severe lung damage was found with high-resolution computed tomography (HRCT. Biopsy of the cutaneous lesion and mycologic sputum examination were performed revealing Paracoccidioides brasiliensis infection. Resumo: A Paracoccidioidomicose é uma micose sistémica endémica nas áreas rurais da América Latina, uma fonte importante de imigrantes e destino de emigração e turismo europeu, a maioria dos casos ocorrendo no Brasil, Argentina, Venezuela e Colômbia. Os autores descrevem o caso clínico de um paciente com 43 anos, anteriormente emigrado na Venezuela e residente em Portugal há 8 anos, que se apresenta com lesão cutânea isolada. Embora sem queixas relevantes do foro respiratório, apresentava extensas lesões do parênquima pulmonar caracterizadas por tomografia computorizada de alta resolução (TCAR. Foi realizada biópsia da lesão cutânea e exame micológico da expetoração que revelaram infeção por Paracoccidioides brasiliensis (PB. Keywords: Paracoccidioidomycosis, Paracoccidioides brasiliensis, Pulmonary fibrosis, High-resolution computed tomography, Palavras-chave: Paracoccidioidomicose, Paracoccidioides brasiliensis, Fibrose pulmonar, Tomografia computorizada de alta resolução

  13. Magnetic resonance imaging findings of paracoccidioidomycosis in the musculoskeletal system.

    Science.gov (United States)

    Savarese, Leonor G; Monsignore, Lucas M; de Andrade Hernandes, Mateus; Martinez, Roberto; Nogueira-Barbosa, Marcello H

    2015-10-01

    To describe magnetic resonance imaging (MRI) findings in musculoskeletal paracoccidioidomycosis (PCM). Retrospective case series study after IRB approval. Two musculoskeletal radiologists reviewed in consensus the MRI findings of 11 patients with microbiologically and/or pathologically proven osteoarticular PCM. The MRI evaluation included discrimination of abnormalities in joints, bones and soft tissues. Mean age of patients was 29 years (10-55 years), eight men and three women. Musculoskeletal involvement was the only or the primary presentation of the disease in seven patients (63%). Osteomyelitis was the most common presentation, with seven cases (63%). Primary arthritis was found in one patient (9%). Isolated extra-articular soft tissue PCM was found in three patients: myositis (2) and subcutaneous infection (1). All cases showed regions with signal intensity higher than or similar to the signal of muscle on T1-weighted images. Penumbra sign was present in five cases (45%). T2-weighted images showed reactive soft tissue oedema in eight cases (72%). Post-gadolinium images showed peripheral (8/9) or heterogeneous (1/9) enhancement. Synovial enhancement was present in all cases of joint involvement (6/6). Lipomatosis arborescens was documented in one case of chronic knee involvement. To our knowledge, this is the first case series describing MRI findings of musculoskeletal PCM. Musculoskeletal involvement was the primary presentation of the disease in most cases, and therefore, neoplasms were initially in the differential diagnosis. Osteomyelitis was the most common presentation, often with secondary involvement of joint and or soft tissue. © 2015 John Wiley & Sons Ltd.

  14. Paracoccidioidomycosis Mimicking Sarcoidosis: A Review of 8 Cases.

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    Coelho, Mariana Guimarães; Severo, Cecília Bittencourt; de Mattos Oliveira, Flávio; Hochhegger, Bruno; Severo, Luiz Carlos

    2016-02-01

    Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with this disease. The diagnosis is based on exhaustive exclusion of differential diagnoses, particularly granulomatous infections. We report data on eight patients with paracoccidioidomycosis mimicking sarcoidosis. Five patients presented with a chronic pulmonary type infection and three had a disseminated form after immunosuppressive treatment. The mycological diagnosis in noncaseating granulomas is emphasized and reviewed.

  15. Paracoccidioidomycosis in southern Rio Grande do Sul: A retrospective study of histopathologically diagnosed cases

    Science.gov (United States)

    de Souza, Silvana Pereira; Jorge, Valéria Magalhães; Xavier, Melissa Orzechowski

    2014-01-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5%) were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9%) were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1%) were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days). An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions. PMID:24948940

  16. Paracoccidioidomycosis in southern Rio Grande do Sul: a retrospective study of histopathologically diagnosed cases

    Directory of Open Access Journals (Sweden)

    Silvana Pereira de Souza

    2014-01-01

    Full Text Available Paracoccidioidomycosis (PCM is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5% were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9% were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1% were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days. An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.

  17. Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972-2012).

    Science.gov (United States)

    López-Martínez, Rubén; Hernández-Hernández, Francisca; Méndez-Tovar, Luis Javier; Manzano-Gayosso, Patricia; Bonifaz, Alexandro; Arenas, Roberto; Padilla-Desgarennes, María Del Carmen; Estrada, Roberto; Chávez, Guadalupe

    2014-09-01

    Paracoccidioidomycosis (PCM) is an endemic systemic infection in several countries of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis. © 2014 Blackwell Verlag GmbH.

  18. [Colon Paracoccidioidomycosis in a hospital from Lima - Peru: report of 4 cases].

    Science.gov (United States)

    Alcántara Figueroa, Christian; Verástegui, Rosa; Aphang Lam, Meylin; Cáceres Alpaca, Daniel

    2017-01-01

    Paracoccidioidomycosis is the most prevalent mycosis in South America. Mucocutaneous and lymph node involvement is the most frequent affectation of this disease in our country, with the intestinal commitment rarely reported. We report 4 cases of colonic manifestation with abdominal pain, chronic diarrhea, and weight loss. The diagnosis was made with biopsy and Gomori stain. The average age was 29 years old. The colonoscopy showed many ulcers in the ileum distal and colon. We found VIH as comorbidity in one patient.

  19. Paracoccidioidomycosis and cryptococcosis with localized skin manifestations: report of two cases in the elderly.

    Science.gov (United States)

    Oliveira, Ederson Valei Lopes de; Almeida, Margarete Teresa Gottardo de; Turatti, Aline; Gomes, Ciro Martins; Roselino, Ana Maria

    2016-04-01

    Distinct cases of Paracoccidioidomycosis and Cryptococcosis with atypical and localized skin manifestation on the upper limbs of two elderly patients are reported. In the 2nd one, he presented asymptomatic pulmonary cancer; the blood tests for fungal infection were negative, and the etiologic agents were seen in skin biopsy samples. This report emphasizes the importance of the differential diagnosis of infectious diseases in elderly patients.

  20. A rare paracoccidioidomycosis diagnosis in a kidney transplant receptor: case report.

    Science.gov (United States)

    Pontes, A M; Borborema, J; Correia, C R B; de Almeida, W L; Maciel, R F

    2015-05-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis of chronic presentation more frequent in adults, which may lead to disseminated severe and lethal forms involving the lungs, skin, lymph nodes, spleen, liver, and lymphoid organs of the digestive tract. Common in Latin America, it is rare in transplanted patients, with few cases described in the literature. To report a case of a patient who underwent kidney transplant 3 years ago with a pseudotumoral cervical PCM diagnosis. A male patient, 45 years old, who underwent kidney transplantation 3 years ago presenting with diarrhea, severe weight loss, and anemia; no breathing complaints. Parasitological stool tests, fecal culture, urine culture, and abdomen USG were performed in order to assess the diarrhea, and were inconclusive. He was treated with antibiotics and antiparasitic drugs with no improvement and continued with weight loss of 15 kg within 3 months. Immunosuppression was changed, with the mycophenolic acid reduced until it was replaced by everolimus. The diarrhea returned to intensify, and there was an increase in the creatinine (from 1.5 to 3.4). He was empirically treated with sulfamethoxazole/trimethoprim, with total remission of the diarrhea. The patient underwent a kidney biopsy, anti-HIV examinations, PCR BK virus, and PCR for Mycobacterium tuberculosis-with no diagnostic conclusion. During his fifth hospitalization (6 months after the beginning of the diagnostic research), presenting a quite compromised general state, loss of 20 kg, anemia, kidney failure, and fever, he developed skin lesions on the legs and a voluminous and hard tumor in the right cervical region. Chest computed tomography was performed, and the tumoral lesions were removed from those regions. He was started on tuberculostatics and underwent a biopsy of the cervical tumoral lesion. Biopsy of the cervical tumor showed a fungal infection by paracoccidioidomycosis. The BAAR test of the biopsy was negative. The patient died a few weeks

  1. Severe Paracoccidioidomycosis in a 14-Year-Old Boy.

    Science.gov (United States)

    Ruas, L P; Pereira, R M; Braga, F G; Lima, X T; Mamoni, R L; Cintra, M L; Schreiber, A Z; Calich, V L G; Blotta, M H S L

    2016-12-01

    Paracoccidioidomycosis (PCM) is the most important systemic mycoses in Latin America. We describe a severe case of paracoccidioidomycosis in a 14-year-old boy, with a rapid disease progression. The fungal strain was isolated and inoculated into a T and/or B cell immunocompromised mice, which revealed a highly virulent strain. The case report presented herein emphasizes the importance of considering PCM in the differential diagnosis of patients with other infectious diseases in endemic areas and highlights a novel isolate.

  2. Sarcoid-like cutaneous lesions in chronic adult paracoccidioidomycosis: report of two cases.

    Science.gov (United States)

    Fernandes, Nurimar C; Côrtes, Júlia Gomes; Akitti, Tiyomi; Quintella, Danielle Carvalho; Cuzzi, Tulia

    2017-06-01

    This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

  3. Sarcoid-like cutaneous lesions in chronic adult paracoccidioidomycosis: report of two cases

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    Nurimar C. Fernandes

    Full Text Available ABSTRACT This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF of the Universidade Federal do Rio de Janeiro (UFRJ. The first case (mild form was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally for three months and, then, with half the dose for nine months; the second (moderate form, with itraconazole (200 mg per day, orally for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.

  4. Case report of myeloperoxidase deficiency associated with disseminated paracoccidioidomycosis and peritoneal tuberculosis.

    Science.gov (United States)

    Domingues-Ferreira, Maurício; Levy, Ariel; Barros, Noac Chuffi; Bertolini, Dalton Luis; Vasconcelos, Dewton de Moraes

    2017-01-01

    Myeloperoxidase (MOP) is present in monocyte and neutrophil lysosomes, catalyzing hydrogen peroxide and chloride ion conversion to hypochlorous acid. MOP seems to destroy pathogens during phagocytosis by neutrophils and is considered an important defense against innumerous bacteria. We present a patient who had MOP deficiency, who presented with a subacute form of paracoccidioidomycosis and later with peritoneal tuberculosis. MOP deficiency leads to the diminished destruction of phagocytized pathogens. This case gives important evidence of an association between MOP deficiency and increased susceptibility to infection by Paracoccidioides brasiliensis and Mycobacterium tuberculosis.

  5. Case report of myeloperoxidase deficiency associated with disseminated paracoccidioidomycosis and peritoneal tuberculosis

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    Maurício Domingues-Ferreira

    Full Text Available Abstract Myeloperoxidase (MOP is present in monocyte and neutrophil lysosomes, catalyzing hydrogen peroxide and chloride ion conversion to hypochlorous acid. MOP seems to destroy pathogens during phagocytosis by neutrophils and is considered an important defense against innumerous bacteria. We present a patient who had MOP deficiency, who presented with a subacute form of paracoccidioidomycosis and later with peritoneal tuberculosis. MOP deficiency leads to the diminished destruction of phagocytized pathogens. This case gives important evidence of an association between MOP deficiency and increased susceptibility to infection by Paracoccidioides brasiliensis and Mycobacterium tuberculosis.

  6. Occurrence of 102 cases of paracoccidioidomycosis in 18 months in the Itaipu Lake region, Western Paraná.

    Science.gov (United States)

    Loth, Eduardo Alexandre; Castro, Solange Venturinide; Silva, Joseane Rodrigues da; Gandra, Rinaldo Ferreira

    2011-10-01

    The study investigated the incidence of disease and death events among patients with paracoccidioidomycosis who were residents in the Itaipu Lake region from 2008 to 2009. A review of patient records was conducted at the Department of Tuberculosis of the Epidemiology Center of the City of Foz do Iguaçu, Paraná. The results identified 102 new cases of paracoccidioidomycosis in the period described, 72 men and 30 women, and 15 deaths were recorded during the study. It can be concluded that the Itaipu Lake region is an endemic region.

  7. EPIDEMIOLOGY OF PARACOCCIDIOIDOMYCOSIS.

    Science.gov (United States)

    Martinez, Roberto

    2015-09-01

    The epidemiological characteristics of paracoccidioidomycosis were reviewed and updated. The new endemic areas in Brazil were discussed in the section regarding the geographic distribution of the mycosis. Subclinical infection with Paracoccidioides brasiliensis was discussed on the basis of skin test surveys with antigens of the fungus, seroepidemiological studies, and disease cases outside Latin America. Large case series permitted a comparison of the prevalence of the mycosis in different regions, its estimated incidence and risk factors for the development of the disease. Aspects modulating the expression of the clinical forms of paracoccidioidomycosis are also presented. This review also deals with diseases associated with the mycosis, opportunistic paracoccidioidomycosis, lethality, mortality and infection and disease in animals.

  8. Central nervous system paracoccidioidomycosis. Report of a case successfully treated with Itraconazol Paracoccidioidomicose do sistema nervoso central. Apresentação de um caso tratado com êxito com itraconazole

    Directory of Open Access Journals (Sweden)

    Luis A. VILLA

    2000-08-01

    Full Text Available Paracoccidioidomycosis (PCM is a primary pulmonary infection that often disseminates to other organs and systems. Involvement of the central nervous system (CNS is rare and due to the fact that both clinical alertness and establishment of the diagnosis are delayed, the disease progresses causing serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM, observed in a 55 year-old male, who consulted due to neurological symptoms (left hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic clonic seizures of a month duration. Upon physical examination, an ulcerated granulomatous lesion was observed in the abdomen. To confirm the diagnosis a stereotactic biopsy was taken; additionally, mycological tests from the ulcerated lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. brasiliensis yeast cells were visualized and later on, the brain biopsy revealed the presence of the fungus. Treatment with itraconazole (ITZ was initiated but clinical improvement was unremarkable; due to the fact that the patient was taking sodium valproate for seizure control, drug interactions were suspected and confirmed by absence of ITZ plasma levels. The latter medication was changed to clonazepam and after several weeks, clinical improvement began to be noticed and was accompanied by diminishing P. brasiliensis antigen and antibody titers. In the PCM endemic areas, CNS involvement should be considered more often and the efficacy of itraconazole therapy should also be taken into consideration.A paracoccidioidomicose (PCM é infecção pulmonar primária que algumas vezes pode se disseminar a outros órgãos e sistemas. O envolvimento do sistema nervoso central (SNC é raro e devido ao fato que a alerta clínica e o estabelecimento do diagnóstico são tardios, a doença progride e o paciente piora. Aquí apresentamos caso de neuroparacoccidioidomicose (NPCM observada em homem de 55 anos de idade que

  9. PARACOCCIDIOIDOMYCOSIS TREATMENT

    Science.gov (United States)

    SHIKANAI-YASUDA, Maria Aparecida

    2015-01-01

    SUMMARY Considered to be an emerging endemic mycosis in Latin America, paracoccidioidomycosis is characterized by a chronic course and involvement of multiple organs in immunocompromised hosts. Infection sequelae are mainly related to pulmonary and adrenal insufficiency. The host-parasite interaction results in different expressions of the immune response depending on parasite pathogenicity, fungal load and genetic characteristics of the host. A few controlled and case series reports have shown that azoles and fast-acting sulfa derivatives are useful treatment alternatives in milder forms of the disease. For moderate/severe cases, more prolonged treatments or even parenteral routes are required especially when there is involvement of the digestive tract mucosa, resulting in poor drug absorption. Although comparative studies have reported that shorter treatment regimens with itraconazole are able to induce cure in chronically-infected patients, there are still treatment challenges such as the need for more controlled studies involving acute cases, the search for new drugs and combinations, and the search for compounds capable of modulating the immune response in severe cases as well as the paradoxical reactions. PMID:26465367

  10. Paracoccidioides brasiliensis PS2: First Autochthonous Paracoccidioidomycosis Case Report in Rio de Janeiro, Brazil, and Literature Review.

    Science.gov (United States)

    de Macedo, Priscila Marques; Almeida-Paes, Rodrigo; de Medeiros Muniz, Mauro; Oliveira, Manoel Marques Evangelista; Zancopé-Oliveira, Rosely Maria; Costa, Regina Lana Braga; do Valle, Antonio Carlos Francesconi

    2016-10-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the Paracoccidioides brasiliensis complex. It is the most important systemic mycosis in Latin America, mainly in Brazil. Despite its severity and high mortality rates, it is considered a neglected disease. Species within the genus Paracoccidioides present genetics and morphological variations with probable clinical, diagnostic and therapeutic consequences. In fact, there are a very small number of detailed case reports with molecular identification of these fungal agents. Here, it is reported a case of PCM due to Paracoccidioides brasiliensis PS2. Molecular identification of the isolate was performed by amplification and sequencing of the arf and gp43 genes. Clinical cases and strain reports with molecular identification in the literature are also reviewed. The case herein presented is the first autochthonous report of PCM due to Paracoccidioides brasiliensis PS2 species in the state of Rio de Janeiro, Brazil, an important endemic area. The patient presented a chronic pulmonary form of PCM and had a satisfactory response to sulfamethoxazole/trimethoprim although sequelae such as adrenal insufficiency and dysphonia were observed. This study may contribute to improve the knowledge about this severe disease, its causative cryptic species and their consequences to patients.

  11. Lung cysts in chronic paracoccidioidomycosis.

    Science.gov (United States)

    Costa, André Nathan; Marchiori, Edson; Benard, Gil; Araújo, Mariana Sponholz; Baldi, Bruno Guedes; Kairalla, Ronaldo Adib; Carvalho, Carlos Roberto Ribeiro

    2013-01-01

    On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.

  12. Lung cysts in chronic paracoccidioidomycosis*

    Science.gov (United States)

    Costa, André Nathan; Marchiori, Edson; Benard, Gil; Araújo, Mariana Sponholz; Baldi, Bruno Guedes; Kairalla, Ronaldo Adib; Carvalho, Carlos Roberto Ribeiro

    2013-01-01

    On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases. PMID:23857700

  13. Lung cysts in chronic paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Andre Nathan Costa

    2013-06-01

    Full Text Available On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%, indicating that patients with paracoccidioidomycosis can present with lung cysts on HRCT scans. Therefore, paracoccidioidomycosis should be included in the differential diagnosis of cystic lung diseases.

  14. Intramedullary spinal cord paracoccidioidomycosis: report of two cases Granuloma paracoccidioidomicótico intramedular: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Benedicto Oscar Colli

    1996-09-01

    Full Text Available Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs, lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion. The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developed paresthesia and tactile/ pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion. The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma. The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.São relatados dois casos de granuloma blastomic

  15. Extra-pulmonary manifestations of paracoccidioidomycosis associated with acquired immunodeficiency syndrome: a case report*

    Science.gov (United States)

    Safe, Izabella Picinin; do Valle, Fabio Francesconi; Maia, Daniela Cristina Caetano; Agonio, Bárbara; Monte, Rossicléia Lins; Araújo, José de Ribamar; Cordeiro-Santos, Marcelo

    2014-01-01

    We present a patient with Paracoccidioidomycosis/HIV coinfection which has been investigated because of chronic monoarthritis and mucocutaneous lesions. A biopsy of the synovial membrane and skin revealed structures consistent with Paracoccidioides brasiliensis. At diagnosis, the count of CD4 + T cells was 44 cells/mm3. We emphasize the importance of clinical suspicion of Paracoccidioidomycosis in patients with HIV/AIDS who live in or are from risk areas. PMID:24626662

  16. Thoracic intraspinal paracoccidioidomycosis: case report Paracoccidioidomicose intramedular torácica: relato de caso

    Directory of Open Access Journals (Sweden)

    Robertson A. B. Pacheco

    1996-09-01

    Full Text Available Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.Lesões intramedulares causadas pelo Paracoccidioides brasiliensis são raras. O quadro clínico de lesão expansiva medular é inespecífico e uma intervenção cirúrgica com fins diagnósticos e terapêuticos constitui o único método de diagnóstico eficiente. Os autores relatam um caso em uma mulher de 45 anos com lesão medular ao nível torácico. Descrevem-se os achados clínicos, cirúrgicos e de ressonância magnética nesta situação incomum.

  17. Disseminated Paracoccidioidomycosis (Simulating Metastatic Lung Cancer) and Strongyloides stercoralis Hyperinfestation in a Steroid-Treated Patient▿

    Science.gov (United States)

    Dall Bello, Aline Gehlen; Severo, Cecília Bittencourt; de Mattos Oliveira, Flávio; Severo, Luiz Carlos

    2011-01-01

    We report a case of disseminated paracoccidioidomycosis, initially suggestive of metastatic lung cancer. The infection was associated with strongyloides hyperinfestation as a result of iatrogenic hypercorticoidism. Examination of a smear prepared from aspirated tracheobronchial secretion and stained by Grocott-methenamine-silver revealed structures consistent with Paracoccidioides brasiliensis and Strongyloides stercoralis. At autopsy, the central nervous system and pulmonary paracoccidioidomycosis, as well as pulmonary strongyloidiasis, were confirmed, without evidence of malignant cells. PMID:21430109

  18. EPIDEMIOLOGY OF PARACOCCIDIOIDOMYCOSIS

    OpenAIRE

    MARTINEZ, Roberto

    2015-01-01

    SUMMARY The epidemiological characteristics of paracoccidioidomycosis were reviewed and updated. The new endemic areas in Brazil were discussed in the section regarding the geographic distribution of the mycosis. Subclinical infection with Paracoccidioides brasiliensis was discussed on the basis of skin test surveys with antigens of the fungus, seroepidemiological studies, and disease cases outside Latin America. Large case series permitted a comparison of the prevalence of the mycosis in dif...

  19. Hypereosinophilia Secondary to Disseminated Paracoccidioidomycosis.

    Science.gov (United States)

    Mejia-Zuluaga, Mateo; Rosas, Samuel; Posada Vélez, Verónica; Quintero, Pedro A

    2017-10-18

    BACKGROUND Paracoccidioidomycosis is an endemic mycosis in Central and South America caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. Despite its self-limited course and usually asymptomatic infection, some patients may present with a systemic illness mimicking multiple conditions and thus question the general state of their immune system. CASE REPORT A 28-year-old male presented to the hospital with fever, dry cough, and non-pruritic rash with no characteristic distribution for the past 10 days. Past medical history revealed that the patient had worked as a farmer three years ago, had abused cocaine paste over the same period, and also had in the last month presented to the hospital for acute appendicitis. Initial laboratory tests revealed hypereosinophilia greater than 10,000 eosinophils/mL. Infection of P. brasiliensis was confirmed by lymph node, skin, and colonoscopy biopsies. After treatment with itraconazole, the patient's eosinophil count returned to normal and his symptoms resolved. CONCLUSIONS Paracoccidioidomycosis may present as a systemic illness with only marked eosinophilia on initial diagnostic tests. Furthermore, in our patient's case, the high degree of eosinophilia may have contributed towards the patient's appendicitis in the weeks preceding the subacute infection. It is possible that the patient's history of working at a farm and abusing cocaine paste may have contributed to the initial colonization by the fungus.

  20. Gallium-67 imaging in a patient with paracoccidioidomycosis: a case report

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    Teixeira, Ana Beatriz Marinho de Jesus; Etchebehere, Elba Cristina Sa de Camargo; Lima, Mariana Cunha Lopes de; Santos, Allan de Oliveira; Pires, Bruno Cunha; Valenca Junior, Jose Telmo; Ramos, Celso Dario; Camargo, Edwaldo E. [Universidade Estadual de Campinas, SP (Brazil). Hospital das Clinicas. Servico de Medicina Nuclear]. E-mail: elba@mn-d.com

    2000-06-01

    A 26 year-old female was admitted with abdominal pain, fever and weight loss. The clinical and laboratory investigations led to the diagnosis of paracoccidioidomycosis. Gallium-67 whole body images correlated well with the clinical course of the disease and with the patient's prognosis. (author)

  1. Paracoccidioidomycosis Epidemiological Features of a 1,000-Cases Series from a Hyperendemic Area on the Southeast of Brazil

    Science.gov (United States)

    Bellissimo-Rodrigues, Fernando; Machado, Alcyone Artioli; Martinez, Roberto

    2011-01-01

    Paracoccidioidomycosis has been known for over 100 years, and until now, there were only few estimates of the disease's incidence. We aim to analyze 1,000 cases treated between 1960 and 1999 at Ribeirão Preto city, São Paulo, Brazil, where the disease's incidence range detected was 1.6 to 3.7 cases per 100,000 habitants per year (mean = 2.7 cases/year). We observed a male to female ratio of 6:1 and an age distribution from 3 to 85 years. The acute/subacute form of the disease accounted for 25.4% of cases. Most of the patients (93.5%) had lived or worked in rural areas before the disease development. Smoking and alcoholism were reported by 64.7% and 37.2% of patients, respectively. Comorbidities identified included tuberculosis (8.3%), Chagas' disease (8.6%), and human immunodeficiency virus/acquired immunodeficiency syndrome (4.2%). The present study revealed an area in Brazil where paracoccidioidomycosis is hyperendemic (has the highest reported incidence of this disease); this endemic area is probably caused by geological and climatic conditions as well as intensive agriculture. PMID:21896820

  2. Musculoskeletal ultrasound findings in paracoccidioidomycosis.

    Science.gov (United States)

    Mendonça, José Alexandre; Peron Filho, Faustino; Schincariol, Nádia Bossolan; Vierhout, Cláudia Valéria; Provenza, José Roberto

    2016-01-01

    Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical-radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  3. Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

    Directory of Open Access Journals (Sweden)

    M A Reyes

    2008-06-01

    Full Text Available Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

  4. Amphotericin B lipid complex in the treatment of severe paracoccidioidomycosis: a case series.

    Science.gov (United States)

    Peçanha, Paulo Mendes; de Souza, Stella; Falqueto, Aloísio; Grão-Veloso, Tânia Regina; Lírio, Ludmila Ventura; Ferreira, Carlos Urbano Gonçalves; Santos, Aline Rocha; Costa, Hélbia Garcia; de Souza, Lúcia Renata Meirelles; Tuon, Felipe Francisco

    2016-10-01

    Amphotericin B deoxycholate is the main option for intravenous (i.v.) treatment of severe paracoccidioidomycosis (PCM). This is the first report of amphotericin B lipid complex (ABLC) in the treatment of PCM. Among 28 patients, cure was achieved in all patients (100%) using ABLC. Mean and median daily doses of ABLC were 3.39 mg/kg/day and 3.35 mg/kg/day, respectively. ABLC may be a choice in the treatment of severe forms of PCM or when i.v. options are required. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  5. Unifocal Bone Paracoccidioidomycosis, Brazil

    Science.gov (United States)

    Correa-de-Castro, Bruna; Pompilio, Mauricio A.; Odashiro, Danilo N.; Odashiro, Maçanori; Arão-Filho, Adalberto; Paniago, Anamaria M. M.

    2012-01-01

    We report a 47 year-old man from the State of Mato Grosso do Sul, Brazil, with unifocal tibial paracoccidioidomycosis. A radiograph showed an osteolytic lesion on the tibial middle third diaphysis. The diagnosis was confirmed by histopathologic analysis, and treatment with sulfamethoxazole and trimethoprim was started. After three months, the patient showed significant clinical improvement. Ten months after treatment, the patient showed lesion bone healing. This case describes the rare occurrence of an osteolytic lesion caused by endemic Paracoccidioides brasiliensis in Latin America. PMID:22403319

  6. Registro de um caso de paracoccidioidomicose no Japão Paracoccidioidomycosis in Japan report of a case

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    Taishiro Chikamori

    1984-10-01

    Full Text Available Os Autores descrevem um caso de paracoccidioidomicose em Tóquio, o segundo observado no Japão. A paciente residiu cerca de cinco anos na zona urbana de São Paulo, onde provavelmente adquiriu a primo-infecção. Não tomou corticóides, nem teve história de outras afecções que justificassem a paracoccidioidomicose. Após três anos do retorno ao Japão apresentou linfadenopatia, comprometimento hepatesplênico e ausência de lesões pulmonares. O presente caso, com exame histopatoló-gico e cultivo positivos para Paracoccidioides brasiliensis também apresentou quadro soroló-gico compatível. O aspecto blástico das lesões ósseas, raro em arcos costáis nesta micose, bem como a linfadenopatia generalizada são discutidos. Tratamento à base de anfotericina B e ketoconazol ofereceu resultados favoráveis. Neste trabalho os Autores discutem o problema de "patologia de importação", com suas implicações.The Authors report a non-autochthonous case of paracoccidioidomycosis in Tokyo, the second related in Japan. The patient lived for nearly five years in the urban area of São Paulo, where probably she acquired the primary infection. There was no history of corticoid therapy or other diseases that could explain paracoccidioidomycosis. Three years after her return to Japan, she presented lymphadenopathy, hepatosplenic involvement and absence of pulmonary lesions. The present case, with histopathological examination and culture positive to Paracoccidioides brasiliensis also showed compatible serological results. The blastic feature of bone lesions, rare in ribs in this mycosis, as well as the generalized lymphadenopathy are discussed. Treatment with amphotericin B and ketoconazole offered good results. In this paper the Authors discuss the problem of the "pathology of importation" with its implications.

  7. Peptide Vaccine Against Paracoccidioidomycosis.

    Science.gov (United States)

    Taborda, Carlos P; Travassos, Luiz R

    2017-01-01

    The chapter reviews methods utilized for the isolation and characterization of a promising immunogen candidate, aiming at a human vaccine against paracoccidioidomycosis. Peptide P10 carries a T-CD4+ epitope and was identified as an internal sequence of the major diagnostic antigen known as gp43 glycoprotein. It successfully treated massive intratracheal infections by virulent Paracoccidioides brasiliensis in combination with chemotherapy.An introduction about the systemic mycosis was found essential to understand the various options that were considered to design prophylactic and therapeutic vaccine protocols using peptide P10.

  8. CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS.

    Science.gov (United States)

    Fernandes, Flávia Fonseca; Alves, Victor Oliveira; Sánchez, Tarquino Erastides Gavilanes; Paula, Wagner Diniz de; Santana, Alfredo Nicodemos Cruz

    2016-07-11

    A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions.

  9. Paracoccidioidomycosis: Epidemiological and Clinical Aspects in 546 Cases Studied in the State of Espírito Santo, Brazil.

    Science.gov (United States)

    Peçanha, Paulo Mendes; Batista Ferreira, Mayara Elisa; Massaroni Peçanha, Maria Angélica; Schmidt, Edilaine Brandão; Lamas de Araújo, Mariceli; Zanotti, Raphael Lubiana; Potratz, Felipe Fonseca; Delboni Nunes, Nilo Eduardo; Gonçalves Ferreira, Carlos Urbano; Delmaestro, Délio; Falqueto, Aloísio

    2017-09-01

    Paracoccidioidomycosis (PCM) is an endemic disease in the southeast region of Brazil, which includes the state of Espírito Santo (ES). This historic case series analyses 546 patients treated in this state from 1978 to 2012. Patients aged from 7 to 83 years, 509 males and 37 females, yielding a ratio of 13.7:1. Most of the patients (81.4%) originated from rural areas in ES, 71.0% being farmers. A higher concentration of cases was observed in municipalities located along the western range of the state. Sixty patients (11.0%) had an acute/subacute form of the disease, 485 (88.9%) had a chronic form, and one had a subclinical form. The most affected organs included the lungs, oropharyngeal mucosa, lymph nodes, skin, and larynx. The diagnosis was confirmed by histopathology in 252 (46.2%) cases, direct examination in 168 (30.7%), both exams in 111 (20.3%) and serology in 15 (2.8%). Tuberculosis, acquired immune deficiency syndrome, leishmaniasis, and intestinal parasites were the most frequently associated infectious diseases. From 328 patients followed up, total regression of the lesions was observed in 17.4%, partial regression in 77.4%, and no regression in 17 (5.2%) cases. Regarding the number of cases in this series, ES emerges as an important endemic area for PCM in Brazil.

  10. Paracoccidioidomycosis in a liver transplant recipient.

    Science.gov (United States)

    Lima, Thais Carneiro; Bezerra, Regis Otaviano Franca; Siqueira, Luiz Tenório de Brito; Menezes, Marcos Roberto de; Leite, Claudia da Costa; Porta, Gilda; Cerri, Giovanni Guido

    2017-01-01

    Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.

  11. Lung cysts in chronic paracoccidioidomycosis*

    OpenAIRE

    Costa, André Nathan; Marchiori, Edson; Benard, Gil; Araújo, Mariana Sponholz; Baldi, Bruno Guedes; Kairalla, Ronaldo Adib; Carvalho, Carlos Roberto Ribeiro

    2013-01-01

    On HRCT scans, lung cysts are characterized by rounded areas of low attenuation in the lung parenchyma and a well-defined interface with the normal adjacent lung. The most common cystic lung diseases are lymphangioleiomyomatosis, Langerhans cell histiocytosis, and lymphocytic interstitial pneumonia. In a retrospective analysis of the HRCT findings in 50 patients diagnosed with chronic paracoccidioidomycosis, we found lung cysts in 5 cases (10%), indicating that patients with paracoccidioidomy...

  12. Paracoccidioidomycosis in children. Report of two cases studied with {sup 67} Ga; Paracoccidioidomicose infantil. Relato de dois casos estudados por galio-67 ({sup 67} Ga)

    Energy Technology Data Exchange (ETDEWEB)

    Calegaro, Jose Ulisses M.; Gomes, Enio de Freitas; Rocha, Jair Evangelista da [Fundacao Hospitalar do Distrito Federal, Brasilia, DF (Brazil). Hospital de Base

    1997-12-31

    Two cases of paracoccidioidomycosis in children are reported, aged 6 years, males,in the subacute clinical form (juvenile type). The first showed generalized lymph nodes involvement and was treated with sulfonamide; the {sup 67} Ga images permitted follow-up until the disease inactivity. The second, besides lumph nodes, had lung and bone (clavicle) involvement characterized by {sup 67} Ga scintigraphy, with normal radiologic study. The {sup 67} Ga images have utility to evaluate the mycoses extension, to monitore the response to specific treatment and to show its inactivity. (author) 16 refs., 3 figs.

  13. New Trends in Paracoccidioidomycosis Epidemiology

    Science.gov (United States)

    Martinez, Roberto

    2017-01-01

    Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region. PMID:29371520

  14. New Trends in Paracoccidioidomycosis Epidemiology

    Directory of Open Access Journals (Sweden)

    Roberto Martinez

    2017-01-01

    Full Text Available Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.

  15. New Trends in Paracoccidioidomycosis Epidemiology.

    Science.gov (United States)

    Martinez, Roberto

    2017-01-03

    Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America and more prevalent in South America. The disease is caused by the dimorphic fungus Paracoccidioides spp. whose major hosts are humans and armadillos. The fungus grows in soil and its infection is associated with exposure to the rural environment and to agricultural activities, with a higher risk in coffee and tobacco plantations. Population studies assessing the reactivity to Paracoccidioides spp. antigens by intradermal reaction or serological tests have detected previous subclinical infections in a significant proportion of healthy individuals living in various endemic countries. Paracoccidioidomycosis-disease is manifested by a small minority of infected individuals. The risk of developing the disease and its type of clinical form are related to the personal and life style characteristics of infected individuals, including genetic background, age, sex, ethnicity, smoking habit, alcohol drinking, and eventual cellular immunosuppression. Brazil, Colombia, Venezuela, Argentina, and Ecuador have endemic areas that had already been defined in the 20th century. The incidence of paracoccidioidomycosis can be altered by climate phenomena and mainly by human migration and occupation of poorly explored territories. In Brazil, the endemy tends to expand towards the North and Center-West around the Amazon Region.

  16. Extra-pulmonary manifestations of paracoccidioidomycosis

    International Nuclear Information System (INIS)

    Costa, Marlos Augusto Bittencourt; Carvalho, Tarcisio Nunes; Araujo Junior, Cyrillo Rodrigues de; Borba, Ana Olivia Cardoso; Veloso, Gerson Augusto; Teixeira, Kim-Ir-Sem Santos

    2001-01-01

    The authors present a review and iconographic study of patients with disseminated paracoccidioidomycosis, including the main radiographic findings seen in the central nervous system, adrenal glands, osteoarticular system, lymph nodes and digestive tract. Imaging diagnostic methods have allowed a more precise approach of these patients due to their high sensitivity in detecting lesions, even in asymptomatic patients. In most cases these abnormalities are unspecific, simulating either neoplasic or chronic infectious lesions, and sometimes difficult to distinguish from tuberculosis. Although these findings are nonspecific and only the mycologic and histologic fungus demonstration can confirm the diagnosis, they may suggest a presumptive one, when these imaging findings are considered in an appropriate clinical and epidemiological setting. (author)

  17. Enlarged, painful cervical and axillary lymph nodes in chronic paracoccidioidomycosis.

    Science.gov (United States)

    de Pinho, Débora Braga; da Costa Neves, Thaís; Célem, Lívia Ribeiro; Quintella, Leonardo; Rodrigues, Rosângela; Ramos-E-Silva, Marcia

    2014-06-30

    Paracoccidioidomycosis is an important medical and social problem mainly in rural areas of Brazil, because of the high incidence of the diseases, its long clinical evolution, frequent recurrences and sequels leading to anatomical and functional incapacities. We present a 73-year-old patient with paracoccidioidomycosis showing significant lymph node manifestations, which are only common in children and teenagers. Paracoccidioidomycosis may have a long incubation period, and it can be diagnosed outside of the endemic regions, where it was acquired. Thus, all dermatologists should maintain a high index of suspicion, especially in unusual cases of extensive lymph node enlargement in the elderly patients.

  18. Prostatic paracoccidioidomycosis: differential diagnosis of prostate cancer

    Directory of Open Access Journals (Sweden)

    Daniel Lima Lopes

    2009-02-01

    Full Text Available Symptomatic prostatic paracoccidioidomycosis (PCM is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.

  19. Disseminated paracoccidioidomycosis with peripleuritis in an AIDS patient Paracoccidioidomicosis diseminada con peripleuritis en paciente con SIDA

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2004-02-01

    Full Text Available Paracoccidioidomycosis is one of the most frequent systemic and endemic mycoses of Latin America caused by a dimorphic fungus. In AIDS patients, paracoccidioidomycosis appears as a severe and disseminated disease with a wide spectrum of clinical findings. The CD4 counts are usually less than 200 cell/mu L. We present a case of disseminated paracoccidioidomycosis with peripleuritis and subcutaneous abscesses on the chest wall as initial manifestation of AIDS. In endemic countries, paracoccidioidomycosis should be included as an opportunistic infection in AIDS.La paracoccidioidomicosis es una de las micosis sistémicas endémicas más frecuentes de Latinoamérica, causada por un hongo dimorfo. En los pacientes con SIDA se presenta como una enfermedad grave y diseminada, con un amplio espectro de manifestaciones clínicas. Los niveles de linfocitos T CD4 + son habitualmente < de 200 cél/myL. Presentamos un caso de paracoccidioidomicosis diseminada con peripleuritis y abscesos subcutáneos sobre la pared torácica como manifestación inicial del SIDA. En países endémicos, la paracoccidioidomicosis debe incluirse como una complicación oportunista de los pacientes con SIDA.

  20. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating*

    Science.gov (United States)

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject. PMID:24173174

  1. Animal Models and Antifungal Agents in Paracoccidioidomycosis: An Overview.

    Science.gov (United States)

    Goldani, Luciano Z; Wirth, Fernanda

    2017-08-01

    Paracoccidioides brasiliensis is the etiologic agent of paracoccidioidomycosis, the most prevalent systemic mycosis in Latin America. The morbidity and mortality associated with paracoccidioidomycosis necessitate our understanding of fungal pathogenesis and discovering of new agents to treat this infection. Animal models have contributed much to the knowledge of fungal infections and their corresponding therapeutic treatments. This is true for animal models of the primary fungal pathogens such as P. brasiliensis. This review describes the development, details and utility of animal models of paracoccidioidomycosis for studying and developing the current antifungal agents used for therapy of this fungal disease and novel agents with antifungal properties against P. brasiliensis.

  2. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating.

    Science.gov (United States)

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular attention to the guideline on paracoccidioidomycosis organized by specialists in this subject.

  3. Revisão radiológica de 173 casos consecutivos de paracoccidioidomicose Radiological review of 173 consecutive cases of paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Henrique Simão Trad

    2006-06-01

    Full Text Available OBJETIVO: Revisar e determinar a incidência dos achados radiológicos mais importantes da paracoccidioidomicose, e verificar as possíveis variantes de suas apresentações. MATERIAIS E MÉTODOS: Foram revistos 173 casos consecutivos de paracoccidioidomicose, atendidos no período de 1970 a 1980. Os estudos radiológicos direcionados a cada caso foram reanalisados por no mínimo dois radiologistas experientes. RESULTADOS: Foram encontrados 94 casos de acometimento pulmonar isolado e 38 de acometimento pulmonar associado a lesões ganglionares, viscerais, ósseas e à tuberculose. Sem envolvimento pulmonar foram encontrados 41 casos, com lesões intestinais, viscerais, ósseas ou combinadas. Os principais achados radiológicos da forma pulmonar foram opacidade intersticial reticular e nodular bilateral, seguida por consolidação, também bilateral. As formas visceral e intestinal apresentaram lesões predominantes no fígado, jejuno e íleo. Na forma ganglionar houve predominância do comprometimento difuso abdominal e periférico, e no ósseo, áreas de lise principalmente em ossos longos e clavícula. CONCLUSÃO: A paracoccidioidomicose é doença granulomatosa comum no Brasil, acometendo principalmente o pulmão, tendo como porta de entrada a inalação dos esporos do fungo. Outras formas desta doença, menos freqüentes ou raras, devem ser permanentemente lembradas no diagnóstico diferencial.OBJECTIVE: To determine the incidence of most significant radiological findings of paracoccidioidomycosis and to verify its possible variants. MATERIALS AND METHODS: One hundred and seventy-three cases of paracoccidioidomycosis presented between 1970 and 1980 were reviewed, including their radiological workup reanalysis by at least two experienced radiologists. RESULTS: Ninety-four cases were pulmonary only and 38 were pulmonary associated with ganglial, visceral and osseous lesions or in association with tuberculosis. There was no pulmonary

  4. Paracoccidioidomicose aguda/subaguda disseminada. Primeiro caso no Rio Grande do Sul Acute/subacute disseminated paracoccidioidomycosis. First case in Rio Grande do Sul State, Brazil

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    Soraya Malafaia Colares

    1998-12-01

    Full Text Available É relatado o primeiro caso autóctone de paracoccidioidomicose disseminada aguda/subaguda ocorrido em criança no Rio Grande do Sul. A doença iniciou com adenomegalias superficiais generalizadas, seis meses antes da internação hospitalar. O diagnóstico foi feito através de biópsia de gânglio cervical. É comentado o espectro de formas clínicas da micose observado nesse Estado.The first autochthonous case of acute/subacute disseminated paracoccidioidomycosis observed in a child in Rio Grande do Sul (Brazil is reported. The disease started with widespread superficial lymphadenopathy six months before the patient was admitted to the hospital. The diagnosis was made through a cervical lymph node biopsy. The spectrum of the clinical forms of the mycosis observed in this State is commented upon.

  5. Paracoccidioidomycosis: acute-subacute clinical form, juvenile type*

    Science.gov (United States)

    Marques, Silvio Alencar; Lastória, Joel Carlos; de Camargo, Rosangela Maria Pires; Marques, Mariangela Esther Alencar

    2016-01-01

    The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation. PMID:27438214

  6. Paracoccidioidomycosis: acute-subacute clinical form, juvenile type*

    OpenAIRE

    Marques, Silvio Alencar; Last?ria, Joel Carlos; de Camargo, Rosangela Maria Pires; Marques, Mariangela Esther Alencar

    2016-01-01

    Abstract: The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity a...

  7. Paracoccidioidomycosis: acute-subacute clinical form, juvenile type.

    Science.gov (United States)

    Marques, Silvio Alencar; Lastória, Joel Carlos; Camargo, Rosangela Maria Pires de; Marques, Mariangela Esther Alencar

    2016-01-01

    The authors report aspects of paracoccidioidomycosis, acute-subacute clinical form, juvenile type, in a 19-year-old female patient. Paracoccidioidomycosis, juvenile type, classically occurs in young patients, both sexes, with lymphoma-like aspects as initial presentation. However, following the natural history of the disease the lymph nodes assume patterns of infectious disease, as an abscess and fistulae. Systemic dissemination of the disease can occur and lethality and morbidity are significant in this clinical presentation.

  8. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating *

    OpenAIRE

    Marques, Silvio Alencar

    2013-01-01

    Paracoccidioidomycosis is an acute - to chronic systemic mycosis caused by fungi of the genus Paracoccidioides. Due to its frequent tegument clinical expression, paracoccidioidomycosis is an important disease for dermatologists, who must be up-to-date about it. This article focuses on recent epidemiological data and discusses the new insights coming from molecular studies, as well as those related to clinical, diagnostic and therapeutic aspects. In the latter section, we give particular atten...

  9. Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006).

    Science.gov (United States)

    Coutinho, Ziadir Francisco; Wanke, Bodo; Travassos, Claudia; Oliveira, Rosely Magalhães; Xavier, Diego Ricardo; Coimbra, Carlos E A

    2015-05-01

    To analyse hospital morbidity records due to paracoccidioidomycosis in Brazil, including its nationwide distribution in time and space, as well as key epidemiological and sociodemographic characteristics. Descriptive analysis of hospital morbidity records due to paracoccidioidomycosis covering the period January 1998 to December 2006. Hospital records were obtained from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). There were 6732 hospitalisations (82% male) due to paracoccidioidomycosis in the period, representing 4.3 per 1.0 million inhabitants. Admissions due to this mycosis were recorded in 27% of the 5560 Brazilian municipalities, covering 35% of the country. Ten municipalities concentrated 52% of all admissions. The temporal distribution of admissions for paracoccidioidomycosis showed a slight increase. The geographical analysis showed two distinct patterns of the disease: (i) traditional areas of southern and south-eastern regions, covering 60% of admissions, and (ii) a second pattern in northern Brazil revealed a transverse band of higher concentration with about 27% of admissions, particularly along the southern border of the Amazon region. This first nationwide analysis of hospitalisation due to paracoccidioidomycosis in Brazil shows that it is the most prevalent systemic mycosis in Brazil. Despite its importance, there are major deficits in its proper registry, diagnostics and treatment. The particular epidemiological and medical challenges of paracoccidioidomycosis will not be met while the disease continues to be perceived as an isolated infectious entity restricted to a few faraway regions of the globe. © 2015 John Wiley & Sons Ltd.

  10. Disseminated paracoccidioidomycosis diagnosis based on oral lesions

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    Liana Preto Webber

    2014-01-01

    Full Text Available Paracoccidioidomycosis (PCM is a deep mycosis with primary lung manifestations that may present cutaneous and oral lesions. Oral lesions mimic other infectious diseases or even squamous cell carcinoma, clinically and microscopically. Sometimes, the dentist is the first to detect the disease, because lung lesions are asymptomatic, or even misdiagnosed. An unusual case of PCM with 5 months of evolution presenting pulmonary, oral, and cutaneous lesions that was diagnosed by the dentist based on oral lesions is presented and discussed.

  11. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues.

    Science.gov (United States)

    Bocca, Anamelia Lorenzetti; Amaral, André Corrêa; Teixeira, Marcus Melo; Sato, Paula Keiko; Sato, Paula; Shikanai-Yasuda, Maria Aparecida; Soares Felipe, Maria Sueli

    2013-09-01

    Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens' diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.

  12. Paracoccidioidomicose: centenário do primeiro relato de caso Paracoccidioidomycosis: a century from the first case report

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    Silvio Alencar Marques

    2008-06-01

    Full Text Available Há 100 anos Adolpho Lutz publicava relato pioneiro de enfermidade descrita como mycose pseudococcidica, hoje paracoccidioidomicose, em que discorria sobre suas manifestações clínico-histopatológicas e micológicas. Com precisão, em abril de 1908, descreveu que "O agrupamento de corpúsculos kysticos é bastante característico. Geralmente há um maior no centro e outros pequenos em redor, o que sempre me produziu a impressão de resultar de um processo de gemmação". Inaugurava-se novo campo para investigações científicas.One hundred years ago Adolpho Lutz published published the frist report of a patient with paracoccidioidomycosis, then referred as mycosis pseudococcidica. in his original article published in April 1908, he accurately informed that "The arrangement of cystic corpuscles is highly characteristic. Generally one finds a large central corpuscle surrounded by small ones, and this feature has always left me under the impression that it is the results of a gemulation process" A new field of scientific research was then opened.

  13. Sarcoid-like paracoccidioidomycosis presenting with perineural granuloma*

    Science.gov (United States)

    Müller, Silvia Ferreira Rodrigues; de Miranda, Mario Fernando Ribeiro

    2013-01-01

    Paracoccidioidomycosis presenting as a sarcoid-like plaque may be misdiagnosed as leprosy, especially when shared endemic areas are concerned. We report the case of a Brazilian male patient presenting with an ulcerated plaque on his left ear and neighboring areas. The plaque simulated tuberculoid leprosy type 1 reaction, both clinically and histopathologically. A perineural granuloma with no organisms detected by routine and Fite-Faraco staining reinforced that diagnosis. Paracoccidioidomycosis was confirmed only after a second biopsy, taken from the ulcerated area. PMID:24474116

  14. Extra-pulmonary manifestations of paracoccidioidomycosis; Manifestacoes extrapulmonares da paracoccidioidomicose

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    Costa, Marlos Augusto Bittencourt; Carvalho, Tarcisio Nunes; Araujo Junior, Cyrillo Rodrigues de; Borba, Ana Olivia Cardoso; Veloso, Gerson Augusto; Teixeira, Kim-Ir-Sem Santos [Goias Univ., Goiania, GO (Brazil). Hospital das Clinicas. Dept. de Diagnostico por Imagem]. E-mail: radiologia@brturbo.com

    2001-02-01

    The authors present a review and iconographic study of patients with disseminated paracoccidioidomycosis, including the main radiographic findings seen in the central nervous system, adrenal glands, osteoarticular system, lymph nodes and digestive tract. Imaging diagnostic methods have allowed a more precise approach of these patients due to their high sensitivity in detecting lesions, even in asymptomatic patients. In most cases these abnormalities are unspecific, simulating either neoplasic or chronic infectious lesions, and sometimes difficult to distinguish from tuberculosis. Although these findings are nonspecific and only the mycologic and histologic fungus demonstration can confirm the diagnosis, they may suggest a presumptive one, when these imaging findings are considered in an appropriate clinical and epidemiological setting. (author)

  15. Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante Concomitant pulmonary paracoccidioidomycosis and pulmonary histoplasmosis: a rare case

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    Veronica Torres Esteche

    2012-04-01

    Full Text Available La incidencia de las micosis pulmonares en Uruguay es muy baja, y estas usualmente aparecen en pacientes inmunocomprometidos. Se discute el caso de un paciente inmunocompetente proveniente de área rural, que presenta tos, disnea y fiebre de dos meses de evolución. La imagenología mostró una neumonitis extensa y fibrosis pulmonar. Los test micológicos directos, cultivo y serológicos muestran histoplasmosis y paraccocidioidomicosis en forma concomitante. El paciente presentó hipotensión arterial diagnosticándose una insuficiencia suprarrenal. A pesar de que la extensa fibrosis pulmonar y la neumonitis no fueron reversibles, el paciente mejoró clínicamente con el tratamiento antifúngico. Se trata de un caso excepcional de dos micosis pulmonares en un mismo paciente.The incidence of pulmonary fungal infections is very low in Uruguay, and such infections typically affect immunocompromised patients. We report the case of an immunocompetent patient presenting with a two-month history of cough, dyspnea, and fever. The patient resided in a rural area. Imaging tests revealed extensive pneumonitis and pulmonary fibrosis. On the basis of direct mycological examination, culture, and serological testing, we made a diagnosis of concomitant histoplasmosis and paracoccidioidomycosis. The patient presented arterial hypotension that was diagnostic of adrenocortical insufficiency. Although the pulmonary fibrosis and pneumonia were irreversible, the clinical condition of the patient improved after antifungal treatment. This was an exceptional case of two pulmonary fungal infections occurring simultaneously in the same patient.

  16. Paracoccidioidomicose em hemisfério cerebral e tronco encefálico: relato de caso Paracoccidioidomycosis in cerebral hemisphere and brainstem: case report

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    Manoel Baldoino Leal Filho

    2006-09-01

    Full Text Available Relata-se sobre um homem de 36 anos com passagem quatro anos antes pela selva amazônica. Admitido após seis meses do aparecimento progressivo de tetraparesia, ataxia de marcha, disfagia, disartria, dispnéia e soluço. A ressonância magnética revelou lesão parietoccipital à direita e no bulbo, sendo esta última maior. Investigações para tuberculose e síndrome da imunodeficiência adquirida tiveram resultados negativos. Foi submetido a microcirurgia da lesão do bulbo. O estudo anatomopatológico revelou paracoccidioidomicose. Recebeu tratamento com anfotericina B até 2100 mg, e sulfametoxazol-trimetoprim por três meses, e fisioterapia. Voltou às atividades após seis meses do término do tratamento. Comenta-se sobre a participação do sistema imunológico e das citocinas (interleucinas.We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines.

  17. Paracoccidioidomycosis: Current Perspectives from Brazil

    Science.gov (United States)

    Mendes, Rinaldo Poncio; Cavalcante, Ricardo de Souza; Marques, Sílvio Alencar; Marques, Mariângela Esther Alencar; Venturini, James; Sylvestre, Tatiane Fernanda; Paniago, Anamaria Mello Miranda; Pereira, Ana Carla; da Silva, Julhiany de Fátima; Fabro, Alexandre Todorovic; Bosco, Sandra de Moraes Gimenes; Bagagli, Eduardo; Hahn, Rosane Christine; Levorato, Adriele Dandara

    2017-01-01

    Background: This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis. Objectives: Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings. Methods: Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse. Results: Clinical forms have been better classified in order to include the pictures less frequently observesiod. Conclusion: Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis. PMID:29204222

  18. Paracoccidioidomycosis in patients with lymphoma and review of published literature.

    Science.gov (United States)

    Ruiz e Resende, Lucilene Silva; Yasuda, Alice Gadotti; Mendes, Rinaldo Poncio; Marques, Sílvio Alencar; Niéro-Melo, Lígia; Defaveri, Júlio; Domingues, Maria Aparecida Custódio

    2015-04-01

    This paper describes four new cases of lymphomas, two Hodgkin lymphomas and two non-Hodgkin lymphomas in patients with paracoccidioidomycosis. All had mycosis diagnosed before lymphomas with Paracoccidioides brasiliensis demonstrated in several lymph nodes, as seen in the disseminated form of the disease. When lymphoma was diagnosed, one patient was under regular paracoccidioidomycosis treatment and in clinic-serological remission for this disease, another was under regular treatment but with clinic-serological mycosis activity, one had abandoned paracoccidioidomycosis treatment 6 years earlier, and the other had not yet received any kind of antifungal drugs. Three patients received treatment for lymphomas with one remaining in remission until now, one achieving tumor remission which relapsed years later, and one having only residual lymphoma in bone marrow for a decade but clinically well. All three experienced paracoccidioidomycosis clinical remission, however, serology became negative just in one. Similar previously described cases were reviewed: five Hodgkin lymphomas, three non-Hodgkin lymphomas, and one described only as "lymphoma" without specifying type; a summary of their findings is presented. Finally, there is also a brief discussion on the possible pathophysiological mechanisms involved in the concomitance of these two disorders.

  19. Paracoccidioidomicose crônica multifocal tendo como primeira manifestação o envolvimento palpebral: relato de caso Chronical and multifocal paracoccidioidomycosis having the lid involvement as the first sign: case report

    Directory of Open Access Journals (Sweden)

    Tiago Nelson de Oliveira Rassi

    2009-12-01

    Full Text Available O acometimento ocular da paracoccidioidomicose é raro e quando ocorre é geralmente secundário à disseminação hematogênica. Descrição de um caso de paracococcidioidomicose multifocal em homem de 73 anos com história de trauma contuso no olho direito por pedaço de madeira e que teve como primeira manifestação clínica lesão palpebro-conjuntival. Interroga-se possível infecção primária ocular por contiguidade e alerta-se para a manifestação da doença em idade mais avançada.Ocular involvement of paracoccidioidomycosis is rare and when it occurs it is usually secondary to hematogenic dissemination. A case of multifocal paracoccidioidomycosis in a 73 year-old male after history of blunt trauma in the right eye with a stick of wood that presented as the first clinical sign a lid-conjunctival lesion is described. The possible primary ocular infection spreading by contiguity is argued and the disease manifestation in an advanced age is highlighted.

  20. Radiologic findings of osteoarticular infection in paracoccidioidomycosis

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    Monsignore, Lucas Moretti; Simao, Marcelo Novelino; Reis Teixeira, Sara; Elias, Jorge Jr.; Nogueira-Barbosa, Marcello Henrique [Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Division of Radiology of the Internal Medicine Department, Ribeirao Preto (Brazil); Martinez, Roberto [Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Division of Infectious Diseases of the Internal Medicine Department, Ribeirao Preto (Brazil)

    2012-02-15

    To report the radiological abnormalities of osteoarticular involvement in paracoccidioidomycosis (PCM). After institutional board approval, the medical records and conventional radiology findings of 19 patients with osseous PCM were retrospectively reviewed. Number, distribution, and lesion characteristics were evaluated in consensus by two experienced musculoskeletal radiologists. The mean age of patients was 16.1 years (range 4-49 years), 11 male and eight female. MSK involvement was the only or the primary presentation of the disease in eight of 19 patients (42.1%). In total, 51 focal bone lesions were detected, being 41 in long bones. In long bones lesions, 19 of 41 (46.4%) were metaphyseal, 12 of 41 (29.3%) meta-epiphyseal, and 12 of 41 (29.3%) diaphyseal. The most common presentation was a geographic osteolytic bone lesion (62.7%), without marginal sclerosis (82.4%) and without periosteal reaction (90.2%). Articular involvement was present in six of 19 patients (31.6%), being two cases of primary arthritis. All encountered bone lesions were osteolytic. Metaphyseal or meta-epiphyseal osteomyelitis of a long bone was the most prevalent osteoarticular manifestation of paracoccidioidomycosis. PCM osteoarticular involvement could be solitary or multifocal, occurs almost exclusively in the acute/subacute clinical form, and it is more common in children and in juvenile patients. Axial skeleton involvement, arthritis, or a disseminated osseous pattern of infection may occasionally occur in this fungal disease. (orig.)

  1. Radiologic findings of osteoarticular infection in paracoccidioidomycosis.

    Science.gov (United States)

    Monsignore, Lucas Moretti; Martinez, Roberto; Simão, Marcelo Novelino; Teixeira, Sara Reis; Elias, Jorge; Nogueira-Barbosa, Marcello Henrique

    2012-02-01

    To report the radiological abnormalities of osteoarticular involvement in paracoccidioidomycosis (PCM). After institutional board approval, the medical records and conventional radiology findings of 19 patients with osseous PCM were retrospectively reviewed. Number, distribution, and lesion characteristics were evaluated in consensus by two experienced musculoskeletal radiologists. The mean age of patients was 16.1 years (range 4-49 years), 11 male and eight female. MSK involvement was the only or the primary presentation of the disease in eight of 19 patients (42.1%). In total, 51 focal bone lesions were detected, being 41 in long bones. In long bones lesions, 19 of 41 (46.4%) were metaphyseal, 12 of 41 (29.3%) meta-epiphyseal, and 12 of 41 (29.3%) diaphyseal. The most common presentation was a geographic osteolytic bone lesion (62.7%), without marginal sclerosis (82.4%) and without periosteal reaction (90.2%). Articular involvement was present in six of 19 patients (31.6%), being two cases of primary arthritis. All encountered bone lesions were osteolytic. Metaphyseal or meta-epiphyseal osteomyelitis of a long bone was the most prevalent osteoarticular manifestation of paracoccidioidomycosis. PCM osteoarticular involvement could be solitary or multifocal, occurs almost exclusively in the acute/subacute clinical form, and it is more common in children and in juvenile patients. Axial skeleton involvement, arthritis, or a disseminated osseous pattern of infection may occasionally occur in this fungal disease.

  2. [Disseminated juvenile paracoccidioidomycosis diagnosed in a girl in an urban area].

    Science.gov (United States)

    Ballesteros, Angélica; Beltrán, Sandra; Patiño, Jaime; Bernal, Cynthia; Orduz, Rocío

    2014-01-01

    Paracoccidioidomycosis is one of the most prevalent systemic fungal infections in Latin American countries. The incidence rate has been increasing and its detection has gotten increasingly common in travelers or immigrants from endemic areas. It is characterized by respiratory symptoms, lymphadenopathies and skin lesions, which gradually progress and subsequently lead to death in some untreated chronic disease cases. To describe the clinical approach and diagnosis of an exotic tropical pathology in an urban area. Case description and extended literature review. We made a case report of urban paracoccidioidomycosis in a young patient, with a clinical syndrome of fever for a month, widespread nodal involvement, cutaneous manifestations and weight loss. During the physical examination, hepatosplenomegaly and a febrile episode were evidenced, whose diagnosis was difficult. Management started with itraconazole and trimethoprim sulfamethoxazole, with subsequent cessation of spiking fevers and significant improvement of the skin lesions. We performed a comprehensive literature review, with search criteria performed in PubMed and adapted for different databases. The review was conducted based on the studies found in Medline, LILACS, SciELO and Cochrane Library, from 1966 up to this moment. Studies were selected by the authors based on their relevance and scientific contribution to the discussion of this case. There are few cases of paracoccidiomycosis in the pediatric population despite the endemicity of this entity in Latin America. An increasing population influx from endemic areas makes suspecting of this disease a must.

  3. Sarcoid-like paracoccidioidomycosis presenting with perineural granuloma*

    OpenAIRE

    Müller, Silvia Ferreira Rodrigues; de Miranda, Mario Fernando Ribeiro

    2013-01-01

    Paracoccidioidomycosis presenting as a sarcoid-like plaque may be misdiagnosed as leprosy, especially when shared endemic areas are concerned. We report the case of a Brazilian male patient presenting with an ulcerated plaque on his left ear and neighboring areas. The plaque simulated tuberculoid leprosy type 1 reaction, both clinically and histopathologically. A perineural granuloma with no organisms detected by routine and Fite-Faraco staining reinforced that diagnosis. Paracoccidioidomycos...

  4. High-resolution computed tomography findings in pulmonary paracoccidioidomycosis; Paracoccidioidomicose pulmonar - aspectos na tomografia computadorizada de alta resolucao

    Energy Technology Data Exchange (ETDEWEB)

    Muniz, Maria Angelica Soares; Magnago, Marcelo; Moreira, Luiza Beatriz Melo [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Marchiori, Edson; Almeida Junior, Jose Guiomar de [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br

    2002-06-01

    Pulmonary disease in paracoccidioidomycosis is very common and in some cases can be the sole manifestation of the disease. We studied the findings observed in 30 patients with pulmonary paracoccidioidomycosis submitted to high-resolution computed tomography in order to determine the most frequent findings, presentation patterns and distribution of paracoccidioidomycosis lesions in the lungs. The most frequent findings observed in high-resolution computed tomography were: interlobular septal thickening (96.7%), ground-glass opacities (66.7%), nodules (60%), irregular air-space enlargement (56.7%), bronchial wall thickening (46.7%), pleural thickening (36.7%), tracheal dilatation (33.3%), architectural distortion (30%), air-space consolidation (30%), parenchymal bands (23.3%), intralobular reticulate (13.3%) and hilar interstitial thickening (10%). Chest X-ray allow limited evaluation of diffuse pulmonary diseases, and hence high-resolution computed tomography is an essential method for studying patients with pulmonary paracoccidioidomycosis. (author)

  5. Lymphoscintigraphy evaluation of paracoccidioidomycosis patients

    Energy Technology Data Exchange (ETDEWEB)

    Griva, B.L. E-mail: bgriva@fmb.unesp.br

    2005-07-01

    Lymph node involvement is very frequent in paracoccidioidomycosis (PBM) mainly in its juvenile form. PBM also affects the lymphatic system of patients with the chronic form as it was confirmed by bipedal lymphangiography and autopsy. Lymphoscintigraphy has been used to evaluate lymphedema and cancer. The purpose of this investigation was to study the lymphoscintigraphic variables in a critical manner, to functionally evaluate the lymphatic system of patients with different forms of PBM, and to evaluate the influence of the antifungal treatment on the lymphoscintigraphic variables by lymphoscintigraphy of the extremities. Forty-six patients with PBM were studied. Twenty-one had the juvenile and 25 the chronic form. Patients with the juvenile form were divided again into three subgroups according to age. Eleven healthy volunteers were evaluated as controls. All of them were injected with 37 MBq of dextran 500-99mTc into the first interdigital space of each foot, and blood was obtained for serum albumin determination. Twenty-nine patients were evaluated after the beginning of the antifungal treatment. The time elapsed between both exams was smaller in patients with the juvenile form than in those with the chronic form. Semi-quantitative variables, such as the intensity of visualization of the radiotracer and the pattern of the time-activity curve with regions of interest over ilioinguinal lymph nodes and legs, were studied. Quantitative variables were also evaluated including the velocity of visualization of the lymph nodes, lymph flow ratio, and lymph node radiotracer uptake. The error propagation was calculated to assess the lymph flow ratio accuracy. Correlation between variables and serum albumin was done. The intensity and velocity of visualization of the radiotracer, the lymph flow ratio, and the pattern of the time-activity curve were useful variables to the evaluation of patients with the juvenile and the chronic form of PBM. The lymph flow ratio calculated by

  6. Fatal septic shock due to a disseminated chronic form of paracoccidioidomycosis in an aged woman.

    Science.gov (United States)

    Benard, Gil; Patzina, Roseli L; Schwab, Juliana Barbosa; Gabriel, Thiago C; Ho, Yeh-Li

    2012-05-01

    Once rare, septic shock (SS) due to disseminated fungal infections has been increasingly reported due to a growing number of immunocompromised patients, but remains rare in non-immune-compromised individuals. In paracoccidioidomycosis, it has been described in only three patients with the severe, acute form of the disease. We describe the development of a refractory, fatal septic shock due to a severe disseminated chronic form of paracoccidioidomycosis in an older woman without any other microbial insults. A striking event in the evolution of her case was the severe depletion of lymphocytes from the peripheral blood and lymphoid organs. Lymphocyte depletion due to apoptosis is described in the late phase of sepsis and can contribute both to immunosuppression and the progression of SS. The possible mechanisms involved in the induction of SS in the chronic form of paracoccidioidomycosis are discussed.

  7. Spontaneous pneumothorax in paracoccidioidomycosis patients from an endemic area in Midwestern Brazil.

    Science.gov (United States)

    Cabrera, Lucas G G; Santos, Aline F; Andrade, Ursulla V; Guedes, Carlos Ivan A; Oliveira, Sandra M V L; Chang, Marilene R; Mendes, Rinaldo P; Paniago, Anamaria M M

    2017-02-01

    Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas. © 2016 Blackwell Verlag GmbH.

  8. Paracoccidioidomicose: estudo clínico e epidemiológico de 422 casos observados no Estado de Mato Grosso do Sul Paracoccidioidomycosis: a clinical and epidemiological study of 422 cases observed in Mato Grosso do Sul

    Directory of Open Access Journals (Sweden)

    Anamaria Mello Miranda Paniago

    2003-07-01

    Full Text Available São descritas as características clínicas e epidemiológicas de 422 casos de paracoccidioidomicose atendidos no Hospital Universitário da Universidade Federal do Mato Grosso do Sul (Campo Grande, Mato Grosso do Sul, Brasil no período de Janeiro de 1980 a Agosto de 1999. A média de idade foi de 43,4 anos e a proporção homem: mulher foi de 10:1. Quase metade (45,5% dos doentes era trabalhadora rural no momento do diagnóstico. A forma aguda/subaguda (tipo juvenil(15,4% dos casos revelou-se com importante comprometimento do sistema fagocítico-monocitário, manifestado principalmente por adenomegalia (95,4%; hepatomegalia (40%; esplenomegalia (23,1%. A forma crônica (tipo adulto(84,6% dos casos apresentou-se com maiores proporções de lesões em orofaringe (66,4%; rouquidão (31,4% e tosse (50,7%. Para o diagnóstico, foram utilizados o exame micológico direto em 365 pacientes e o histopatológico em 302, com positividade de 50,7% e 97,3%, respectivamente. O tratamento antifúngico preferencial foi a associação de sulfametoxazol e trimetoprim (co-trimoxazol, utilizado em 90,3% dos doentes. Seqüelas foram observadas em 30,3% e óbito em 7,6% dos casos.Clinical and epidemiological features of 422 cases of paracoccidioidomycosis attended at University Hospital of Universidade Federal de Mato Grosso do Sul (Campo Grande, Mato Grosso do Sul, Brazil from January 1980 to August 1999, were analysed. The mean age was 43.4 years old and the male: female ratio was 10:1. Nearly half (45.5% of the patients were agricultural workers at the moment of diagnosis. In the acute/subacute form (juvenile type the phagocytic-monocytic system was very much impaired and mainly marked by lymphadenopathy (95.4%, hepatomegaly (40%, splenomegaly (23.1%. The chronic form (adult type presents more lesions in oropharynx (66.4%, dysphonia (31.4% and cough (50.7%. Mycological diagnosis was obtained by direct microscopy of wet mounts in 185/365 (50.7% patients and by

  9. Associação da rifampicina à anfotericina B no tratamento da paracoccidioidomicose: resultados em três pacientes tratados Association of Amphotericin B and Rifampicin in the treatment of paracoccidioidomycosis. Report of efficacy in three cases

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    Bodo Wanke

    1984-08-01

    Full Text Available Trabalhos experimentais demonstraram que a anfotericina B, desorganizando funcionalmente a membrana celular fúngica, permite a penetração da rifampicina no citoplasma e sua conseqüente ação contra Histoplasma capsulatum, Blastomyces dermatitidis e Candida albicans. Com metade das doses habituais' de anfotericina B associada à rifampicina conseguem-se melhores resultados do que com a anfotericina B isoladamente em doses plenas. Os Autores discutem as possíveis aplicações desta associação no tratamento da paracoccidioidomi-cose e apresentam 3 casos desta micose em que a inatividade clínica e micológica só foi obtida após o emprego combinado destas drogas.Experimental data have shown that low concentration of amphotericin B disrupts of the fungal cellular membranes, enhancing entrance of rifampicin into citoplasm, where it acts specifically as an antifungal agent against Histoplasma capsulatum, Blastomyces dermatitidis and Candida albicans. Amphotericin B in half dosage combined with rifampicin is more effective than when used alone in full dosage. The Authors discuss the possible indications of this association in the therapy of paracoccidioidomycosis, and report its efficacy in three cases of this disease only controlled after its use.

  10. Important aspects of oral paracoccidioidomycosis--a literature review.

    Science.gov (United States)

    Abreu e Silva, Mariana Àlvares de; Salum, Fernanda Gonçalves; Figueiredo, Maria Antonia; Cherubini, Karen

    2013-05-01

    Paracoccidioidomycosis is a deep mycosis endemic to Latin America, with considerable morbidity and mortality. It is caused by the dimorphic fungus Paracoccidioides brasiliensis, which affects, among other organs in the human body, the oral cavity. Fungus virulence and immunocompetence of the host determine the establishment of infection or active disease, whose severity and clinical behaviour depend mostly on the cellular immune response of the host. Often, oral lesions constitute the first sign and site of confirmation of diagnosis, which in most cases is delayed. The success of the treatment depends on early and correct diagnosis, as well as on the patient's adherence to the drug therapy. © 2012 Blackwell Verlag GmbH.

  11. Endemic paracoccidioidomycosis: relationship between clinical presentation and patients' demographic features.

    Science.gov (United States)

    Bellissimo-Rodrigues, Fernando; Bollela, Valdes Roberto; Da Fonseca, Benedito Antônio Lopes; Martinez, Roberto

    2013-04-01

    Paracoccidioidomycosis (PCM) is a systemic fungal disease endemic to Latin America and characterized by two clinical presentations, i.e., patients develop either acute/subacute or chronic clinical manifestations. The differences in clinical presentations are mainly dependent on the host immune response, but may also be related to demographic characteristics of some patients. In this retrospective study, 1,219 PCM cases treated between 1970 and 2009 in a university medical center, located in southeastern Brazil, were analyzed according to their clinical and demographic features. The most affected anatomical sites were lungs (63.8%) and oral mucosa (50.0%), with increasing involvement of these sites in accord with the age of the patients. Generalized lymphadenopathy (28.1%) and skin lesions (29.6%) were more frequent on the first decades of life. Involvement of the larynx (16.1%), gut (7.5%), spleen (4.7%), central nervous system (3.4%), bones and joints (2.2%), and adrenal (2.1%) were also variable according to the age of the host. The acute/subacute form of the disease accounted for 26.4% of PCM cases and, on a multivariate analysis, was inversely associated with aging (OR = 0.8 per year, P < 0.001), and directly associated with female sex (OR = 7.2, P < 0.001), mixed black and white racial background (OR = 2.3, P < 0.001) or black skin color (OR = 4.6, P < 0.001). Based on these findings, we have shown that host immune response, as well as age, gender and ethnicity may influence the clinical presentation of PCM.

  12. The lung in paracoccidioidomycosis: new insights into old problems

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    Andre Nathan Costa

    2013-04-01

    Full Text Available OBJECTIVES: Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. METHODS: A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. RESULTS: Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%, reticulate and septal thickening (88%, centrilobular and paraseptal emphysema (84% and parenchymal bands (74%. Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. CONCLUSIONS: Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more

  13. The lung in paracoccidioidomycosis: new insights into old problems.

    Science.gov (United States)

    Costa, Andre Nathan; Benard, Gil; Albuquerque, Andre Luis Pereira; Fujita, Carmem Lucia; Magri, Adriana Satie Kono; Salge, João Marcos; Shikanai-Yasuda, Maria Aparecida; Carvalho, Carlos Roberto Ribeiro

    2013-04-01

    Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial serology and more severe emphysema, stressing the importance of adequate

  14. Microimmunodiffusion test for the serodiagnosis of paracoccidioidomycosis

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    Maria Isabel Correa da Silva

    1989-02-01

    Full Text Available We used the micro- and macroimmunodiffusion test for the qualitative and quantitative measurement of anti - P. brasiliensis antibodies in serum of patients with paracoccidioidomycosis. All 103 paracoccidioidomycosis sera (100% were positive in the micro test versus 87% positivity index in the macrotest. All 83 control sera from patients with other diseases were negative in both tests. Titers of the positive sera tended to be higher in the microtest, which revealed sharper and easier to read precipiting bands. Microimmunodiffusion is simple to be performed, requires a minimum amount of reagents and allows the simultaneous testing of 102 sera. It may replace the macrotest specially in laboratories dealing with great serologic routine.

  15. Paracoccidioidomicose primária de pálpebra e conjuntiva Primary paracoccidioidomycosis of eyelid and conjunctiva

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    Ezon Ferraz

    2001-06-01

    Full Text Available A paracoccidioidomicose (Pbmicose é a micose profunda mais freqüente no Brasil, mas o acometimento ocular é raro e, quando presente, geralmente secundário. Os autores relatam caso de Pbmicose pálpebro-conjuntival em que não foi encontrado foco extra-ocular. É feita uma revisão da literatura e discutida a importância da suspeita diagnóstica em população de risco e do tratamento precoce desta condição para o bom prognóstico visual.Paracoccidioidomycosis is the most frequent systemic mycosis in Brazil, but ocular involvement is rare and, if present, often secondary to another site. The authors report a case of paracoccidioidomycosis of eyelid and conjunctiva where no extraocular focus was found. A brief review of the literature is made discussing the importance of diagnostic suspecion in a population at risk and early treatment for a good visual prognosis.

  16. Case Report: Occurrence of Paracoccidioides lutzii in the Amazon Region: Description of Two Cases

    NARCIS (Netherlands)

    Marques-da Silva, S.H.; Rodrigues, A.M.; de Hoog, G.S.; Silveira-Gomes, F.; Camargo, Z.P.

    2012-01-01

    Paracoccidioidomycosis (PCM), the most important human systemic mycosis in Latin America, is known to be caused by at least four different phylogenetic lineages within the Paracoccidioides brasiliensis complex, including S1, PS2, PS3, and Pb01-like group. Herein, we describe two cases of PCM in

  17. Brazilian guidelines for the clinical management of paracoccidioidomycosis.

    Science.gov (United States)

    Shikanai-Yasuda, Maria Aparecida; Mendes, Rinaldo Pôncio; Colombo, Arnaldo Lopes; Queiroz-Telles, Flávio de; Kono, Adriana Satie Gonçalves; Paniago, Anamaria M M; Nathan, André; Valle, Antonio Carlos Francisconi do; Bagagli, Eduardo; Benard, Gil; Ferreira, Marcelo Simão; Teixeira, Marcus de Melo; Silva-Vergara, Mario León; Pereira, Ricardo Mendes; Cavalcante, Ricardo de Souza; Hahn, Rosane; Durlacher, Rui Rafael; Khoury, Zarifa; Camargo, Zoilo Pires de; Moretti, Maria Luiza; Martinez, Roberto

    2017-01-01

    Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.

  18. Hepatic involvement in paediatric patients with paracoccidioidomycosis: a histological study.

    Science.gov (United States)

    de Melo Braga, Giselle; Hessel, Gabriel; Pereira, Ricardo Mendes; Escanhoela, Cecília Amélia Fazzio

    2014-01-01

    Paracoccidioidomycosis is a systemic mycosis that is endemic to certain countries in Latin America. This study aimed to describe the histological features of liver involvement in patients with paracoccidioidomycosis aged <16 years of age who were treated between 1980 and 2010, with a diagnosis that was confirmed by detection of the fungus by pathological examination. Liver tissue was obtained from one necropsy and 12 biopsies. Throughout 2007, biopsies were taken from patients with persistent jaundice or portal hypertension, after which biopsies became indicated due to elevated aminotransferase and low albumin levels. Using haematoxylin and eosin (H&E), Masson's trichrome and immunohistochemical (CK7 and CK19) staining, we noted degenerative alterations in bile duct cells and inflammatory injury to the bile ducts in 10 biopsies. Using immunohistochemistry for CK7 and CK19, we observed ductal proliferation in all 12 samples. Bile duct injuries by inflammatory cells might explain the predominant increase in canalicular enzymes; immunohistochemistry is more sensitive in demonstrating ductular reactions and might show changes that are not apparent on H&E staining. © 2013 John Wiley & Sons Ltd.

  19. Treatment of severe forms of paracoccidioidomycosis: is there a role for corticosteroids?

    Science.gov (United States)

    Benard, Gil; Campos, Aléia F; Netto, Lucas C; Gonçalves, Luiz G; Machado, Luis R; Mimicos, Evanthia V; França, Francisco O S; Gryschek, Ronaldo C B

    2012-08-01

    Despite their immunosuppressive effects, corticosteroids have long been used as adjunct therapy (aCST) in the treatment of infectious diseases. The rationale is that in certain infections it is necessary to decrease the exacerbated host's inflammatory response, which can otherwise result in tissue damage and organ dysfunction. In fact, a major concern in treating paracoccidioidomycosis (PCM) is the host's intense inflammatory response to Paracoccidioides brasiliensis, which can be further intensified by antifungal therapy. Depending on its localization, this immunological phenomenon may be life threatening or result in permanent sequels, as is the case for some patients with cerebral or laryngeal involvement. However, the literature on aCST in paracoccidioidomycosis treatment is scarce and as a result we present our recent experience in the management of four patients with severe PCM manifestations, i.e., cerebral paracoccidioidal granuloma, laryngeal stenosis, compressive abdominal mass, and exacerbated inflammatory response with tissue destruction. In addition to the antifungal therapy, these patients required aCST, which probably promoted their clinical improvement and/or prevented serious complications. We suggest that aCST: (a) can potentially help in the management of selected cases of severe forms of PCM, particularly when there is a risk of acute complications, and (b) that it can be used safely provided that the risk-benefit ratio is carefully weighed. Well-controlled, prospective studies of aCST in the treatment of severe cases of paracoccidioidomycosis are needed to better define its role in the management of PCM.

  20. Oral Paracoccidioidomycosis Granulomas are Predominantly Populated by CD163+ Multinucleated Giant Cells.

    Science.gov (United States)

    do Prado Gomes Pedreira, Renato; de Carli, Marina Lara; Beijo, Luiz Alberto; Nonogaki, Suely; Pereira, Alessandro Antônio Costa; Junior, Noé Vital Ribeiro; Sperandio, Felipe Fornias; Hanemann, João Adolfo Costa

    2016-10-01

    Multinucleated giant cells (MGC) are considered to be a hallmark of granulomatous inflammation; thus, they may play an essential role in the host response against pathogens, particularly Paracoccidioides brasiliensis. This study characterizes the MGC found in oral paracoccidioidomycosis and assesses the correlation of MGC with the amount of fungi within oral tissues. Twenty-six cases were included. They were classified as loose or dense granulomas, and the total MGC, including foreign-body and Langhans giant cells, besides the total and intracellular fungi, were taken into consideration. CD163 immunoexpression was performed, and CD163+ multinucleated giant cells were also quantified. Dense granulomas revealed more foreign-body type and total giant cells than loose granulomas (P paracoccidioidomycosis lesions contain MGC that mainly belong to a CD163+ phenotype, also showing both Langhans and foreign-body arrangements. Additionally, the higher the presence of MGC, the higher the amount of phagocytized fungi.

  1. Tendência da mortalidade relacionada à paracoccidioidomicose, Estado de São Paulo, Brasil, 1985 a 2005: estudo usando causas múltiplas de morte Paracoccidioidomycosis-related mortality trend, state of São Paulo, Brazil: a study using multiple causes of death

    Directory of Open Access Journals (Sweden)

    Augusto Hasiak Santo

    2008-05-01

    Full Text Available OBJETIVO: Estudar a mortalidade relacionada à paracoccidioidomicose informada em qualquer linha ou parte do atestado médico da declaração de óbito. MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados (SEADE de São Paulo entre 1985 e 2005. Foram calculados os coeficientes padronizados de mortalidade relacionada à paracoccidioidomicose como causa básica, como causa associada e pelo total de suas menções. RESULTADOS: No período de 21 anos ocorreram 1 950 óbitos, sendo a paracoccidioidomicose a causa básica de morte em 1 164 (59,7% e uma causa associada de morte em 786 (40,3%. Entre 1985 e 2005 observou-se um declínio do coeficiente de mortalidade pela causa básica de 59,8% e pela causa associada, de 53,0%. O maior número de óbitos ocorreu entre os homens, nas idades mais avançadas, entre lavradores, com tendência de aumento nos meses de inverno. As principais causas associadas da paracoccidioidomicose como causa básica foram a fibrose pulmonar, as doenças crônicas das vias aéreas inferiores e as pneumonias. As neoplasias malignas e a AIDS foram as principais causas básicas estando a paracoccidioidomicose como causa associada. Verificou-se a necessidade de adequar as tabelas de decisão para o processamento automático de causas de morte nos atestados de óbito com a menção de paracoccidioidomicose. CONCLUSÕES: A metodologia das causas múltiplas de morte, conjugada com a metodologia tradicional da causa básica, abre novas perspectivas para a pesquisa que visa a ampliar o conhecimento sobre a história natural da paracoccidioidomicose.OBJECTIVE: To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate. METHODS: Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE. Standardized mortality coefficients were

  2. Gallium-67 imaging in a patient with paracoccidioidomycosis: a case report Pesquisa de corpo inteiro com gálio-67 em uma paciente com paracoccidioidomicose: relato de caso

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    Ana Beatriz Marinho de Jesus TEIXEIRA

    2000-06-01

    Full Text Available A 26 year-old female was admitted with abdominal pain, fever and weight loss. The clinical and laboratory investigations led to the diagnosis of paracoccidioidomycosis. Gallium-67 whole body images correlated well with the clinical course of the disease and with the patient's prognosis.Paciente do sexo feminino de 26 anos foi internada com dor abdominal, febre e emagrecimento. A investigação clínico-laboratorial estabeleceu o diagnóstico de paracoccidioidomicose. Os achados cintilográficos com citrato de gálio-67 correlacionaram-se com o curso clínico da paciente.

  3. Paracoccidioidal infection in HIV patients at an endemic area of paracoccidioidomycosis in Brazil.

    Science.gov (United States)

    Sarti, Elaine Cristina Fernandes Baez; de Oliveira, Sandra Maria do Valle Leone; dos Santos, Liara Ferreira; de Camargo, Zoilo Pires; Paniago, Anamaria Mello Miranda

    2012-03-01

    The association between paracoccidioidomycosis (PCM) and AIDS is relatively rare in contrast to the higher incidence of other systemic mycosis. The explanation may be that AIDS is still predominantly an urban disease, and the PCM is endemic in Latin American rural areas. The aim of this study was to detect the prevalence of Paracoccidioides brasiliensis infection in HIV-positive patients at an endemic area of paracoccidioidomycosis in Brazil. Skin test with purified 43 kD glycoprotein (gp43) was performed in 90 HIV/AIDS patients. The prevalence found was 12.2% and it may be even greater, considering that HIV/AIDS patients may not respond to the intradermal test, which depends on cellular immunity for its positivity.

  4. Accuracy of routine diagnostic tests used in paracoccidioidomycosis patients at a university hospital.

    Science.gov (United States)

    Moreto, T C; Marques, M E A; de Oliveira, M L S C; Moris, D V; de Carvalho, L R; Mendes, R P

    2011-08-01

    The identification of appropriate laboratory measures to confirm clinical hypotheses is important in routine paracoccidioidomycosis medical care. The clinical records and laboratory reports of 401 paracoccidioidomycosis patients attended at the Tropical Diseases Area, Faculdade de Medicina de Botucatu, from 1974 to 2008 were reviewed. Direct mycological (DM), cell block (CB), histopathological (HP), and double immunodiffusion (DID) tests were evaluated before treatment. Typical Paracoccidioides brasiliensis yeast forms were observed in clinical specimens of 86% of the patients, but 14% were detected only by serological test. DM of 51 different tissue specimens produced 74.5% sensitivity, and 62.5% sensitivity was observed in 112 sputum samples. CB in 483 sputum samples generated 55.3% sensitivity. HP performed in 239 samples from different tissues revealed 96.7% sensitivity. Serology carried out in 351 patients and 200 healthy controls provided 90.0% sensitivity, 100.0% specificity, 100.0% positive predictive value, 85.1% negative predictive value and 93.6% accuracy. Comparisons of laboratory measurements performed in the same patient showed that sensitivity decreases from HP to DID to CB and DM, with the last two assays providing similar sensitivities. This study demonstrated that P. brasiliensis identification by HP, CB, and/or DM associated with DID is sufficient to establish the laboratorial diagnosis of paracoccidioidomycosis in practically all cases. Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

  5. Abdominal alterations in disseminated paracoccidioidomycosis: computed tomography findings

    Energy Technology Data Exchange (ETDEWEB)

    Vermelho, Marli Batista Fernandes; Correia, Ademir Silva; Michailowsky, Tania Cibele de Almeida; Suzart, Elizete Kazumi Kuniyoshi; Ibanes, Aline Santos; Almeida, Lanamar Aparecida; Khoury, Zarifa; Barba, Mario Flores, E-mail: marlivermelho@globo.com [Instituto de Infectologia Emilio Ribas (IIER), Sao Paulo, SP (Brazil)

    2015-03-15

    Objective: to evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and methods: retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results: abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion: computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis. (author)

  6. DNAhsp65 Vaccine as Therapy against Paracoccidioidomycosis.

    Science.gov (United States)

    Ribeiro, Alice M; Amaral, André C; Felipe, Maria Sueli S; Bocca, Anamelia L

    2017-01-01

    The conventional treatment for fungal diseases usually shows long periods of therapy and the high frequency of relapses and sequels. New strategies of the treatment are necessary. We have shown that the Mycobacterium leprae HSP65 gene can be successfully used as therapy against murine Paracoccidioidomycosis (PCM). Here, we described the methodology of DNAhsp65 immunotherapy in mice infected with the dimorphic fungus Paracoccidioides brasiliensis, one of PCM agent, evaluating cytokines levels, fungal burden, and lung injury. Our results provide a new prospective on the immunotherapy of mycosis.

  7. Antifungal Activity of Amphotericin B Conjugated to Nanosized Magnetite in the Treatment of Paracoccidioidomycosis.

    Science.gov (United States)

    Saldanha, Camila Arruda; Garcia, Mônica Pereira; Iocca, Diego Cesar; Rebelo, Luciana Guilherme; Souza, Ana Camila Oliveira; Bocca, Anamélia Lorenzetti; Almeida Santos, Maria de Fátima Menezes; Morais, Paulo Cesar; Azevedo, Ricardo Bentes

    2016-06-01

    This study reports on in vitro and in vivo tests that sought to assess the antifungal activity of a newly developed magnetic carrier system comprising amphotericin B loaded onto the surface of pre-coated (with a double-layer of lauric acid) magnetite nanoparticles. The in vitro tests compared two drugs; i.e., this newly developed form and free amphotericin B. We found that this nanocomplex exhibited antifungal activity without cytotoxicity to human urinary cells and with low cytotoxicity to peritoneal macrophages. We also evaluated the efficacy of the nanocomplex in experimental paracoccidioidomycosis. BALB/c mice were intratracheally infected with Paracoccidioides brasiliensis and treated with the compound for 30 or 60 days beginning the day after infection. The newly developed amphotericin B coupled with magnetic nanoparticles was effective against experimental paracoccidioidomycosis, and it did not induce clinical, biochemical or histopathological alterations. The nanocomplex also did not induce genotoxic effects in bone marrow cells. Therefore, it is reasonable to believe that amphotericin B coupled to magnetic nanoparticles and stabilized with bilayer lauric acid is a promising nanotool for the treatment of the experimental paracoccidioidomycosis because it exhibited antifungal activity that was similar to that of free amphotericin B, did not induce adverse effects in therapeutic doses and allowed for a reduction in the number of applications.

  8. Antifungal Activity of Amphotericin B Conjugated to Nanosized Magnetite in the Treatment of Paracoccidioidomycosis.

    Directory of Open Access Journals (Sweden)

    Camila Arruda Saldanha

    2016-06-01

    Full Text Available This study reports on in vitro and in vivo tests that sought to assess the antifungal activity of a newly developed magnetic carrier system comprising amphotericin B loaded onto the surface of pre-coated (with a double-layer of lauric acid magnetite nanoparticles. The in vitro tests compared two drugs; i.e., this newly developed form and free amphotericin B. We found that this nanocomplex exhibited antifungal activity without cytotoxicity to human urinary cells and with low cytotoxicity to peritoneal macrophages. We also evaluated the efficacy of the nanocomplex in experimental paracoccidioidomycosis. BALB/c mice were intratracheally infected with Paracoccidioides brasiliensis and treated with the compound for 30 or 60 days beginning the day after infection. The newly developed amphotericin B coupled with magnetic nanoparticles was effective against experimental paracoccidioidomycosis, and it did not induce clinical, biochemical or histopathological alterations. The nanocomplex also did not induce genotoxic effects in bone marrow cells. Therefore, it is reasonable to believe that amphotericin B coupled to magnetic nanoparticles and stabilized with bilayer lauric acid is a promising nanotool for the treatment of the experimental paracoccidioidomycosis because it exhibited antifungal activity that was similar to that of free amphotericin B, did not induce adverse effects in therapeutic doses and allowed for a reduction in the number of applications.

  9. Validation and clinical application of a nested PCR for paracoccidioidomycosis diagnosis in clinical samples from Colombian patients.

    Science.gov (United States)

    Gaviria, Marcela; Rivera, Vanessa; Muñoz-Cadavid, Cesar; Cano, Luz Elena; Naranjo, Tonny Williams

    2015-01-01

    Paracoccidioidomycosis is a systemic and endemic mycosis, restricted to tropical and subtropical areas of Latin America. The infection is caused by the thermal dimorphic fungus Paracoccidioides brasiliensis and Paracoccidioides lutzii. The diagnosis of paracoccidioidomycosis is usually performed by microscopic examination, culture and immunodiagnostic tests to respiratory specimens, body fluids and/or biopsies; however these methods require laboratory personnel with experience and several days to produce a result. In the present study, we have validated and evaluated a nested PCR assay targeting the gene encoding the Paracoccidioides gp43 membrane protein in 191 clinical samples: 115 samples from patients with proven infections other than paracoccidioidomycosis, 51 samples as negative controls, and 25 samples from patients diagnosed with paracoccidioidomycosis. Additionally, the specificity of the nested PCR assay was also evaluated using purified DNA isolated from cultures of different microorganisms (n=35) previously identified by culture and/or sequencing. The results showed that in our hands, this nested PCR assay for gp43 protein showed specificity and sensitivity rates of 100%. The optimized nested PCR conditions in our laboratory allowed detection down to 1fg of P. brasiliensis DNA. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  10. Abdominal alterations in disseminated paracoccidioidomycosis: computed tomography findings

    OpenAIRE

    Marli Batista Fernandes Vermelho; Ademir Silva Correia; Tânia Cibele de Almeida Michailowsky; Elizete Kazumi Kuniyoshi Suzart; Aline Santos Ibanês; Lanamar Aparecida Almeida; Zarifa Khoury; Mário Flores Barba

    2015-01-01

    Objective: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. Materials and Methods: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. Results: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. Conclusion: Computed tomography has demonstrated to...

  11. Itraconazole vs. trimethoprim-sulfamethoxazole: A comparative cohort study of 200 patients with paracoccidioidomycosis.

    Science.gov (United States)

    Borges, Sheila Rocha Conceição; Silva, Gilberto Marcelo Sperandio da; Chambela, Mayara da Costa; Oliveira, Raquel de Vasconcellos C de; Costa, Regina Lana Braga; Wanke, Bodo; Valle, Antonio Carlos Francesconi do

    2014-04-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America. Brazil accounts for approximately 80% of cases, where it represents a major public health issue due to its disabling impact and the number of premature deaths it causes. We present a retrospective cohort study that was conducted in order to better understand factors that relate to cure of the infection in the treatment of 200 patients with PCM. We evaluated the influence of sociodemographic and clinical factors as well as therapeutic regimen (trimethoprim-sulfamethoxazole [TMP-SMX] and itraconazole) on the progress of PCM (cure and noncure). There was a higher incidence of cure (83%) among patients who regularly received treatment for their infections and completed the treatment protocol. Moreover, itraconazole (86.4%) was significantly superior to TMP-SMX (51.3%) in terms of cure rate and had a median treatment period that was significantly shorter (12 months) than that for TMP-SMX (23 months). A Cox proportional hazard regression model showed that use of itraconazole increased the hazard of cure, regardless of sex, age, education, clinical form, completion of treatment, and regularity. Although the results of this study show that itraconazole was the best treatment option for PCM patients, a double-blind, randomized, controlled trial is necessary to confirm this conclusion.

  12. Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients.

    Science.gov (United States)

    Trindade, Aline Heloísa; Meira, Henrique Côrtes; Pereira, Igor Figueiredo; de Lacerda, Julio César Tanos; de Mesquita, Ricardo Alves; Santos, Vagner Rodrigues

    2017-08-01

    Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease. © 2017 Blackwell Verlag GmbH.

  13. Real Time Polymerase Chain Reaction (rt-PCR): A New Patent to Diagnostic Purposes for Paracoccidioidomycosis.

    Science.gov (United States)

    Rocha-Silva, Fabiana; Gomes, Luciana I; Gracielle-Melo, Cidiane; Goes, Alfredo M; Caligiorne, Rachel B

    2017-01-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by dimorphic fungi Paracoccidioides brasiliensis and Paracoccidioides lutzii. It is prevalent in Latin American, mainly in Brazil. Therefore, PCM has fundamental impact on the Brazilian global economy, especially in public health system, since it is affecting economical active population in different country regions. The present study aimed to standardize the Real Time-Polymerase Chain Reaction (rt-PCR) for an efficient and safe PCM diagnosis amplifying the recombinant protein PB27 gene, only expressed by specimens of Paracoccidioides genus. To standardize a methodology of rt-PCR using species-specific primers and probe designed for annealing in this specific region of the fungi´s genome, amplifying the recombinant protein PB27 gene, only expressed by specimens of Paracoccidioides genus. Followed by design in silico, experiments were performed in vitro to determine rt-PCR specificity, efficiency and genome detection limit. The primers and probe sequences were deposited in Brazilian Coordination of Technological Innovation and Transfer (CTIT), under patent reference number BR1020160078830. The present study demonstrated the rt-PCR applicability for support on diagnosis of paracoccidioidomycosis, presenting low cost, which makes it affordable for public health services in developing countries as Brazil. It is noteworthy that it is necessary to validate this methodology using clinical samples before to use as a safe method of diagnosis. A review of all patents related to this topic was performed and it was shown that, to date, there are no records of patent on kits for paracoccidioidomycosis´s diagnostic. Indeed, there is still a lot to go to reach this goal. The reaction developed was standardized and patented, opening perspectives to molecular diagnosis development for paracoccidioidomycosis, since rt-PCR can be applied to a broad spectrum of infectious diseases. It would need to be tested in biological

  14. Synchronous oral paracoccidioidomycosis and pulmonary tuberculosis in an immunocompetent patient.

    Science.gov (United States)

    Amorim Pellicioli, Ana Carolina; Neves-Silva, Rodrigo; Santos-Silva, Alan Roger; Vargas, Pablo Agustin; Lopes, Márcio Ajudarte

    2015-06-01

    Paracoccidioidomycosis (PCM) and tuberculosis (TB) are chronic granulomatous infectious diseases, in which the main form of contraction is through inhalation of the microorganism-Paracoccidioides brasiliensis and Mycobacterium tuberculosis. Oral involvement of PCM is observed in up to 70 % of the cases and usually presents clinically as ulcerations with granular surface showing tiny hemorrhagic areas. Oral presentation of TB is rare with prevalence smaller than 0.5 % of all cases. Clinical presentation of oral TB mainly consists of single ulcers with irregular limits and necrotic base. A 70-year-old immunocompetent man presented simultaneously oral PCM and pulmonary TB. Medical history revealed a previous diagnosis of pulmonary TB; however, even under treatment for TB, the patient remained with oral lesions and intense pulmonary fibrosis. The physician requested P. brasiliensis serological analysis, which resulted positive. Although the combination of PCM and TB has been reported in the literature, it is still considered an uncommon condition and their diagnosis may represent a challenge to healthcare professionals because of the similarity between their clinical and radiological presentations.

  15. M2 macrophages and inflammatory cells in oral lesions of chronic paracoccidioidomycosis.

    Science.gov (United States)

    de Carli, Marina Lara; Miyazawa, Marta; Nonogaki, Suely; Shirata, Neuza Kasumi; Oliveira, Denise Tostes; Pereira, Alessandro Antônio Costa; Hanemann, João Adolfo Costa

    2016-02-01

    Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides brasiliensis (Pb) and associated with deficient cellular immune response, which is modulated by inflammatory cells, mainly macrophages, and cytokines. Recently, the comprehension of the macrophage polarization mediated by Th1 and Th2 cytokines has contributed to elucidate the immune response that takes part in some diseases. Thus, the aim of this study was to assess the presence of Th1- and Th2-immune response and also Pb counting in oral lesions of chronic PCM. Forty-eight cases of chronic PCM oral lesions were included. All cases were classified as loose or dense granulomas. S100 protein, IL-1β, IL-6, TNF-α, CD163 and CD68 immunoexpressions, and Pb localization were evaluated. The fungi present in the tissue were quantified by anti-Pb antibody. Most patients were white men with mean age of 47 years old and showed higher incidence of multiple lesions. Loose granulomas were predominant and exhibited a great amount of M2 macrophages, which were visualized with anti-CD163 antibody. The expression for CD163 and CD68 was similar (P = 0.05), highlighting the predominance of M2 macrophages in PCM. IL-1β, IL-6, and TNF-α immunoexpression did not significantly change with CD163, CD68, and S100 protein. The number of fungi was significantly higher in cases with intense IL-1β immunoexpression (P = 0.003). M2-activated macrophages were the majority among inflammatory cells in chronic PCM, characterizing the action of a Th2-immune response. Nevertheless, Th1 cytokines were also found; mainly IL-1β, which was associated with fungi counting in oral lesions. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Hormones and the Resistance of Women to Paracoccidioidomycosis

    Science.gov (United States)

    Shankar, Jata; Restrepo, Angela; Clemons, Karl V.; Stevens, David A.

    2011-01-01

    Summary: Paracoccidioidomycosis, one of the most important endemic and systemic mycoses in Latin America, presents several clinical pictures. Epidemiological studies indicate a striking rarity of disease (but not infection) in females, but only during the reproductive years. This suggested a hormonal interaction between female hormones and the etiologic dimorphic fungus Paracoccidioides brasiliensis. Many fungi have been shown to use hormonal (pheromonal) fungal molecules for intercellular communication, and there are increasing numbers of examples of interactions between mammalian hormones and fungi, including the specific binding of mammalian hormones by fungal proteins, and suggestions of mammalian hormonal modulation of fungal behavior. This suggests an evolutionary conservation of hormonal receptor systems. We recount studies showing the specific hormonal binding of mammalian estrogen to proteins in P. brasiliensis and an action of estrogen to specifically block the transition from the saprophytic form to the invasive form of the fungus in vitro. This block has been demonstrated to occur in vivo in animal studies. These unique observations are consistent with an estrogen-fungus receptor-mediated effect on pathogenesis. The fungal genes responsive to estrogen action are under study. PMID:21482727

  17. Paracoccidioidomycosis: High-resolution computed tomography-pathologic correlation

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    Marchiori, Edson, E-mail: edmarchiori@gmail.com [Fluminense Federal University, Rio de Janeiro (Brazil); Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); Valiante, Paulo Marcos, E-mail: valiante.rlk@terra.com.br [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); Mano, Claudia Mauro, E-mail: cacaumano@gmail.com [Fluminense Federal University, Rio de Janeiro (Brazil); Zanetti, Glaucia, E-mail: glauciazanetti@gmail.com [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil); Petropolis Faculty of Medicine, Rio de Janeiro (Brazil); Escuissato, Dante L., E-mail: danteescuissato@gmail.com [Federal University of Parana, Curitiba (Brazil); Souza, Arthur Soares, E-mail: asouzajr@gmail.com [Faculty of Medicine of Rio Preto, Sao Paulo (Brazil); Capone, Domenico, E-mail: domenicocap@gmail.com [Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)

    2011-01-15

    Objective: The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of pulmonary paracoccidioidomycosis and to correlate them with pathologic findings. Methods: The study included 23 adult patients with pulmonary paracoccidioidomycosis. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. An experienced lung pathologist reviewed all pathological specimens. The HRCT findings were correlated with histopathologic data. Results: The predominant HRCT findings included areas of ground-glass opacities, nodules, interlobular septal thickening, airspace consolidation, cavitation, and fibrosis. The main pathological features consisted of alveolar and interlobular septal inflammatory infiltration, granulomas, alveolar exudate, cavitation secondary to necrosis, and fibrosis. Conclusion: Paracoccidioidomycosis can present different tomography patterns, which can involve both the interstitium and the airspace. These abnormalities can be pathologically correlated with inflammatory infiltration, granulomatous reaction, and fibrosis.

  18. Paracoccidioidomycosis infection in domestic and wild mammals by Paracoccidioides lutzii.

    Science.gov (United States)

    Mendes, Josiara F; Klafke, Gabriel B; Albano, Ana Paula N; Cabana, Ângela L; Teles, Alessandra J; de Camargo, Zoilo P; Xavier, Melissa O; Meireles, Mário Carlos A

    2017-06-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis that occurs in several Latin American countries, especially in Brazil. It is caused by the thermo-dimorphic fungus Paracoccidioides spp. Serological studies to detect animal infection represent an excellent strategy for data on the agent's ecology. Although the state of Rio Grande do Sul (RS) is an endemic area for PCM in humans, there is scarce information available on the ecology of the agent in the region. This study aimed to investigate the infection by Paracoccidioides lutzii in animals living in RS, Brazil. A total of 85 wild mammals, 200 horses and 196 domestic dogs, previously tested for infection by P. brasiliensis, were included in this study. Serum samples from the animals were tested by ELISA to detect anti- P. lutzii antibodies. From the 481 animals tested, 105 (21.8%) were seropositive for IgG anti-P. lutzii. Of these, 54 were also positive for P. brasiliensis. A total of 11 horses (10.5%), 30 dogs (28.8%) and 10 wild mammals (9.5%) were positive only for P. lutzii (n=51). The detection of anti-P. lutzii antibodies in animals of RS suggests that the fungus can be found in southern Brazil, despite being described mainly in the midwest and southeast of the country. © 2017 Blackwell Verlag GmbH.

  19. Characterization of the immune response in human paracoccidioidomycosis.

    Science.gov (United States)

    de Castro, Lívia Furquim; Ferreira, Maria Carolina; da Silva, Rosiane Maria; Blotta, Maria Heloisa de Souza Lima; Longhi, Larissa Nara Alegrini; Mamoni, Ronei Luciano

    2013-11-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis that presents two main clinical forms: the adult form (AF) and the juvenile form (JF); and an asymptomatic form denominated PCM-infection (PI). These forms of PCM are related to the immune response developed after infection, which has been associated with Th1 and Th2 responses. However, some PCM characteristics cannot be explained by this balance. In this study we aimed to complement the characterization of the immune response in PCM, including the newly described T cells subpopulations (Th17, Th9 and Th22). We analyzed the expression of cytokines and transcription factors characteristics of these different subpopulations of CD4(+) T cells in PBMCs from PCM patients and a PI group. The results showed that the PI group presented a predominant Th1 response; that JF patients were characterized by a mixed Th2/Th9 response; and AF patients were characterized by a predominant Th17/Th22 response, as well as substantial participation of Th1 cells. These results contribute to the existing knowledge on the immune responses associated with resistance or susceptibility to the P. brasiliensis infection, and thus could lead to the development of new strategies for patient management. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  20. Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract.

    Science.gov (United States)

    da Costa, Ananda Dutra; Vargas, Amanda Pereira; Lucena, Marcia Mendonça; Ruas, Ana Cristina Nunes; Braga, Fernanda da Silva Santos; Bom-Braga, Mateus Pereira; Bom-Braga, Frederico Pereira; do Valle, Antonio Carlos Francesconi; Igreja, Ricardo Pereira; Valete-Rosalino, Cláudia Maria

    Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Paracoccidioidomicose sistêmica multifocal: desafio diagnóstico por manifestação cutânea tardia Multifocal paracoccidioidomycosis: a diagnostic challenge due to late cutaneous manifestation

    Directory of Open Access Journals (Sweden)

    Priscilla Maria Rodrigues Pereira

    2011-02-01

    Full Text Available No Brasil, a paracoccidioidomicose é uma micose sistêmica endêmica frequente na zona rural e em homens adultos. É relatado caso em agricultor, usuário de drogas ilícitas, com manifestações insidiosas, atingindo rins, pulmões, gânglios, ossos e tardiamente pele, com atraso no diagnóstico e na terapêutica eficaz em mais de um ano. É importante incluir a paracoccidioidomicose como diagnóstico diferencial frente a um quadro sugestivo, mesmo na ausência de lesões cutâneas, para reconhecimento e tratamento precoce, em vista da elevada morbimortalidade desta entidade.Paracoccidioidomycosis is an endemic systemic mycosis in Brazil, frequent in the rural areas and often in adult men. It is reported the case of a farmer, who is an illicit drugs' user, with insidious manifestations affecting kidneys, lungs, lymphonodes, bones and lately, the skin, with a delay of more than one year in the diagnosis and effective therapy It is important to include paracoccidioidomycosis as differential diagnosis, even in the absence of cutaneous lesions, for early recognition and treatment, given the high mortality of this entity.

  2. Hepatic involvement in pediatric patients with paracoccidioidomycosis: a clinical and laboratory study.

    Science.gov (United States)

    Braga, Giselle de Melo; Hessel, Gabriel; Pereira, Ricardo Mendes

    2013-10-01

    The liver is one of the organs most affected by paracoccidioidomycosis, a systemic mycosis endemic in some Latin American countries. The majority of articles focused on adult populations and failed to describe any detailed experience of liver abnormalities in pediatric patients. Therefore, the aim of this study was to describe the frequency and characteristics of liver involvement in children with paracoccidioidomycosis. This study comprised 102 patients less than 16 years of age (median 104.3 months) diagnosed with paracoccidioidomycosis from 1980 to 2010. Diagnosis was established by the identification of fungus. Forty-one patients had liver involvement. The main clinical features were generalized lymph node enlargement (39/41), weight loss (34/41) and fever 32/41). Approximately, one-third of the patients had jaundice. Patients with hepatic involvement were younger. A predominant elevation of canalicular enzymes occurred. There was a statistically significant difference in albumin (p < 0.001) and hemoglobin (p = 0.002) values between patients with and without liver involvement, and the lowest values were found in the former group. Cutoff levels of albumin (<3.05 g/dL) and hemoglobin (<9.2 g/dL) can be used to infer hepatic involvement. Hypoalbuminemia (median 2.4 g/dl) is more severe in patients with hepatic involvement and may indicate a worse liver function or complication of the disease (intestinal lymphangiectasia). Deaths (6) occurred only among patients with liver involvement. Particular clinical and laboratory characteristics are present in pediatric patients with hepatic involvement. Younger patients and those with severe hypoalbuminemia are more likely to present liver involvement by Paracoccidioides brasiliensis.

  3. Subtractive phage display selection for screening and identification of peptide sequences with potential use in serodiagnosis of paracoccidioidomycosis caused by Paracoccidioides brasiliensis.

    Science.gov (United States)

    Portes, L da Silva; Kioshima, E S; de Camargo, Z P; Batista, W L; Xander, P

    2017-11-01

    Paracoccidioidomycosis (PCM) is a systemic granulomatous disease endemic in Latin America whose aetiologic agents are the thermodimorphic fungi Paracoccidioides brasiliensis and Paracoccidioides lutzii. Despite technological advances, some problems have been reported for the fungal antigens used for serological diagnosis, and inconsistencies among laboratories have been reported. The use of synthetic peptides in the serological diagnosis of infectious diseases has proved to be a valuable strategy because in some cases, the reactions are more specific and sensitive. In this study, we used a subtractive selection with a phage display library against purified polyclonal antibodies for negative and positive PCM sera caused by P. brasiliensis. The binding phages were sequenced and tested in a binding assay to evaluate its interaction with sera from normal individuals and PCM patients. Synthetic peptides derived from these phage clones were tested in a serological assay, and we observed a significant recognition of LP15 by sera from PCM patients infected with P. brasiliensis. Our results demonstrated that subtractive phage display selection may be useful for identifying new epitopes that can be applied to the serodiagnosis of PCM caused by P. brasiliensis. Currently, there is no standardized method for the preparation of paracoccidioidomycosis (PCM) antigens, which has resulted in differences in the antigens used for serological diagnosis. Here, we report a procedure that uses subtractive phage display selection to select and identify new epitopes for the serodiagnosis of PCM caused by Paracoccidioides brasiliensis. A synthetic peptide obtained using this methodology was successfully recognized by sera from PCM patients, thus demonstrating its potential use for improving the serodiagnosis of this mycosis. The development of synthetic peptides for the serodiagnosis of PCM could be a promising alternative for the better standardization of diagnoses among laboratories.

  4. Paracoccidioidomycosis in a western Brazilian Amazon State: clinical-epidemiologic profile and spatial distribution of the disease.

    Science.gov (United States)

    Vieira, Gabriel de Deus; Alves, Thaianne da Cunha; Lima, Sônia Maria Dias de; Camargo, Luís Marcelo Aranha; Sousa, Camila Maciel de

    2014-01-01

    Paracoccidioidomycosis (PCM) is a systemic infection caused by the fungus Paracoccidioides brasiliensis. PCM is considered one of the most important systemic mycoses in Latin America. This is a clinical, epidemiological, retrospective, quantitative study of PCM cases in patients attending the National Health Service in the State of Rondônia in 1997-2012. The examined variables included sex, age group, year of diagnosis, education level, profession, place of residence, diagnostic test, prior treatment, medication used, comorbidities and case progress. During the study period, 2,163 PCM cases were registered in Rondônia, and the mean annual incidence was 9.4/100,000 people. The municipalities with the highest rates were located in the southeastern region of Rondônia, and the towns of Pimenteiras do Oeste and Espigão do Oeste had the highest rates in the state, which were 39.1/100,000 and 37.4/100,000 people, respectively. Among all cases, 90.2% and 9.8% were observed in men and women, respectively, and most cases (58.2%) were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771) of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases). One hundred thirty-one (6%) patients died. The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM.

  5. Paracoccidioidomycosis in a western Brazilian Amazon State: Clinical-epidemiologic profile and spatial distribution of the disease

    Directory of Open Access Journals (Sweden)

    Gabriel de Deus Vieira

    2014-01-01

    Full Text Available Introduction: Paracoccidioidomycosis (PCM is a systemic infection caused by the fungus Paracoccidioides brasiliensis. PCM is considered one of the most important systemic mycoses in Latin America. Methods: This is a clinical, epidemiological, retrospective, quantitative study of PCM cases in patients attending the National Health Service in the State of Rondônia in 1997-2012. The examined variables included sex, age group, year of diagnosis, education level, profession, place of residence, diagnostic test, prior treatment, medication used, comorbidities and case progress. Results: During the study period, 2,163 PCM cases were registered in Rondônia, and the mean annual incidence was 9.4/100,000 people. The municipalities with the highest rates were located in the southeastern region of Rondônia, and the towns of Pimenteiras do Oeste and Espigão do Oeste had the highest rates in the state, which were 39.1/100,000 and 37.4/100,000 people, respectively. Among all cases, 90.2% and 9.8% were observed in men and women, respectively, and most cases (58.2% were observed in patients aged between 40 and 59 years. Itraconazole was used to treat 91.6% (1,771 of cases, followed by sulfamethoxazole in combination with trimethoprim (4.4% [85] of cases. One hundred thirty-one (6% patients died. Conclusions: The State of Rondônia has a high incidence of PCM, and the municipalities in the southeastern region of the state were found to have the highest incidence rates of this disease. Our findings suggest that Rondônia is the state in the northern region with the highest mortality rate for PCM.

  6. Paracoccidioidomycosis after Highway Construction, Rio de Janeiro, Brazil.

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    do Valle, Antonio C Francesconi; Marques de Macedo, Priscila; Almeida-Paes, Rodrigo; Romão, Anselmo R; Lazéra, Marcia Dos Santos; Wanke, Bodo

    2017-11-01

    Transmission of Paracoccidioides spp. fungi to humans is usually related to manipulation of soil. Rural workers are the most affected group. We report an outbreak of paracoccidioidomycosis after deforestation and massive earth removal during construction of a highway in Rio de Janeiro, Brazil. Extensive environmental disturbances might be involved in fungal transmission.

  7. Parinaud's oculoglandular syndrome associated with paracoccidioidomycosis Síndrome oculoglandular de Parinaud associada à paracoccidioidomicose

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    Paulo Sérgio Gonçalves da COSTA

    2002-02-01

    Full Text Available The authors report one case of Parinaud's oculoglandular syndrome associated with Paracoccidioides brasiliensis infection. No other medical report of this condition was found in the medical literature available at Index Medicus and Medline. The eye involvement has been rather uncommon in paracoccidioidomycosis and this report emphasizes the possibility of this kind of presentation making it also necessary to include paracoccidioidomycosis among the several known causes of Parinaud's oculoglandular syndrome.Os autores relatam um caso de síndrome oculoglandular de Parinaud associada à infecção por Paracoccidioides brasiliensis. Nenhum outro relato desta condição foi encontrado na literatura médica disponível pelo Index Medicus e Medline. O envolvimento ocular é incomum na paracoccidioidomicose e este relato enfatiza a possibilidade deste tipo de apresentação, tornando-se necessário incluir a paracoccidioidomicose entre as várias causas conhecidas de síndrome oculoglandular de Parinaud.

  8. Serology of paracoccidioidomycosis due to Paracoccidioides lutzii.

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    Gegembauer, Gregory; Araujo, Leticia Mendes; Pereira, Edy Firmina; Rodrigues, Anderson Messias; Paniago, Anamaria Mello Miranda; Hahn, Rosane Christine; de Camargo, Zoilo Pires

    2014-07-01

    Paracoccidioides lutzii is a new agent of paracoccidioidomycosis (PCM) and has its epicenter localized to the Central-West region of Brazil. Serological diagnosis of PCM caused by P. lutzii has not been established. This study aimed to develop new antigenic preparations from P. lutzii and to apply them in serological techniques to improve the diagnosis of PCM due to P. lutzii. Paracoccidioides lutzii exoantigens, cell free antigen (CFA), and a TCA-precipitated antigen were evaluated in immunodiffusion (ID) tests using a total of 89 patient sera from the Central-West region of Brazil. Seventy-two sera were defined as reactive for P. brasiliensis using traditional antigens (AgPbB339 and gp43). Non-reactive sera for traditional antigens (n = 17) were tested with different P. lutzii preparations and P. lutzii CFA showed 100% reactivity. ELISA was found to be a very useful test to titer anti-P. lutzii antibodies using P. lutzii-CFA preparations. Sera from patients with PCM due to P. lutzii presented with higher antibody titers than PCM due to P. brasiliensis and heterologous sera. In western blot, sera from patients with PCM due to P. lutzii were able to recognize antigenic molecules from the P. lutzii-CFA antigen, but sera from patients with PCM due to P. brasiliensis could not recognize any P. lutzii molecules. Due to the facility of preparing P. lutzii CFA antigens we recommend its use in immunodiffusion tests for the diagnosis of PCM due to P. lutzii. ELISA and western blot can be used as complementary tests.

  9. Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects

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    Wilma Batista de Matos

    2012-06-01

    Full Text Available INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05. The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%. At CREDIP, 29 cases were diagnosed, of which 26 (89.6% had multifocal manifestations. Mucous tissues were involved more (75.8% frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão.

  10. Associação entre paracoccidioidomicose e alcoolismo The relationship between paracoccidioidomycosis and alcoholism

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    Roberto Martinez

    1992-02-01

    Full Text Available A associação entre alcoolismo e paracoccidioidomicose foi avaliada pelo método de caso-controle, comparando-se o hábito de ingestão etílica de 70 doentes com o de outros 70 pacientes hospitalizados por razões diversas e pareados por sexo e idade. Os participantes foram interrogados de maneira padronizada sobre a quantidade, tipo e periodicidade da ingestão de bebidas alcoólicas, duração do consumo e também sobre manifestações de abuso e/ou dependência do álcool. Na forma crônica da micose foi observada proporção significativamente maior de doentes com ingestão média de álcool acima de 60 ml/dia (50,0% x 30,0% e com preferência por aguardente de cana (89,4% x 68,3% em relação ao grupo controle, além dos grandes bebedores (>100 ml/dia mostrarem tendência de reativação da doença durante ou após seu tratamento. Na forma aguda/subaguda da paracoccidioidomicose verificou-se que 64,3% dos consumidores de bebidas alcoólicas já haviam tido um ou mais episódios de embriaguez etílica, versus 17,6% no grupo controle. Os dados sugerem que o alcoolismo seja fator predisponente da paracoccidioidomicose e talvez possa prejudicar sua cura, principalmente da forma crônica da infecção.The relationship between alcoholism and paracoccidioidomycosis was evaluated by the casecontrol method. The alcohol consumption of 4 groups of patients was compared: 50 patients with chronic paracoccidioidomycosis, 20 patients with the acute or subacute form of this mycosis and their respective control groups of hospitalized patients, each case matched by sex and age. Between September 1986 and July 1988 the cases and their controls were interviewed by one and the same investigator using a questionnaire on drinking habits: quantity and type of beverage consumed, time of onset and frequency of use and whether they had manifested symptoms of inebriation or of alcohol dependence previously, As compared with control patients, the mean daily ingestion

  11. PARACOCCIDIOIDOMYCOSIS: CHALLENGES IN THE DEVELOPMENT OF A VACCINE AGAINST AN ENDEMIC MYCOSIS IN THE AMERICAS.

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    Taborda, Carlos P; Urán, M E; Nosanchuk, J D; Travassos, L R

    2015-09-01

    Paracoccidioidomycosis (PCM), caused by Paracoccidioides spp, is an important endemic mycosis in Latin America. There are two recognized Paracoccidioides species, P. brasiliensis and P. lutzii, based on phylogenetic differences; however, the pathogenesis and disease manifestations of both are indistinguishable at present. Approximately 1,853 (~51,2%) of 3,583 confirmed deaths in Brazil due to systemic mycoses from 1996-2006 were caused by PCM. Antifungal treatment is required for patients with PCM. The initial treatment lasts from two to six months and sulfa derivatives, amphotericin B, azoles and terbinafine are used in clinical practice; however, despite prolonged therapy, relapses are still a problem. An effective Th1-biased cellular immune response is essential to control the disease, which can be induced by exogenous antigens or modulated by prophylactic or therapeutic vaccines. Stimulation of B cells or passive transference of monoclonal antibodies are also important means that may be used to improve the efficacy of paracoccidioidomycosis treatment in the future. This review critically details major challenges facing the development of a vaccine to combat PCM.

  12. Comparative genomic analysis of human fungal pathogens causing paracoccidioidomycosis.

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    Christopher A Desjardins

    2011-10-01

    Full Text Available Paracoccidioides is a fungal pathogen and the cause of paracoccidioidomycosis, a health-threatening human systemic mycosis endemic to Latin America. Infection by Paracoccidioides, a dimorphic fungus in the order Onygenales, is coupled with a thermally regulated transition from a soil-dwelling filamentous form to a yeast-like pathogenic form. To better understand the genetic basis of growth and pathogenicity in Paracoccidioides, we sequenced the genomes of two strains of Paracoccidioides brasiliensis (Pb03 and Pb18 and one strain of Paracoccidioides lutzii (Pb01. These genomes range in size from 29.1 Mb to 32.9 Mb and encode 7,610 to 8,130 genes. To enable genetic studies, we mapped 94% of the P. brasiliensis Pb18 assembly onto five chromosomes. We characterized gene family content across Onygenales and related fungi, and within Paracoccidioides we found expansions of the fungal-specific kinase family FunK1. Additionally, the Onygenales have lost many genes involved in carbohydrate metabolism and fewer genes involved in protein metabolism, resulting in a higher ratio of proteases to carbohydrate active enzymes in the Onygenales than their relatives. To determine if gene content correlated with growth on different substrates, we screened the non-pathogenic onygenale Uncinocarpus reesii, which has orthologs for 91% of Paracoccidioides metabolic genes, for growth on 190 carbon sources. U. reesii showed growth on a limited range of carbohydrates, primarily basic plant sugars and cell wall components; this suggests that Onygenales, including dimorphic fungi, can degrade cellulosic plant material in the soil. In addition, U. reesii grew on gelatin and a wide range of dipeptides and amino acids, indicating a preference for proteinaceous growth substrates over carbohydrates, which may enable these fungi to also degrade animal biomass. These capabilities for degrading plant and animal substrates suggest a duality in lifestyle that could enable pathogenic

  13. Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 plus HIV co-infection.

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    Macedo, Priscila Marques de; Almeida-Paes, Rodrigo; Almeida, Marcos de Abreu; Coelho, Rowena Alves; Andrade, Hugo Boechat; Ferreira, Ana Beatriz Teixeira Brandão Camello; Zancopé-Oliveira, Rosely Maria; Valle, Antonio Carlos Francesconi do

    2018-03-01

    Paracoccidioidomycosis (PCM) is one of the most important systemic mycoses in Latin America and the leading fungal cause of mortality in non-immunosuppressed individuals in Brazil. However, HIV/PCM co-infection can increase the clinical severity in these co-infected patients. This co-infection is rarely reported in the literature mainly because of the different epidemiological profiles of these infections. Furthermore, PCM is a neglected and non-notifiable disease, which may underestimate the real importance of this disease. The advent of molecular studies on the species of the genus Paracoccidioides has expanded the knowledge regarding the severity and the clinical spectrum in PCM. In this context, the development of studies to describe the association of the Paracoccidioides phylogenetic cryptic species in vulnerable populations, such as HIV-infected patients, appears relevant. To describe the clinical, epidemiological, therapeutic and prognostic aspects in HIV/PCM co-infected patients, along with the molecular identification of the Paracoccidioides species involved in these cases. The investigators performed a molecular and clinical retrospective study involving HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the fungal strains was done by amplification of partial sequences of arf and gp43 genes. Of 89 patients diagnosed with PCM by fungal isolation in the culture, a viable isolate was recovered for molecular analysis from 44 patients. Of these 44 patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All cases were considered severe, with a variable clinical presentation, including mixed, acute/subacute clinical forms and a high rate of complications, requiring combination therapy. Paracoccidioides brasiliensis S1 was the species identified in all cases

  14. A modification of the indirect fluorescence test (IFT for Paracoccidioidomycosis

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    Walter B. Petana

    1976-12-01

    Full Text Available A modification of the indirect fluorescence test (IFT for serological diagnosis of Paracoccidioidomycosis is described in which formolized budding forms (yeast cells of the fungus Paracoccidioides brasiliensis are used as antigen. A further modification introduced is a less eiaborate technical procedure of the test without lowering the sensitivity of the reaction. The test may be considered as adequateiy accurate and easy to perform in any laboratory with immunofluorescence facilities.

  15. Intestinal paracoccidioidomycosis simulating colon cancer Paracoccidioidomicose intestinal simulando câncer de cólon

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    Rubens Chojniak

    2000-06-01

    Full Text Available We report a case of intestinal involvement of Paracoccidioidomycosis, in a patient considered to have colonic cancer. The diagnosis of this mycosis should be considered when an abdominal mass associated with intra-lesional calcifications on X-ray is observed. CT scans increase the findings.Relatamos um caso de envolvimento intestinal pela Paracoccidioidomicose, em paciente considerado como portador de câncer. O diagnóstico desta micose deve ser considerado na presença de massa abdominal associada a calcificações intralesionais ao raio X. A tomografia amplia os achados.

  16. Incubation Period and Early Natural History Events of the Acute Form of Paracoccidioidomycosis: Lessons from Patients with a Single Paracoccidioides spp. Exposure.

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    Buccheri, Renata; Khoury, Zarifa; Barata, Luis Carlos Barradas; Benard, Gil

    2016-06-01

    Several aspects of the natural history of paracoccidioidomycosis are still poorly understood. Different from the most prevalent, chronic form of the disease, the acute form represents a continuum from the initial respiratory infection to the full-blown disease, thus providing an opportunity to elucidate the pathogenesis of the early phase of this mycosis. We describe, for the first time, two patients with a single time point exposure to Paracoccidioides spp., for whom we were able to determine the time lapsed between exposure to the fungus Paracoccidioides spp. and the onset of signs and symptoms. In case 1, the pulmonary infection was unapparent, and the first manifestations of the acute/subacute form of the disease presented 4 months after Paracoccidioides spp. In case 2, self-limited, non-specific respiratory and systemic symptoms presented 45 days after infection. Thus, our patients confirm that, within a few weeks of infection, Paracoccidioides spp. affects the pulmonary lymphatic system and initially causes no or mild-to-moderate self-limited symptoms, eventually causing abnormalities on a chest X-ray, all of which spontaneously subside. These cases provide some insight into the natural history of this mycosis, the extent of the host exposure to the fungus, and the determination of its incubation period.

  17. Prevalence and Serological Diagnosis of Relapse in Paracoccidioidomycosis Patients

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    Sylvestre, Tatiane Fernanda; Silva, Luciane Regina Franciscone; Cavalcante, Ricardo de Souza; Moris, Daniela Vanessa; Venturini, James; Vicentini, Adriana Pardini; de Carvalho, Lídia Raquel; Mendes, Rinaldo Poncio

    2014-01-01

    A review of 400 clinical records of paracoccidioidomycosis (PCM) patients, 93 with the acute/subacute (AF) and 307 with the chronic form (CF), attended from 1977 to 2011, selected as to the schedule of release for study by the Office of Medical Records at the University Hospital of the Faculdade de Medicina de Botucatu – São Paulo State University – UNESP, was performed to detect cases in relapse. The control of cure was performed by clinical and serological evaluation using the double agar gel immunodiffusion test (DID). In the diagnosis of relapse, DID, enzyme-linked immunosorbent assay (ELISA) and immunoblotting assay (IBgp70 and IBgp43) were evaluated. Out of 400 patients, 21 (5.2%) went through relapse, 18 of them were male and 3 were female, 6∶1 male/female ratio. Out of the 21 patients in relapse, 15 (4.8%) showed the CF, and 6 (6.4%) the AF (p>0.05). The sensitivity of DID and ELISA before treatment was the same (76.1%). DID presented higher sensitivity in pre-treatment (80%) than at relapse (45%; p = 0.017), while ELISA showed the same sensitivity (80% vs 65%; p = 0.125). The serological methods for identifying PCM patients in relapse showed low rates of sensitivity, from 12.5% in IBgp70 to 65.0% in IBgp43 identification and 68.8% in ELISA. The sensitivity of ELISA in diagnosing PCM relapse showed a strong tendency to be higher than DID (p = 0.06) and is equal to IBgp43 (p = 0.11). In sum, prevalence of relapse was not high in PCM patients whose treatment duration was based on immunological parameters. However, the used methods for serological diagnosis present low sensitivity. While more accurate serological methods are not available, we pay special attention to the mycological and histopathological diagnosis of PCM relapse. Hence, direct mycological, cytopathological, and histopathological examinations and isolation in culture for P. brasiliensis must be appropriately and routinely performed when the hypothesis of relapse is

  18. Altered distribution of peripheral blood dendritic cell subsets in patients with pulmonary paracoccidioidomycosis.

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    Venturini, James; Cavalcante, Ricardo Souza; Moris, Daniela Vanessa; Golim, Márjorie de Assis; Levorato, Adriele Dandara; Reis, Karoline Hagatha Dos; Arruda, Maria Sueli Parreira de; Mendes, Rinaldo Poncio

    2017-09-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by fungi from the genus Paracoccidioides in Latin America. PCM-patients (PCM-p) are classified as having acute/subacute or chronic (CF) clinical forms. CF is responsible for 75%-90% of all cases, affects mainly adults over 30 years old and the clinical manifestation are associated mainly with lungs and mucosa of upper airdigestive tract. In addition, the CF patients exhibit fibrosis of the lungs, oral mucous membranes and adrenals, and pulmonary emphysema. Consequently, CF PCM-p with active disease, as well as those that have been apparently cured, seem to be an interesting model for studies aiming to understand the long-term host-fungi relationship and hypoxia. Dendritic cells (DCs) constitute a system that serve as a major link between innate and adaptive immunity composed of several subpopulations of cells including two main subsets: myeloid (mDCs) and plasmacytoid (pDCs). The present study aimed to access the distribution of PBDC subsets of CF PCM-p who were not treated (NT) or treated (apparently cured - AC). CF PCM-p were categorized into two groups, consisting of 9 NTs and 9 ACs. Twenty-one healthy individuals were used as the control group. The determination of the PBDC subsets was performed by FACS (fluorescence-activated cell sorting) and the dosage of serum TNF-α, IL1β, IL-18, CCL3, IL-10 and basic fibroblast growth factor (bFGF) by ELISA (enzyme-linked immunosorbent assay). A high count and percentage of mDCs was observed before treatment, along with a low count of pDCs in treated patients. Furthermore, the mDC:pDC ratio and serum levels of TNF-α was higher in both of the PCM-p groups than in the control group. In conclusion, our findings demonstrated that active PCM influences the distribution of mDCs and pDCs, and after treatment, PCM-p retained a lower count of pDCs associated with pro-inflammatory profile. Therefore, we identified new evidences of persistent immunological abnormalities in

  19. Current strategies for diagnosis of paracoccidioidomycosis and prospects of methods based on gold nanoparticles.

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    Silva Ferreira, Cyntia; de Castro Ribeiro, Erica Milena; Miranda Goes, Alfredo de; Mello Silva, Breno de

    2016-07-01

    Paracoccidioidomycosis (PCM) is a human systemic granulomatous mycosis caused by thermodimorphic fungi from Paracoccidioides genus. The disease is prevalent in Latin America and triggers a serious clinical condition. Consequently, rapid diagnosis and treatment are crucial to prevent progression of the disease, which can result in death. Currently, there are several established methods for PCM diagnosis. However, many of these tests still present challenges in terms of cost, accessibility and efficiency. In this scenario, gold nanoparticles represent a promising alternative since they have particular optical and electronic properties, which allow its use for biomolecules detection. This review will briefly present techniques available for PCM diagnosis and the perspectives of implementation of gold nanoparticles for diagnosis of this mycosis.

  20. Brain paracoccidioidomycosis - evaluation by computed tomography; Estudo da paracoccidioidomicose encefalica por tomografia computadorizada

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    Noro, Fabio [Universidade Federa, Rio de Janeiro, RJ (Brazil). Dept. de Radiologia; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia; Silva, Ana Lucia Aguirre

    1998-10-01

    The brain CT scans of 11 patients with known paracoccidioidomycosis of the central nervous system were retrospectively studied regarding the granulomas characteristics and the progression of the treated lesions. CT aspects of mycotic meningeal involvement were also described, as small cortical nodules and leptomeningeal contrast enhancement, both of which were not reported in the author`s references. Six patients were meticulously followed and one of them had CT scans performed periodically during a seven years follow-up period. The most common aspect of the granulomatous form was that of isodense nodules with central hipodensity, exhibiting peripheral contrast enhancement. The most frequent imaging aspect consisted of multiple lesions predominating at the supratentorial compartment, specially on the lobes of the telencephalon. The lesions tend to regress and to calcify, as well as to loose contrast enhancement following the onset of treatment. (author) 12 refs., 8 figs.

  1. Amphotericin B: an antifungal drug in nanoformulations for the treatment of paracoccidioidomycosis

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    Mônica Pereira Garcia

    2013-12-01

    Full Text Available The use of magnetic nanoparticles (MNPs in drug delivery vehicles must address issues such as drugloading capacity, desired release profile, aqueous dispersion stability, biocompatibility with cells and tissue, and retention of magnetic properties after interaction with macromolecules or modification via chemical reactions. Amphotericin B (AmB is still the first choice for the treatment of severe paracoccidioidomycosis, an important systemic fungal infection caused by Paracoccidoides brasiliensis. Unfortunately, AmB causes acute side effects (mainly urinary problems following intravenous administration, which limits its clinical use. The use of magnetic nanoparticles stabilized with biocompatible substances, together with the possibility of their conjugation with drugs has become a new nanotechnological strategy in the treatment of diseases for drug delivery to specific locations, such as the lungs in paracoccidoidiodomycosis. This review provides an overview of the disease, its etiologic agent and treatment with emphasis on the main strategies to improve the use of AmB in nanoformulations.

  2. Application of PCR in serum samples for diagnosis of paracoccidioidomycosis in the southern Bahia-Brazil.

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    Lucas Dias

    Full Text Available Paracoccidioidomycosis (PCM cannot always be diagnosed by conventional means such as direct examination of histopathology or clinical samples, and serological methods, used as an alternative, still have many cases of cross-reactivity. In this scenario, molecular techniques seem to arise as a rapid approach, specific and direct that could be used in the diagnosis of this mycosis. In this study we analyzed 76 serum samples from patients in southern Bahia suspected of having paracoccidioidomycosis using a conventional PCR with primers for the ITS1 ribosomal DNA of P. brasiliensis. Of these 76 patients, 5 were positive for PCM by double immunodiffusion and/or direct examination and histopathology. To test specificity of PCR, we used human DNA and three isolates of P. lutzii (1578, 01 and ED01. Additionally, we analyzed by serial dilutions of DNA the limit of detection of the assay. The test of PCR proved specific, as only a 144 bp fragment of the three isolates of P. lutzii and no human DNA was amplified. Detection limit was 1.1 pg/µL of DNA. Despite the high detection limit and specificity of PCR none of the 76 serum samples were found positive by PCR, but a biopsy specimen obtained from one of the patients with PCM was positive. These results, albeit limited, show that PCR is not effective in detecting DNA of P. brasiliensis or P. lutzii in serum, but could perhaps be used with other types of clinical samples, especially in those instances in which conventional methods fail.

  3. Acute juvenile Paracoccidioidomycosis: A 9-year cohort study in the endemic area of Rio de Janeiro, Brazil.

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    de Macedo, Priscila Marques; Almeida-Paes, Rodrigo; Freitas, Dayvison Francis Saraiva; Varon, Andréa Gina; Paixão, Ariane Gomes; Romão, Anselmo Rocha; Coutinho, Ziadir Francisco; Pizzini, Claudia Vera; Zancopé-Oliveira, Rosely Maria; Francesconi do Valle, Antonio Carlos

    2017-03-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by pathogenic dimorphic fungi of the genus Paracoccidioides. It is the most important systemic mycosis in Latin America and the leading cause of hospitalizations and death among them in Brazil. Acute PCM is less frequent but relevant because vulnerable young patients are affected and the severity is usually higher than that of the chronic type. The authors performed a retrospective cohort study from 2001 to 2009 including acute juvenile PCM patients from a reference center in Rio de Janeiro, Brazil. Clinical, epidemiological, diagnostic, therapeutic, and prognostic data were reported. Twenty-nine patients were included. The average age was 23 years old and the male to female ratio was 1:1.07. All cases were referred from 3 of 9 existing health areas in the state of Rio de Janeiro, predominantly from urban areas (96.5%). Lymph nodes were the most affected organs (100%), followed by the skin and the spleen (31% each). Twenty-eight patients completed treatment (median 25 months) and progressed to clinical and serological cure; 1 death occurred. Twenty-four patients completed 48-month median follow-up. Four patients abandoned follow-up after the end of treatment. The most frequent sequela was low adrenal reserve. Paracoccidioides brasiliensis S1 was identified by partial sequencing of the arf and gp43 genes from 4 patients who presented a viable fungal culture. Acute juvenile PCM is a severe disease with a high rate of complications. There are few cohort clinical studies of acute PCM in the literature. More studies should be developed to promote improvement in patients' healthcare.

  4. Revisiting Langerhans cells in paracoccidioidomycosis: expression of CD207/langerin in human cutaneous and mucosal lesions.

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    Pagliari, Carla; Fernandes, Elaine Raniero; Ferreira da Silva, Wellington Luiz; Alves de Lima Silva, Aline; Stegun, Felipe Weisshaupt; Duarte, Maria Irma Seixas; Sotto, Mirian Nacagami

    2011-11-01

    Langerhans cells are identified by the expression of langerin. We detected this molecule in cutaneous and mucosal lesions in paracoccidioidomycosis, an important infection in Latin America. Langerin+ cells were scarcely distributed, with short dendrites in epidermis and epithelium and were frequent in the dermis and corium, in the inflammatory infiltrate and granulomas. Mucosal lesions presented a higher expression of langerin in lesions with loose granulomas. For the first time we presented the expression of langerin in paracoccidioidomycosis. Positive cells in dermis and corium could represent migrating Langerhans cells or a new subset of langerin+ cells with a role in paracoccidioidomycosis. Copyright © 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  5. Th1-Inducing Agents in Prophylaxis and Therapy for Paracoccidioidomycosis.

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    da Silva, Thiago Aparecido; Fernandes, Fabrício Freitas; Landgraf, Taise Natali; Panunto-Castelo, Ademílson; Roque-Barreira, Maria Cristina

    2017-01-01

    Adjuvants and immunomodulatory molecules could be included in the treatment of P. brasiliensis infection. In this context, we reported that the therapeutic and/or prophylactic administration of Th1-inducing agents, such as immunomodulatory lectins and adjuvants, was able to provide protection against experimental paracoccidioidomycosis. Then, we described the protocols to investigate the effect of immunomodulatory agents on the course of P. brasiliensis infection. In this sense, we detailed the measurement of fungal burden and cytokine production, and the histopathological analysis used to evaluate the most effective administration regime.

  6. Paracoccidioidomycosis with sarcoid-like lesions:a diagnostic challenge.

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    Abreu, Marilda Aparecida Milanez Morgado de; Lastória, Joel Carlos; Mattos, Antonio Luiz de Arruda; Alchorne, Maurício Mota de Avelar

    2017-01-01

    Clinical presentation of paracoccidioidomycosis (PCM) can be diverse. Morphology and quantity of skin lesions depends on interactions between host immunity and fungus virulence. Diagnosis can be a challenge considering that this fungus has low virulence and some individuals have immunity to microorganism, which results in well-marked granulomas without visible microorganisms. We report herein a clinical presentation of sarcoid-like PCM, initially diagnosed as tuberculoid leprosy. This rare type of PCM is often mistaken for other types of chronic granulomatous diseases. Diagnosis was confirmed after 4 years when a special stain analysis helped in the identification of the specific etiologic agent.

  7. Role of omega-3 polyunsaturated fatty acids in the production of prostaglandin E2 and nitric oxide during experimental murine paracoccidioidomycosis.

    Science.gov (United States)

    Sargi, S C; Dalalio, M M O; Moraes, A G; Visentainer, J E L; Morais, D R; Visentainer, J V

    2013-01-01

    There has recently been increased interest in the potential health effects of omega-3 polyunsaturated fatty acids on the immune system. Paracoccidioidomycosis is the most important endemic mycosis in Latin America. Macrophages have a fundamental role and act as first line of organism defense. The purpose of this study was to analyze the effect of n-3 fatty acids on the production of PGE2 and NO by mice infected with Pb18 and fed a diet enriched with LNA for 8 weeks. To study the effect of omega-3 fatty acids on macrophage activity during experimental paracoccidioidomycosis, mice were infected with Pb18 and fed a diet supplemented with LNA. PGE2 in the serum of animals was analyzed and NO in the supernatants of macrophages cultured and challenged in vitro with Pb18 was measured. Omega-3 fatty acids seemed to decrease the production of PGE2 in vivo in the infected group fed an LNA-supplemented diet during the 4th and 8th weeks of the experiment. At the same time, we observed an increase in synthesis of NO by peritoneal macrophages in this group. Omega-3 fatty acids thus appear to have an immunomodulatory effect in paracoccidioidomycosis.

  8. Role of Omega-3 Polyunsaturated Fatty Acids in the Production of Prostaglandin E2 and Nitric Oxide during Experimental Murine Paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    S. C. Sargi

    2013-01-01

    Full Text Available There has recently been increased interest in the potential health effects of omega-3 polyunsaturated fatty acids on the immune system. Paracoccidioidomycosis is the most important endemic mycosis in Latin America. Macrophages have a fundamental role and act as first line of organism defense. The purpose of this study was to analyze the effect of n-3 fatty acids on the production of PGE2 and NO by mice infected with Pb18 and fed a diet enriched with LNA for 8 weeks. To study the effect of omega-3 fatty acids on macrophage activity during experimental paracoccidioidomycosis, mice were infected with Pb18 and fed a diet supplemented with LNA. PGE2 in the serum of animals was analyzed and NO in the supernatants of macrophages cultured and challenged in vitro with Pb18 was measured. Omega-3 fatty acids seemed to decrease the production of PGE2 in vivo in the infected group fed an LNA-supplemented diet during the 4th and 8th weeks of the experiment. At the same time, we observed an increase in synthesis of NO by peritoneal macrophages in this group. Omega-3 fatty acids thus appear to have an immunomodulatory effect in paracoccidioidomycosis.

  9. Two energy system analysis - cases

    DEFF Research Database (Denmark)

    Lund, Henrik; Antonoff, Jayson; Andersen, Anders N.

    2004-01-01

    The chapter presents tow cases of energy system analysis, illustrating the types of tools and methodologies presently being used for these studies in Denamrk and elsewhere.......The chapter presents tow cases of energy system analysis, illustrating the types of tools and methodologies presently being used for these studies in Denamrk and elsewhere....

  10. Case report: Multifocal chronic paracoccidioidomycosis in an adult

    OpenAIRE

    Karen Zapata; Janeth Villanueva; Adriana Arrunátegui; Juana Gabriela López

    2011-01-01

    Paracoccidioides brasiliensis es el agente causal de una de las micosis sistémicas con mayor prevalencia en Latinoamérica. Existen alrededor de 10 millones de afectados y la mayor incidencia se presenta en Brasil y se han observado casos en Venezuela, Colombia, Ecuador y Argentina. Se presenta el caso de un hombre de 56 años con lesiones de un año de evolución en labios, mucosa oral y pulmón. El estudio histopatológico con hematoxilina-eosina informó la presencia de granulomas y células gigan...

  11. Functional and phenotypic evaluation of eosinophils from patients with the acute form of paracoccidioidomycosis.

    Science.gov (United States)

    Braga, Fernanda Gambogi; Ruas, Luciana Pereira; Pereira, Ricardo Mendes; Lima, Xinaida Taligare; Antunes, Edson; Mamoni, Ronei Luciano; Blotta, Maria Heloisa Souza Lima

    2017-05-01

    Eosinophilia is a typical finding of the acute/juvenile form of paracoccidioidomycosis (PCM), a systemic mycosis endemic in Latin America. This clinical form is characterized by depressed cellular immune response and production of Th2 cytokines. Moreover, it has been shown that the increased number of eosinophils in peripheral blood of patients returns to normal values after antifungal treatment. However, the role of eosinophils in PCM has never been evaluated. This study aimed to assess the phenotypic and functional characteristics of eosinophils in PCM. In 15 patients with the acute form of the disease, we detected expression of MBP, CCL5 (RANTES) and CCL11 (eotaxin) in biopsies of lymph nodes and liver. In addition, there were higher levels of chemokines and granule proteins in the peripheral blood of patients compared to controls. Isolation of eosinophils from blood revealed a higher frequency of CD69+ and TLR2+ eosinophils in patients compared to controls, and a lower population of CD80+ cells. We also evaluated the fungicidal capacity of eosinophils in vitro. Our results revealed that eosinophils from PCM patients and controls exhibit similar ability to kill P. brasiliensis yeast cells, although eosinophils of patients were less responsive to IL-5 stimulation than controls. In conclusion, we suggest that eosinophils might play a role in the host response to fungi and in the pathophysiology of PCM by inducing an intense and systemic inflammatory response in the initial phase of the infection.

  12. The contribution of ultrasonography and computed tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

    Energy Technology Data Exchange (ETDEWEB)

    Paula, Ivie Braga de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Radiologia; Pedroso, Enio Roberto Pietra; Ferreira, Cid Sergio, E-mail: enio@medicina.ufmg.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Fac. de Medicina

    2014-01-15

    Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The study was approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvement and ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations. (author)

  13. Regulatory T cells in cutaneous lesions of patients with Paracoccidioidomycosis.

    Science.gov (United States)

    Silva, Aline Alves de Lima; Sotto, Mirian N; Duarte, Maria Irma Seixas; Pagliari, Carla

    2013-12-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the dimorphic fungus Paracoccidioides brasiliensis, with high incidence in Brazil and very significant in Latin America. The disease is clinically classified as acute, subacute or chronic where the primary lesion initiates in the lungs and can spread to other organs such as the skin and mucous membranes. The lesions are characterized by granulomatous formation, organized according to the type of pattern of host immune response. We demonstrated and quantified by immunohistochemistry the expression of Foxp3, CD25, TGF-beta and IL-10 in thirty cutaneous lesions with different presentation of granulomatous response. Cells expressing Foxp3 and CD25 were increased in lesions with compact granulomas. The expression of TGF-beta and IL-10 was similar in all PCM lesions. As previous studies, our data suggest the correlation of Treg cells with the chronicity of the disease and the participation in suppressing mechanism as a possible source of IL-10. TGF-β and IL-10, two important suppressor cytokines, are expressed in great amounts in the lesions but our results do not allow correlating with the differences in the granulomatous response. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. The contribution of ultrasonography and computed tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

    International Nuclear Information System (INIS)

    Paula, Ivie Braga de; Pedroso, Enio Roberto Pietra; Ferreira, Cid Sergio

    2014-01-01

    Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The study was approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvement and ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations. (author)

  15. Therapeutic follow-up paracoccidioidomycosis by {sup 67} Ga images; Acompanhamento terapeutico da paracoccidioidomicose por imagens com {sup 67} Ga

    Energy Technology Data Exchange (ETDEWEB)

    Calegaro, J.U.M.; Salinas, L.F.G.; Gomes, E.F.; Rulli, E.; Ulysses, R.; pereira, D.M.M.; Carvalho, A.C.M. de [Hospital de Base do Distrito Federal, Brasilia, DF (Brazil)

    1994-12-31

    Paracoccidioidomycosis by P. Brasiliensis, is a systemic mycoses with chronic evolution. The main objective of this study was to determine the contribution obtained by {sup 67} Ga images in the follow-up of its specific treatment. The definitive diagnosis was made by histological study. Reevaluation was made by clinical evolution, serological and laboratorial tests, ultra-sound (abdominal) and radiological studies, compared with whole body planar images obtained 48-72 hours after i.v. injection of 3-6 mCi(11-222 MBq) of {sup 67} Ga citrate. The median time of therapeutical follow-up was 10 months. The {sup 67} Ga studies a larger number of active disease sites in reevaluation under specific treatment specially in lungs and lymphonodes. This was related to: 1 to have whole body information; 2. the information is concerned to activity of disease, compared with the usual methods of investigation. (author). 22 refs, 3 figs, 2 tabs.

  16. Paracoccidioidomicose pulmonar: aspectos na tomografia computadorizada de alta resolução High-resolution computed tomography findings in pulmonary paracoccidioidomycosis

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    Maria Angélica Soares Muniz

    2002-06-01

    Full Text Available O comprometimento pulmonar na paracoccidioidomicose é muito freqüente, podendo até ser a única manifestação da doença. Neste trabalho são analisados os aspectos encontrados nas tomografias computadorizadas de alta resolução do tórax de 30 pacientes com paracoccidioidomicose confirmada. Por meio desta análise foram determinados os achados mais comuns e suas formas de apresentação e distribuição nos pulmões. Os aspectos mais freqüentemente observados foram: espessamento esparso de septos interlobulares (96,7%, opacidades em vidro fosco (66,7%, nódulos (60%, aumento irregular do espaço aéreo (enfisema paracicatricial (56,7%, espessamento de paredes brônquicas (46,7%, espessamento pleural (36,7%, cavidades (36,7%, dilatação da traquéia (33,3%, distorção arquitetural (30%, consolidação do espaço aéreo (30%, bandas parenquimatosas (23,3%, reticulado intralobular (13,3% e espessamento irregular do interstício axial peri-hilar (10%. A radiografia do tórax apresenta limitada capacidade de avaliar doenças pulmonares difusas, tornando a tomografia computadorizada de alta resolução do tórax essencial para avaliação dos pacientes com paracoccidioidomicose pulmonar.Pulmonary disease in paracoccidioidomycosis is very common and in some cases can be the sole manifestation of the disease. We studied the findings observed in 30 patients with pulmonary paracoccidioidomycosis submitted to high-resolution computed tomography in order to determine the most frequent findings, presentation patterns and distribution of paracoccidioidomycosis lesions in the lungs. The most frequent findings observed on high-resolution computed tomography were: interlobular septal thickening (96.7%, ground-glass opacities (66.7%, nodules (60%, irregular air-space enlargement (56.7%, bronchial wall thickening (46.7%, pleural thickening (36.7%, cavitation (36.7%, tracheal dilatation (33.3%, architectural distortion (30%, air-space consolidation (30

  17. Paracoccidioidomycosis in Brazilian Patients With and Without Human Immunodeficiency Virus Infection.

    Science.gov (United States)

    Almeida, Fabrício Arantes de; Neves, Fernando Freitas; Mora, Delio Jose; Reis, Tarcisio Albertin Dos; Sotini, Diego Moelas; Ribeiro, Barbara De Melo; Andrade-Silva, Leonardo Eurípedes; Nascentes, Gabriel Nogueira; Ferreira-Paim, Kennio; Silva-Vergara, Mario León

    2017-02-08

    Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis / Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies. © The American Society of Tropical Medicine and Hygiene.

  18. Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis

    Directory of Open Access Journals (Sweden)

    Gabriel Capella Machado

    2013-08-01

    Full Text Available We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM. Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339 from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens.

  19. Cryptic species of Paracoccidioides brasiliensis: impact on paracoccidioidomycosis immunodiagnosis

    Science.gov (United States)

    Machado, Gabriel Capella; Moris, Daniela Vanessa; Arantes, Thales Domingos; Silva, Luciane Regina Franciscone; Theodoro, Raquel Cordeiro; Mendes, Rinaldo Pôncio; Vicentini, Adriana Pardini; Bagagli, Eduardo

    2013-01-01

    We aimed to evaluate whether the occurrence of cryptic species of Paracoccidioides brasiliensis, S1, PS2, PS3 and Paracoccidioides lutzii, has implications in the immunodiagnosis of paracoccidioidomycosis (PCM). Small quantities of the antigen gp43 were found in culture filtrates of P. lutzii strains and this molecule appeared to be more variable within P. lutzii because the synonymous-nonsynonymous mutation rate was lower, indicating an evolutionary process different from that of the remaining genotypes. The production of gp43 also varied between isolates belonging to the same species, indicating that speciation events are important, but not sufficient to fully explain the diversity in the production of this antigen. The culture filtrate antigen AgEpm83, which was obtained from a PS3 isolate, showed large quantities of gp43 and reactivity by immunodiffusion assays, similar to the standard antigen (AgB-339) from an S1 isolate. Furthermore, AgEpm83 was capable of serologically differentiating five serum samples from patients from the Botucatu and Jundiaí regions. These patients had confirmed PCM but, were non-reactive to the standard antigen, thus demonstrating an alternative for serological diagnosis in regions in which S1 and PS2 occur. We also emphasise that it is not advisable to use a single antigen preparation to diagnose PCM, a disease that is caused by highly diverse pathogens. PMID:23903981

  20. Serological Diagnosis of Paracoccidioidomycosis through a Western Blot Technique

    Science.gov (United States)

    Perenha-Viana, M. C. Z.; Gonzales, I. A. A.; Brockelt, S. R.; Machado, L. N. C.

    2012-01-01

    Paracoccidioidomycosis (PCM) is a serious infectious disease that progresses toward death if untreated. Its confirmatory diagnosis is made by the detection of the fungus Paracoccidioides brasiliensis in a direct mycological examination or by histopathology. However, these techniques are of low sensitivity. Serological tests seem to be more promising. The objective of this study was to test Western blot (WB) analysis using sera from patients suspected of PCM to determine whether it represents a safe and sensitive serological technique for a rapid and effective diagnosis for this disease. Sera from 517 patients were analyzed through WB analysis and double-immunodiffusion (DID) techniques using a crude exoantigen of P. brasiliensis 339. DID gave positive reactions for 140 sera (27%) and WB for 250 sera (48.4%). All sera that had a positive reaction by DID also had a positive result with a 43-kDa glycoprotein by WB analysis. Among the 377 samples that were negative by DID, 29.1% were reactive in WB analysis. For the cutoff dilution used (1:400), a positive reaction was not observed with any of the 102 sera from patients with other diseases in regions where such diseases are endemic and 30 healthy individuals tested as negative controls. These results prove WB analysis to be a sensitive technique and suggest its inclusion among routine laboratory assays as a safe method for PCM diagnosis. PMID:22301695

  1. Serological diagnosis of paracoccidioidomycosis through a Western blot technique.

    Science.gov (United States)

    Perenha-Viana, M C Z; Gonzales, I A A; Brockelt, S R; Machado, L N C; Svidzinski, T I E

    2012-04-01

    Paracoccidioidomycosis (PCM) is a serious infectious disease that progresses toward death if untreated. Its confirmatory diagnosis is made by the detection of the fungus Paracoccidioides brasiliensis in a direct mycological examination or by histopathology. However, these techniques are of low sensitivity. Serological tests seem to be more promising. The objective of this study was to test Western blot (WB) analysis using sera from patients suspected of PCM to determine whether it represents a safe and sensitive serological technique for a rapid and effective diagnosis for this disease. Sera from 517 patients were analyzed through WB analysis and double-immunodiffusion (DID) techniques using a crude exoantigen of P. brasiliensis 339. DID gave positive reactions for 140 sera (27%) and WB for 250 sera (48.4%). All sera that had a positive reaction by DID also had a positive result with a 43-kDa glycoprotein by WB analysis. Among the 377 samples that were negative by DID, 29.1% were reactive in WB analysis. For the cutoff dilution used (1:400), a positive reaction was not observed with any of the 102 sera from patients with other diseases in regions where such diseases are endemic and 30 healthy individuals tested as negative controls. These results prove WB analysis to be a sensitive technique and suggest its inclusion among routine laboratory assays as a safe method for PCM diagnosis.

  2. Plasmacytoid dendritic cells in cutaneous lesions of patients with chromoblastomycosis, lacaziosis, and paracoccidioidomycosis: a comparative analysis.

    Science.gov (United States)

    Pagliari, Carla; Kanashiro-Galo, Luciane; Silva, Aline Alves de Lima; Barboza, Tânia Cristina; Criado, Paulo Ricardo; Duarte, Maria Irma Seixas; Brito, Arival Cardoso de; Xavier, Marília Brasil; Unger, Deborah; Maria Moraes Oliveira, Clivia; Quaresma, Juarez Antonio Simões; Sotto, Mirian Nacagami

    2014-05-01

    Plasmacytoid dendritic cells (pDCs) are characterized by expression of CD123 and BDCA-2 (Blood Dendritic Cell Antigen 2) (CD303) molecules, which are important in innate and adaptive immunity. Chromoblastomycosis (CBM), lacaziosis or Jorge Lobo's disease (JLD), and paracoccidioidomycosis (PCM), are noteworthy in Latin America due to the large number of reported cases. The severity of lesions is mainly determined by the host's immune status and in situ responses. The dendritic cells studied in these fungal diseases are of myeloid origin, such as Langerhans cells and dermal dendrocytes; to our knowledge, there are no data for pDCs. Forty-three biopsies from patients with CBM, 42 from those with JLD and 46 diagnosed with PCM, were evaluated by immunohistochemistry. Plasmacytoid cells immunostained with anti-CD123 and anti-CD303 were detected in 16 cases of CBM; in those stained with anti-CD123, 24 specimens were obtained from PCM. We did not detect the presence of pDCs in any specimen using either antibody in JLD. We believe that, albeit a secondary immune response in PCM and CBM, pDCs could act as a secondary source of important cytokines. The BDCA-2 (CD303) is a c-type lectin receptor involved in cell adhesion, capture, and processing of antigens. Through the expression of the c-lectin receptor, there could be an interaction with fungi, similar to other receptors of this type, namely, CD207 in PCM and CD205 and CD209 in other fungal infections. In JLD, the absence of expression of CD123 and CD303 seems to indicate that pDCs are not involved in the immune response.

  3. CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis

    Science.gov (United States)

    Menna Barreto, Miriam; de Brito, Andrea; Escuissato, Dante Luiz; Hochhegger, Bruno; Souza, Arthur Soares; Rodrigues, Rosana Souza

    2015-01-01

    Objective: The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease. Methods: We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus. Results: We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions. Conclusion: Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. Advances in knowledge: This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease. PMID:26329468

  4. TLR 9 involvement in early protection induced by immunization with rPb27 against Paracoccidioidomycosis.

    Science.gov (United States)

    Morais, Elis Araujo; Chame, Daniela Ferreira; Melo, Eliza Mathias; de Carvalho Oliveira, Junnia Alvarenga; de Paula, Ana Cláudia Chagas; Peixoto, Andiara Cardoso; da Silva Santos, Lílian; Gomes, Dawidson Assis; Russo, Remo Castro; de Goes, Alfredo Miranda

    2016-02-01

    Paracoccidioidomycosis is caused by fungi of the Paracoccidioides genus and constitutes the most prevalent deep mycosis in Latin America. Toll-like receptors promote immune response against infectious agents. Recently, it was reported that TLR9 is crucial for mice survival during the first 48 h of P. brasiliensis infection. In this study, we used CPG oligodeoxynucleotide motif as an adjuvant with and without rPb27 to immunize mice against Paracoccidioidomycosis. CPG adjuvant induced differential recruitment of lymphocytes in the inflammatory process and a lower recruitment of neutrophils. In addition, CPG induced the production of pro-inflammatory cytokines such as IL-1β, TNF-α, IL-6 and IL-12; increased phagocytic ability and microbicidal activity by macrophages; and induced differential production of lgG2a and lgG2b, subtypes of Ig. Knockout mice for TLR9 and IL-12 showed higher fungal loads and rates of mortality compared to control mice after 30 days of infection. The association between CPG and rPb27 induced a high level of protection against Paracoccidioidomycosis after the first 30 days of infection but not at 60 days. Our findings demonstrate that TLR 9 plays a role in the protection induced by immunization with rPb27 and confirms the importance of TLR9 in the initial protection against Paracoccidioidomycosis. Copyright © 2015 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  5. Delayed results of treatment of paracoccidioidomycosis with amphotericin B plus sulfamides versus amphotericin B alone

    Directory of Open Access Journals (Sweden)

    Neuza Lima Dillon

    1986-08-01

    Full Text Available A delayed evaluation of two groups of patients with paracoccidioidomycosis was carried out. Both groups were treated with amphotericin B, "but one of them was submitted to maintenance treatment with sulfonamides. Statistical analysis showed that treatment is more effective when patients are maintained with sulfonamide drugs.

  6. Paracoccidioides brasiliensis and P. lutzii antigens elicit different serum IgG responses in chronic paracoccidioidomycosis.

    Science.gov (United States)

    Lenhard-Vidal, A; Assolini, J P; Ono, M A; Bredt, C S O; Sano, A; Itano, E N

    2013-12-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis (S1, PS2, and PS3) and by the new species, P. lutzii. Considering that genetic differences in the Paracoccidioides genus could elicit distinct immune responses by the host, current research investigated serum IgG levels to antigens from P. brasiliensis B339 (S1), P. brasiliensis LDR3 (PS2), and atypical strain LDR2 (P. lutzii), in patients with chronic PCM from the northern and west regions of Paraná, Brazil (n = 35). Cell-free antigen (CFA) and high molecular mass fraction (hMM) were produced from each strain. Samples were analyzed by ELISA and immunodiffusion (ID). ELISA positivity using CFA: B339-100 %, LDR3-83 %, and LDR2-74 %. Response to CFA from B339 was more intense (p < 0.05), while there was no difference between LDR3-LDR2. IgG anti-hMM was higher for antigens from B339 or LDR3, when compared with LDR2 (p < 0.05). There was a positive correlation for each strain between CFA-hMM and for hMM between B339-LDR3 and LDR3-LDR2. ID positivity with CFA: B339-63 %, LDR3-66 %, and LDR2-60 %. We conclude that the intensity of reaction of the patients' sera varies with the strain used; hMM influences tests that use CFA, independently of strain; using ID, positive rates were very similar, but there was a large number of false negative results; ELISA tests using antigens from P. brasiliensis S1 were able to detect a larger number of patients than PS2 and P. lutzii (which had a considerable number of false negative results), and therefore, its use may be more appropriate in this region of Brazil.

  7. Humoral response of paracoccidioidomycosis sera in hamsters with different Venezuelan isolates

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    Lilian M Spencer

    2009-09-01

    Full Text Available Humoral response of paracoccidioidomycosis sera in hamsters with different Venezuelan isolates. Paracoccidioidomycosis (PCM is a progressive systemic mycosis caused by the fungus Paraccocidioides brasiliensis (Pb, endemic to Venezuela and Latin America. In this study, eight different Venezuelan isolates obtained from patients with PCM, were inoculated intraperitoneally in Syrian hamsters (Cricetus auratus and studied by immune-serum. Each strain was collected by gently scraping the surface of the culture medium (Sabouraud Dextrose Agar and suspended in 3ml of 0.15 M phosphate-buffered saline. The antigen obtained was called Paraccocidioides brasiliensis Crude Antigen (CAP. Immunoblotting results showed that the immune-sera from hamsters recognized at least 3 bands: one over 200 kDa, and two of 80 and 15-20 kDa. This study suggests that IgG anti-CAP can reveal a significant variability in the eight Venezuelan isolates. Sera from 88 infected hamsters were evaluated by ELISA with eight different CAPs and Western blot with CAP 37383. ELISA results showed that, the antigen of the virulent isolate 37383 had the highest percentage (38% of positivity, while the non-virulent isolate 1458 had the lowest one (13.6%. Furthermore, scanning densitometry revealed that the isolate 37383 had less bands than the non-virulent isolates. These results suggest that the ELISA test with CAP 37383 can detect circulating antibodies, and that this virulent isolate may be useful for the diagnosis of PCM, and to monitor disease responses to treatments. Rev. Biol. Trop. 57 (3: 505-513. Epub 2009 September 30.La Paracoccidioidomicosis (PCM, es una micosis sistémica causada por el hongo Paraccocidioides brasiliensis (Pb, endémica en Venezuela y Latino América. En este estudio ocho diferentes aislados venezolanos, obtenidos de pacientes con PCM, fueron inoculados intraperitonealmente en hámsteres y fueron estudiados por ELISA e inmunoblotting. Los antígenos obtenidos de P

  8. Paracoccidioidomicosis en la Provincia de Formosa, Argentina Paracoccidioidomycosis in Formosa province (Argentina

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    A. G. Tichellio

    2008-03-01

    Full Text Available Durante 2 años, en un estudio de corte trasversal, se estudiaron los pacientes con síntomas compatibles con paracoccidioidomicosis (PCM que concurrieron al Hospital Central de Formosa. Se seleccionaron 335 enfermos, de los cuales 264 eran varones y 71 mujeres, con edades comprendidas entre los 25 y los 79 años. Se hizo diagnóstico de PCM en 24 pacientes, obteniéndose una prevalencia de 7,16%. Hubo un solo caso femenino. La mayoría (83% de los pacientes había consumido tabaco por un tiempo mayor a 10 años, el 96% pertenecía al área rural y el 63% de ellos refería una ingesta elevada de alcohol. Se detectaron también un caso de PCM infanto-juvenil y uno de neuroparacoccidioidomicosis. El 100% de las muestras de lesiones muco-cutáneas de pacientes con PCM estudiadas fue positivo. El estudio serológico por inmunodifusión en gel de agar (IDGA permitió el diagnóstico en 22/249 pacientes estudiados. La PCM es endémica en la provincia de Formosa donde coexiste con otras afecciones con manifestaciones semejantes, por lo que se debe realizar siempre el diagnóstico diferencial.Patients with paracoccidioidomycosis (PCM compatible symptoms who attended Hospital Central de Formosa, were studied during 2 years. Three hundred and thirty five patients were selected, 264 male and 71 female, ages were between 25 and 79 years old. Twenty four patients were diagnosed, the prevalence observed was 7.16%. There was only one female positive case. Most patients (83% had smoked for more than 10 years, 96% came from a rural area and 63% was alcoholic. Also a case of neuroparacoccidioidomycosis and a juvenile-type PCM case were detected. Specimens of mucocutaneous lesions were 100% positives. Immunodiffusion (IDGA allowed the diagnostic in 22/249 patients. PCM and others infectious diseases with similar clinical manifestations coexist in Formosa province, for this reason differential diagnostic must be done.

  9. Caso para diagnóstico Case for diagnosis

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    Silvio Alencar Marques

    2007-12-01

    Full Text Available A paracoccidioidomicose é enfermidade potencialmente grave podendo levar ao óbito. Lesões cutâneas específicas são freqüentes e propícias ao diagnóstico precoce. A disseminação para órgãos do sistema monocítico-macrofágico corresponde à forma aguda-subaguda da enfermidade. Derrame pleural e ascite, raros na paracoccidioidomicose, no presente caso foram conseqüentes à pancreatite aguda hemorrágica. Nos casos graves a anfotericina B e o suporte hospitalar adequado são decisivos na recuperação.Paracoccidioidomycosis is a potentially severe disease that may lead to death. Specific skin lesions are common and suitable for early diagnosis. Dissemination to the reticuloendothelial system is the main characteristic of the acute and subacute clinical forms. Pleural exudate and ascitis are rare in paracoccidioidomycosis. In the present case, these followed an acute hemorrhagic pancreatitis. Amphotericin B and proper hospital care are crucial for the recovery of severe cases.

  10. Teaching Case: MiHotel--Applicant Processing System Design Case

    Science.gov (United States)

    Miller, Robert E.; Dunn, Paul

    2018-01-01

    This teaching case describes the functionality of an applicant processing system designed for a fictitious hotel chain. The system detailed in the case includes a webform where applicants complete and submit job applications. The system also includes a desktop application used by hotel managers and Human Resources to track applications and process…

  11. Paracoccidioidomicose: atualização epidemiológica, clínica e terapêutica Paracoccidioidomycosis: epidemiological, clinical and treatment up-date

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    Silvio Alencar Marques

    2003-04-01

    Full Text Available São apresentados dados de atualização epidemiológica, clínica, diagnóstica e terapêutica relativos à paracoccidioidomicose. Discute-se a importância epidemiológica resultante do isolamento do Paracoccidioides brasiliensis a partir do tatu (Dasypus novemcinctus em regiões do Brasil e Colômbia, assim como dos resultados de inquéritos soroepidemiológicos em cães e do surgimento do primeiro caso de paracoccidioidomicose doença em cão. As dificuldades de isolamento do fungo a partir do solo são correlacionadas com novos informes de investigação epidemiológica. São apresentados aspectos clínicos das manifestações da forma aguda da doença, assim como das manifestações da neuroparacoccidioidomicose e da enfermidade associada à infecção pelo HIV. Discute-se o papel da sorologia e da técnica da PCR no diagnóstico e dos possíveis avanços no tratamento da paracoccidioidomicose com os novos derivados triazólicos.The present report provides new data related to the epidemiology, clinical aspects and treatment of paracoccidioidomycosis. The epidemiological impact of the isolation of Paracoccidioides brasiliensis from the armadillo (Dasypus novemcinctus in areas of Brazil and Columbia, the results from seroepidemiologic study in dogs and the first case of paracoccidioidomycosis-disease on a dog are presented. New insights related to the classical difficulties of isolation of the fungus from soil are correlated with epidemiological data. Clinical manifestation of the acute form of the disease as well as aspects of the neuroparacoccidioidomycosis, and aspects of the association of the disease with the HIV infection are considered. The role of serology and PCR in the diagnosis, as well as the possible advances in the treatment of paracoccidioidomycosis with the new triazole derivatives are discussed.

  12. Paracoccidioides-host Interaction: An Overview on Recent Advances in the Paracoccidioidomycosis

    Science.gov (United States)

    de Oliveira, Haroldo C.; Assato, Patrícia A.; Marcos, Caroline M.; Scorzoni, Liliana; de Paula E Silva, Ana C. A.; Da Silva, Julhiany De Fátima; Singulani, Junya de Lacorte; Alarcon, Kaila M.; Fusco-Almeida, Ana M.; Mendes-Giannini, Maria J. S.

    2015-01-01

    Paracoccidioides brasiliensis and P. lutzii are etiologic agents of paracoccidioidomycosis (PCM), an important endemic mycosis in Latin America. During its evolution, these fungi have developed characteristics and mechanisms that allow their growth in adverse conditions within their host through which they efficiently cause disease. This process is multi-factorial and involves host–pathogen interactions (adaptation, adhesion, and invasion), as well as fungal virulence and host immune response. In this review, we demonstrated the glycoproteins and polysaccharides network, which composes the cell wall of Paracoccidioides spp. These are important for the change of conidia or mycelial (26°C) to parasitic yeast (37°C). The morphological switch, a mechanism for the pathogen to adapt and thrive inside the host, is obligatory for the establishment of the infection and seems to be related to pathogenicity. For these fungi, one of the most important steps during the interaction with the host is the adhesion. Cell surface proteins called adhesins, responsible for the first contact with host cells, contribute to host colonization and invasion by mediating this process. These fungi also present the capacity to form biofilm and through which they may evade the host’s immune system. During infection, Paracoccidioides spp. can interact with different host cell types and has the ability to modulate the host’s adaptive and/or innate immune response. In addition, it participates and interferes in the coagulation system and phenomena like cytoskeletal rearrangement and apoptosis. In recent years, Paracoccidioides spp. have had their endemic areas expanding in correlation with the expansion of agriculture. In response, several studies were developed to understand the infection using in vitro and in vivo systems, including alternative non-mammal models. Moreover, new advances were made in treating these infections using both well-established and new antifungal agents. These

  13. The function of the adrenal cortex in patients with paracoccidioidomycosis: a study by radioimmunoassay of plasma ACTH

    International Nuclear Information System (INIS)

    Tendrich, M.; Vaisman, M.; Pedrosa, P.N.; Guimaraes, M.M.; Cordeiro, J.G.H.

    1987-01-01

    Fifteen patients with paracoccidioidomycosis were studied: ten with the chronic disseminated form (adult types), 4 with the acute or subacute disseminated form (juvenile type) and 1 with the progressive pulmonary form. Ten patients reported no previous treatment and 5 had relapse of the disease. In all cases P. brasiliensis was demonstrated in specimens obtained from the lesions by direct microscopy (KOH), histopathology and/or culture. The adrenocortical function was evaluated by means of basal plasma determination of ACTH and cortisol, and 24 hour urine determination of 17 hydroxisteroids (17 OHCS); after stimulation by ACTH determinations were repeated. Patients were classified in 3 groups: 1) plasma ACTH 58 pg/ml. According to the correlation between ACTH and cortisol level after simulation test 8 patients were classified in group 1, 2 of them with cortisol response lower than twice the basal levels; four patients were classified in group 3. All them had ACTH levels definitely above the normal, 2 of them had no cortisol response after stimulation in addition to signs and symptoms of Addison's disease, thus fulfilling the criteria of primary adrenal insufficiency. The correlation between ACTH and 17 OHCS after stimulation test demonstrated that in 7 out of 8 patientes from group 1 response was lower than twice the basal and that in 3 out of 4 patientes from group 3 proven primary adrenal insufficiency was present. (The other patient showed a 17 OHCS response three times higher than the basal levels). (author) [pt

  14. Effects of Pretreating Serum Samples on the Performance of a Latex Agglutination Test for Serodiagnosis of Paracoccidioidomycosis

    Science.gov (United States)

    Silveira-Gomes, Fabíola

    2012-01-01

    Paracoccidioidomycosis (PCM) is a fungal disease caused by Paracoccidioides brasiliensis, and Brazil is one of the principal countries where it is endemic. Diagnosis is based on the observation of budding P. brasiliensis yeast in clinical specimens from patients; however, the sensitivity of the visualization of fungi is low, indicating that serological tests are used for early diagnosis. The double-immunodiffusion test (ID) is the “gold standard” test for serology in PCM, although the execution of this test requires the availability of laboratorial infrastructure. We report the improved performance of a latex agglutination test (LAT) by pretreating 30 serum samples from PCM patients and 71 controls (histoplasmosis and aspergillosis patients, patients with bacterial infections, and normal human sera) with a dilution buffer incubated at 37°C for 30 min. The sensitivity and specificity of the LAT test in the nonpretreated samples were 73% and 79%, respectively. However, when samples were pretreated, the sensitivity and specificity of the test increased to 90%. In this study, we did not observe cross-reactivity with histoplasmosis patient sera, but some reactions to sera from patients with aspergillosis and bacterial infections were noted. Normal human sera were not reactive in our tests. These results indicate the need for the elimination of heterologous reactions so that we can adequately use this method for screening cases of PCM. PMID:22205661

  15. Aspectos radiológicos torácicos na paracoccidioidomicose Thoracic radiologic aspects in paracoccidioidomycosis

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    Antônio Carlos Francesconi do Valle

    1992-04-01

    Full Text Available São analisadas as telerradiografias de tórax de 159 pacientes portadores de paracoccidioidomicose atendidos no Hospital Evandro Chagas - FIOCRUZ, no período de janeiro de 1960 a dezembro de 1988. Em 24 pacientes (15,09% houve associação com tuberculose; 1 com pneumoconiose; 1 com aspergilose e 2 com carcinoma. Foram excluídos da análise do padrão radiológico 20 casos: em 8 o diagnóstico de tuberculose foi concomitante e em 12 por apresentarem fibrose pulmonar por tratamento prévio para tuberculose e/ou paracoccidioidomicose. Nos 139 casos restantes, as alterações radiológicas encontradas foram agrupadas observando-se a predominância de lesões nos diferentes sítios pulmonares, alveolares ou intersticiais, de acordo com a classificação de MAGALHÃES (198219 modificada: infiltrativa 55 casos (39,6%; misto 28 (20,1%; pneumônico 23 (16,6%; nodular 16 (11,5%; micronodular 10 (7,2% e fibrótico 7 (5,0%. Em 113 pacientes acompanhados radiologicamente, a regressão do processo pulmonar ocorreu 85 casos (75,2% em até 6 meses; em 17 (15,0%, entre 7 e 12 meses; em 4 (3,5%, entre 13 e 24 meses e em 7 (6,1% não houve modificação do padrão radiológicoIn this paper the authors analyse 159 radiographs from paracocidioidomycosis patients seen at the Evandro Chagas Hospital/Fiocruz in the period between January 1960 to December 1988. Twenty four cases (15.09% of association with tuberculosis were observed; one with pneumoconicosis; one with aspergillosis, and two with carcinoma. Twenty cases were excluded from the radiologic analisis: in 8 of these the diagnosis of tuberculosis occured concomitantly, and in 12 patients, lung fibrosis due to previous treatment for tuberculosis or paracoccidioidomycosis was present in. the 139 remaining cases, the radiographic abnormalities encountered were grouped according to the predominance of lesions at the various lung sites, if alveolar or interstitial, according to Magalhães' (1982 classification

  16. scFv from Antibody That Mimics gp43 Modulates the Cellular and Humoral Immune Responses during Experimental Paracoccidioidomycosis.

    Science.gov (United States)

    Jannuzzi, Grasielle Pereira; Tavares, Aldo Henrique F P; Kaihami, Gilberto Hideo; de Almeida, José Roberto Fogaça; de Almeida, Sandro Rogério; Ferreira, Karen Spadari

    2015-01-01

    Paracoccidioidomycosis (PCM), caused by Paracoccidioides species is a prevalent systemic and progressive mycosis that occurs in Latin America. It is caused by Paracoccidioides species. Immunization with dendritic cells transfected with a plasmid encoding the scFv (pMAC/PS-scFv) that mimics the main antigen of P. brasiliensis (gp43) confers protection in experimental PCM. DCs link innate and adaptive immunity by recognizing invading pathogens and selecting the type of effector T cell to mediate the immune response. Here, we showed that DC-pMAC/PS-scFv induces the activation of CD4+ and CD8+ T cells. Moreover, our results demonstrated that BALB/c mice infected with P. brasiliensis and treated with DC-pMAC/PS-scFv showed the induction of specific IgG production against gp43 and IFN-γ, IL-12 and IL-4 cytokines. Analysis of regional lymph nodes revealed increases in the expression of clec7a, myd88, tlr2, gata3 and tbx21, which are involved in the immune response. Taken together, our results indicate that the scFv modulates the humoral and cellular immune responses and presents epitopes to CD4+ and CD8+ T cells.

  17. DNA vaccine encoding peptide P10 against experimental paracoccidioidomycosis induces long-term protection in presence of regulatory T cells.

    Science.gov (United States)

    de Amorim, Juliana; Magalhães, Adriana; Muñoz, Julián Esteban; Rittner, Glauce M G; Nosanchuk, Joshua D; Travassos, Luiz R; Taborda, Carlos P

    2013-03-01

    Paracoccidioidomycosis is a granulomatous systemic mycosis endemic in Brazil and other Latin America countries. A DNA vaccine encoding the immunoprotective peptide 10 (P10) significantly reduced the fungal burden in mice when given prior to or after intratracheal challenge with Paracoccidioides brasiliensis. Presently, the generation/expansion of CD4+ CD44hi memory T cells as well as Foxp3+ Treg cells in mice immunized with the DNA vaccine (pcDNA3-P10) before and after infection with P. brasiliensis was investigated. Memory CD4+ CD44hi T cells simultaneously with Foxp3+ Treg cells increased in the spleens and lungs of pcDNA3-P10 immunized mice on day 0, 30, 60 and 120 postinfection. Histopathology of the lung tissue showed minimal inflammation in immunized mice compared with the unimmunized group, suggesting a role for regulatory T cells in controlling the immunopathology. The DNA vaccine shows that the repeated immunization generates memory cells and regulatory T cells that replace the initially protective pro-inflammatory T cells conferring a long term protection while preserving the integrity of the infected tissue. Copyright © 2012 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

  18. Evaluation of polymerase chain reaction for the detection of Paracoccidioides brasiliensis DNA on serum samples from patients with paracoccidioidomycosis

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    Cecília Eugenia Charbel

    2006-03-01

    Full Text Available The aim of this study was to demonstrate the DNA of Paracoccidioides brasiliensis in human serum samples of patients with paracoccidioidomycosis using the polymerase chain reaction (PCR. The diagnosis of paracoccidioidomycosis (PCM was defined by microscopic observation of the fungus on direct exam or histopathology, culture, and serological positivity. DNA from serum of 33 patients with PCM was extracted and submitted to nested-PCR using primers from the gp 43 gene. Only one sample was positive on nested-PCR. We conclude that the prevalence of fungemia in patients with different clinical forms of PCM is low, limiting the use of serum DNA detection as an alternative diagnostic tool.

  19. Paracoccidioidomycosis in children in the state of Rio de Janeiro (Brazil: Geographic distribution and the study of a "reservarea"

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    A. J. RIOS GONÇALVES

    1998-01-01

    Full Text Available Thirty six cases of acute disseminated paracoccidioidomycosis in 3 to 12 year-old children, natives of the state of Rio de Janeiro, were seen in the period 1981-1996. All patients were residents in the rural region of 15 counties, scattered on the Southwestern part of this state. The rural region of two neighboring counties, where 16 cases (44.4% occurred, was visited. It exhibited the environmental conditions that are considered favorable to the survival of P. brasiliensis. The most important of these conditions, abundant watercourses and autochthonous forest, are distributed on well defined and limited areas, in which the dwellings are also localized. Probably, a careful epidemiological study of forthcoming cases of the disease in children may facilitate the search for the micro-niche of the fungus.No período 1981-1996 foram observados 36 casos de paracoccidioidomicose aguda disseminada em crianças, entre 3 e 12 anos de idade, nativas do estado do Rio de Janeiro. Todos os pacientes residiam em região rural, distribuída por 15 municípios localizados na parte sudoeste do estado. Dois municípios vizinhos, onde haviam ocorrido 16 (44,4% dos casos, foram visitados. Na região rural de ambos, existem as condições climáticas e ambientais favoráveis à sobrevivência do P. brasiliensis. Dentre essas condições, as mais importantes, abundantes cursos de água e vegetação nativa, distribuem-se em áreas limitadas e bem definidas. Nessas áreas localizam-se, também, as casas dos rurículas. Provavelmente, um cuidadoso estudo epidemiológico de novos casos, que venham a ocorrer na região, facilitará a busca do nicho do fungo

  20. Emergence of acute/subacute infant-juvenile paracoccidioidomycosis in Northeast Argentina: Effect of climatic and anthropogenic changes?

    Science.gov (United States)

    Giusiano, Gustavo; Aguirre, Clarisa; Vratnica, Claudia; Rojas, Florencia; Corallo, Teresa; Cattana, María Emilia; Fernández, Mariana; Mussin, Javier; de Los Angeles Sosa, María

    2018-01-13

    Argentina has two endemic areas of paracoccidioidomycosis (PCM). Bordering Paraguay and Brazil, Northeast Argentina (NEA) comprises the area with the highest incidence where the chronic adult clinical form has historically been reported. Juvenile form in children and adolescents is rare in this area since only one case was reported in the last 10 years. Despite this, between 2010 and 2012, several cases of acute/subacute clinical forms in children aged 10 to 16 (median 12) were detected. In the last decade, the NEA region has been exposed to ecological variations as consequences of certain climatic and anthropogenic changes, including El Niño-Southern Oscillation phenomenon during 2009, and deforestation. The region has also suffered from the significant ecological effects of the construction of one of the biggest hydroelectric dams of South America. This study aims to describe clinical and epidemiological aspects of acute/subacute PCM cases detected in children from NEA and to discuss climatic and anthropogenic changes as possible contributing factors in the emergence of this disease in children. This acute/subacute PCM cluster was characterized by severe disseminated and aggressive presentations to localized form, with a high spectrum of clinical manifestations uncommonly observed. Due to the lack of experience in acute/subacute PCM in children in the studied area and the atypical clinical manifestations observed, the diagnosis was delayed. In order to avoid misdiagnosis, a higher level of suspicion is now required in NEA and countries bordering the southern part of the endemic area, which are affected by the changes discussed in this article. © The Author(s) 2018. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Intelligent Adaptation Process for Case Based Systems

    International Nuclear Information System (INIS)

    Nassar, A.M.; Mohamed, A.H.; Mohamed, A.H.

    2014-01-01

    Case Based Reasoning (CBR) Systems is one of the important decision making systems applied in many fields all over the world. The effectiveness of any CBR system based on the quality of the storage cases in the case library. Similar cases can be retrieved and adapted to produce the solution for the new problem. One of the main issues faced the CBR systems is the difficulties of achieving the useful cases. The proposed system introduces a new approach that uses the genetic algorithm (GA) technique to automate constructing the cases into the case library. Also, it can optimize the best one to be stored in the library for the future uses. However, the proposed system can avoid the problems of the uncertain and noisy cases. Besides, it can simply the retrieving and adaptation processes. So, it can improve the performance of the CBR system. The suggested system can be applied for many real-time problems. It has been applied for diagnosis the faults of the wireless network, diagnosis of the cancer diseases, diagnosis of the debugging of a software as cases of study. The proposed system has proved its performance in this field

  2. Interrelationship of clinical, histomorphometric and immunohistochemical features of oral lesions in chronic paracoccidioidomycosis.

    Science.gov (United States)

    de Abreu E Silva, Mariana À; Salum, Fernanda G; Figueiredo, Maria A; Lopes, Tiago G; da Silva, Vinicius D; Cherubini, Karen

    2013-03-01

    This study aimed to analyze the oral lesions of chronic paracoccidioidomycosis concerning their histomorphometric, immunohistochemical, and clinical features in a standardized sample. Fifty biopsy specimens of oral lesions of chronic paracoccidioidomycosis were submitted to hematoxylin and eosin (H&E), Grocott-Gomori and immunohistochemical staining. Data regarding disease duration and size and number of oral lesions, as well as erythrocytes, leukocytes, lymphocytes, hematocrit, hemoglobin, and erythrocyte sedimentation rate, were collected from medical charts. Granuloma density and number and diameter of buds and fungal cells, and IL-2, TNF-alpha and IFN-gamma expression, as well as clinical and hematological features, were quantified and correlated. Bud diameter was significantly greater in intermediate density granulomas compared to higher density granulomas. The other variables (number of buds, number and diameter of fungi, expression of IL-2, TNF-alpha and IFN-gamma, and clinical and hematological features) did not significantly change with the density of granulomas. There was a positive correlation between bud number and fungal cell number (r = 0.834), bud diameter and fungal cell diameter (r = 0.496), erythrocytes and number of fungi (r = 0.420), erythrocytes and bud number (r = 0.408), and leukocytes and bud number (r = 0.396). Negative correlation occurred between number and diameter of fungi (r = -0.419), bud diameter and granuloma density (r = -0.367), TNF-alpha expression and number of fungi (r = -0.372), and TNF-alpha expression and bud number (r = -0.300). The histological, immunological, and clinical features of oral lesions evaluated did not differ significantly between patients in our sample of chronic paracoccidioidomycosis. TNF-alpha levels were inversely correlated with intensity of infection. © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  3. Western Blotting Is an Efficient Tool for Differential Diagnosis of Paracoccidioidomycosis and Pulmonary Tuberculosis

    Science.gov (United States)

    Bertoni, Thâmara Aline; Perenha-Viana, Maysa Cláudia Zolin; Patussi, Eliana Valéria; Cardoso, Rosilene Fressatti

    2012-01-01

    Sputum and sera from 134 patients screened for tuberculosis (TB) were analyzed to investigate TB and paracoccidioidomycosis (PCM). Of these patients, 11 (8.2%) were confirmed to have TB, but six (4.5%) were positive only for PCM. All patients with PCM presented anti-43-kDa-component antibodies in Western blotting (WB) assays, while in the TB-positive patients these antibodies did not appear. This preliminary study suggests WB as a potential tool for differential laboratory diagnosis between TB and PCM. PMID:22971781

  4. High Serum Interleukin-10 and Tumor Necrosis Factor Alpha Levels in Chronic Paracoccidioidomycosis

    Science.gov (United States)

    Fornari, M. C.; Bava, A. J.; Guereño, M. T.; Berardi, V. E.; Silaf, M. R.; Negroni, R.; Diez, R. A.

    2001-01-01

    In patients with chronic paracoccidioidomycosis (n = 10), levels of tumor necrosis factor alpha, interleukin-10, and interleukin-2 in serum, measured by enzyme-linked immunosorbent assay (in picograms per milliliter, as mean ± standard error of the mean), were higher than in normal controls (n = 8): 186 ± 40 versus 40 ± 7 (P < 0.05), 203 ± 95 versus 20 ± 8 (P = 0.001), and 96.3 ± 78.57 versus 1.19 ± 1.19 (P = 0.045), respectively. Gamma interferon and interleukin-4 levels were similar in patients and controls. PMID:11527826

  5. PREVALENCE OF PARACOCCIDIOIDOMYCOSIS INFECTION BY INTRADERMAL REACTION IN RURAL AREAS IN ALFENAS, MINAS GERAIS, BRAZIL

    Directory of Open Access Journals (Sweden)

    Evandro Monteiro de Sá Magalhães

    2014-07-01

    Full Text Available This study aimed to estimate the prevalence of paracoccidioidal infection by intradermal reaction (Delayed-Type Hypersensitivity, DTH to Paracoccidioides brasiliensis in rural areas in Alfenas, Southern Minas Gerais (MG State, Brazil, and to assess risk factors (gender, occupation, age, alcohol intake and smoking associated with infection. We conducted a population-based cross-sectional study using intradermal tests with gp 43 paracoccidioidin in 542 participants, who were previously contacted by local health agents and so spontaneously attended the test. Participants underwent an interview by filling out a registration form with epidemiological data and were tested with an intradermal administration of 0.1 mL of paracoccidioidin in the left forearm. The test was read 48 hours after injection and was considered positive if induration was greater than or equal to 5 mm. Out of 542 participants, 46.67% were positive to the skin test. Prevalence increased in accordance with an increase of age. There was statistical significance only for males. Occupation, alcohol intake and smoking habits were not significantly associated with the risk of paracoccidioidomycosis infection. There is relevance of paracoccidioidomycosis infection in such rural areas, which suggests that further epidemiological and clinical studies on this mycosis should be done in the southern part of Minas Gerais State.

  6. Prevalence of paracoccidioidomycosis infection by intradermal reaction in rural areas in Alfenas, Minas Gerais, Brazil.

    Science.gov (United States)

    Magalhães, Evandro Monteiro de Sá; Ribeiro, Carla de Fátima; Dâmaso, Carla Silva; Coelho, Luiz Felipe Leomil; Silva, Roberta Ribeiro; Ferreira, Eric Batista; Rodrigues, Maria Rita; Camargo, Zoilo Pires de; Velloso, Tânia Regina Grão; Malaquias, Luiz Cosme Cotta

    2014-01-01

    This study aimed to estimate the prevalence of paracoccidioidal infection by intradermal reaction (Delayed-Type Hypersensitivity, DTH) to Paracoccidioides brasiliensis in rural areas in Alfenas, Southern Minas Gerais (MG) State, Brazil, and to assess risk factors (gender, occupation, age, alcohol intake and smoking) associated with infection. We conducted a population-based cross-sectional study using intradermal tests with gp 43 paracoccidioidin in 542 participants, who were previously contacted by local health agents and so spontaneously attended the test. Participants underwent an interview by filling out a registration form with epidemiological data and were tested with an intradermal administration of 0.1 mL of paracoccidioidin in the left forearm. The test was read 48 hours after injection and was considered positive if induration was greater than or equal to 5 mm. Out of 542 participants, 46.67% were positive to the skin test. Prevalence increased in accordance with an increase of age. There was statistical significance only for males. Occupation, alcohol intake and smoking habits were not significantly associated with the risk of paracoccidioidomycosis infection. There is relevance of paracoccidioidomycosis infection in such rural areas, which suggests that further epidemiological and clinical studies on this mycosis should be done in the southern part of Minas Gerais State.

  7. Paracoccidioidomycosis mimicking squamous cell carcinoma on the dorsum of the tongue and review of published literature.

    Science.gov (United States)

    Pedreira, Renato do Prado Gomes; Guimarães, Eduardo Pereira; de Carli, Marina Lara; Magalhães, Evandro Monteiro de Sá; Pereira, Alessandro Antônio Costa; Hanemann, João Adolfo Costa

    2014-06-01

    Paracoccidioidomycosis is a disease that is endemic to southern and southeastern Brazil, caused by the fungus Paracoccidioides brasiliensis. The most common clinical oral manifestation is the presence of multiple granulomatous ulcers with hemorrhagic dots, located mainly on the lips, palate, and buccal mucosa. However, the disease can manifest atypically as a single ulcer, mimicking oral squamous cell carcinoma (SCC) or tuberculosis. A 65-year-old male patient presented with a complaint of a single ulcerated lesion on the dorsum of the tongue; the lesion had evolved over 6 months. The diagnostic hypotheses were SCC and oral manifestation of tuberculosis. An incisional biopsy was performed, and histopathological analysis of the specimen revealed pseudoepitheliomatous hyperplasia, a granulomatous structure of epithelioid histiocytes, multinucleated giant cells, and lymphocytes in the connective tissue. Grocott staining confirmed the presence of the fungus in the lesion, and a diagnosis was made of paracoccidioidomycosis. The patient was treated with 200 mg/day of itraconazole for 12 months and now shows no signs or symptoms of recurrence of the disease. Correct diagnosis is essential for a successful therapeutic approach and resolution of the lesion.

  8. Objective CT-based quantification of lung sequelae in treated patients with paracoccidioidomycosis.

    Science.gov (United States)

    Alvarez, Matheus; Pina, Diana R; de Oliveira, Marcela; Ribeiro, Sérgio M; Mendes, Rinaldo P; Duarte, Sérgio B; Miranda, José R A

    2014-11-01

    This study presents methodology for objectively quantifying the pulmonary region affected by emphysemic and fibrotic sequelae in treated patients with paracoccidioidomycosis. This methodology may also be applied to any other disease that results in these sequelae in the lungs.Pulmonary high-resolution computed tomography examinations of 30 treated paracoccidioidomycosis patients were used in the study. The distribution of voxel attenuation coefficients was analyzed to determine the percentage of lung volume that consisted of emphysemic, fibrotic, and normal tissue. Algorithm outputs were compared with subjective evaluations by radiologists using a scale that is currently used for clinical diagnosis.Affected regions in the patient images were determined by computational analysis and compared with estimates by radiologists, revealing mean (± standard deviation) differences in the scores for fibrotic and emphysemic regions of 0.1% ± 1.2% and -0.2% ± 1.0%, respectively.The computational results showed a strong correlation with the radiologist estimates, but the computation results were more reproducible, objective, and reliable.

  9. Diagnosis of paracoccidioidomycosis by a dot blot assay using a recombinant Paracoccidioides brasiliensis p27 protein.

    Science.gov (United States)

    Correa, M M; Bedoya, A M; Guerrero, M P; Méndez, J; Restrepo, A; McEwen, J G

    2007-01-01

    A variety of immunological methods have proven useful for Paracoccidioidomycosis (PCM) diagnosis; however, they are often time consuming and many lack sensitivity and specificity, partially attributed to the use of crude antigens, which give cross reactivity. Until now, attempts to clone and express Paracoccidioides brasiliensis immunodominant antigens have presented difficulties of process and problems of cost. In an attempt to obtain a more rapid, sensitive, and specific test for PCM diagnosis, we subcloned the P. brasiliensis p27 gene and used the recombinant protein as the antigen in dot blot assays to evaluate its usefulness in paracoccidioidomicosis diagnosis. The development of an optimised procedure for p27 recombinant protein purification and production led to an easier and less expensive process than the one previously used in our laboratory and allowed the availability of enough purified protein for its evaluation as the antigen in the dot blot assays. In these assays, antibodies present in ten serum samples from seven patients with PCM recognised the recombinant protein showing a sensitivity of 100% with a specificity of 98%. These results confirm the value of the 27-kDa recombinant antigen in the serodiagnosis of paracoccidioidomycosis and that the dot blot format is an alternative to the immunoenzymatic assay procedure.

  10. Cyclopalladated Compound 7a Induces Apoptosis- and Autophagy-Like Mechanisms in Paracoccidioides and Is a Candidate for Paracoccidioidomycosis Treatment.

    Science.gov (United States)

    Arruda, Denise C; Matsuo, Alisson L; Silva, Luiz S; Real, Fernando; Leitão, Natanael P; Pires, Jhon H S; Caires, Antonio Carlos F; Garcia, Daniel M; Cunha, Fernanda F M; Puccia, Rosana; Longo, Larissa V G

    2015-12-01

    Paracoccidioidomycosis (PCM), caused by Paracoccidioides species, is the main cause of death due to systemic mycoses in Brazil and other Latin American countries. Therapeutic options for PCM and other systemic mycoses are limited and time-consuming, and there are high rates of noncompliance, relapses, toxic side effects, and sequelae. Previous work has shown that the cyclopalladated 7a compound is effective in treating several kinds of cancer and parasitic Chagas disease without significant toxicity in animals. Here we show that cyclopalladated 7a inhibited the in vitro growth of Paracoccidioides lutzii Pb01 and P. brasiliensis isolates Pb18 (highly virulent), Pb2, Pb3, and Pb4 (less virulent) in a dose-response manner. Pb18 was the most resistant. Opportunistic Candida albicans and Cryptococcus neoformans were also sensitive. BALB/c mice showed significantly lighter lung fungal burdens when treated twice a day for 20 days with a low cyclopalladated 7a dose of 30 μg/ml/day for 30 days after intratracheal infection with Pb18. Electron microscopy images suggested that apoptosis- and autophagy-like mechanisms are involved in the fungal killing mechanism of cyclopalladated 7a. Pb18 yeast cells incubated with the 7a compound showed remarkable chromatin condensation, DNA degradation, superoxide anion production, and increased metacaspase activity suggestive of apoptosis. Autophagy-related killing mechanisms were suggested by increased autophagic vacuole numbers and acidification, as indicated by an increase in LysoTracker and monodansylcadaverine (MDC) staining in cyclopalladated 7a-treated Pb18 yeast cells. Considering that cyclopalladated 7a is highly tolerated in vivo and affects yeast fungal growth through general apoptosis- and autophagy-like mechanisms, it is a novel promising drug for the treatment of PCM and other mycoses. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  11. Polymorphisms on IFNG, IL12B and IL12RB1 genes and paracoccidioidomycosis in the Brazilian population.

    Science.gov (United States)

    Carvalho, F M C; Busser, F D; Freitas, V L T; Furucho, C R; Sadahiro, A; Kono, A S G; Criado, P R; Moretti, M L; Sato, P K; Shikanai-Yasuda, M A

    2016-09-01

    Paracoccidioidomycosis (PCM) is a systemic chronic mycosis, endemic in Latin America, especially Brazil, and is the eighth leading cause of death among chronic and recurrent infectious diseases. PCM infection is characterized by the presence of Th1 immune response; the acute form, by a mixed Th2/Th9, while the chronic form is characterized by Th17/Th22 profiles. The occurrence and severity of human PCM may also be associated with genetic factors such as single nucleotide polymorphisms (SNP) on cytokines encoding genes. We investigated the association between these polymorphisms and the different clinical forms of PCM. We included 156 patients with PCM (40 with the acute form, 99 with the chronic multifocal and 17 with the chronic unifocal form) and assayed their DNA samples for IFNG +874 T/A SNP by PCR-ARMS (Amplification Refractory Mutational System), IL12B +1188 A/C SNP on 3' UTR and IL12RB1 641 A/G SNP on exon 7 by PCR-RFLP (Restriction Fragment Length Polymorphism). We found similar genotypic and allelic frequencies of the investigated SNPs among the clinical forms of PCM. Considering male patients, the IL12RB1 641 AA genotype was more frequent in the chronic multifocal form while heterozygosis was in the chronic unifocal form of PCM (p=0.048). Although our data suggest that the AA genotype (IL12RB1) may be associated with the more disseminated chronic disease, more patients of the chronic unifocal PCM group need to be analyzed as well as the secretion patterns of IFN-γ combined with the IL-12Rβ1 expression for a better comprehension of this association. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Dissociação clínico-radiológica nas manifestações pulmonares da paracoccidioidomicose Clinical-radiological dissociation in lung manifestations of paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Elenice Gomes

    2008-10-01

    Full Text Available Os pulmões estão entre os principais sítios acometidos pela paracoccidioidomicose, contudo as alterações nem sempre são fáceis de serem diferenciadas de outros distúrbios respiratórios. O objetivo deste estudo foi verificar a freqüência do comprometimento pulmonar na paracoccidioidomicose e se existe associação clínico-radiológica. Foi realizado um estudo retrospectivo de março de 1996 a novembro de 2006, em pacientes com paracoccidioidomicose no Hospital Universitário Regional de Maringá, PR. No período foram confirmados 45 casos, dos quais 79,5% apresentavam alterações radiológicas em Raios-X de tórax e quatro deles tinham também tuberculose pulmonar. De 40 pacientes com paracoccidioidomicose exclusivamente, 57,5% apresentavam manifestações clínicas respiratórias e 77,5% alterações radiológicas, ficando evidente uma dissociação clínico-radiológica, o tabagismo foi declarado por 80,6% dos pacientes que apresentavam alterações radiológicas. Concluímos que as alterações morfológicas no pulmão, embora freqüentes, nem sempre correspondem a sinais e sintomas respiratórios e são difíceis de serem atribuídas exclusivamente à paracoccidioidomicose.Lungs are among the main sites affected by paracoccidioidomycosis. However, the alterations are not always easy to differentiate from other respiratory disorders. The objectives of the present study were to investigate the frequency of lung impairment in paracoccidioidomycosis cases and to investigate whether any clinical-radiological association exists. A retrospective study was carried out from March 1996 to November 2006, among patients with paracoccidioidomycosis at the Regional University Hospital of Maringá, Paraná, Brazil. Over this period, 45 cases were confirmed, of which 79.5% presented radiological abnormalities on chest X-rays, and four of them also presented pulmonary tuberculosis. Out of the total of 40 patients with paracoccidioidomycosis alone

  13. Case Report: An atypical case of systemic lupus erythematosus ...

    African Journals Online (AJOL)

    Background: Systemic lupus erythematosus (SLE) is a multisystem disease that can be a diagnostic conundrum. Case report: We describe a patient who presented with recurrent fleeting exudative and hemorrhagic pleural effusion. It took multiple visits over 3 months and renal biopsy to con rm the diagnosis of SLE.

  14. Neutrophil Extracellular Traps Identification in Tegumentary Lesions of Patients with Paracoccidioidomycosis and Different Patterns of NETs Generation In Vitro.

    Science.gov (United States)

    Della Coletta, Amanda Manoel; Bachiega, Tatiana Fernanda; de Quaglia e Silva, Juliana Carvalho; Soares, Ângela Maria Victoriano de Campos; De Faveri, Julio; Marques, Silvio Alencar; Marques, Mariângela Esther Alencar; Ximenes, Valdecir Farias; Dias-Melicio, Luciane Alarcão

    2015-01-01

    Paracoccidioidomycosis (PCM) is a systemic mycosis, endemic in most Latin American countries, especially in Brazil. It is caused by the thermo-dimorphic fungus of the genus Paracoccidioides (Paracoccidioides brasiliensis and Paracoccidioides lutzii). Innate immune response plays a crucial role in host defense against fungal infections, and neutrophils (PMNs) are able to combat microorganisms with three different mechanisms: phagocytosis, secretion of granular proteins, which have antimicrobial properties, and the most recent described mechanism called NETosis. This new process is characterized by the release of net-like structures called Neutrophil Extracellular Traps (NETs), which is composed of nuclear (decondensed DNA and histones) and granular material such as elastase. Several microorganisms have the ability of inducing NETs formation, including gram-positive and gram-negative bacteria, viruses and some fungi. We proposed to identify NETs in tegumentary lesions of patients with PCM and to analyze the interaction between two strains of P. brasiliensis and human PMNs by NETs formation in vitro. In this context, the presence of NETs in vivo was evidenced in tegumentary lesions of patients with PCM by confocal spectrum analyzer. Furthermore, we showed that the high virulent P. brasiliensis strain 18 (Pb18) and the lower virulent strain Pb265 are able to induce different patterns of NETs formation in vitro. The quantification of extracellular DNA corroborates the idea of the ability of P. brasiliensis in inducing NETs release. In conclusion, our data show for the first time the identification of NETs in lesions of patients with PCM and demonstrate distinct patterns of NETs in cultures challenged with fungi in vitro. The presence of NETs components both in vivo and in vitro open new possibilities for the detailed investigation of immunity in PCM.

  15. Cell-Free Antigens from Paracoccidioides brasiliensis Drive IL-4 Production and Increase the Severity of Paracoccidioidomycosis

    Science.gov (United States)

    Oliveira, Leandro L.; Rocha, Fernanda A.; Vancim, Jaqueline O.; Moreira, Ana Paula; Campanelli, Ana Paula; Panagio, Luciano A.; Milanezi, Cristiane M.; Martinez, Roberto; Rossi, Marcos A.; Silva, Joao S.

    2011-01-01

    The thermally dimorphic fungus Paracoccidioides brasiliensis (Pb) is the causative agent of paracoccidioidomycosis (PCM), one of the most frequent systemic mycosis that affects the rural population in Latin America. PCM is characterized by a chronic inflammatory granulomatous reaction, which is consequence of a Th1-mediated adaptive immune response. In the present study we investigated the mechanisms involved in the immunoregulation triggered after a prior contact with cell-free antigens (CFA) during a murine model of PCM. The results showed that the inoculation of CFA prior to the infection resulted in disorganized granulomatous lesions and increased fungal replication in the lungs, liver and spleen, that paralleled with the higher levels of IL-4 when compared with the control group. The role of IL-4 in facilitating the fungal growth was demonstrated in IL-4-deficient- and neutralizing anti-IL-4 mAb-treated mice. The injection of CFA did not affect the fungal growth in these mice, which, in fact, exhibited a significant diminished amount of fungus in the tissues and smaller granulomas. Considering that in vivo anti-IL-4-application started one week after the CFA-inoculum, it implicates that IL-4-CFA-induced is responsible by the mediation of the observed unresponsiveness. Further, the characterization of CFA indicated that a proteic fraction is required for triggering the immunosuppressive mechanisms, while glycosylation or glycosphingolipids moieties are not. Taken together, our data suggest that the prior contact with soluble Pb antigens leads to severe PCM in an IL-4 dependent manner. PMID:21731741

  16. The relation between FoxP3⁺ regulatory T cells and fungal density in oral paracoccidioidomycosis: a preliminary study.

    Science.gov (United States)

    Cardoso, Rhanderson Miller Nascimento; Jham, Bruno Correia; do Carmo, Gabriela Mota; Batista, Aline Carvalho; de Oliveira, Flávia Aparecida; de Paula, Elbio Candido; Mesquita, Ricardo Alves; da Silva, Tarcília Aparecida; Duarte, Eliza Carla Barroso

    2014-12-01

    Regulatory T (Treg) cells may play an important role in the pathogenesis of paracoccidioidomycosis (PCM), but data on the role of Treg cells in the context of oral PCM are still scarce. The objectives of this study were to investigate the density of FoxP3(+) T regulatory cells in oral PCM and to correlate the results with the density of Paracoccidioides brasiliensis in the lesions. Cases of chronic oral PCM seen between 2000 and 2008 were included in this study. The diagnosis of all lesions was confirmed with histopathological examination and Grocott-Gomori staining. The quantitative analysis of the viable fungi was conducted in all cases with Grocott-stained slides. Treg cells were identified using antibodies against FoxP3. Pearson correlation coefficient was used to test the correlation between the density of fungi and Treg cells. Results were considered significant when P < 0.05. A total of 11 cases of oral PCM were obtained. There was a positive correlation between fungal density and FoxP3(+) Treg cells density in oral lesions, however, without statistical significance. A positive relation between Treg cells and fungal density was seen in oral PCM. Further studies are required to further elucidate the role of these cells in the pathogenesis of oral PCM, as well the clinical significance of these findings. © 2014 Blackwell Verlag GmbH.

  17. [Mycoses in Venezuela: Working Groups in Mycology reported cases (1984-2010)].

    Science.gov (United States)

    Martínez Méndez, Dilia; Hernández Valles, Rosaura; Alvarado, Primavera; Mendoza, Mireya

    2013-01-03

    In 1984 the Venezuelan Work Groups in Mycology (VWGM) were created introducing an innovative approach to the study of the mycoses in Venezuela. To study the occurrence of the mycoses in Venezuela. Review the reported cases of mycoses by the newsletter Boletín Informativo Las Micosis en Venezuela (VWGM) from 1984 to 2010. The data collected showed 36,968 reported cases of superficial mycoses, 1,989 of deep systemic cases, and 822 of localized mycoses. Pityriasis dermatophytosis was the most common superficial infection, and paracoccidioidomycosis and histoplasmosis the most frequent deep systemic infection. Chromoblastomycosis was the most frequently diagnosed subcutaneous infection. The data provided showed the distribution by geographical area for each of the fungal infections studied, which may help to establish the endemic areas. Superficial mycosis is a public health problem due to its high morbidity and is probably responsible for some of the outbreaks in high-risk groups. Paracoccidioidomycosis and histoplasmosis were reported more often, which agrees with earlier reports prior to the formation of the VWGM. Cases of sporotrichosis and chromoblastomycosis in Venezuela can be considered unique due to the high number of cases. This study highlights the contribution of the VWGM to the behavior of the mycoses in Venezuela, its incidence, prevalence, and the recognition of these infections as a problem of public health importance. The VWGM should keep working in this endeavor, not only reporting new cases, but also unifying the clinical and epidemiological criteria, in order to properly monitor the evolving epidemiological changes reported in these types of infections. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier España, S.L. All rights reserved.

  18. Systemic Design: Two Canadian Case Studies

    Directory of Open Access Journals (Sweden)

    Alex Ryan

    2014-12-01

    Full Text Available This paper introduces two novel applications of systemic design to facilitate a comparison of alternative methodologies that integrate systems thinking and design. In the first case study, systemic design helped the Procurement Department at the University of Toronto re-envision how public policy is implemented and how value is created in the broader university purchasing ecosystem. This resulted in an estimated $1.5 million in savings in the first year, and a rise in user retention rates from 40% to 99%. In the second case study, systemic design helped the clean energy and natural resources group within the Government of Alberta to design a more efficient and effective resource management system and shift the way that natural resource departments work together. This resulted in the formation of a standing systemic design team and contributed to the creation of an integrated resource management system. A comparative analysis of the two projects identifies a shared set of core principles for systemic design as well as areas of differentiation that reveal potential for learning across methodologies. Together, these case studies demonstrate the complementarity of systems thinking and design thinking, and show how they may be integrated to guide positive change within complex sociotechnical systems.

  19. Adrenal Function Status in Patients with Paracoccidioidomycosis after Prolonged Post-Therapy Follow-Up

    Science.gov (United States)

    Tobón, Angela M.; Agudelo, Carlos A.; Restrepo, Carlos A.; Villa, Carlos A.; Quiceno, William; Estrada, Santiago; Restrepo, Angela

    2010-01-01

    This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy. PMID:20595488

  20. Advances and challenges in paracoccidioidomycosis serology caused by Paracoccidioides species complex: an update.

    Science.gov (United States)

    da Silva, Julhiany de Fátima; de Oliveira, Haroldo Cesar; Marcos, Caroline Maria; Assato, Patricia Akemi; Fusco-Almeida, Ana Marisa; Mendes-Giannini, Maria José Soares

    2016-01-01

    Understanding the possible methodologies for the rapid and inexpensive identification of fungal infections is essential for disease diagnosis, but there are some limitations. To help with this problem, serological methods that detect antigens or antibodies are widely used and are useful for the diagnosis of paracoccidioidomycosis (PCM) through the detection of gp43, which is the main antigen employed for the immunodiagnosis of this disease caused by Paracoccidioides brasiliensis. However, the use of gp43 has become restricted because it was recently found that this marker is not identified in the infections caused by Paracoccidioides lutzii. Therefore, it is necessary to identify new antigens in both species or antigens specific for P. lutzii to decrease the morbidity and/or mortality associated with PCM. This review provides a discussion of new diagnostic challenges after the recent discoveries regarding the taxonomy of the Paracoccidioides genus. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Inapparent lung involvement in patients with the subacute juvenile type of paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    A. Restrepo

    1989-02-01

    Full Text Available Three patients with the diagnosis of subacute juvenile paracoccidioidomycosis who, at the time of their first visit, had no signs or symptoms of lung involvement, were studied. Initially the diagnosis was confirmed by the observation of P. brasiliensis in biopsy material obtained from clinically involved lymphadenopathies. The lung X-rays done in all patients, did not reveal pathologic changes, although it was possible to observe and isolate the fungus from sputum samples obtained from the three patients. This fact reinforces the pulmonary genesis of the mycosis and proofs the existence of a pulmonary primary infection, even in patients with the juvenile manifestations, in whom the lung component is obscured by the predominant lymph node involvement.

  2. Anthropocentric language theory and Serbian case systems

    Directory of Open Access Journals (Sweden)

    Topolinjska Zuzana

    2002-01-01

    Full Text Available The author understands case as a relationship of syntactic dependence between a subordinated noun phrase and the governing syntactic construction (predicative expression and/or another noun phrase. The above definition construes case as a universal category characteristics of all the languages sharing the nomen vs verbum opposition. Particular cases are conceived as primarily semantically motivated. The two relevant semantic parameters are /+/ -human / (or /+/ -animated/ and /+/ -localized/, i. e. - in other words - the so-called hierarchy of animateness and the spatial location of the objects that the corresponding noun phrases refer to. N and D are being characterized as /+ hum/, A and I as /-hum/ and L as belonging to another semantic paradigm is defined simply as /+ loc/. Results of the analyses of morphological syncretism's and of syntactic exponents of the NPs-dependence found in Serbian case systems support the above tentative interpretation of the case as a (semantic and syntactic category.

  3. Global Hawk Systems Engineering. Case Study

    Science.gov (United States)

    2010-01-01

    Charles Garland, whose support was integral in guiding me throughout this case study. Bill Kinzig Global Hawk Systems Engineering Case Study...necessary to characterize the system’s utility. 3.2.3.2 First Flight AV-1 rolled out of the TRA facility on February 20, 1997. While at Lindbergh Field... Lindbergh Field, but its delivery to Edwards AFB, California, was already late. Thus, the air vehicle was disassembled and trucked to Edwards AFB on

  4. Business cases for product configuration systems

    DEFF Research Database (Denmark)

    Shafiee, Sara; Kristjansdottir, Katrin; Hvam, Lars

    In the recent years, product configuration systems (PCSs) have received greater attention from industries providing customized products as a response to increased demand to fulfil diverse customers’ needs for customized products. Before developing a PCS, a well-established business case has...... to be made in order to secure the success and delivery of the project as it will increase the commitment from the business side. This paper presents a framework for supporting the development of business cases for PCSs and discusses the experiences from multiple case studies benefiting from the suggested...

  5. Increased peripheral blood TCD4+ counts and serum SP-D levels in patients with chronic paracoccidioidomycosis, during and after antifungal therapy.

    Science.gov (United States)

    Venturini, James; Cavalcante, Ricardo Souza; Sylvestre, Tatiane Fernanda; Santos, Rodolfo Ferreira Dos; Moris, Daniela Vanessa; Carvalho, Lídia Raquel; Arruda, Maria Sueli Parreira de; Golim, Marjorie de Assis; Mendes, Rinaldo Poncio

    2017-11-01

    The main clinical forms of paracoccidioidomycosis (PCM) are the acute/subacute form (AF) and the chronic form (CF), and they both display considerable clinical variability. The immune responses of PCM patients, during and after treatment, remain neglected, mainly in the case of CF patients, due to the high prevalence of pulmonary sequelae. To evaluate the distribution of whole blood T cell subsets, serum cytokines, and biomarkers of pulmonary fibrosis in PCM patients, according to the clinical form and at different time points, during the antifungal therapy. Eighty-seven PCM patients, from an endemic area in Brazil, were categorised into groups, according to the clinical form (AF or CF) and the moment of treatment. The peripheral blood T lymphocyte subsets of these patients were analysed using fluorescence-activated cell sorting. The serum levels of cytokines, basic fibroblast growth factor and surfactant protein-D (SP-D) were also analysed. In the CF patients, an expansion of the peripheral blood TCD4+ cells was observed during the treatment, and this persisted even after two years of antifungal treatment. In addition, these patients showed high serum levels of SP-D. Our findings highlight the immunological changes CF patients undergo, during and after treatment, possibly due to the hypoxia triggered by pulmonary fibrosis and emphysema.

  6. Production of TNF-α, nitric oxide and hydrogen peroxide by macrophages from mice with paracoccidioidomycosis that were fed a linseed oil-enriched diet

    Directory of Open Access Journals (Sweden)

    Sheisa Cyléia Sargi

    2012-05-01

    Full Text Available Omega-3 polyunsaturated fatty acids (n-3 PUFA can modulate the immune system and their primary effect is on macrophage function. Paracoccidioidomycosis (PCM is an endemic systemic mycosis in Latin America that is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb. Macrophages are the main defence against this pathogen and have microbicidal activity that is dependent on interferon-Γ and tumour necrosis factor (TNF-α. These cytokines stimulate the synthesis of nitric oxide (NO and hydrogen peroxide (H2O2, leading to the death of the fungus. To study the effect of n-3 PUFA on the host immune response during experimental PCM, macrophages that were obtained from animals infected with Pb18 and fed a diet enriched by linseed (LIN oil were cultured and challenged with the fungus in vitro. The macrophage function was analysed based on the concentrations of TNF-α, NO and H2O2. LIN oil seems to influence the production of TNF-α during the development of disease. A diet enriched with LIN oil influences the microbicidal activity of the macrophages by inducing the production of cytokines and metabolites such as NO and H2O2, predominantly in the chronic phase of infection.

  7. Production of TNF-α, nitric oxide and hydrogen peroxide by macrophages from mice with paracoccidioidomycosis that were fed a linseed oil-enriched diet.

    Science.gov (United States)

    Sargi, Sheisa Cyléia; Dalalio, Márcia Machado de Oliveira; Visentainer, Jesuí Vergílio; Bezerra, Rafael Campos; Perini, João Ângelo de Lima; Stevanato, Flávia Braidotti; Visentainer, Jeane Eliete Laguila

    2012-05-01

    Omega-3 polyunsaturated fatty acids (n-3 PUFA) can modulate the immune system and their primary effect is on macrophage function. Paracoccidioidomycosis (PCM) is an endemic systemic mycosis in Latin America that is caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb). Macrophages are the main defence against this pathogen and have microbicidal activity that is dependent on interferon-Γ and tumour necrosis factor (TNF)-α. These cytokines stimulate the synthesis of nitric oxide (NO) and hydrogen peroxide (H₂O₂), leading to the death of the fungus. To study the effect of n-3 PUFA on the host immune response during experimental PCM, macrophages that were obtained from animals infected with Pb18 and fed a diet enriched by linseed (LIN) oil were cultured and challenged with the fungus in vitro. The macrophage function was analysed based on the concentrations of TNF-α, NO and H₂O₂. LIN oil seems to influence the production of TNF-α during the development of disease. A diet enriched with LIN oil influences the microbicidal activity of the macrophages by inducing the production of cytokines and metabolites such as NO and H₂O₂, predominantly in the chronic phase of infection.

  8. DCBITS: Distributed Case Base Intelligent Tutoring System

    Science.gov (United States)

    Rishi, O. P.; Govil, Rekha

    2008-05-01

    Online learning with Intelligent Tutoring System (ITS) is becoming very popular where the system models the student's learning behavior and presents to the student the learning material (content, questions-answers, assignments) accordingly. In today's distributed computing environment, the tutoring system can take advantage of networking to utilize the model for a student for students from other similar groups. In the present paper we present a methodology where using Case Based Reasoning (CBR), ITS provides student modeling for online learning in a distributed environment with the help of agents. Student modeling is a key component in any Intelligent Tutoring System (ITS). In today's distributed computing environment, the tutoring system can take advantage of networking to utilize the model for a student for students from other similar group. In the present paper we present a methodology where using Case Based Reasoning (CBR), the ITS provides student modeling for online learning in a distributed environment with the help of agents. The Chapter describes the approach, the architecture, and the agent characteristics for the student modeling in the ITS. This concept can be deployed to develop ITS where the tutor can author and the students can learn locally whereas the ITS can model the students' learning globally in a distributed environment. The advantage of such an approach is that both the learning material (domain knowledge) and students' model can be globally distributed thus enhancing the efficiency of ITS with reducing the bandwidth requirement and complexity of the system.

  9. Systemic mastocytosis: Case report with literature review

    Directory of Open Access Journals (Sweden)

    Mitrović Mirjana

    2012-01-01

    Full Text Available Introduction. Mastocytosis is a clonal neoplastic disorder of the mast cells. The clinical signs and symptoms of mastocytosis are heterogeneous ranging from indolent disease with a longterm survival to a highly aggressive neoplasm with survival of about 6 months. Systemic mastocytosis (SM is characterized by mastocyte infiltration of one or more organs, with or without skin involvment. Case Outline. The presented patient presents a highly challenging diagnostic and therapeutic case. A 46-year-old man was referred to our Centre due to the 7-year-long history of hepatosplenomegaly and mild thrombocytopenia. Ultrasound examination showed hepatosplenomegaly (liver 170 mm; spleen 200 mm, platelet count was 90Č109/L, serum tryptase level was elevated and bone marrow biopsy showed infiltration with mast cells (CD117, CD25 and mast cell tryptase positive. Our patient was diagnosed with aggressive systemic mastocytosis (SM according to WHO Classification (2008, although the clinical course of the disease was indolent, without complications for more than 7 years. Because of the ‘intermediate’ course, this patient was referred to as smouldering or intermediate SM and was not treated with cytostatics. Conclusion. Utilizing the established criteria, indolent SM can be discriminated from the aggressive subvariants of SM in most cases. However, a small group of patients, like our case belongs to the „grey zone“. Therapeutic approach to these patients is individual and prognosis is uncertain.

  10. Interactive Russian Grammar: The Case System

    Directory of Open Access Journals (Sweden)

    Rimma Gam

    2009-01-01

    Full Text Available My paper addresses a problem many of us in North American college language programs confront regularly, the solution to which regularly and frustratingly remains just out of our reach. I refer to the teaching of the most basic and most crucial element of Russian grammar, namely, its case system, and teaching it to our students whose native language, English, does not have such a system. As I teach the Russian cases, I see vividly the disconnect between grammar presented for students (simplified, episodic, based on the "pick it up along the way" principle and the learned papers on Russian grammar by linguists, which are barely comprehensible to a non-linguist. Materials in the middle are lacking-materials to help a literature professor acting as a "de facto" language instructor understand and address the needs of students as they learn this crucial segment of basic Russian grammar. This core element of Russian grammar is presented to students in the first year of college language study, is revisited in the second year, and very often by the third year students either manage to completely block it out from their memory (as if it were some traumatic experience that happened "a long time ago"-that is, before .summer break-but most importantly due to the lack of practice or demonstrate a partial or even complete lack of understanding or misunderstanding of this system forcing us to deal with it again in the third year. Not only is it frustrating for both the students and the language instructor; but from the point of view of their overall proficiency, the lack of control of the case system holds our students back. There can be no talk of advanced language proficiency without a complete and automatic mastery of this basic system. Unfortunately, regardless of the specific textbooks used, the students very often manage not to have a general idea and mastery of this system even by the third year of study.

  11. Progressive systemic scleroderma (A case report)

    Energy Technology Data Exchange (ETDEWEB)

    Han, Jung Suh; Kwon, Chung Sik [Chonnam University College of Medicine, Kwangju (Korea, Republic of)

    1974-10-15

    This is a report of a rare case of progressive systemic scleroderma involving the skin, lungs, bones, esophagus, duodenum, and colon in a 27 year old Korean female whose chief complaints were generalized edema, knee joint pain, hard and indurated skin lesions on the anterior chest, neck, both upper and lower extremities with loss of pain and touch sensation for one year. A review of literature is submitted.

  12. In pulmonary paracoccidioidomycosis IL-10 deficiency leads to increased immunity and regressive infection without enhancing tissue pathology.

    Science.gov (United States)

    Costa, Tânia A; Bazan, Silvia B; Feriotti, Claudia; Araújo, Eliseu F; Bassi, Ênio J; Loures, Flávio V; Calich, Vera L G

    2013-01-01

    Cellular immunity is the main defense mechanism in paracoccidioidomycosis (PCM), the most important systemic mycosis in Latin America. Th1 immunity and IFN-γ activated macrophages are fundamental to immunoprotection that is antagonized by IL-10, an anti-inflammatory cytokine. Both in human and experimental PCM, several evidences indicate that the suppressive effect of IL-10 causes detrimental effects to infected hosts. Because direct studies have not been performed, this study was aimed to characterize the function of IL-10 in pulmonary PCM. Wild type (WT) and IL-10(-/-) C57BL/6 mice were used to characterize the role of IL-10 in the innate and adaptive immunity against Paracoccidioides brasiliensis (Pb) infection. We verified that Pb-infected peritoneal macrophages from IL-10(-/-) mice presented higher phagocytic and fungicidal activities than WT macrophages, and these activities were associated with elevated production of IFN-γ, TNF-α, nitric oxide (NO) and MCP-1. For in vivo studies, IL-10(-/-) and WT mice were i.t. infected with 1×10(6) Pb yeasts and studied at several post-infection periods. Compared to WT mice, IL-10(-/-) mice showed increased resistance to P. brasiliensis infection as determined by the progressive control of pulmonary fungal loads and total clearance of fungal cells from dissemination organs. This behavior was accompanied by enhanced delayed-type hypersensitivity reactions, precocious humoral immunity and controlled tissue pathology resulting in increased survival times. In addition, IL-10(-/-) mice developed precocious T cell immunity mediated by increased numbers of lung infiltrating effector/memory CD4(+) and CD8(+) T cells. The inflammatory reactions and the production of Th1/Th2/Th17 cytokines were reduced at late phases of infection, paralleling the regressive infection of IL-10(-/-) mice. Our work demonstrates for the first time that IL-10 plays a detrimental effect to pulmonary PCM due to its suppressive effect on the innate and

  13. Phenotypic and functional evaluations of peripheral blood monocytes from chronic-form paracoccidioidomycosis patients before and after treatment.

    Science.gov (United States)

    Venturini, James; Cavalcante, Ricardo Souza; Golim, Márjorie de Assis; Marchetti, Camila Martins; Azevedo, Priscila Zacarias de; Amorim, Bárbara Casella; Arruda, Maria Sueli Parreira de; Mendes, Rinaldo Poncio

    2014-10-16

    Paracoccidioidomycosis (PCM) is systemic mycosis caused by the thermal dimorphic fungus of genus Paracoccidioides, leading to either acute/subacute (AF) or chronic (CF) clinical forms. Numerous CF patients after treatment exhibit sequels, such as pulmonary and adrenal fibrosis. Monocytes are cells that are involved in the inflammatory response during active infection as well as in the fibrogenesis. These cells comprise a heterogeneous population with distinct phenotypic and functional activities. The scope of this study was to identify changes regarding functional and phenotypical aspects in monocytes comparing CF PCM patients on antifungal treatment versus non-treated patients (PMC-p). Twenty-three CF PCM composed of 11 non-treated patients (NTG) and 12 patients in apparent cure (ACG) were studied. Sixteen healthy individuals were used as control group (CG). Monocyte subsets were determined by immunophenotyping based on CD14 and CD16 expression. Cellular function was measured in vitro with and without stimulation with lipopolysaccharide (LPS) and P. brasiliensis exoantigen (PbAg) for 24 hours. Independent samples were compared using unpaired t tests, dependent samples were analyzed by paired t-test. Groups of more than two independent samples were analyzed using an ANOVA, with Tukey's post-test. Significance was set up at p <0.05. Our results showed high counts of peripheral blood CD14+CD16+ and CD14+CD16++ monocytes in untreated PCM-p accompanied by intense production of pro-inflammatory cytokines (IL-1β and TNF-α) and profibrotic growth factors (TGF-β1 and bFGF) by monocytes challenged with P. brasiliensis antigens. After the introduction of antifungal therapy, the counts of CD14+CD16+ cells returned to baseline while CD14+CD16++ counts remained high. Interestingly, counts of CD14+CD16++ monocytes remained elevated even 52 ± 7 months after successful antifungal treatment. Furthermore, the ACG-patients showed preserved pro-inflammatory activity in the

  14. In pulmonary paracoccidioidomycosis IL-10 deficiency leads to increased immunity and regressive infection without enhancing tissue pathology.

    Directory of Open Access Journals (Sweden)

    Tânia A Costa

    Full Text Available BACKGROUND: Cellular immunity is the main defense mechanism in paracoccidioidomycosis (PCM, the most important systemic mycosis in Latin America. Th1 immunity and IFN-γ activated macrophages are fundamental to immunoprotection that is antagonized by IL-10, an anti-inflammatory cytokine. Both in human and experimental PCM, several evidences indicate that the suppressive effect of IL-10 causes detrimental effects to infected hosts. Because direct studies have not been performed, this study was aimed to characterize the function of IL-10 in pulmonary PCM. METHODOLOGY/PRINCIPAL FINDINGS: Wild type (WT and IL-10(-/- C57BL/6 mice were used to characterize the role of IL-10 in the innate and adaptive immunity against Paracoccidioides brasiliensis (Pb infection. We verified that Pb-infected peritoneal macrophages from IL-10(-/- mice presented higher phagocytic and fungicidal activities than WT macrophages, and these activities were associated with elevated production of IFN-γ, TNF-α, nitric oxide (NO and MCP-1. For in vivo studies, IL-10(-/- and WT mice were i.t. infected with 1×10(6 Pb yeasts and studied at several post-infection periods. Compared to WT mice, IL-10(-/- mice showed increased resistance to P. brasiliensis infection as determined by the progressive control of pulmonary fungal loads and total clearance of fungal cells from dissemination organs. This behavior was accompanied by enhanced delayed-type hypersensitivity reactions, precocious humoral immunity and controlled tissue pathology resulting in increased survival times. In addition, IL-10(-/- mice developed precocious T cell immunity mediated by increased numbers of lung infiltrating effector/memory CD4(+ and CD8(+ T cells. The inflammatory reactions and the production of Th1/Th2/Th17 cytokines were reduced at late phases of infection, paralleling the regressive infection of IL-10(-/- mice. CONCLUSIONS/SIGNIFICANCE: Our work demonstrates for the first time that IL-10 plays a

  15. In Pulmonary Paracoccidioidomycosis IL-10 Deficiency Leads to Increased Immunity and Regressive Infection without Enhancing Tissue Pathology

    Science.gov (United States)

    Feriotti, Claudia; Araújo, Eliseu F.; Bassi, Ênio J.; Loures, Flávio V.; Calich, Vera L. G.

    2013-01-01

    Background Cellular immunity is the main defense mechanism in paracoccidioidomycosis (PCM), the most important systemic mycosis in Latin America. Th1 immunity and IFN-γ activated macrophages are fundamental to immunoprotection that is antagonized by IL-10, an anti-inflammatory cytokine. Both in human and experimental PCM, several evidences indicate that the suppressive effect of IL-10 causes detrimental effects to infected hosts. Because direct studies have not been performed, this study was aimed to characterize the function of IL-10 in pulmonary PCM. Methodology/Principal Findings Wild type (WT) and IL-10−/− C57BL/6 mice were used to characterize the role of IL-10 in the innate and adaptive immunity against Paracoccidioides brasiliensis (Pb) infection. We verified that Pb-infected peritoneal macrophages from IL-10−/− mice presented higher phagocytic and fungicidal activities than WT macrophages, and these activities were associated with elevated production of IFN-γ, TNF-α, nitric oxide (NO) and MCP-1. For in vivo studies, IL-10−/− and WT mice were i.t. infected with 1×106 Pb yeasts and studied at several post-infection periods. Compared to WT mice, IL-10−/− mice showed increased resistance to P. brasiliensis infection as determined by the progressive control of pulmonary fungal loads and total clearance of fungal cells from dissemination organs. This behavior was accompanied by enhanced delayed-type hypersensitivity reactions, precocious humoral immunity and controlled tissue pathology resulting in increased survival times. In addition, IL-10−/− mice developed precocious T cell immunity mediated by increased numbers of lung infiltrating effector/memory CD4+ and CD8+ T cells. The inflammatory reactions and the production of Th1/Th2/Th17 cytokines were reduced at late phases of infection, paralleling the regressive infection of IL-10−/− mice. Conclusions/Significance Our work demonstrates for the first time that IL-10 plays a detrimental

  16. Recombinant 60-kDa heat shock protein from Paracoccidioides brasiliensis: is it a good antigen for serological diagnosis of paracoccidioidomycosis?

    Science.gov (United States)

    Peron, G; Fernandes, F F; Landgraf, T N; Martinez, R; Panunto-Castelo, A

    2017-04-03

    Paracoccidioides brasiliensis and P. lutzii are fungi that cause paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in South America. For serological diagnosis, although 43-kDa glycoprotein (gp43) is regarded as highly specific for PCM, the occurrence of false negative reactions in sera from patients infected with P. lutzii suggests that preparation with only one antigen is not recommended. Heat shock proteins are feasible alternatives as a second antigen because they are often highly immunogenic. In this study, we evaluated the usefulness of recombinant 60-kDa heat shock protein from P. brasiliensis (rPbHsp60) for the serological diagnosis of PCM. Using western blotting assay, we observed that 77.3% of the sera from PCM patients were positive to rPbHsp60, with 90.9% positivity to recombinant gp43 (rgp43). More importantly, sera from healthy subjects had 27% positivity to rPbHsp60 and none to rgp43. When rPbHsp60 was used in ELISA, we did not observe significant differences between the reactions with sera from PCM patients and healthy subjects, while the difference was clearly evident when the antigen was rgp43. Furthermore, rPbHsp60 was recognized by sera from patients with histoplasmosis, aspergillosis, sporotrichosis or tuberculosis in an ELISA test. These results show that rPbHsp60 is not a good antigen for PCM diagnosis.

  17. The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease

    Energy Technology Data Exchange (ETDEWEB)

    Yamaga, L.Y.I.; Hironaka, F.H.; Funari, M.G.; De Castro, C.C.; Guertzenstein, C.; Watanabe, T.; Buchpiguel, C.; Cerri, G.G. [Department of Radiology, Hospital das Clinicas, Sao Paulo University School of Medicine, Av. Dr. Eneas de Carvalho Aguiar 255, 05403-010, Sao Paulo, Capital (Brazil); Benard, G. [Laboratory of Medical Investigation n. 56, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo (Brazil); Castro, L.G. [Department of Dermatology, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo (Brazil); Shikanai-Yasuda, M.A. [Department of Infectious Diseases, Hospital das Clinicas, Sao Paulo University School of Medicine, Sao Paulo (Brazil)

    2003-06-01

    The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The {sup 67}Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). {sup 67}Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by {sup 67}Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between {sup 67}Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. {sup 67}Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, {sup 67}Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, {sup 67}Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement. (orig.)

  18. Detection of Circulating Paracoccidioides brasiliensis Antigen in Urine of Paracoccidioidomycosis Patients before and during Treatment

    Science.gov (United States)

    Salina, Margarete Aparecida; Shikanai-Yasuda, Maria Aparecida; Mendes, Rinaldo Poncio; Barraviera, Benedito; Mendes Giannini, Maria José Soares

    1998-01-01

    For the diagnosis and follow-up of paracoccidioidomycosis patients undergoing therapy, we evaluated two methods (immunoblotting and competition enzyme immunoassay) for the detection of circulating antigen in urine samples. A complex pattern of reactivity was observed in the immunoblot test. Bands of 70 and 43 kDa were detected more often in urine samples from patients before treatment. The immunoblot method detected gp43 and gp70 separately or concurrently in 11 (91.7%) of 12 patients, whereas the competition enzyme immunoassay detected antigenuria in 9 (75%) of 12 patients. Both tests appeared to be highly specific (100%), considering that neither fraction detectable by immunoblotting was present in urine samples from the control group. gp43 remained present in the urine samples collected during the treatment period, with a significant decrease in reactivity in samples collected during clinical recovery and increased reactivity in samples collected during relapses. Reactivity of some bands was also detected in urine specimens from patients with “apparent cure.” The detection of Paracoccidioides brasiliensis antigens in urine appears to be a promising method for diagnosing infection, for evaluating the efficacy of treatment, and for detecting relapse. PMID:9620407

  19. Severe Changes in Thymic Microenvironment in a Chronic Experimental Model of Paracoccidioidomycosis.

    Science.gov (United States)

    Alves da Costa, Thiago; Di Gangi, Rosária; Thomé, Rodolfo; Barreto Felisbino, Marina; Pires Bonfanti, Amanda; Lumi Watanabe Ishikawa, Larissa; Sartori, Alexandrina; Burger, Eva; Verinaud, Liana

    2016-01-01

    T cell maturation takes place within the thymus, a primary lymphoid organ that is commonly targeted during infections. Previous studies showed that acute infection with Paracoccidioides brasiliensis (Pb), the causative agent of paracoccidioidomycosis (PCM), promotes thymic atrophy that is associated with the presence of yeast cells in the organ. However, as human PCM is a chronic infection, it is imperative to investigate the consequences of Pb infection over the thymic structure and function in chronic infection. In this sense, we developed a new experimental model where Pb yeast cells are injected through the intraperitoneal route and mice are evaluated over 120 days of infection. Thymuses were analyzed in chronically infected mice and we found that the thymus underwent extensive morphological alterations and severe infiltration of P. brasiliensis yeast cells. Further analyses showed an altered phenotype and function of thymocytes that are commonly found in peripheral mature T lymphocytes. We also observed activation of the NLRP3 inflammasome in the thymus. Our data provide new information on the severe changes observed in the thymic microenvironment in a model of PCM that more closely mimics the human infection.

  20. High interleukin-4 expression and interleukin-4 gene polymorphisms are associated with susceptibility to human paracoccidioidomycosis.

    Science.gov (United States)

    Mendonça, Mônica Sawan; Peraçolli, Terezinha S; Silva-Vergara, Mário León; Ribeiro, Sílvio C; Oliveira, Rafael Faria; Mendes, Rinaldo Poncio; Rodrigues, Virmondes

    2015-09-01

    Paracoccidioidomycosis (PCM) is caused by dimorphic fungi from the Paracoccidioides brasiliensis complex. Previous studies have demonstrated that the severity of disease is associated with a T-helper 2 immune response characterised by high interleukin (IL)-4 production. In the present study we analysed two polymorphisms in the IL-4 gene (-590 C/T and intron-3 microsatellite) in 76 patients with PCM and 73 control subjects from an endemic area. The production of IL-4 by peripheral blood mononuclear cells after antigen or phytohaemagglutinin stimulation was determined by ELISA. A significant correlation was observed between the RP2/RP2 intron-3 genotype and infection with Paracoccidioides sp.(p = 0.011), whereas the RP1/RP1 genotype was correlated with resistance. No significant correlation was observed for the IL-4 promoter polymorphism. Furthermore, the low IL-4 expression observed in the control group compared with patients was associated with the RP1/RP1 genotype. These results suggest that IL-4 polymorphisms might be associated with the ability of the host to control Paracoccidioides sp.infection. The relevance of this polymorphism is supported by the observation that patients with disease produce high levels of IL-4 following mitogen or antigen stimulation. The IL-4 gene is located in the cytokine cluster region of chromosome 5 where other polymorphisms have also been described.

  1. Complexo primário da paracoccidioidomicose e hipereosinofilia Primary complex of paracoccidioidomycosis and hypereosinophilia

    Directory of Open Access Journals (Sweden)

    Roberto Martinez

    2009-12-01

    Full Text Available A infecção primária por Paracoccidioides brasiliensis é observada raramente. Um paciente masculino de 28 anos de idade apresentou febre, sintomas respiratórios e indisposição durante três meses. Exames radiológicos evidenciaram infiltrado pulmonar apical bilateral, pleurite à direita e linfadenomegalia hilar. O paciente apresentava leucocitose, intensa eosinofilia e títulos crescentes de anticorpos séricos anti-P. brasiliensis. Até onde sabemos, este é o primeiro relato do complexo primário da paracoccidioidomicose, associado com hipereosinofilia, apresentado por um adulto previamente hígido.Primary infection with Paracoccidioides brasiliensis has rarely been observed. A 28-year-old male patient presented with a three-month history of fever, respiratory symptoms and malaise. Chest X-rays revealed bilateral apical infiltrates, right pleuritis and hilar lymphadenomegaly. The patient presented with leukocytosis, severe eosinophilia and increasing titers of anti-P. brasiliensis antibodies in serum. To our knowledge, this is the first report of the primary pulmonary lymph node complex of paracoccidioidomycosis accompanied by hypereosinophilia and affecting a previously healthy adult.

  2. Robust control systems theory and case studies

    CERN Document Server

    Mackenroth, Uwe

    2004-01-01

    "Robust Control Systems" gives a self-contained introduction to modern Control Theory. It thus adds a textbook to the existing research-oriented literature on Robust Control. The author lays emphasis on the modern aspects of the design of controllers with prescribed performance and robustness properties. Different to the classical engineering approach, a rigorous mathematical treatment is essential for the full understanding and applicability of the modern methods such as H2 or H8 control or methods based on the structured singular value µ. Nevertheless, no prior knowledge of Control Theory is required as the classical fundamentals are introduced within the first few chapters. Subsequently a large part of the text provides elementary examples and industrial case studies, which are developed in full detail to show how modern methods can be applied to advanced problems. They make intensive use of MATLAB, especially the Control Systems Toolbox and the µ-Analysis and Synthesis Toolbox.

  3. Dectin-1 induces M1 macrophages and prominent expansion of CD8+IL-17+ cells in pulmonary Paracoccidioidomycosis.

    Science.gov (United States)

    Loures, Flávio V; Araújo, Eliseu F; Feriotti, Claudia; Bazan, Silvia B; Costa, Tânia A; Brown, Gordon D; Calich, Vera L G

    2014-09-01

    Dectin-1, the innate immune receptor that recognizes β-glucan, plays an important role in immunity against fungal pathogens. Paracoccidioides brasiliensis, the etiological agent of paracoccidioidomycosis, has a sugar-rich cell wall mainly composed of mannans and glucans. This fact motivated us to use dectin-1-sufficient and -deficient mice to investigate the role of β-glucan recognition in the immunity against pulmonary paracoccidioidomycosis. Initially, we verified that P. brasiliensis infection reinforced the tendency of dectin-1-deficient macrophages to express an M2 phenotype. This prevalent antiinflammatory activity of dectin-1(-/-) macrophages resulted in impaired fungicidal ability, low nitric oxide production, and elevated synthesis of interleukin 10 (IL-10). Compared with dectin-1-sufficient mice, the fungal infection of dectin-1(-/-) mice was more severe and resulted in enhanced tissue pathology and mortality rates. The absence of dectin-1 has also impaired the production of T-helper type 1 (Th1), Th2, and Th17 cytokines and the activation and migration of T cells to the site of infection. Remarkably, dectin-1 deficiency increased the expansion of regulatory T cells and reduced the differentiation of T cells to the IL-17(+) phenotype, impairing the migration of IL-17(+)CD8(+) T cells and polymorphonuclear cells to infected tissues. In conclusion, dectin-1 exerts an important protective role in pulmonary paracoccidioidomycosis by controlling the innate and adaptive phases of antifungal immunity. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. Building Energy Information Systems: User Case Studies

    Energy Technology Data Exchange (ETDEWEB)

    Granderson, Jessica; Piette, Mary Ann; Ghatikar, Girish

    2010-03-22

    Measured energy performance data are essential to national efforts to improve building efficiency, as evidenced in recent benchmarking mandates, and in a growing body of work that indicates the value of permanent monitoring and energy information feedback. This paper presents case studies of energy information systems (EIS) at four enterprises and university campuses, focusing on the attained energy savings, and successes and challenges in technology use and integration. EIS are broadly defined as performance monitoring software, data acquisition hardware, and communication systems to store, analyze and display building energy information. Case investigations showed that the most common energy savings and instances of waste concerned scheduling errors, measurement and verification, and inefficient operations. Data quality is critical to effective EIS use, and is most challenging at the subsystem or component level, and with non-electric energy sources. Sophisticated prediction algorithms may not be well understood but can be applied quite effectively, and sites with custom benchmark models or metrics are more likely to perform analyses external to the EIS. Finally, resources and staffing were identified as a universal challenge, indicating a need to identify additional models of EIS use that extend beyond exclusive in-house use, to analysis services.

  5. Building energy information systems. User case studies

    Energy Technology Data Exchange (ETDEWEB)

    Granderson, J.; Piette, M.A.; Ghatikar, G. [Lawrence Berkeley, National Laboratory, 1 Cyclotron Road, Berkeley, CA 94720 (United States)

    2011-01-15

    Measured energy performance data are essential to national efforts to improve building efficiency, as evidenced in recent benchmarking mandates, and in a growing body of work that indicates the value of permanent monitoring and energy information feedback. This paper presents case studies of energy information systems (EIS) at four enterprises and university campuses, focusing on the attained energy savings, and successes and challenges in technology use and integration. EIS are broadly defined as performance monitoring software, data acquisition hardware, and communication systems to store, analyze, and display building energy information. Case investigations showed that the most common energy savings and instances of waste concerned scheduling errors, measurement and verification, and inefficient operations. Data quality is critical to effective EIS use, and is most challenging at the subsystem or component level, and with non-electric energy sources. Sophisticated prediction algorithms may not be well understood but can be applied quite effectively, and sites with custom benchmark models or metrics are more likely to perform analyses external to the EIS. Finally, resources and staffing were identified as a universal challenge, indicating a need to identify additional models of EIS use that extend beyond exclusive in-house use, to analysis services.

  6. National Environmental Change Information System Case Study

    Science.gov (United States)

    Goodman, S. J.; Ritschard, R.; Estes, M. G., Jr.; Hatch, U.

    2001-01-01

    The Global Hydrology and Climate Center and NASA's Marshall Space Flight Center conducted a fact-finding case study for the Data Management Working Group (DMWG), now referred to as the Data and Information Working Group (DIWG), of the U.S. Global Change Research Program (USGCRP) to determine the feasibility of an interagency National Environmental Change Information System (NECIS). In order to better understand the data and information needs of policy and decision makers at the national, state, and local level, the DIWG asked the case study team to choose a regional water resources issue in the southeastern United States that had an impact on a diverse group of stakeholders. The southeastern United States was also of interest because the region experiences interannual climatic variations and impacts due to El Nino and La Nina. Jointly, with input from the DIWG, a focus on future water resources planning in the Apalachicola-Chattahoochee-Flint (ACF) River basins of Alabama, Georgia, and Florida was selected. A tristate compact and water allocation formula is currently being negotiated between the states and U.S. Army Corps of Engineers (COE) that will affect the availability of water among competing uses within the ACF River basin. All major reservoirs on the ACF are federally owned and operated by the U.S. Army COE. A similar two-state negotiation is ongoing that addresses the water allocations in the adjacent Alabama-Coosa-Tallapoosa (ACT) River basin, which extends from northwest Georgia to Mobile Bay. The ACF and ACT basins are the subject of a comprehensive river basin study involving many stakeholders. The key objectives of this case study were to identify specific data and information needs of key stakeholders in the ACF region, determine what capabilities are needed to provide the most practical response to these user requests, and to identify any limitations in the use of federal data and information. The NECIS case study followed the terms of reference

  7. Integrated Agent-based and Case-based Reasoning System

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2014-01-01

    Increasing the complexity of the modern systems drives to use multiple case bases in the case based reasoning (CBR) system to solve a single problem. Sometimes, it is difficult and unman gable task to store the knowledge of the domain of these complex systems in a single case base. On the other hand, usually these multiple case bases having different structures that cause main limitation for solving the problem. This research introduces integrating the case based systems using multiple case bases with agent-based technique. This enables the system to use different case base structures. The proposed system has been applied for designing the radiotherapy of the kidney, liver and skin cancers. It is found that, the suggested system has simplified, managed the complexity, increasing the accuracy of the of CBR systems. Therefore, it can be applied with a good performance for the practical sites

  8. Cutaneous involvement in the deep mycoses: A review. Part II -Systemic mycoses.

    Science.gov (United States)

    Carrasco-Zuber, J E; Navarrete-Dechent, C; Bonifaz, A; Fich, F; Vial-Letelier, V; Berroeta-Mauriziano, D

    2016-12-01

    In the second part of this review on the deep mycoses, we describe the main systemic mycoses-paracoccidioidomycosis, coccidioidomycosis, histoplasmosis, mucormycosis, and cryptococcosis-and their cutaneous manifestations. Skin lesions are only occasionally seen in deep systemic mycoses either directly, when the skin is the route of entry for the fungus, or indirectly, when the infection has spread from a deeper focus. These cutaneous signs are often the only clue to the presence of a potentially fatal infection. As with the subcutaneous mycoses, early diagnosis and treatment is important, but in this case, even more so. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. DDACE cogeneration systems : 10 case studies

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    DDACE Power Systems are experts in green energy power generation and provide solutions that deal with waste and industrial by-products. The company develops practical energy solutions that address environmental and financial concerns facing both industrial and municipal customers. The following 10 case studies are examples of the installations that DDACE Power Systems have completed in recent years: (1) a combined heat and emergency power installation on the roof of a 19 storey apartment building on Bloor Street in Toronto, Ontario. The cogeneration package provides electricity and heat to the entire building, replacing an old diesel generator, (2) a combined heat and emergency power installation at the Villa Colombo extended care facility in Vaughan, Ontario. The cogeneration system provides heat and power to the building, as well as emergency power, (3) emergency standby power with demand response capabilities at Sobeys Distribution Warehouse in Vaughan, Ontario. The primary purpose of the 2.4 MW low emission, natural gas fuelled emergency standby generator is to provide emergency power to the building in the event of a grid failure, (4) a dual fuel combined heat and power installation at the Queensway Carleton Hospital in Ottawa, Ontario that provides electricity, hot water and steam to all areas of the hospital, (5) a tri-generation installation at the Ontario Police College in Aylmer, Ontario which provides power and heat to the building as well as emergency power in the event of a grid failure. An absorption chiller provides cooling in the summer and an exhaust emission control system reduces NOx emissions, (6) a biomass gasification installation at Nexterra Energy in Kamloops, British Columbia. The 239 kW generator is fueled by synthesis gas, (7) biogas utilization at Fepro Farms in Cobden, Ontario for treatment of the facility's waste products. The biogas plant uses cow manure, as well as fats, oil and grease from restaurants to produce electricity and

  10. Expanding the clinical and genetic spectrum of human CD40L deficiency: the occurrence of paracoccidioidomycosis and other unusual infections in Brazilian patients.

    Science.gov (United States)

    Cabral-Marques, Otavio; Schimke, Lena-Friederike; Pereira, Paulo Vítor Soeiro; Falcai, Angela; de Oliveira, João Bosco; Hackett, Mary J; Errante, Paolo Ruggero; Weber, Cristina Worm; Ferreira, Janaíra Fernandes; Kuntze, Gisele; Rosário-Filho, Nelson Augusto; Ochs, Hans D; Torgerson, Troy R; Carvalho, Beatriz Tavares Costa; Condino-Neto, Antonio

    2012-04-01

    CD40 ligand (CD40L) deficiency or X-linked hyper-IgM syndrome (X-HIGM) is a well-described primary immunodeficiency in which Pneumocystis jiroveci pneumonia is a common clinical feature. We have identified an unusual high incidence of fungal infections and other not yet described infections in a cohort of 11 X-HIGM patients from nine unrelated Brazilian families. Among these, we describe the first case of paracoccidioidomycosis (PCM) in X-HIGM. The molecular genetic analysis of CD40L was performed by gene sequencing and evaluation of CD40L protein expression. Nine of these 11 patients (82%) had fungal infections. These included fungal species common to CD40L deficiency (P. jiroveci and Candida albicans) as well as Paracoccidioides brasiliensis. One patient presented with PCM at age 11 years and is now doing well at 18 years of age. Additionally, one patient presented with a simultaneous infection with Klebsiella and Acinetobacter, and one with condyloma caused by human papilloma virus. Molecular analysis revealed four previously described CD40L mutations, two novel missense mutations (c.433 T > G and c.476 G > C) resulting in the absence of CD40L protein expression by activated CD4(+) cells and one novel insertion (c.484_485insAA) within the TNFH domain leading to a frame shift and premature stop codon. These observations demonstrated that the susceptibility to fungal infections in X-HIGM extends beyond those typically associated with X-HIGM (P. jiroveci and C. albicans) and that these patients need to be monitored for those pathogens.

  11. Writing case studies in information systems research

    NARCIS (Netherlands)

    van der Blonk, H.C.

    Case study research can be reported in different ways. This paper explores the various ways in which researchers may choose to write down their case studies and then introduces a subsequent typology of writing case studies. The typology is based on a 2 x 2 matrix, resulting in four forms of writing

  12. Computed tomography findings of paracoccidiodomycosis in musculoskeletal system

    Energy Technology Data Exchange (ETDEWEB)

    Lima Junior, Francisco Valtenor Araujo; Savarese, Leonor Garbin; Monsignore, Lucas Moretti; Martinez, Roberto; Nogueira-Barbosa, Marcello Henrique, E-mail: fvaltenor@gmail.com [Universidade de Sao Paulo (FM/USP), Ribeirao Preto, SP (Brazil). Fac. de Medicina

    2015-01-15

    Objective: to evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. Materials and methods: development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. Results: a total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. Conclusion: paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis. (author)

  13. Implementing Business Intelligence System - Case Study

    Directory of Open Access Journals (Sweden)

    Yasser AL-HADAD

    2016-08-01

    Full Text Available Understanding and analysis data is essential for making decision within a system. Any analytical tasks can be implemented directly by the transactional system but it becomes more difficult as the transactional system grows. Analytical systems and their extension appear as a solution for complex and large datasets. We think that it's time for medium companies to get the benefit from such systems as analytical systems become more variant and in hand for every possible user. In this paper, we propose an architecture of analytical system that can adapt and integrate with existent transactional system of timber export company. The proposed analytical system should have the ability of implementing the tasks required by the decision makers of the system. Also, we try to explore the ability of SQL server of implementing our proposed architecture.

  14. Paracoccidioidomicosis diseminada con peripleuritis en paciente con SIDA

    OpenAIRE

    Corti, Marcelo; Villafañe, María F.; Negroni, Ricardo; Palmieri, Omar

    2004-01-01

    Paracoccidioidomycosis is one of the most frequent systemic and endemic mycoses of Latin America caused by a dimorphic fungus. In AIDS patients, paracoccidioidomycosis appears as a severe and disseminated disease with a wide spectrum of clinical findings. The CD4 counts are usually less than 200 cell/mu L. We present a case of disseminated paracoccidioidomycosis with peripleuritis and subcutaneous abscesses on the chest wall as initial manifestation of AIDS. In endemic countries, paracoccidio...

  15. Guidelines for Conducting Positivist Case Study Research in Information Systems

    Directory of Open Access Journals (Sweden)

    Graeme Shanks

    2002-11-01

    Full Text Available The case study research approach is widely used in a number of different ways within the information systems community. This paper focuses on positivist, deductive case study research in information systems. It provides clear definitions of important concepts in positivist case study research and illustrates these with an example research study. A critical analysis of the conduct and outcomes of two recently published positivist case studies is reported. One is a multiple case study that validated concepts in a framework for viewpoint development in requirements definition. The other is a single case study that examined the role of social enablers in enterprise resource planning systems implementation. A number of guidelines for successfully undertaking positivist case study research are identified including developing a clear understanding of key concepts and assumptions within the positivist paradigm; providing clear and unambiguous definitions of the units and interactions when using any theory; carefully defining the boundary of the theory used in the case study; using hypotheses rather than propositions in the empirical testing of theory; using fuzzy or probabilistic propositions in recognising that reality can never be perfectly known; selecting case studies carefully, particularly single case studies; and recognising that generalisation from positivist, single case studies is inherently different from generalisation from single experiments. When properly undertaken, positivist, deductive case study research is a valuable research approach for information systems researchers, particularly when used within pluralist research programs that use a number of different research approaches from different paradigms.

  16. Pension Systems in Europe. Case of Sweden

    Directory of Open Access Journals (Sweden)

    Jarosław Poteraj

    2008-04-01

    Full Text Available The author's goal was to present both past and present solutions employed by the Swedishs pension system, in search for ideas worth consideration in international comparisons. Author analysis Swedish pension system evolution and presents strengths and weaknesses of present Swedish pension system.

  17. Hipercalcemia e lesões osteolíticas múltiplas em criança com paracoccidioidomicose disseminada e tuberculose pulmonar Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Antonia T. Tresoldi

    2005-08-01

    Full Text Available OBJETIVO: Descrever o caso de uma criança com paracoccidioidomicose, que apresentou hipercalcemia associada a múltiplas lesões osteolíticas. DESCRIÇÃO: Menino de 6 anos, internado com história de febre e hepatoesplenomegalia há 1 mês. À internação, apresentava-se em regular estado geral, descorado, com linfonodomegalia generalizada e hepatoesplenomegalia. Os exames laboratoriais identificaram anemia (hemoglobina = 6,8 g/dl, eosinofilia (1.222/mm³, plaquetopenia (102.000/mm³ e hipoalbuminemia (albumina = 2,2 g/dl. Paracoccidioides brasiliensis foi identificado no mielograma. A partir da segunda semana de internação, apresentou artralgia, hipoatividade e dificuldade à deambulação, sendo constatada hipercalcemia (dosagem máxima de 14,9 mg% e redução da função renal, que duraram pouco mais de 2 semanas. No 42º dia de internação, foram vistas, na radiografia de tórax, múltiplas lesões líticas em clavículas, escápulas, costelas e úmeros, com escorregamento epifisário de úmero bilateral. Apresentou nefrocalcinose e nefrolitíase, com redução no clearance de creatinina e evidências de lesão tubular. No final do segundo mês de internação, na cultura do lavado gástrico, foi identificado Mycobacterium tuberculosis. Recebeu tratamento para paracoccidioidomicose e tuberculose e está há mais de 3 anos em acompanhamento, sem nenhuma seqüela. COMENTÁRIOS: O desenvolvimento da hipercalcemia sintomática, levando à lesão renal e associada a lesões ósseas múltiplas e disseminadas, nunca foi descrito em paracoccidioidomicose. Embora tenha sido diagnosticada tuberculose pulmonar, que pode estar relacionada à hipercalcemia, a forma abrupta como se instalou e como se normalizou sem o tratamento específico para tuberculose sugere que a lise óssea foi o fator mais importante na gênese da hipercalcemia.OBJECTIVE: To describe the case of a child with paracoccidioidomycosis who presented hypercalcemia with multiple

  18. Case for real-time systems development - Quo vadis?

    Science.gov (United States)

    Erb, Dona M.

    1991-01-01

    The paper focuses on the distinctive issues of computer-aided software engineering (CASE) products for the development of real-time systems. CASE technologies and associated standardization efforts are evolving from sets of conflicting interests. The majority of case products are intended for use in the development of management information systems. CASE products to support the development of large, complex real-time systems must provide additional capabilities. Generic concerns include the quality of the implementation of the required method for the phase of the system's development and whether the vendor is stable and committed to evolving the products in parallel with nonproprietary standards. The CASE market is undergoing considerable consolidation. The paper describes the major forces, cooperating entities, and remaining uncertainties that need to be weighed in near-term CASE procurements to limit risk of loss of investment in project time, trianing, and money.

  19. Teaching Case: Analysis of an Electronic Voting System

    Science.gov (United States)

    Thompson, Nik; Toohey, Danny

    2014-01-01

    This teaching case discusses the analysis of an electronic voting system. The development of the case was motivated by research into information security and management, but as it includes procedural aspects, organizational structure and personnel, it is a suitable basis for all aspects of systems analysis, planning and design tasks. The material…

  20. Making System Dynamics Cool IV : Teaching & Testing with Cases & Quizzes

    NARCIS (Netherlands)

    Pruyt, E.

    2012-01-01

    This follow-up paper presents cases and multiple choice questions for teaching and testing System Dynamics modeling. These cases and multiple choice questions were developed and used between January 2012 and April 2012 a large System Dynamics course (250+ 2nd year BSc and 40+ MSc students per year)

  1. Making System Dynamics Cool III : New Hot Teaching & Testing Cases

    NARCIS (Netherlands)

    Pruyt, E.

    2011-01-01

    This follow-up paper presents seven actual cases for testing and teaching System Dynamics developed and used between January 2010 and January 2011 for one of the largest System Dynamics courses (250+ students per year) at Delft University of Technology in the Netherlands. The cases presented in this

  2. Paracoccidioidomycosis: high-resolution computed tomography - anatomo-pathological correlation; Paracoccidioidomicose: correlacao da tomografia computadorizada de alta resolucao com a anatomopatologia

    Energy Technology Data Exchange (ETDEWEB)

    Marchiori, Edson; Muniz, Maria Angelica Soares; Santos, Maria Lucia de Oliveira [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. de Radiologia; Moraes, Heleno Pinto de [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Inst. de Patologia; Capone, Domenico [Universidade do Estado, Rio de Janeiro, RJ (Brazil). Inst. de Pneumologia

    2000-12-01

    We reviewed the high-resolution computed tomography scans of 13 patients with paracoccidioidomycosis and correlated the findings with the anatomo-pathological findings of 5 patients. The most frequent findings observed were thickening of the interlobular septa, emphysema, ground glass areas, thickening of bronchial walls, tracheal dilatation, nodules, cavities and evidence of fibrosing disease such as architectural distortion, parenchymatous bands, spicular pleural thickening, intralobular reticulate and thickening with distortion off the axial interstitium. (author)

  3. Pension Systems in Europe. Case of Portugal

    Directory of Open Access Journals (Sweden)

    Jarosław Poteraj

    2009-03-01

    Full Text Available The article presents an insight into the old age pension system in Portugal. The author’s goal was to present both past and present solutions employed by the Portuguese’s pension system, in search for ideas worth consideration in international comparisons. In the summary, the author highlights as a particular Portuguese approach, on the background of other countries, the fact of using in Portugal definite part of VAT income for pension system financing.

  4. Disability Case Adjudication and Review System

    Data.gov (United States)

    Social Security Administration — DICARS is the legacy system supporting business processes in the Disability Quality Branches (DQBs). It supports quality reviews of DDS disability determinations....

  5. Shuttle Transportation System Case-Study Development

    Science.gov (United States)

    Ransom, Khadijah

    2012-01-01

    A case-study collection was developed for NASA's Space Shuttle Program. Using lessons learned and documented by NASA KSC engineers, analysts, and contractors, decades of information related to processing and launching the Space Shuttle was gathered into a single database. The goal was to provide educators with an alternative means to teach real-world engineering processes and to enhance critical thinking, decision making, and problem solving skills. Suggested formats were created to assist both external educators and internal NASA employees to develop and contribute their own case-study reports to share with other educators and students. Via group project, class discussion, or open-ended research format, students will be introduced to the unique decision making process related to Shuttle missions and development. Teaching notes, images, and related documents will be made accessible to the public for presentation of Space Shuttle reports. Lessons investigated included the engine cutoff (ECO) sensor anomaly which occurred during mission STS-114. Students will be presented with general mission infom1ation as well as an explanation of ECO sensors. The project will conclude with the design of a website that allows for distribution of information to the public as well as case-study report submissions from other educators online.

  6. A Case Study on Distributed Antenna Systems

    DEFF Research Database (Denmark)

    Sørensen, Troels Bundgaard

    2007-01-01

    Passive distributed antenna systems (DASs) consisting of distributed feeder lines or single point antennas are now often installed in large office buildings where they provide efficient coverage throughout the building. More sophisticated DASs with intelligent reuse and the ability to adapt...... is described in terms of algorithms for power allocation and access port assignment, as well as algorithms for (dynamic) channel assignment. After an outline of simulation assumptions, system capacity comparisons are given between the adaptive DAS and a system with fixed channel and access port assignment...

  7. System identification advances and case studies

    CERN Document Server

    Mehra, Raman K

    1976-01-01

    In this book, we study theoretical and practical aspects of computing methods for mathematical modelling of nonlinear systems. A number of computing techniques are considered, such as methods of operator approximation with any given accuracy; operator interpolation techniques including a non-Lagrange interpolation; methods of system representation subject to constraints associated with concepts of causality, memory and stationarity; methods of system representation with an accuracy that is the best within a given class of models; methods of covariance matrix estimation;methods for low-rank mat

  8. Pension Systems in Europe. Case of Greece

    Directory of Open Access Journals (Sweden)

    Jarosław Poteraj

    2007-09-01

    Full Text Available The article presents an insight into the old age pension system in Greece. The introduction is followed by four topic paragraphs: 1. the general information about the country, 2. the historical development of its pension system, 3. the present situation, and 4. challenges and foreseen changes. There, the authorís goal was to present both past and present solutions employed by the Greeceís pension system, in search for ideas worth consideration in international comparisons. In the summary, the author highlights as a particular Greek approach, on the background of other countries, the fact of existing in the Greek reality The National Actuary.

  9. Pension Systems in Europe. Case of Germany

    Directory of Open Access Journals (Sweden)

    Jarosław Poteraj

    2008-01-01

    Full Text Available The article presents an insight into the old age pensionsystem in Germany. The authors goal was to present both, past and present solutions employed by the Germans pension system, in search for ideas worth consideration in international comparisons. In the summary, the author highlights as a particular German approach, on the background of other countries, the fact of implementing in the German reality the special smart card system for pensioners.

  10. Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

    Science.gov (United States)

    Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

    2015-01-01

    The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

  11. Cyclophosphamide effect on paracoccidioidomycosis in the rat Efecto de la ciclofosfamida en ratas con paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    J. L. Blejer

    1995-06-01

    Full Text Available Paracoccidioidomycosis is an endemic fungal disease widely distributed throughout Latin America. The potent immunosuppressor cyclophosphamide (CY has been used to modulate host immune response to Paracoccidioides brasiliensis in an experimental model. Inbred male Buffalo/Sim rats weighing 250-300 g were inoculated with 5 x 10(6 P. brasiliensis cells of the yeast phase form by intracardiac route. One group of animals was treated with 20 mg/kg body weight at days +4, +5, +6, +7, +11 and +12 post-infection (pi., while a control group was infected alone. No mortality was recorded in either group. Treated rats presented: a a decrease in granuloma size, which contained less fungal cells; b a lack of specific antibodies up to 35 days pi., and c a significant increase in the footpad swelling test (DTH against paracoccidioidin. Splenic cell transfer from CY-treated P. brasiliensis-infected donors to recipients infected alone led to a significant increase in DTH response in the latter versus untreated infected controls. Likewise, in treated infected recipients transferred with untreated infected donor spleen cells, footpad swelling proved greater than in controls. Thus, it would seem that each successive suppressor T lymphocyte subset belonging to the respective cascade may be sensitive to repeated CY doses administered up to 12 days pi.. Alternatively, such CY schedule may induce the appearance of a T cell population capable of amplifying DTH response.La paracoccidioidomicosis es una enfermedad endémica fúngica ampliamente distribuida en Latino-América. La ciclofosfamida ha sido usada como potente inmunosupresor para modular la respuesta inmune, en un modelo experimental infectado con Paracoccidioides brasiliensis. Ratas machos Buffalo/Sim endocriadas de 250-300 gr. de peso, fueron inoculadas por via intracardiaca con 5.10 6 células de P. brasiliensis en fase levaduriforme. Un grupo de animales fue tratado con 20 mg/kg de peso de ciclofosfamida en

  12. Development of automated measuring system for machining of turbine casings

    International Nuclear Information System (INIS)

    Sakamoto, Hironobu; Otsuka, Shunpei; Niinaga, Yasunori; Arai, Takao.

    1984-01-01

    In the machining of large turbine components, the method of NC machining and measuring and inspection system which can ensure the flexibility and high accuracy are now desired. Stub boring is the large NC machining system developed on the basis of such requirement, and the machining the inside diameter of steam turbine casings can be realized with high efficiency and high accuracy. In this paper, the large NC machining system, the method of centering alignment for casings by utilizing an industrial television, and the automatic measuring system for machining dimensions are described. The reliability of computer-aided assembly system for steam turbines can be thus promoted. (J.P.N.)

  13. Higher Education Provision Using Systems Thinking Approach--Case Studies

    Science.gov (United States)

    Dhukaram, Anandhi Vivekanandan; Sgouropoulou, Cleo; Feldman, Gerald; Amini, Ardavan

    2018-01-01

    The purpose of this paper is to highlight the complexities involved in higher education provision and how systems thinking and socio-technical systems (STS) thinking approach can be used to understand the education ecosystem. Systems thinking perspective is provided using two case studies: the development of European Learner Mobility (EuroLM)…

  14. Describing Elementary Teachers' Operative Systems: A Case Study

    Science.gov (United States)

    Dotger, Sharon; McQuitty, Vicki

    2014-01-01

    This case study introduces the notion of an operative system to describe elementary teachers' knowledge and practice. Drawing from complex systems theory, the operative system is defined as the network of knowledge and practices that constituted teachers' work within a lesson study cycle. Data were gathered throughout a lesson study cycle in which…

  15. Systems design of case hardened polymers for gears

    Science.gov (United States)

    D'Oyen, Raquel Maria

    A multicomponent thermosetting system employing existing models of case-core systems used in steel gears is proposed for scientific design of new-generation plastic gears. The system consists of a tough, rubber-modified epoxy core and a hard, unmodified epoxy case. Gradients in hardness, toughness, and residual stress are achieved exploiting density differences between rubber particles and the epoxy matrix. Spinning the system during cure moves lighter particles to the center of the part, leaving a hard rubber-depleted case. Residual stresses in the case are formed by quenching the part after curing. Because of its simple chemistry and low processing-temperature and viscosity, a model system of diglycidyl ether of bisphenol A epoxy, carboxyl-terminated acrylonitrile-butadiene rubber, and piperidine curing agent was used. Mechanical testing of epoxies and rubber-toughened systems shows increasing fatigue strength and toughness but decreasing strength and hardness with increased crosslinking. A cure schedule of 16-24 hours at 120sp°C results in a material optimized for Ksb{Ic}, fatigue strength and thermal stability. Rubber composition to maximize critical flaw size at yield with a particle size of 1.5 mum is approximately 10%. Thermodynamic and kinetic models consistent with glass transition and cloud point measurements were developed and validated for the prediction of phase separation, cure behavior, and case depths attainable in this system. These models predict that preformed rubber particles are required for the toughening dispersion to achieve desired case depths. The demonstrated property range gives a core critical flaw size 15 times larger than in the case, and fatigue strength in the case approximately twice that of the core. Further enhancements are expected in the case with controlled residual stress. By using a stronger epoxy system, fatigue strengths greater than those seen in a current Delrin gear material should be achievable. The feasibility of a

  16. A case for human systems neuroscience.

    Science.gov (United States)

    Gardner, J L

    2015-06-18

    Can the human brain itself serve as a model for a systems neuroscience approach to understanding the human brain? After all, how the brain is able to create the richness and complexity of human behavior is still largely mysterious. What better choice to study that complexity than to study it in humans? However, measurements of brain activity typically need to be made non-invasively which puts severe constraints on what can be learned about the internal workings of the brain. Our approach has been to use a combination of psychophysics in which we can use human behavioral flexibility to make quantitative measurements of behavior and link those through computational models to measurements of cortical activity through magnetic resonance imaging. In particular, we have tested various computational hypotheses about what neural mechanisms could account for behavioral enhancement with spatial attention (Pestilli et al., 2011). Resting both on quantitative measurements and considerations of what is known through animal models, we concluded that weighting of sensory signals by the magnitude of their response is a neural mechanism for efficient selection of sensory signals and consequent improvements in behavioral performance with attention. While animal models have many technical advantages over studying the brain in humans, we believe that human systems neuroscience should endeavor to validate, replicate and extend basic knowledge learned from animal model systems and thus form a bridge to understanding how the brain creates the complex and rich cognitive capacities of humans. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

  17. Enhancing Systems Engineering Education Through Case Study Writing

    Science.gov (United States)

    Stevens, Jennifer Stenger

    2016-01-01

    Developing and refining methods for teaching systems engineering is part of Systems Engineering grand challenges and agenda for research in the SE research community. Retention of systems engineering knowledge is a growing concern in the United States as the baby boom generation continues to retire and the faster pace of technology development does not allow for younger generations to gain experiential knowledge through years of practice. Government agencies, including the National Aeronautics and Space Administration (NASA), develop their own curricula and SE leadership development programs to "grow their own" systems engineers. Marshall Space Flight Center (MSFC) conducts its own Center-focused Marshall Systems Engineering Leadership Development Program (MSELDP), a competitive program consisting of coursework, a guest lecture series, and a rotational assignment into an unfamiliar organization engaged in systems engineering. Independently, MSFC developed two courses to address knowledge retention and sharing concerns: Real World Marshall Mission Success course and its Case Study Writers Workshop and Writers Experience. Teaching case study writing and leading students through a hands-on experience at writing a case study on an SE topic can enhance SE training and has the potential to accelerate the transfer of experiential knowledge. This paper is an overview of the pilot experiences with teaching case study writing, its application in case study-based learning, and identifies potential areas of research and application for case study writing in systems engineering education.

  18. Serological follow-up of patients with paracoccidioidomycosis treated with itraconazole using Dot-blot, ELISA and Western-blot

    Directory of Open Access Journals (Sweden)

    Rosana MARTINS

    1997-09-01

    Full Text Available Twenty-seven mycologically proven cases of paracoccidioidomycosis (PCM were treated with itraconazole (100-200 mg/day in month 1 and 100 mg/day until month 6-8 and evaluated clinically and serologically, up to 3.5 years post-therapy, using Dot-blot and ELISA for measuring the titers of IgG, IgA and IgM anti-P. brasiliensis antibodies and Western-blot for determining IgG, IgA and IgM antibodies against the antigen components of the fungus. Before treatment, 81.5% (Dot-blot and 84% (ELISA of the patients presented elevated IgG anti-P. brasiliensis antibody titers which dropped slightly with treatment. On the other hand, the percentages of pre-treatment high-titered sera for IgA and IgM anti-P.brasiliensis were lower (5l.9% and 5l.8%: Dot-blot; 16.5 and 36%: ELISA, respectively but the titers tended to become negative more frequently with treatment. Prior to treatment, the percentages of positivity for IgG, IgA and IgM anti-P.brasiliensis antibodies in Western-blot were 96%, 20.8% and 41.6%, respectively. Antigens with molecular weights varying from 16-78 kDa, from 21-76 kDa and from 27-78 kDa were reactive for IgG, IgA and IgM antibodies, respectively. The most frequently reactive antigenic components had molecular weights of 27, 33 and 43 kDa for IgG, and 70 for IgA and IgM antibodies. During the period of study, the patients responded well to treatment. The present data confirm the diversity and complexity of the humoral response in PCM, and the importance of utilizing different serological tests to detect IgG, IgA and IgM anti-P. brasiliensis antibodiesVinte e sete pacientes portadores de paracoccidioidomicose (PCM foram tratados com itraconazole (100-200 mg/dia no primeiro mês e 100 mg/dia até 6-8 meses e avaliados sob o ponto de vista clínico e sorológico, até 3 e meio anos após o início do tratamento, utilizando-se os testes de Dot-blot e ELISA para medir os títulos de anticorpos IgG, IgA e IgM anti-P. brasiliensis, e Western

  19. An Economic Case for End System Multicast

    Science.gov (United States)

    Analoui, Morteza; Rezvani, Mohammad Hossein

    This paper presents a non-strategic model for the end-system multicast networks based on the concept of replica exchange economy. We believe that microeconomics is a good candidate to investigate the problem of selfishness of the end-users (peers) in order to maximize the aggregate throughput. In this solution concept, the decisions that a peer might make, does not affect the actions of the other peers at all. The proposed mechanism tunes the price of the service in such a way that general equilibrium holds.

  20. Progressive Systemic sclerosis, manifested like malabsorption syndrome. Case report

    International Nuclear Information System (INIS)

    Ortiz Piza, Gabriel Jaime; Gonzalez Vasquez, Carlos Mario

    2005-01-01

    We report the case of a 32 year old woman whose first manifestation of systemic sclerosis was malabsorption syndrome. The small bowel series was the clue to the diagnosis, confirmed by laboratory tests and progression of the disease

  1. Immunodiagnosis of paracoccidioidomycosis due to Paracoccidioides brasiliensis using a latex test: detection of specific antibody anti-gp43 and specific antigen gp43.

    Science.gov (United States)

    Dos Santos, Priscila Oliveira; Rodrigues, Anderson Messias; Fernandes, Geisa Ferreira; da Silva, Silvia Helena Marques; Burger, Eva; de Camargo, Zoilo Pires

    2015-02-01

    Paracoccidioidomycosis (PCM) is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations. A latex immunoassay using sensitized latex particles (SLPs) with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43) was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF), and bronchoalveolar lavage (BAL) from patients with PCM due to P. brasiliensis. The gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0), specificity (93.94%, 95% CI 87.3-97.7), and positive (91.4%) and negative (98.9%) predictive values. In addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6), specificity (88.89%, 95% CI 81.0-94.3), and positive (85.1%) and negative (97.8%) predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924) and mAb17c-SLPs (k = 0.850), which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. In addition, the latex test was useful for monitoring PCM patients receiving therapy. The high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure and

  2. Immunodiagnosis of Paracoccidioidomycosis due to Paracoccidioides brasiliensis Using a Latex Test: Detection of Specific Antibody Anti-gp43 and Specific Antigen gp43

    Science.gov (United States)

    dos Santos, Priscila Oliveira; Rodrigues, Anderson Messias; Fernandes, Geisa Ferreira; da Silva, Silvia Helena Marques; Burger, Eva; de Camargo, Zoilo Pires

    2015-01-01

    Background Paracoccidioidomycosis (PCM) is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations. Method/Principle Findings A latex immunoassay using sensitized latex particles (SLPs) with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43) was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF), and bronchoalveolar lavage (BAL) from patients with PCM due to P. brasiliensis. The gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7–100.0), specificity (93.94%, 95% CI 87.3–97.7), and positive (91.4%) and negative (98.9%) predictive values. In addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3–99.6), specificity (88.89%, 95% CI 81.0–94.3), and positive (85.1%) and negative (97.8%) predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924) and mAb17c-SLPs (k = 0.850), which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. In addition, the latex test was useful for monitoring PCM patients receiving therapy. Conclusions/Significance The high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but

  3. Immunodiagnosis of paracoccidioidomycosis due to Paracoccidioides brasiliensis using a latex test: detection of specific antibody anti-gp43 and specific antigen gp43.

    Directory of Open Access Journals (Sweden)

    Priscila Oliveira Dos Santos

    2015-02-01

    Full Text Available Paracoccidioidomycosis (PCM is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations.A latex immunoassay using sensitized latex particles (SLPs with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43 was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF, and bronchoalveolar lavage (BAL from patients with PCM due to P. brasiliensis. The gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0, specificity (93.94%, 95% CI 87.3-97.7, and positive (91.4% and negative (98.9% predictive values. In addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6, specificity (88.89%, 95% CI 81.0-94.3, and positive (85.1% and negative (97.8% predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924 and mAb17c-SLPs (k = 0.850, which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. In addition, the latex test was useful for monitoring PCM patients receiving therapy.The high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure

  4. Preliminary consideration of CFETR ITER-like case diagnostic system

    International Nuclear Information System (INIS)

    Li, G. S.; Liu, Y. K.; Gao, X.; Yang, Y.; Wang, Y. M.; Ming, T. F.; Han, X.; Liu, S. C.; Wang, E. H.; Yang, W. J.; Li, G. Q.; Hu, Q. S.

    2016-01-01

    Chinese Fusion Engineering Test Reactor (CFETR) is a new superconducting tokamak device being designed in China, which aims at bridging the gap between ITER and DEMO, where DEMO is a tokamak demonstration fusion reactor. Two diagnostic cases, ITER-like case and towards DEMO case, have been considered for CFETR early and later operating phases, respectively. In this paper, some preliminary consideration of ITER-like case will be presented. Based on ITER diagnostic system, three versions of increased complexity and coverage of the ITER-like case diagnostic system have been developed with different goals and functions. Version A aims only machine protection and basic control. Both of version B and version C are mainly for machine protection, basic and advanced control, but version C has an increased level of redundancy necessary for improved measurements capability. The performance of these versions and needed R&D work are outlined.

  5. Preliminary consideration of CFETR ITER-like case diagnostic system.

    Science.gov (United States)

    Li, G S; Yang, Y; Wang, Y M; Ming, T F; Han, X; Liu, S C; Wang, E H; Liu, Y K; Yang, W J; Li, G Q; Hu, Q S; Gao, X

    2016-11-01

    Chinese Fusion Engineering Test Reactor (CFETR) is a new superconducting tokamak device being designed in China, which aims at bridging the gap between ITER and DEMO, where DEMO is a tokamak demonstration fusion reactor. Two diagnostic cases, ITER-like case and towards DEMO case, have been considered for CFETR early and later operating phases, respectively. In this paper, some preliminary consideration of ITER-like case will be presented. Based on ITER diagnostic system, three versions of increased complexity and coverage of the ITER-like case diagnostic system have been developed with different goals and functions. Version A aims only machine protection and basic control. Both of version B and version C are mainly for machine protection, basic and advanced control, but version C has an increased level of redundancy necessary for improved measurements capability. The performance of these versions and needed R&D work are outlined.

  6. Aspectos laboratoriais evolutivos de crianças em tratamento da paracoccidioidomicose Laboratory evolutive aspects of children under paracoccidioidomycosis treatment

    Directory of Open Access Journals (Sweden)

    Maria Gorete dos Santos Nogueira

    2006-10-01

    Full Text Available Estudo de 38 crianças com paracoccidioidomicose, até 14 anos de idade, tratados por 24-30 meses, com um derivado sulfamídico ou cetoconazol, desde o início do tratamento ou em seguida ao uso da anfotericina B. Dados laboratoriais à admissão foram analisados e comparados com exames seqüenciais até 30 meses de acompanhamento. Anemia, eosinofilia e bilirrubinas e aminotransferases elevadas normalizaram-se, na maioria, até os três meses de tratamento e, hipoalbuminemia, até os seis meses, sugerindo que esses achados sejam bons parâmetros para o monitoramento da resposta terapêutica inicial. Leucócitos periféricos, velocidade de hemossedimentação, IgG e títulos sorológicos para o Paracoccidioides brasiliensis estavam elevados e normalizaram-se, freqüentemente, após nove a 12 meses de tratamento, o que sugere utilidade desses exames no monitoramento de todo o tratamento e enfatiza a necessidade de curso terapêutico prolongado da paracoccidioidomicose na infância.The study of 38 children with paracoccidioidomycosis, aged up to 14, treated for 24 to 30 months with either a sulfonamide derivative or ketoconazole either alone or, after the use of amphotericin B. Laboratory data at admission were analyzed and compared with those of sequential tests after up to 30 months follow-up. Anemia, eosinophilia, increased bilirubin and aminotransferases normalized, in most patients, after three months treatment and hypoalbuminemia normalized after six months, suggesting that these laboratory findings are useful for monitoring early therapeutic response. Peripheral leucocytes, erythrocyte sedimentation rate, IgG, and serological titers for Paracoccidioides brasiliensis were increased and frequently normalized after nine to 12 months of treatment. They may be useful for monitoring the entire treatment and emphasize the need for long term treatment of paracoccidioidomycosis in children.

  7. Congestive cardiac failure in a patient with systemic sclerosis: Case ...

    African Journals Online (AJOL)

    Congestive cardiac failure in a patient with systemic sclerosis: Case report and literature review. ... The presence of CCF in patients with SSe is a poor prognostic marker and cause of mortality and morbidity, ... not been reported in Nigerians. Keywords: Systemic sclerosis; Primary Cardiac Disease; Heart failure; Nigerians ...

  8. Making System Dynamics Cool? Using Hot Testing & Teaching Cases

    NARCIS (Netherlands)

    Pruyt, E.

    2009-01-01

    This paper deals with the use of ‘hot’ real-world cases for both testing and teaching purposes such as in the Introductory System Dynamics course at Delft University of Technology in the Netherlands. The paper starts with a brief overview of the System Dynamics curriculum. Then the problem-oriented

  9. C++ and operating systems performance - A case study

    Science.gov (United States)

    Russo, Vincent F.; Madany, Peter W.; Campbell, Roy H.

    1990-01-01

    Object-oriented design and programming has many software engineering advantages. Its application to large systems, however, has previously been constrained by performance concerns. The Choices operating system, which has over 75,000 lines of code, is object-oriented and programmed in C++. This paper is a case study of the performance of Choices.

  10. A Textual Case-Based Mobile Phone Diagnosis Support System ...

    African Journals Online (AJOL)

    In this paper, a Mobile Phone Diagnosis Support System is presented as an extension to jCOLIBRI which accepts a problem and reasons with cases to provide a solution related to a new given problem. Experimental evaluation using some set of problems shows that the developed system predicts the solution that is ...

  11. Client-Controlled Case Information: A General System Theory Perspective

    Science.gov (United States)

    Fitch, Dale

    2004-01-01

    The author proposes a model for client control of case information via the World Wide Web built on principles of general system theory. It incorporates the client into the design, resulting in an information structure that differs from traditional human services information-sharing practices. Referencing general system theory, the concepts of…

  12. case reports atypical presentation of systemic lupus erythematosus ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... SUMMARY. Systemic lupus erythematosus (SLE) is a chronic, auto- immune multi-system disorder. About seventy to nine- ty percent of all cases of SLE occur in women. Alt- hough the disease is common in black young women residing in Europe and North America, it is reputed to be a very rare diagnosis ...

  13. Eastern Cape hybrid mini-grid systems - a case study

    CSIR Research Space (South Africa)

    Szewczuk, S

    2010-05-01

    Full Text Available -GRID SYSTEMS A CASE STUDY WIND POWER AFRICA 2010 S Szewczuk CSIR May 2010 PRESENTATION OUTLINE • Rationale for Projects • Renewable Energy for Rural Electrification in E Cape • Integrated Energy/Economic Framework • Hybrid mini-grid energy systems... investigated: wind, mini-hydro & biomass • Geographic Information Systems (GIS) to present & interpret results • Output: identification of implementable projects – emphasis on objective technological evaluations Wind assessment at 60 m height Example...

  14. DECREASING PREVALENCE OF THE ACUTE/SUBACUTE CLINICAL FORM OF PARACOCCIDIOIDOMYCOSIS IN MATO GROSSO DO SUL STATE, BRAZIL

    Directory of Open Access Journals (Sweden)

    Larissa Rodrigues Fabris

    2014-04-01

    Full Text Available With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%. It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease.

  15. DECREASING PREVALENCE OF THE ACUTE/SUBACUTE CLINICAL FORM OF PARACOCCIDIOIDOMYCOSIS IN MATO GROSSO DO SUL STATE, BRAZIL

    Science.gov (United States)

    Fabris, Larissa Rodrigues; Andrade, Úrsulla Vilella; Santos, Aline Ferreira Dos; Marques, Ana Paula da Costa; de Oliveira, Sandra Maria do Valle Leone; Mendes, Rinaldo Pôncio; Paniago, Anamaria Mello Miranda

    2014-01-01

    With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease. PMID:24626413

  16. Serum antibody levels correlate with oral fungal cell numbers and influence the patients' response to chronic paracoccidioidomycosis.

    Science.gov (United States)

    de Carli, Marina Lara; Cardoso, Beatriz Cristina Bachião; Malaquias, Luiz Cosme Cotta; Nonogaki, Suely; Pereira, Alessandro Antônio Costa; Sperandio, Felipe Fornias; Hanemann, João Adolfo Costa

    2015-06-01

    Paracoccidioidomycosis (PCM) is a neglected fungal disease that elicits an important granulomatous inflammatory reaction which aims to isolate the fungi and resolve the infection; besides the innate cellular response, the patients' sera may contain different levels of antibodies directed against PCM's pathogenic agent: Paracoccidioides brasiliensis (Pb). The aim of the study was to assess the distinct serum antibody levels of 19 chronic PCM patients and to associate these levels to the granulomatous inflammatory response and presence of fungi in oral lesions caused by Pb. The presence of Pb was detected and counted within oral tissues using immunohistochemistry; antibody levels were classified as negative, low-grade, moderate or high-grade groups. The Kruskal-Wallis and Dunn's test were used to verify possible associations among the groups. Interestingly, lower antibody titres were associated with lesser numbers of Pb, which favours the cellular response over the humoral response to fight PCM. On the other hand, negative serological results were linked to a higher presence of Pb in the tissues, indicating that a deficient humoral response supports the fungal proliferation. The number of Pb was conveniently associated with the level of serum antibodies, showing that the humoral immune response is required, however, not solely responsible to restrain the dissemination of Pb. © 2015 Blackwell Verlag GmbH.

  17. Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

    DEFF Research Database (Denmark)

    Tsushima, Y; Kanal, E; Thomsen, H S

    2010-01-01

    The aim of this article is to review the published cases of nephrogenic systemic fibrosis (NSF) in Japan. The Japanese medical literature database and MedLine were searched using the keywords NSF and nephrogenic fibrosing dermopathy (January 2000 to March 2009). Reports in peer-reviewed journals...... and meeting abstracts were included, and cases with biopsy confirmation were selected. 14 biopsy-verified NSF cases were found. In seven of eight patients reported after the association between gadolinium-based contrast agent (GBCA) and NSF was proposed, GBCA administration was documented: five received only...

  18. Plant-wide performance optimisation – The refrigeration system case

    DEFF Research Database (Denmark)

    Green, Torben; Razavi-Far, Roozbeh; Izadi-Zamanabadi, Roozbeh

    2012-01-01

    This paper investigates the problem of plant-wide performance optimisation seen from an industrial perspective. The refrigeration system is used as a case study, because it has a distributed control architecture and operates in steady state conditions, which is common for many industrial applicat......This paper investigates the problem of plant-wide performance optimisation seen from an industrial perspective. The refrigeration system is used as a case study, because it has a distributed control architecture and operates in steady state conditions, which is common for many industrial...

  19. Fire protection in ventilation systems and in case of fire operating ventilation systems

    International Nuclear Information System (INIS)

    Zitzelsberger, J.

    1983-01-01

    The fire risks in ventilation systems are discussed. It follows a survey of regulations on fire prevention and fire protection in ventilation systems and smoke and heat exhaust systems applicable to nuclear installations in the Federal Republic of Germany. Fire protection concepts for normal systems and for systems operating also in case of fire will be given. Several structural elements for fire protection in those systems will be illustrated with regard to recent research findings

  20. Identification of material flow systems: Extensions and case study.

    Science.gov (United States)

    Gleiss, A; Matyus, T; Bauer, G; Deistler, M; Glenck, E; Lampert, C

    1998-01-01

    The paper consists of two main parts. The first part is concerned with different aspects of mathematical modeling of material flow systems for the linear static case. The problems considered are the description of the model class, data reconciliation, identification of subsystems and the analysis of system properties relevant e.g. for simulation. In the second part an application of the modeling tools proposed in the first part to a study on the metabolism of phosphorus in an Austrian region is given.

  1. Case management and adherence to an online disease management system.

    Science.gov (United States)

    Robertson, Lucy; Smith, Michael; Tannenbaum, Dennis

    2005-01-01

    Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.

  2. A Unique Case of Systemic Lupus Erythematosus Pelvic Vasculitis

    Directory of Open Access Journals (Sweden)

    Pamela Traisak

    2016-01-01

    Full Text Available The clinical presentation of Systemic Lupus Erythematosus (SLE is diverse and vasculitis can be a potential manifestation. Cutaneous lesions involving small vessels are the most frequent presentation. However, medium and large vessel vasculitis may present with life-threatening visceral manifestations. We present a unique case of pelvic vasculitis mimicking a pelvic mass as an initial presentation of SLE. There are case reports of systemic vasculitis involving the female genital tract with giant cell arteritis (GCA, polyarteritis nodosa (PAN, and granulomatous with polyangiitis and microscopic polyangiitis (GPA/MPA, among others, but only a few cases attributed to SLE. Awareness of this condition and a prompt diagnosis are warranted as this is a severe and potentially life-threatening condition.

  3. Systemic sclerosis presenting as CREST syndrome: A case report ...

    African Journals Online (AJOL)

    Case report. A 31 years old female patient from senafe with remote history of systemic sclerosis and recurrent hospital admissions presented to the ED of Orotta hospital with shortness of breath and altered mental status. She had generalized body weakness, and dry cough associated with chest pain. She also complained.

  4. Systemic sclerosis presenting as CREST syndrome: A case report ...

    African Journals Online (AJOL)

    Systemic sclerosis (SSc) is a chronic multisystem disorder of unknown etiology, characterized by diffuse fibrosis; degenerative changes; and vascular abnormalities in the skin (scleroderma), articular structures, and internal organs especially the esophagus, GI tract, lung, heart, and kidney. We report the case of a 31 years ...

  5. Bilateral single system ectopic ureters: Case report with literature ...

    African Journals Online (AJOL)

    Bilateral single system ureteral ectopia (BSSEU) is one of the rarest entities in urology, with less than 80 cases reported so far. Incontinence resulting from the underlying anomaly can be devastating to the child. It is generally agreed that suitable urinary continence and long dry intervals are seldom obtainable because of ...

  6. Worst-case tolerance optimization of antenna systems

    DEFF Research Database (Denmark)

    Schjær-Jacobsen, Hans

    1980-01-01

    The application of recently developed algorithms to antenna systems design is demonstrated by the worst-case tolerance optimization of linear broadside arrays, using both spacings and excitation coefficients as design parameters. The resulting arrays are optimally immunized against deviations...... of the design parameters from their nominal values....

  7. Simplified Worst-Case Analysis of Complex Systems

    Science.gov (United States)

    Pond, C. L.

    1985-01-01

    Statistical method avoids excessive computer time. Technique involves simplified Monte Carlo simulation of system with randomly chosen parameters and comparison of tolerance extremes of several of worst-case situations found. Resulting combination of tolerance extremes then used in detailed analysis - one that makes use of full complex nonlinear model capable of accurate simulations.

  8. Hybrid case-neural network (CNN) diagnostic system

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2010-01-01

    recently, the mobile health care has a great attention for the researcher and people all over the world. Case based reasoning (CBR) systems have proved their performance as world wide web (WWW) medical diagnostic systems. They were preferred rather than different reasoning approaches due to their high performance and results' explanation. But, their operations require a complex knowledge acquisition and management processes. On the other hand, it is found that, artificial neural network (ANN) has a great acceptance as a classifier methodology using a little amount of knowledge. But, ANN lacks of an explanation capability .The present research introduces a new web-based hybrid diagnostic system that can use the ANN inside the CBR , cycle.It can provide higher performance for the web diagnostic systems. Besides, the proposed system can be used as a web diagnostic system. It can be applied for diagnosis different types of systems in several domains. It has been applied in diagnosis of the cancer diseases that has a great spreading in recent years as a case of study . However, the suggested system has proved its acceptance in the manner.

  9. The quality of HIV/AIDS case-detection and case-reporting systems ...

    African Journals Online (AJOL)

    Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in ...

  10. Average Case vs. Worst Case-Margins of Safety in System Design

    DEFF Research Database (Denmark)

    Probst, Christian; Gal, Andreas; Franz, Michael

    2005-01-01

    We predict that we will soon witness attacks on all kinds of systems that will be based on the attacked systems’ worstcase behavior. For example, the worst-case performance of Java Bytecode Verification rises quadratically with program length. By sending a legal, but difficult-to-verify program t...

  11. A zirconia implant-crown system: a case report.

    Science.gov (United States)

    Kohal, Ralf J; Klaus, Gerold

    2004-04-01

    Exposed metal crown margins in the porcelain-fused-to-metal technique might be an esthetic problem. Therefore, all-ceramic crown systems are used for restoring teeth and dental implants. In addition, the gray color of a titanium implant might hamper the esthetic appearance of the entire reconstruction in cases of thin peri-implant soft tissue or tissue retraction. To further improve the esthetic aspect of dental implants, efforts are undertaken to develop implant systems fabricated out of tooth-colored materials that are biocompatible and able to withstand masticatory forces. One such material may be zirconia. The present article presents a case in which an all-ceramic custom-made zirconia implant-crown system was used for the replacement of a single tooth.

  12. Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

    OpenAIRE

    Rusnak, James E.

    1987-01-01

    Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...

  13. Paracoccidioidomicose: estudo radiológico e pulmonar de 58 casos Pulmonary and radiological studies in 58 paracoccidioidomycosis patients

    Directory of Open Access Journals (Sweden)

    E.P. Campos

    1991-08-01

    Full Text Available Provas funcionais respiratórias foram realizadas em 58 pacientes com Paracoccidioidomicose (Pbmicose pulmonar uni e multifocal em 52; tumoral em 5 e genital feminino interno em 01. A idade oscilou de 20 a 74 anos e a duração da doença variou de 3 a 25 anos. Manifestações respiratórias, tegumentares e linfáticas foram predominantes. Catorze deles desenvolveram Cor pulmonale, função renal alterada em 19, modificações eletrocardiográficas em 8 e atividade hiporeatora adrenal em 13 dos 20 casos estudados. A análise radiológica revelou lesões designadas: leve em 16; moderada em 24 e grave em 18 que à evolução evidenciaram: manutenção e piora, respectivamente, em 35 e em 23 deles. As provas funcionais respiratórias mostraram: espirografia normal em 17; obstrutivo em 32 e misto em 9 doentes. O espaço morto foi superior a 35% em 25 e a ventilação alveolar minuto estava elevada em 54. A diferença alvéolo-arterial de Oxigênio estava aumentada em todos. A análise estatística revelou associação significativa entre radiologia: evolução radiológica e a função pulmonar. A Pbmicose em doentes tabagistas inveterados conduziu ao enfisema, enquanto que as modificações alvéolo-arteriais anoxêmicas propiciaram a disseminação da Doença de Lutz.Spirometric and haemogasimetric tests were performed in 52 patients with unifocal and multi-focal progressive Paracoccidioidomycosis pulmonary diseases, in 5 patients with juvenil and 1 female internal genital forms. The age ranged from 20 to 74 years old and the duration of disease from 3 to 25 years. Dyspnea, cough, tegumentar and lymphatic manifestations were the most predominant signs observed. Fourteen of them was developed Cor pulmonale. Impaired renal function was recorded in 19 patients, cardiac symptons were described in 7 and hyporeactor adrenal activity was showed in 13 patients. Radiological studies demonstrated mild in 16, moderate in 24 and severe pulmonary lesions types

  14. Association of systemic sclerosis and psoriatic arthritis: a case report

    Directory of Open Access Journals (Sweden)

    A. Musio

    2011-09-01

    Full Text Available The association of Systemic Sclerosis (SSc and Psoriatic Arthritis (PsA is unfrequent; only few cases are reported in literature. We describe a case of a patient with SSc following the onset of PsA. The disease begun with tenosynovitis, polyarthritis in association with psoriasis. After two years, Raynaud’s phenomenon and sclerodactyly appeared, and, later, pulmonary interstizial fibrosis and esophageal dysfunction. The existence of a common pathogenesis of the two diseases, SSc and PsA, is discussed.

  15. Infantile systemic hyalinosis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Bhushan Madke

    2010-01-01

    Full Text Available We report a case of infantile systemic hyalinosis in a 3.5-month-old male child born out of consanguineous marriage. He presented with multiple brownish raised lesions over bony prominences. He had also developed difficulty in movement of limbs and as a result developed severe flexion joint contractures. There was history of similar complaints in elder sibling who died at the age of 5 months due to repeated episodes of pneumonia. Skin biopsy from one of the papulonodular lesions showed increased amount of amorphous hyaline matrix, which was Periodic Acid Schiff positive with scattered fibroblasts. Though classical, we report this case for its rarity in western India.

  16. Therapeutic Response in Adult Patients with Nonsevere Chronic Paracoccidioidomycosis Treated with Sulfamethoxazole-Trimethoprim: A Retrospective Study.

    Science.gov (United States)

    Nery, Andreia F; Crepaldi, Natasha P; Rossi, Soraya B R S; Tadano, Tomoko; Leal-Santos, Fabio A; Hahn, Rosane Christine; Menezes, Valfredo M; Fontes, Cor Jesus F

    2017-08-01

    According to the Brazilian Consensus on Paracoccidioidomycosis (PCM), itraconazole is the drug of choice for treatment. However, the combination of sulfamethoxazole and trimethoprim (SMX-TMP) is most commonly used in clinical practice because of its higher availability in the public health services. The aims of this study were to evaluate the therapeutic response of patients with nonsevere chronic PCM to SMX-TMP and highlight the factors related to treatment failure. An adequate therapeutic response was defined as completely improved disease signs and symptoms after medication use for a minimum of 6 months, followed by normalized hematological and biochemical changes, radiological improvements, and negative mycological examination findings. Medical records were analyzed for 244 patients with nonsevere chronic PCM who were treated between 1998 and 2014. In total, 41.9% of the patients had PCM for ≥ 8 months. Seven (2.9%) patients were coinfected with human immunodeficiency virus (HIV). The median (25%, 75% percentiles) treatment duration was 21 (10, 25) months. Adequate treatment adherence was reported by 68.3% of patients. In addition, 73.6% of patients exhibited an adequate therapeutic response. The majority (82.6%) of patients who were treated with SMX-TMP for > 24 months displayed an adequate therapeutic response, and the frequency of adequate therapeutic response gradually decreased as the duration of treatment decreased. Treatment nonadherence ( P < 0.001) and PCM-HIV coinfection ( P = 0.019) were factors associated with therapeutic failure. The study results support the good efficacy of SMX-TMP. Attention should be given to PCM-HIV coinfection, emphasizing the concern of a higher risk of PCM therapeutic failure in these patients.

  17. Serum interleukin-18 and soluble tumour necrosis factor receptor 2 are associated with disease severity in patients with paracoccidioidomycosis

    Science.gov (United States)

    Corvino, C L; Mamoni, R L; Fagundes, G Z Z; Blotta, M H S L

    2007-01-01

    Interleukin (IL)-18 is a proinflammatory cytokine of the IL-1 superfamily that exhibits broad functional effects in innate and acquired immune responses and which has been found in high levels in several chronic inflammatory and autoimmune diseases. Over-expression of IL-18 may promote early resolution of infection or could promote a detrimental exaggerated immune response. The aim of this study was to determine serum levels of IL-18 and other inflammatory mediators [IL-12, soluble intercellular adhesion molecule 1 (sICAM-1), soluble tumour necrosis factor receptor 1 (TNF-RI), sTNF-RII, CXC chemokine ligand 9 (CXCL9), CXCL10] at baseline and after anti-fungal therapy in serum from patients with juvenile (JF) and adult (AF) forms of paracoccidioidomycosis (PCM), as well as in healthy controls (C), and to assess their possible relationships to the severity of disease. IL-18 and sTNF-RII levels in patients with the JF of PCM were significantly higher than those in the AF and controls. In relation to sICAM-1, no difference was observed between JF and AF patients but both presented higher levels than controls. sTNF-RI levels were higher in patients with PCM than in controls, and significantly higher concentrations were detected in AF patients compared to JF patients. Moreover, IL-12 and chemokines CXCL9 and CXCL10 were also higher in patients than in controls. In JF patients IL-18 levels correlated significantly with sICAM-1 (r = 0·62, P < 0·0001), sTNF-RI (r = 0·63, P < 0·0001), sTNF-RII (r = 0·51, P = 0·02), as well as with clinical severity. The results suggest the value of serum IL-18 and sTNF-Rs levels as a parameter of PCM severity and may support a possible role for them in the pathogenesis of the disease. PMID:17302897

  18. Digital case-based learning system in school.

    Science.gov (United States)

    Gu, Peipei; Guo, Jiayang

    2017-01-01

    With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

  19. Digital case-based learning system in school.

    Directory of Open Access Journals (Sweden)

    Peipei Gu

    Full Text Available With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

  20. Flexible Process Notations for Cross-organizational Case Management Systems

    DEFF Research Database (Denmark)

    Slaats, Tijs

    these tools within customer projects, we report on a number of case studies based on these projects. Finally we report on a new angle of research within the Business Process Management field tentatively called Hybrid BPM Technologies, which aims to combine the advantages of both the flow- and constraint...... frustration and inefficiency because they do not allow workers to use their expert experience to make the best judgements on how to solve the unique challenges they are faced with. However some structuring of their work is still required to ensure that laws and business rules are being followed. IT Systems...... of the process and techniques for runtime adaptation. This dissertation reports on the results of the Technologies for Flexible Cross-organizational Case Management Systems (FLExCMS) research project which was started in cooperation between ITU and the company Exformatics A/S. The goals of the project were...

  1. Experimental paracoccidioidomycosis in the mouse. III. Histopathological and immunological findings after intravenous infection in the presence or absence of previous immunization

    Directory of Open Access Journals (Sweden)

    Maura Moscardi Bacchi

    1985-06-01

    Full Text Available Fifty male white Swiss mice aged 4 weeks were inoculated with 5 x 10(5 viable yeast forms of Paracoccidioides brasiliensis (strain 18. Ten of these animals had been previously immunized with particulate P. brasiliensis antigenfor 4 weeks by intradermal injection. The controls consisted of 10 animals that were only immunized and 10 animals submitted to no treatment. The animals were sacrificed 2, 4, 7,11 and 16 weeks later. We studied: 1 the anti-P. brasiliensis delayed hypersensitivity response measured by the footpad test 24 hours prior to sacrifice; 2 the specific antibody production measured by double immunodiffusion in agar gel; 3 the histopathology of lungs, liver, spleen, adrenals and kidneys. We observed that: a the immunized animals developed more intense cell-immune responses than the infected ones; b infection reduced the cell- immune response of the immunized animals; c intravenous infection of mice with P. brasiliensis was characterized by a systemic and progressive granulomatous inflammation. The animals infected after previous immunization showed less extensive lung inflammation, with smaller granulomas and fewer fungi. The results indicate that the present murine model mimics some findings of the human subacute form of paracoccidioidomycosis (systemic disease with depressed cellular immunity and that the extrapulmonary immunization scheme was able to induce a certain degree of protection of the lung from infection with P. brasiliensisCinqüenta camundongos suíços, brancos, com quatro semanas de idade, foram inoculados com 5x10(5 formas leveduriformes, viáveis de Paracoccidiodes brasiliensis (cepa 18. Dez destes animais tinham sido previamente imunizados com antígeno particulado de P. brasiliensis, durante quatro semanas, por injeção intradérmica. Os controles consistiram de 10 animais que foram somente imunizados e 10 inoculados com solução salina estéril. Os animais foram sacrificados após 2, 4, 7, 11 e 16 semanas

  2. The Case-agreement System in Subjunctive Complements

    Directory of Open Access Journals (Sweden)

    Feras Saeed

    2016-06-01

    Full Text Available Unlike matrix verbs, the verb in subjunctive complements in Standard Arabic lacks tense; nonetheless, it inflects for agreement and mood. The subject of subjunctive verbs is Case-marked accusative if it surfaces in a preverbal position; and nominative if it appears in a postverbal position. In addition, the subjunctive verb shows agreement asymmetry with its subject, depending on the position of the subject. Subjunctive complements appear in tenseless contexts in this language, i.e. control structures, ECM-like structures, and obviative structures. In this paper, I provide a new analysis for subject-verb agreement asymmetry in these complements and account for the different Case markers that appear on their subject. In particular, I argue that feature-specification on the inflectional head T triggers the verbal agreement asymmetry in subjunctive complements. I also argue that formal features and nominative Case in these complements can be valued by a defective probe. Crucially, I argue that the defective probe can establish agreement and assign nominative Case in-situ, without resorting to A-movement, and the subsequent movement of the embedded subject to a preverbal position is triggered by the EPP feature on the Φ-complete T. The corollary of this investigation lends support to the assumption that the Case-agreement system in this language is not contingent on tense.

  3. Systemic sarcoidosis induced by etanercept: first Brazilian case report

    OpenAIRE

    Unterstell, Natasha; Bressan, Aline Lopes; Serpa, Laura Araújo; Castro, Pérola Peres da Fonseca e; Gripp, Alexandre Carlos

    2013-01-01

    The antagonists of tumor necrosis factor alpha (TNF-α) are increasingly being used in the treatment of inflammatory and autoimmune diseases. Several adverse effects of these drugs have been reported, including the paradoxical development of sarcoidosis, especially with the use of etanercept. We present the first Brazilian case report of systemic sarcoidosis induced by etanercept and a literature review. Os medicamentos antagonistas do fator de necrose tumoral alfa (TNF-α) estão sendo cada ...

  4. Improving the Reliability of Case-Based Reasoning Systems

    Directory of Open Access Journals (Sweden)

    Xu Xu

    2010-09-01

    also discussed in this paper, especially the property that whether inter-feature of case exists redundancy. After that, the reliability of an individual suggested solution is studied. To illustrate these ideas, some experiments and their results are discussed in this paper. The results of experiments show a new route concerning on how to improve the reliability of a CBR system at an overall level.

  5. Method of sealing casings of subsurface materials management system

    Science.gov (United States)

    Nickelson, Reva A.; Richardson, John G.; Kostelnik, Kevin M.; Sloan, Paul A.

    2007-02-06

    Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

  6. Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

    DEFF Research Database (Denmark)

    Tsushima, Y; Kanal, E; Thomsen, H S

    2010-01-01

    The aim of this article is to review the published cases of nephrogenic systemic fibrosis (NSF) in Japan. The Japanese medical literature database and MedLine were searched using the keywords NSF and nephrogenic fibrosing dermopathy (January 2000 to March 2009). Reports in peer-reviewed journals...... of knowledge about the possible association between GBCA and NSF. NSF is found among Japanese end-stage renal failure patients even after examinations using a single dose....

  7. Plant-wide performance optimisation – The refrigeration system case

    DEFF Research Database (Denmark)

    Green, Torben; Razavi-Far, Roozbeh; Izadi-Zamanabadi, Roozbeh

    2012-01-01

    This paper investigates the problem of plant-wide performance optimisation seen from an industrial perspective. The refrigeration system is used as a case study, because it has a distributed control architecture and operates in steady state conditions, which is common for many industrial...... applicationsin the process industry. The paper addresses the fact that dynamic performance of the system is important, to ensure optimal changes between different operation conditions. To enable optimisation of the dynamic controller behaviour a method for designing the required excitation signal is presented...

  8. Temporomandibular joint disorder in systemic sclerosis: a case report

    Science.gov (United States)

    Chebbi, Raja; Khalifa, Hanen Ben; Dhidah, Monia

    2016-01-01

    Systemic sclerosis have several effects on the orofacial region such as widening of the periodontal ligament space, xerostomia and bone resorption of the mandible. We report a case of systemic sclerosis with temporomandibular joint involvement in a 45-year-old female patient accompanied by severe limited mouth opening and pain in the right and left preauricular regions and tenderness in masseter muscles with a morning stiffness of jaws.Magnetic resonance imaging showed a resorption of mandibular condylar process, with disk and joint abnormalities. PMID:28292126

  9. How Choice Changes the Education System: A Michigan Case Study

    Science.gov (United States)

    Plank, David; Sykes, Gary

    1999-11-01

    In countries around the world policy makers propose that parents should exercise more control over the choice of schools that their children attend. This paper considers the ways in which the introduction of new opportunities for school choice changes the education system. It argues that choice affects the education system as a whole by introducing new actors into the system, by changing the terms of relationships among existing actors, and by creating new pressures within the system that require new responses. The nature, magnitude, and consequences of these effects cannot be predicted in advance, as they depend on a number of factors including the social and economic context. The empirical basis for this paper derives from a case study of the implementation of choice policies in the state of Michigan in the US, but the conceptual issues raised have important implications for the study of school choice wherever such policies are adopted.

  10. Energy storage systems: power grid and energy market use cases

    Directory of Open Access Journals (Sweden)

    Komarnicki Przemysław

    2016-09-01

    Full Text Available Current power grid and market development, characterized by large growth of distributed energy sources in recent years, especially in Europa, are according energy storage systems an increasingly larger field of implementation. Existing storage technologies, e.g. pumped-storage power plants, have to be upgraded and extended by new but not yet commercially viable technologies (e.g. batteries or adiabatic compressed air energy storage that meet expected demands. Optimal sizing of storage systems and technically and economically optimal operating strategies are the major challenges to the integration of such systems in the future smart grid. This paper surveys firstly the literature on the latest niche applications. Then, potential new use case and operating scenarios for energy storage systems in smart grids, which have been field tested, are presented and discussed and subsequently assessed technically and economically.

  11. The Keith Edward scoring system: A case control study

    Directory of Open Access Journals (Sweden)

    Sarkar Supriya

    2009-01-01

    Full Text Available Objective: The World health organization (WHO has accepted Keith Edward scoring system for the diagnosis of childhood tuberculosis (TB. In the present study, we evaluated this scoring system. Methods and Results: We included 53 children with confirmed TB involving different organs, admitted in NB Medical College, during two years period as cases; and 50 randomly selected, age, sex, and organ matched confirmed non-TB cases as controls. We noticed 15.1% false negative and 22% false positive results in our study, and the scoring system had 84.9% sensitivity, 78% specificity, and 80.36% positive predictive value. Likelihood ratio positive (LR+ was 3.86, likelihood ratio negative (LR- was 0.19, and overall agreement was 81.55%. We observed that Keith Edward scoring system was less effective in children suffering from non-TB chronic diseases (false positive rate: 45.5%. We found no significant difference in nutritional status between study and control groups (P = 0.65. We noticed that more than 15-mm indurations for tuberculin test were specific for TB in children. Conclusion: We concluded that Keith Edward scoring system is good for public health purpose, but there is a scope for improvement, and further study is required for this purpose.

  12. Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

    Directory of Open Access Journals (Sweden)

    Guenter Karl Schiepek

    2016-10-01

    Full Text Available Objective. The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD and dissociative identity disorder. Methods. A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client’s dynamics of cognitions, emotions, and behavior. The components (variables of this idiographic system model (ISM were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS, to capture the client’s individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results. For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion. By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and

  13. Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

    Science.gov (United States)

    Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin

    2016-01-01

    Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and

  14. Case-based reasoning as a decision support system for cancer diagnosis: A case study

    OpenAIRE

    Bajo Pérez, Javier; Paz Santana, Juan Francisco de; Rodríguez, Sara; Corchado Rodríguez, Juan Manuel

    2009-01-01

    [EN]Microarray technology can measure the expression levels of thousands of genes in an experiment. This fact makes the use of computational methods in cancer research absolutely essential. One of the possible applications is in the use of Artificial Intelligence techniques. Several of these techniques have been used to analyze expression arrays, but there is a growing need for new and effective solutions. This paper presents a Case-based reasoning (CBR) system for automatic classification of...

  15. Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

    Science.gov (United States)

    Rusnak, James E.

    1987-01-01

    Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

  16. Aerothermal Analysis of a Turbine Casing Impingement Cooling System

    Directory of Open Access Journals (Sweden)

    Riccardo Da Soghe

    2012-01-01

    Full Text Available Heat transfer and pressure drop for a representative part of a turbine active cooling system were numerically investigated by means of an in-house code. This code has been developed in the framework of an internal research program and has been validated by experiments and CFD. The analysed system represents the classical open bird cage arrangement that consists of an air supply pipe with a control valve and the present system with a collector box and pipes, which distribute cooling air in circumferential direction of the casing. The cooling air leaves the ACC system through small holes at the bottom of the tubes. These tubes extend at about 180° around the casing and may involve a huge number of impinging holes; as a consequence, the impinging jets mass flow rate may vary considerably along the feeding manifold with a direct impact on the achievable heat transfer levels. This study focuses on the performance, in terms of heat transfer coefficient and pressure drop, of several impinging tube geometries. As a result of this analysis, several design solutions have been compared and discussed.

  17. Systemic Mastocytosis with Smoldering Multiple Myeloma: Report of a Case.

    Science.gov (United States)

    Ghanem, Sassine; Garcia, Gwenalyn; Ying, Liu; Hurford, Matthew; Odaimi, Marcel

    2016-01-01

    Systemic mastocytosis (SM) is a disease characterized by a clonal infiltration of mast cells affecting various tissues of the body. It is grouped into six different subtypes according to the World Health Organization classification. It is called indolent systemic mastocytosis (ISM) when there is no evidence of end organ dysfunction, while the presence of end organ dysfunction defines aggressive systemic mastocytosis (ASM). When SM coexists with a clonal hematological disorder, it is classified as systemic mastocytosis with associated clonal hematological nonmast cell lineage disease (SM-AHNMD). Over 80% of SM-AHNMD cases involve disorders of the myeloid cell lines. To our knowledge, there are only 8 reported cases to date of SM associated with a plasma cell disorder. We report a patient with ISM who was found to have concomitant smoldering multiple myeloma. His disease later progressed to ASM. We discuss this rare association between SM and a plasma cell disorder, and potential common pathophysiologic mechanisms linking the two disorders will be reviewed. We also discuss prognostic factors in SM as well as the management options considered during the evolution of the patient's disease.

  18. Systemic Mastocytosis with Smoldering Multiple Myeloma: Report of a Case

    Directory of Open Access Journals (Sweden)

    Sassine Ghanem

    2016-01-01

    Full Text Available Systemic mastocytosis (SM is a disease characterized by a clonal infiltration of mast cells affecting various tissues of the body. It is grouped into six different subtypes according to the World Health Organization classification. It is called indolent systemic mastocytosis (ISM when there is no evidence of end organ dysfunction, while the presence of end organ dysfunction defines aggressive systemic mastocytosis (ASM. When SM coexists with a clonal hematological disorder, it is classified as systemic mastocytosis with associated clonal hematological nonmast cell lineage disease (SM-AHNMD. Over 80% of SM-AHNMD cases involve disorders of the myeloid cell lines. To our knowledge, there are only 8 reported cases to date of SM associated with a plasma cell disorder. We report a patient with ISM who was found to have concomitant smoldering multiple myeloma. His disease later progressed to ASM. We discuss this rare association between SM and a plasma cell disorder, and potential common pathophysiologic mechanisms linking the two disorders will be reviewed. We also discuss prognostic factors in SM as well as the management options considered during the evolution of the patient’s disease.

  19. III Systems Symposium at Case Institute of Technology

    CERN Document Server

    1968-01-01

    By J OHN A. HRONES Provost, Case Institute 0/ Technology SYSTEMS have been the subject of man's study for many hundreds of years. Thus, the solar system has been the concern of the astronomer. The study of the allocation of material and human resources within the boundaries of an industrial firm or a government has been the concern of the economist. The subject of such studies have been widely known as economic systems. Medieal men have worked with the human body. Thus, man has attempted to deal with a complicated array of interconnected elements since the very earliest of recorded time. In his attcmpt to improve his understanding of physieal systems the need to concentrate on a specific kind of system, e.g., the solar system. the human body, became more imperative. However in recent years there has begun to grow and develop an increasing number of people who are working on thc development of general systems theory and analysis. Such a development is based upon the belief that certain view points, certain kin...

  20. Automated Generation and Assessment of Autonomous Systems Test Cases

    Science.gov (United States)

    Barltrop, Kevin J.; Friberg, Kenneth H.; Horvath, Gregory A.

    2008-01-01

    This slide presentation reviews some of the issues concerning verification and validation testing of autonomous spacecraft routinely culminates in the exploration of anomalous or faulted mission-like scenarios using the work involved during the Dawn mission's tests as examples. Prioritizing which scenarios to develop usually comes down to focusing on the most vulnerable areas and ensuring the best return on investment of test time. Rules-of-thumb strategies often come into play, such as injecting applicable anomalies prior to, during, and after system state changes; or, creating cases that ensure good safety-net algorithm coverage. Although experience and judgment in test selection can lead to high levels of confidence about the majority of a system's autonomy, it's likely that important test cases are overlooked. One method to fill in potential test coverage gaps is to automatically generate and execute test cases using algorithms that ensure desirable properties about the coverage. For example, generate cases for all possible fault monitors, and across all state change boundaries. Of course, the scope of coverage is determined by the test environment capabilities, where a faster-than-real-time, high-fidelity, software-only simulation would allow the broadest coverage. Even real-time systems that can be replicated and run in parallel, and that have reliable set-up and operations features provide an excellent resource for automated testing. Making detailed predictions for the outcome of such tests can be difficult, and when algorithmic means are employed to produce hundreds or even thousands of cases, generating predicts individually is impractical, and generating predicts with tools requires executable models of the design and environment that themselves require a complete test program. Therefore, evaluating the results of large number of mission scenario tests poses special challenges. A good approach to address this problem is to automatically score the results

  1. A business case for Smart Grid technologies: A systemic perspective

    International Nuclear Information System (INIS)

    Giordano, Vincenzo; Fulli, Gianluca

    2012-01-01

    The digitalization of the electricity grid opens the way to bundle value added services to the electricity commodity, and possibly shift business value to electricity services in line with the notions of efficiency, conservation and sustainability. In this context, market forces should be mobilized within the boundaries of energy policy goals to contribute to the massive investments that are required to fulfill the Smart Grid vision. In this paper, we present a systemic perspective aimed at establishing technical and economic synergies that may improve the business cases of individual different Smart Grid technologies and contribute to reverse the consumption-driven paradigm of the electricity sector. Our analysis is supported by evidence from applications in the electric vehicle and smart meter ecosystems. Throughout the paper, an EU (European Union) perspective is primarily considered. - Highlights: ► We show how the analysis of systemic effects can play a fundamental role in offering a business case to Smart Grid technology and in providing some guidance to new policy interventions and initiatives. ► We base our discussion on two case studies: the set-up of business platforms for (1) Electric Vehicles and E-mobility services and (2) Smart Meters and Smart Home Services. ► We highlight how new business arrangements might leverage technological/business synergies, foster investments and shift business value to electricity services. ► We discuss possible downsides and challenges such as privacy concerns, dominant positions in new business platforms, and consumers' resistance.

  2. Applying of component system development in object methodology, case study

    Directory of Open Access Journals (Sweden)

    Milan Mišovič

    2013-01-01

    Full Text Available To create computarization target software as a component system has been a very strong requirement for the last 20 years of software developing. Finally, the architectural components are self-contained units, presenting not only partial and overall system behavior, but also cooperating with each other on the basis of their interfaces. Among others, components have allowed flexible modification of processes the behavior of which is the foundation of components behavior without changing the life of the component system. On the other hand, the component system makes it possible, at design time, to create numerous new connections between components and thus creating modified system behaviors. This all enables the company management to perform, at design time, required behavioral changes of processes in accordance with the requirements of changing production and market.The development of software which is generally referred to as SDP (Software Development Process contains two directions. The first one, called CBD (Component–Based Development, is dedicated to the development of component–based systems CBS (Component–based System, the second target is the development of software under the influence of SOA (Service–Oriented Architecture. Both directions are equipped with their different development methodologies. The subject of this paper is only the first direction and application of development of component–based systems in its object–oriented methodologies. The requirement of today is to carry out the development of component-based systems in the framework of developed object–oriented methodologies precisely in the way of a dominant style. In some of the known methodologies, however, this development is not completely transparent and is not even recognized as dominant. In some cases, it is corrected by the special meta–integration models of component system development into an object methodology.This paper presents a case study

  3. Societal Constraints, Systemic Disadvantages and Homelessness: An Individual Case Study

    Directory of Open Access Journals (Sweden)

    Carol Kauppi

    2013-10-01

    Full Text Available Research utilizing the individual case study method examined the complex issues related to pathways into and out of home-lessness for an Aboriginal man from a First Nation community on the western James Bay in Canada. This instrumental case study focused on an individual's story, rather than on a site or a group of individuals, an incident or a series of incidents, or a program [6] [15]. First, as a research tool, it provides insight into the issue of homelessness and some of its causes from the perspective of an Aboriginal person. Second, the in-depth data gathered allowed us to understand some of the factors that work and those that do not work in facilitating transitions out of homelessness. Third, as an educational tool, it allows people from the outside to have a better understanding of how systemic disadvantages contribute to individuals falling into homelessness.

  4. Small invasive colon cancer with systemic metastasis: A case report

    Directory of Open Access Journals (Sweden)

    Sakamoto Taku

    2011-05-01

    Full Text Available ABSTRACT Background Recently, especially in Japan, several researchers have suggested that colorectal cancer can develop not only through an adenoma-carcinoma sequence but also from normal mucosa via a de novo pathway, and that these de novo cancers have more aggressive malignant potential. We report a case of aggressive colon cancer resulting in systemic metastasis despite small tumour size. Case Presentation A 35-year-old woman presented at the referring hospital with swelling of the left cervical lymph node. Biopsy of the lymph node revealed metastatic adenocarcinoma; however, CT scan and mammography were unable to identify the site of the primary lesion. She was diagnosed with unknown primary cancer and referred to our hospital for further examination. Immunohistochemical reevaluation showed the cervical lymph node biopsy specimen to be positive for CDX2 and CK20 and negative for CK7 expression, leading us to suspect the presence of a primary colorectal cancer. We performed a total colonoscopy, and detected a small protruding lesion in the transverse colon. The tumour was only 12 mm in diameter, with a central depressed component and a severely thickened stalk, which suggested direct cancer invasion of the deep submucosa. We concluded that this lesion was the site of origin of the metastasis despite the small tumour size, and performed diagnostic endoscopic mucosal resection. The lesion was found to have an intramucosal cancer component, demonstrating that this lesion represented primary colon cancer. The patient was referred to the gastrointestinal oncology division for systemic chemotherapy. Conclusions In this case, immunohistochemical findings strongly suggested the existence of a colorectal cancer. The non-polypoid gross appearance of the tumour suggested that it can originate de novo , thus providing a valuable case in support of the aggressive malignant potential of a de novo colorectal cancer pathway.

  5. TNF-α and CD8+ T cells mediate the beneficial effects of nitric oxide synthase-2 deficiency in pulmonary paracoccidioidomycosis.

    Science.gov (United States)

    Bernardino, Simone; Pina, Adriana; Felonato, Maíra; Costa, Tânia A; Frank de Araújo, Eliseu; Feriotti, Cláudia; Bazan, Silvia Boschi; Keller, Alexandre C; Leite, Katia R M; Calich, Vera L G

    2013-01-01

    Nitric oxide (NO), a key antimicrobial molecule, was previously shown to exert a dual role in paracoccidioidomycosis, an endemic fungal infection in Latin America. In the intravenous and peritoneal models of infection, NO production was associated with efficient fungal clearance but also with non-organized granulomatous lesions. Because paracoccidioidomycosis is a pulmonary infection, we aimed to characterize the role of NO in a pulmonary model of infection. C57Bl/6 wild type (WT) and iNOS(-/-) mice were i.t. infected with 1×10(6) Paracoccidioides brasiliensis yeasts and studied at several post-infection periods. Unexpectedly, at week 2 of infection, iNOS(-/-) mice showed decreased pulmonary fungal burdens associated with an M2-like macrophage profile, which expressed high levels of TGF-β impaired ability of ingesting fungal cells. This early decreased fungal loads were concomitant with increased DTH reactions, enhanced TNF-α synthesis and intense migration of activated macrophages, CD4(+) and CD8(+) T cells into the lungs. By week 10, iNOS(-/-) mice showed increased fungal burdens circumscribed, however, by compact granulomas containing elevated numbers of activated CD4(+) T cells. Importantly, the enhanced immunological reactivity of iNOS(-/-) mice resulted in decreased mortality rates. In both mouse strains, depletion of TNF-α led to non-organized lesions and excessive influx of inflammatory cells into the lungs, but only the iNOS(-/-) mice showed increased mortality rates. In addition, depletion of CD8(+) cells abolished the increased migration of inflammatory cells and decreased the number of TNF-α and IFN-γ CD4(+) and CD8(+) T cells into the lungs of iNOS(-/-) mice. Our study demonstrated that NO plays a deleterious role in pulmonary paracoccidioidomycosis due to its suppressive action on TNF-α production, T cell immunity and organization of lesions resulting in precocious mortality of mice. It was also revealed that uncontrolled fungal growth can be

  6. The Federated Satellite Systems paradigm: Concept and business case evaluation

    Science.gov (United States)

    Golkar, Alessandro; Lluch i Cruz, Ignasi

    2015-06-01

    This paper defines the paradigm of Federated Satellite Systems (FSS) as a novel distributed space systems architecture. FSS are networks of spacecraft trading previously inefficiently allocated and unused resources such as downlink bandwidth, storage, processing power, and instrument time. FSS holds the promise to enhance cost-effectiveness, performance and reliability of existing and future space missions, by networking different missions and effectively creating a pool of resources to exchange between participants in the federation. This paper introduces and describes the FSS paradigm, and develops an approach integrating mission analysis and economic assessments to evaluate the feasibility of the business case of FSS. The approach is demonstrated on a case study on opportunities enabled by FSS to enhance space exploration programs, with particular reference to the International Space Station. The application of the proposed methodology shows that the FSS concept is potentially able to create large commercial markets of in-space resources, by providing the technical platform to offer the opportunity for spacecraft to share or make use of unused resources within their orbital neighborhood. It is shown how the concept is beneficial to satellite operators, space agencies, and other stakeholders of the space industry to more flexibly interoperate space systems as a portfolio of assets, allowing unprecedented collaboration among heterogeneous types of missions.

  7. Evaluation of in situ expression of effector and regulatory cytokines, TLR, galectins and matrix metalloproteinases in oral manifestations of paracoccidioidomycosis.

    Science.gov (United States)

    de Araújo, Marcelo Sivieri; Alves, Polyanna Miranda; de Lima, Lilian Margareth Biagioni; da Silva, Marcelo Fernandes; de Lima Pereira, Sanívia Aparecida; Rodrigues, Virmondes; Rodrigues, Denise Bertulucci Rocha

    2015-01-01

    Although the pathophysiology of paracoccidioidomycosis (PCM) is not completely understood, the study of immune response against fungus has provided insight into understanding the natural course of the disease and its clinical manifestations, hence contributing to the development of preventive measures and treatment proposals. The aim of this study was to evaluate the histopathological and immunological aspects involved in the role of different effector and regulatory responses, as well as the correlation between the TLRs, Galectins, Matrix Metalloproteinases and cytoplasmic proteases of mast cells in this infection. Sixteen biopsy specimens with oral lesions of chronic PCM, as well as 13 sections of normal oral mucosa were analyzed. Histopathological and immunological aspects involved in the role of different effector and regulatory responses were evaluated. Indirect immunohistochemistry was performed for IL-17, IL-10, IL-4, TGF-β, FoxP3, Gal-1, Gal-3, Gal-9, TLR-2, TLR-4, MMP-3 and MMP-9, as well as for chymase and tryptase for mast cells identification. Fibrosis was quantified using Picrosirius. There was a significant increase in the area of fibrosis and in the number of cells expressing IL-10, IL-4, IL-17, FoxP3, Gal-3, TLR-2, MMP3 and MMP9 in patients with PCM in comparison with patients in the group control. There was no difference in the expression of TGF-β, TLR-4, Gal-1 or Gal-9. Mast cells number was found to be significantly lower in oral chronic PCM when compared to control samples after quantification of mast cells and expression of chymase and tryptase. PCM granulomas were classified to the morphological aspects in organized ou non-organized. Expression of IL-4 in non-organized granulomas was significantly higher. The proteins studied herein appear to play an important role in the development and maintenance of oral lesions of PCM, as well as in the processes of development and progression of lesions caused by the fungus and by the immune response

  8. NOD-Like Receptor P3 Inflammasome Controls Protective Th1/Th17 Immunity against Pulmonary Paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Claudia Feriotti

    2017-07-01

    Full Text Available The NOD-like receptor P3 (NLRP3 inflammasome is an intracellular multimeric complex that triggers the activation of inflammatory caspases and the maturation of IL-1β and IL-18, important cytokines for the innate immune response against pathogens. The functional NLRP3 inflammasome complex consists of NLRP3, the adaptor protein apoptosis-associated speck-like protein, and caspase-1. Various molecular mechanisms were associated with NLRP3 activation including the presence of extracellular ATP, recognized by the cell surface P2X7 receptor (P2X7R. Several pattern recognition receptors on innate immune cells recognize Paracoccidioides brasiliensis components resulting in diverse responses that influence adaptive immunity and disease outcome. However, the role of NLRP3 inflammasome was scantily investigated in pulmonary paracoccidioidomycosis (PCM, leading us to use an intratracheal (i.t. model of infection to study the influence of this receptor in anti-fungal immunity and severity of infection. For in vivo studies, C57BL/6 mice deficient for several NLRP3 inflammasome components (Nlrp3−/−, Casp1/11−/−, Asc−/− as well as deficient for ATP receptor (P2x7r−/− were infected via i.t. with P. brasiliensis and several parameters of immunity and disease severity analyzed at the acute and chronic periods of infection. Pulmonary PCM was more severe in Nlrp3−/−, Casp1/11−/−, Asc−/−, and P2x7r−/− mice as demonstrated by the increased fungal burdens, mortality rates and tissue pathology developed. The more severe disease developed by NLRP3, ASC, and Caspase-1/11 deficient mice was associated with decreased production of IL-1β and IL-18 and reduced inflammatory reactions mediated by PMN leukocytes and activated CD4+ and CD8+ T cells. The decreased T cell immunity was concomitant with increased expansion of CD4+CD25+Foxp3 regulatory T (Treg cells. Characterization of intracellular cytokines showed a persistent reduction of CD4+ and

  9. Avaliação Do Tratamento Da Paracoccidioidomicose Com O Ketoconazol Evaluation of ketoconazole in the treatment of paracoccidioidomycosis

    Directory of Open Access Journals (Sweden)

    Jussara Marcondes

    1984-04-01

    Full Text Available Foram, tratados 12 doentes atendidos na Disciplina de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina de Botucatu com diagnóstico etiológico de paracoccidioidomicose que apresentavam lesões orgânicas múltiplas e evolução prolongada. O tratamento foi realizado por 18 meses, com o ketoconazol, pela via oral, nas doses diárias de 400 mg no primeiro mês e de 200 mg nos meses seguintes. Todos os doentes foram acompanhados durante o tratamento e, em média 4 meses e meio após o mesmo, clínica, radiológica e sorologicamente pelas reações de imunofluorescência indireta, precipitinas e imunodifusão em gel. A competência imunitária foi avaliada em todos os doentes antes do tratamento e repetida em quatro, no final do mesmo. Os resultados mostraram que houve recaída em 5 doentes. A droga foi bem tolerada e a imunodifusão em gel e a hemossedimentação foram as provas que mostraram maior paralelismo com a evolução clínica.Twelve patients with chronical and sistemic lesions due to paracoccidioidomycosis were treated with Ketoconazole. The treatment lasted for 18 months and the Ketoconazole was ad ministered by oral route, in a once a day do sage of 400 mg during the first month and of 200 mg in the next 17 months. All patients were evaluated in the course of the treatment as well as for 135 days after the end of it, by means of clinical picture, chest X-Ray and serological tests. The immune response was observed in all patients before the treatment and in 4 of them at the end of it. Results showed that there was recrudescence in 5 patients and side effect was observed in only one patient (pruritus. The agar-gel difusion and the sedimentation rate were the laboratorial findings which paralleled the best the clinical picture.

  10. Making the Case for Reusable Booster Systems: The Operations Perspective

    Science.gov (United States)

    Zapata, Edgar

    2012-01-01

    Presentation to the Aeronautics Space Engineering Board National Research Council Reusable Booster System: Review and Assessment Committee. Addresses: the criteria and assumptions used in the formulation of current RBS plans; the methodologies used in the current cost estimates for RBS; the modeling methodology used to frame the business case for an RBS capability including: the data used in the analysis, the models' robustness if new data become available, and the impact of unclassified government data that was previously unavailable and which will be supplied by the USAF; the technical maturity of key elements critical to RBS implementation and the ability of current technology development plans to meet technical readiness milestones.

  11. Dynamics of Technological Innovation Systems. The Case of Biomass Energy

    International Nuclear Information System (INIS)

    Negro, S.O.

    2007-01-01

    The starting point is that the current energy system largely depends on fossil fuels. This phenomenon, which is labelled as carbon lock-in, causes a long breakthrough period for renewable energy. The most suitable theoretical approach to analyse the development, diffusion and implementation of emergent technologies, such as renewable energy, is the Technological Innovation Systems' (TIS) perspective. This approach focuses on a particular technology and includes all those factors (institutions, actors, and networks) that influence its development. Recent research has identified several so-called System Functions that need to be fulfilled for a TIS to support successfully the evolution of a technology. In this paper we will use the following set of System Functions: F1: Entrepreneurial Activities, F2: Knowledge Development (learning), F3: Knowledge Diffusion through Networks, F4: Guidance of the Search, F5: Market Formation, F6: Resources Mobilisation, F7: Counteracting Resistance to Change (also Support from Advocacy Coalitions). By focusing on the System Functions the key processes that occur in a system which influence the development, diffusion and implementation of that technology will be identified and insight will be gained in the system dynamics. The System Functions are not independent but interact and influence each other. The nature of interactions whether they are positive or negative will influence the performance of the system respectively. Positive System Function fulfilment can lead to positive, i.e. virtuous cycles of processes that strengthen each other and lead to the building up of momentum that creates a process of creative destruction within the incumbent system. According to the same reasoning, a system in decline is characterised by one or more vicious cycles, where the System Functions interact and reinforce each other in a negative way. The results from the case studies showed that different functional patterns occurred for the Biomass

  12. Signal Analysis of Automotive Engine Spark Ignition System using Case-Based Reasoning (CBR) and Case-based Maintenance (CBM)

    International Nuclear Information System (INIS)

    Huang, H.; Vong, C. M.; Wong, P. K.

    2010-01-01

    With the development of modern technology, modern vehicles adopt electronic control system for injection and ignition. In traditional way, whenever there is any malfunctioning in an automotive engine, an automotive mechanic usually performs a diagnosis in the ignition system of the engine to check any exceptional symptoms. In this paper, we present a case-based reasoning (CBR) approach to help solve human diagnosis problem. Nevertheless, one drawback of CBR system is that the case library will be expanded gradually after repeatedly running the system, which may cause inaccuracy and longer time for the CBR retrieval. To tackle this problem, case-based maintenance (CBM) framework is employed so that the case library of the CBR system will be compressed by clustering to produce a set of representative cases. As a result, the performance (in retrieval accuracy and time) of the whole CBR system can be improved.

  13. CRM system benefits : A case study of banking sector

    OpenAIRE

    Murrawat, Adnan; Nasershariati, Foroozan

    2011-01-01

    Seminar Date: 05-11-2011 Level: Master Thesis in Information Technology Management,   15ECTS Institution: School of Sustainable Development of Society and Technology, Malardalen University Authors: Adnan Murrawat Khan [amt1001]         Foroozan Nasershariati [fni10002]                                              Title: CRM system benefits, a case study of banking sector Supervisor: Dr Ole Liljefors Problem statement: Customer relationship management (CRM) systems have been adopted to have b...

  14. ERP System for Custom Tailoring: A Case Study

    Directory of Open Access Journals (Sweden)

    Petr Sodomka

    2017-04-01

    Full Text Available The Case Study deals with the implementation and use of a global ERP system in Bernhardt Fashion CZ, which is one of the leading custom garment manufacturers in the market. The study describes the way this prestigious company has utilized a global ERP product to standardize a part of its processes as well as the areas that needed to be modified or custom adjusted. The crucial part of the study comprises a detailed description of key processes and their automation requirements that are specific in the clothing industry. Moreover, the study includes a complex evaluation of achieved benefits and significant functional improvements the company has developed by using the new system.

  15. A shaped charge system for well casing perforating

    Energy Technology Data Exchange (ETDEWEB)

    Raymond, J.R.

    1958-10-06

    Water wells drilled in the Hanford Works area for water quality monitoring, water level determination and geologic information demand use of steel casing. This casing is required due to the inability of the unconsolidated sediments penetrated by the well to stand without support. It is obvious that openings in the casing must be provided to permit free communication with the water bearing formation if the well is to be useful for water quality determination, aquifer testing and water level information. A shaped charge system originally designed for oil well squeeze cementing was adapted for non-routine re-perforating of Hanford water wells. Ten-gram shaped charges developed by Jet Research Center, Arlington, Texas are utilized. The charge carrier is a special 5`` diameter, 5` long heavy-wall steel tube. This carrier or gun is so designed that in each plane of shots there are four horizontal charges placed at 90{degree} angles. These shot planes are placed 3`` apart and successive shot planes are phased at 45{degree} angles with respect to each other. A maximum of 16 perforations per foot may be made and a maximum of four feet perforated with one carrier. Tandem or multiple runs may be made if greater length and density is desired.

  16. A Human Proximity Operations System test case validation approach

    Science.gov (United States)

    Huber, Justin; Straub, Jeremy

    A Human Proximity Operations System (HPOS) poses numerous risks in a real world environment. These risks range from mundane tasks such as avoiding walls and fixed obstacles to the critical need to keep people and processes safe in the context of the HPOS's situation-specific decision making. Validating the performance of an HPOS, which must operate in a real-world environment, is an ill posed problem due to the complexity that is introduced by erratic (non-computer) actors. In order to prove the HPOS's usefulness, test cases must be generated to simulate possible actions of these actors, so the HPOS can be shown to be able perform safely in environments where it will be operated. The HPOS must demonstrate its ability to be as safe as a human, across a wide range of foreseeable circumstances. This paper evaluates the use of test cases to validate HPOS performance and utility. It considers an HPOS's safe performance in the context of a common human activity, moving through a crowded corridor, and extrapolates (based on this) to the suitability of using test cases for AI validation in other areas of prospective application.

  17. Hybrid Genetic Algorithm Optimization for Case Based Reasoning Systems

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2008-01-01

    The success of a CBR system largely depen ds on an effective retrieval of useful prior case for the problem. Nearest neighbor and induction are the main CBR retrieval algorithms. Each of them can be more suitable in different situations. Integrated the two retrieval algorithms can catch the advantages of both of them. But, they still have some limitations facing the induction retrieval algorithm when dealing with a noisy data, a large number of irrelevant features, and different types of data. This research utilizes a hybrid approach using genetic algorithms (GAs) to case-based induction retrieval of the integrated nearest neighbor - induction algorithm in an attempt to overcome these limitations and increase the overall classification accuracy. GAs can be used to optimize the search space of all the possible subsets of the features set. It can deal with the irrelevant and noisy features while still achieving a significant improvement of the retrieval accuracy. Therefore, the proposed CBR-GA introduces an effective general purpose retrieval algorithm that can improve the performance of CBR systems. It can be applied in many application areas. CBR-GA has proven its success when applied for different problems in real-life

  18. Building a comprehensive geriatric health care system: a case study.

    Science.gov (United States)

    Bleiweiss, L; Simson, S

    1976-01-01

    This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

  19. [Gastrointestinal manifestations of systemic lupus erythematosus. Case report].

    Science.gov (United States)

    Zietkiewicz, Marcin; Smoleńska, Zaneta; Zdrojewski, Zbigniew

    2010-01-01

    Systemic lupus erythematosus (SLE) is an inflammatory connective tissue disease with an autoimmune background, involving various organs and systems during its course. The most important and characteristic clinical manifestations have been included in the revised diagnostic criteria for the classification of SLE published by the American College of Rheumatology (ACR) in 1987. One of them is oral ulceration which occurs in 50% of SLE patients. Oral ulcers and other gastrointestinal complaints such as dyspepsia, abdominal pain and diarrhea, usually attributed to the side-effects of medications, are among the most frequent symptoms in patients with lupus. We report the case of a 42-year-old female suffering from long-standing lupus with kidney and joint involvement, who developed abdominal pain, diarrhea, edema, and cachexia. Our case illustrates the difficulties encountered when searching for the cause of gastrointestinal symptoms. Attention during diagnosis should be given to rare gastrointestinal manifestations of SLE, such as intestinal pseudo-obstruction (IPO) and protein-losing enteropathy (PLE).

  20. Case study field evaluation of a systems approach to retrofitting a residential HVAC system

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.; McWiliams, Jennifer A.; Konopacki, Steven J.

    2003-09-01

    This case study focusing on a residence in northern California was undertaken as a demonstration of the potential of a systems approach to HVAC retrofits. The systems approach means that other retrofits that can affect the HVAC system are also considered. For example, added building envelope insulation reduces building loads so that smaller capacity HVAC system can be used. Secondly, we wanted to examine the practical issues and interactions with contractors and code officials required to accomplish the systems approach because it represents a departure from current practice. We identified problems in the processes of communication and installation of the retrofit that led to compromises in the final energy efficiency of the HVAC system. These issues must be overcome in order for HVAC retrofits to deliver the increased performance that they promise. The experience gained in this case study was used to optimize best practices guidelines for contractors (Walker 2003) that include building diagnostics and checklists as tools to assist in ensuring the energy efficiency of ''house as a system'' HVAC retrofits. The best practices guidelines proved to be an excellent tool for evaluating the eight existing homes in this study, and we received positive feedback from many potential users who reviewed and used them. In addition, we were able to substantially improve the energy efficiency of the retrofitted case study house by adding envelope insulation, a more efficient furnace and air conditioner, an economizer and by reducing duct leakage.

  1. Assessment of hospital information systems implementation: a case study.

    Science.gov (United States)

    Zikos, Dimitrios; Mitsios, Athanasios; Mantas, John

    2011-01-01

    The use of integrated Hospital Information Systems is related with many benefits for the healthcare system, increasing the effectiveness of the provided services and assuring quality of care. Aim of this study is to investigate the types of Information Systems, the level of integration and the problems identified during the implementation phase, in three public hospitals. The above are expected to contribute to the understanding of the organizational, human resource and technical factors related with the successful implementation of a hospital IS. In order to investigate those elements, an assessment questionnaire was developed and completed by nine hospitals IT employees of the three hospitals. In addition, open interviews were organized with the same employees to further formulate an overall aspect, while in one hospital case, observation and discussion with four different categories of involved staff was undertaken. It was found that the implementation problems are mainly related with the underfunding, inadequate use of standards, lack of skilled IT experts, insufficiently trained personnel and users' reserve. The problems may be tackled with a supportive hospital administration committed to the successful implementation. The external contracting company working on its own, without any participation of the hospital IT department seems to be a failure recipe. It is evident that an active management support and skillful hospital IT employees, are expected to result to success stories during the implementation of integrated hospital information systems.

  2. Myeloid Dendritic Cells (DCs) of Mice Susceptible to Paracoccidioidomycosis Suppress T Cell Responses whereas Myeloid and Plasmacytoid DCs from Resistant Mice Induce Effector and Regulatory T Cells

    Science.gov (United States)

    Pina, Adriana; Frank de Araujo, Eliseu; Felonato, Maíra; Loures, Flávio V.; Feriotti, Claudia; Bernardino, Simone; Barbuto, José Alexandre M.

    2013-01-01

    The protective adaptive immune response in paracoccidioidomycosis, a mycosis endemic among humans, is mediated by T cell immunity, whereas impaired T cell responses are associated with severe, progressive disease. The early host response to Paracoccidioides brasiliensis infection is not known since the disease is diagnosed at later phases of infection. Our laboratory established a murine model of infection where susceptible mice reproduce the severe disease, while resistant mice develop a mild infection. This work aimed to characterize the influence of dendritic cells in the innate and adaptive immunity of susceptible and resistant mice. We verified that P. brasiliensis infection induced in bone marrow-derived dendritic cells (DCs) of susceptible mice a prevalent proinflammatory myeloid phenotype that secreted high levels of interleukin-12 (IL-12), tumor necrosis factor alpha, and IL-β, whereas in resistant mice, a mixed population of myeloid and plasmacytoid DCs secreting proinflammatory cytokines and expressing elevated levels of secreted and membrane-bound transforming growth factor β was observed. In proliferation assays, the proinflammatory DCs from B10.A mice induced anergy of naïve T cells, whereas the mixed DC subsets from resistant mice induced the concomitant proliferation of effector and regulatory T cells (Tregs). Equivalent results were observed during pulmonary infection. The susceptible mice displayed preferential expansion of proinflammatory myeloid DCs, resulting in impaired proliferation of effector T cells. Conversely, the resistant mice developed myeloid and plasmacytoid DCs that efficiently expanded gamma interferon-, IL-4-, and IL-17-positive effector T cells associated with increased development of Tregs. Our work highlights the deleterious effect of excessive innate proinflammatory reactions and provides new evidence for the importance of immunomodulation during pulmonary paracoccidioidomycosis. PMID:23340311

  3. Activity of two different triazoles in a murine model of paracoccidioidomycosis Actividad de dos triazoles diferentes en un modelo murino de paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Susana Restrepo

    1992-04-01

    Full Text Available A new orally absorbable triazole (Schering 39304 with a long serum half-life in man (60 hours, was tried in a murine model of progressive paracoccidioidomycosis and compared with itraconazole, another triazole which has proven effective in this mycosis. Only 15% of the infected, untreated mice survived while 53 to 75% of the animals receiving itraconazole survived. Mice treated with Schering 39304 exhibited higher (86 - 100% survival rates. Statistically, the 5 mg/kg Sch 39304 was superior to the 50 mg/kg itraconazole dose. Lung cultures showed that 20 mg/kg/day of Sch achieved sterilization of the infectious foci. These results indicate that the new triazole will have a place in the treatment of paracoccidioidomycosisUn nuevo derivado triazólico Schering 39304 que tiene una vida promedio prolongada (60 horas, asi como otro triazol (itraconazole de eficacia comprobada en la paracoccidioidomicosis, fueron ensayados en un modelo murino. Se encontró que solo sobrevivían el 15% de los animales infectados no tratados; del grupo tratado con Itrazonazol sobrevivieron el 53% de los que recibieron 20 mg/kg/dia y el 86% de aquellos con 50 mg/kg/dia. De los ratones que recibieron Sch 39304 sobrevivieron el 86% de los tratados con la dosis baja (5 mg/kg y el 100% con la dosis mayor (20 mg/kg. Se encontraron diferencias estadísticamente significativas entre esta última droga y el itraconazol. Además, los cultivos de pulmón mostraron que solo Sch 39304 a la dosis alta, era capaz de erradicar el hongo de los tejidos. Estos resultados indican que tal triazol tendrá importancia en el tratamiento de la paracoccidioidomicosis humana

  4. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006.

    Science.gov (United States)

    Prado, Marli; Silva, Marcelo Barbosa da; Laurenti, Ruy; Travassos, Luiz R; Taborda, Carlos P

    2009-05-01

    Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (approximately 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

  5. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006

    Directory of Open Access Journals (Sweden)

    Marli Prado

    2009-05-01

    Full Text Available Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (~ 51.2%. When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9% appeared at the top of the list, followed by candidiasis (30.2%, histoplasmosis (10.1% and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

  6. Hotel Classification Systems: A Comparison of International Case Studies

    Directory of Open Access Journals (Sweden)

    Roberta Minazzi,

    2010-12-01

    Full Text Available Over the last few decades we have witnessed an increasing interest of scholars andespecially operators in service quality in the lodging business. Firstly, it is important to observe thatthe diverseness of the hospitality industry also affects the classification of hotel quality. We canactually find many programmes, classifications and seals of quality promoted by public authoritiesand private companies that create confusion in the consumer perceptions of hotel quality. Moreover,new electronic distribution channels and their ratings are becoming a new way to gather informationabout a hotel and its quality. Secondly, a point that can cause complications is that different countriesand regions can choose differing approaches depending on the features of the classification (numberof levels, symbols used, etc. and the nature of the programme (public, private. Considering theseassumptions and the recent changes in the Italian hotel classification system, this paper aims toanalyse the situation in Italy, underlining both its positive and negative aspects and comparing it withother European and North American cases. Based on a review of literature and tourism laws as wellas personal interviews with public authorities and exponents of the private sectors, we were able toidentify critical issues and trends in hotel classification systems. The comparison of case studiesshows a heterogeneous situation. Points in common are the scale and the symbol used but, if weanalyse the requirements of each category, we discover very different circumstances, also sometimesin the same country. A future European classification system could be possible only after astandardization of minimum requirements and criteria at a national level. In this situation brands andonline consumers’ feedbacks become even more considered by the customers in the hospitalityindustry.

  7. Restrained Integration of European Case Reports in Danish Information Systems and Culture

    DEFF Research Database (Denmark)

    Gøtze, Michael; Olsen, Henrik Palmer

    2011-01-01

    Danish Publication of European Case Law, EU Law, European Human Rights Law, Selective Danish Information Systems, Legal Knowledge......Danish Publication of European Case Law, EU Law, European Human Rights Law, Selective Danish Information Systems, Legal Knowledge...

  8. Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Leigh R. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-09-01

    This document was prepared to meet FCR&D level 3 milestone M3FT-14IN0304022, “Perform Thermodynamics Measurements on Fuel Cycle Case Study Systems.” This work was carried out under the auspices of the Thermodynamics and Kinetics FCR&D work package. This document reports preliminary work in support of determining the thermodynamic parameters for the ALSEP process. The ALSEP process is a mixed extractant system comprised of a cation exchanger 2-ethylhexyl-phosphonic acid mono-2-ethylhexyl ester (HEH[EHP]) and a neutral solvating extractant N,N,N’,N’-tetraoctyldiglycolamide (TODGA). The extractant combination produces complex organic phase chemistry that is challenging for traditional measurement techniques. To neutralize the complexity, temperature dependent solvent extraction experiments were conducted with neat TODGA and scaled down concentrations of the ALSEP formulation to determine the enthalpies of extraction for the two conditions. A full set of thermodynamic data for Eu, Am, and Cm extraction by TODGA from 3.0 M HNO3 is reported. These data are compared to previous extraction results from a 1.0 M HNO3 aqueous medium, and a short discussion of the mixed HEH[EHP]/TODGA system results is offered.

  9. Managing urban energy system: A case of Suzhou in China

    International Nuclear Information System (INIS)

    Liang Sai; Zhang Tianzhu

    2011-01-01

    Managing urban energy system is vital for energy conservation and CO 2 reduction. Integrating energy input-output model with carbon emission pinch analysis, we propose a framework for managing urban energy system. This framework could analyze current energy demands and CO 2 emissions, predict their future possibilities and optimize energy mix of key sectors under CO 2 emission constraints. Key sectors are identified by the energy input-output table from both direct and accumulative perspectives. Moreover, taking Suzhou, a typical manufacturing center and export-oriented city in China, as a case example, energy metabolism of Suzhou in 2020 is predicted using energy input-output model. And three sectors named Coking, Smelting and pressing of metals and Production and supply of electric power are identified to have big effects on CO 2 emissions. Subsequently, energy mix of three identified key sectors is optimized under CO 2 emission constraints by the carbon emission pinch analysis. According to the results, clean energy sources will occupy a great position in Suzhou's future energy demands. And the reuse of wastes as energy sources should be limited to achieve CO 2 mitigation targets. Finally, policy implications of results and future work are discussed. - Research highlights: → We construct a framework for sustainable energy system management. → We apply the framework in a typical manufacturing center named Suzhou in China. → Key sectors for CO 2 emissions are identified, and energy mix is optimized. → Policy implications of results and future work are discussed.

  10. Paracoccidioidomicosis asociada a otras patologías respiratorias en un hospital de Corrientes, Argentina Association of paracoccidioidomycosis with different pulmonary pathologies in a hospital in Corrientes province, Argentina

    Directory of Open Access Journals (Sweden)

    A. M. Pato

    2007-09-01

    Full Text Available Se realizó la búsqueda sistemática de paracoccidioidomicosis (PCM en un conjunto de pacientes que fueron atendidos en un hospital de la ciudad de Corrientes dentro de un período de dos años. El criterio de inclusión fue: pacientes con tuberculosis (TBC, pacientes con diagnóstico presuntivo o confirmado de cáncer de pulmón (CA, pacientes con enfermedad pulmonar obstructiva crónica (EPOC y pacientes con imagen radiológica compatible con micosis pulmonar (IRXC. Se estudiaron 84 pacientes: 57 con TBC, 1 con CA, 5 con EPOC, 3 con TBC+CA, 4 con TBC+EPOC, 4 con EPOC+CA y 10 con IRXC. A todos se les realizó serología por inmunodifusión en gel de agar (IDGA y, en los casos en que se pudo obtener una muestra clínica, también se efectuaron estudios microbiológicos. Por IDGA se diagnosticaron 10 casos de PCM: 4 asociados a TBC, 1 a TBC+CA, 3 a EPOC y 2 a IRXC; 9 de ellos se corroboraron por el hallazgo del hongo. La búsqueda sistemática de PCM en habitantes del área endémica que presentan patología pulmonar favorecería el diagnóstico precoz y, por lo tanto, las posibilidades de un tratamiento eficaz.For 2 years, a systematic research of paracoccidioidomycosis (PCM had been conducted in a hospital in the city of Corrientes. The inclusion criterium used was: tuberculosis patients (TBC, presumptive or confirmed diagnosis of pulmonary cancer (CA, chronic obstructive pulmonary disease (COPD and/or X-ray images compatible with pulmonary mycosis (XRC. Eighty four patients were studied: 57 (TBC, 1 (CA, 5 (COPD, 3 (TBC+CA, 4 (TBC+COPD, 4 (COPD+CA and 10 (XRC. Serology tests by agar gel immunodiffusion (IDGA were performed on all patients, whereas microbiological studies were performed on those cases in which clinical samples could be obtained. Ten PCM were diagnosed by IDGA; 4 associated to TBC, 1 to TBC+CA, 3 to COPD and only 2 to XRC. PCM was mycologically proven in 9 of these cases. Systematic research of PCM would lead to an early

  11. Breast systemic follicular lymphoma in a man: a case report

    Directory of Open Access Journals (Sweden)

    La Mantia Elvira

    2012-07-01

    Full Text Available Abstract Introduction Breast involvement by non-Hodgkin lymphoma is particularly rare in men. We describe the case of a patient with a rapidly growing, painless gynecomastia-like nodule in the left breast. On ultrasonography, the nodule was suspicious for breast carcinoma. Case presentation A breast biopsy from a 54-year-old Caucasian man showed the morphoimmunophenotypical features of grade 3 follicular lymphoma. Moreover, fluorescence in situ hybridization analysis showed a t(14,18 translocation suggesting breast involvement by a systemic lymphoma rather than a primary breast lymphoma. The histological diagnosis was subsequently confirmed after nodule excision. Mediastinal and abdominal node involvement was then identified on computed tomography and positron emission tomography scans during staging examinations. Our patient was treated with chemotherapy. After three years our patient experienced a right retro-areolar relapse. He then received two further cycles of chemotherapy but developed a myeloid acute leukemia and, as a result of this, he subsequently died. Conclusions The rarity of breast lymphomas, especially in men, and the problems related to the therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis.

  12. INDICATORS FOR SUSTAINABILITY IN INDUSTRIAL SYSTEMS CASE STUDY: PAPER MANUFACTURING

    Directory of Open Access Journals (Sweden)

    Maria Emiliana Fortună

    2011-12-01

    Full Text Available The paper describes a framework for promoting sustainability by using indicators for sustainable production. The concept of sustainable production is described as it is viewed by various organisms actions involved in the analysis of the sustainable industrial systems.The measure of sustainability is approached considering indicators of sustainable production, addressing both their dimensions and qualitative and quantitative features.The proposed framework refines the sustainability dimension for a case study which envisages sustainability in paper manufacturing. The analysis takes into account the life cycle analysis for the considered process since the environmental impact is seen as an essential sustainability indicator. Paper recycling and reuse is associated environmental and social costs, as a preferred alternative in waste minimization hierarchy in the manufacturing of non-trees eco-friendly paper.Proactive initiatives to improve the environmental performances of production process are considered as powerful tools for improving the paper manufacturing environmental footprint.

  13. Field induced order in magnetic systems: Marginal case

    Energy Technology Data Exchange (ETDEWEB)

    Reyes, D., E-mail: daniel@cbpf.b [Centro Brasileiro de Pesquisas Fisicas - Rua Dr. Xavier Sigaud, 150-Urca, 22290-180 RJ (Brazil); Continentino, M.A. [Instituto de Fisica, Universidade Federal Fluminense, Campus da Praia Vermelha, Niteroi, RJ 24.210-340 (Brazil)

    2009-10-15

    The bond operator representation and the one-loop renormalization group treatment are used to study the spin-1 Heisenberg antiferromagnetic with single-ion anisotropy and transversal magnetic fields in three-dimensional cubic lattices. We start from a disordered spin-liquid phase to an ordered phase, at a critical field H{sub c1} above which the system enters an XY-antiferromagnetic phase. This transition is interpreted as belonging to a universality class with a dynamical critical exponent z=1. In this marginal case logarithmic corrections are found to the physical quantities. These theoretical predictions are compared with the scaling of the magnetization as a function of field and temperature for the organic compound NiCl{sub 2}-4SC(NH{sub 2}){sub 2}.

  14. Systemic Lupus Erythematosus with Hepatosplenic Granuloma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Anju Bharti

    2014-01-01

    Full Text Available Background. Systemic lupus erythematosus (SLE is an autoimmune disease which is known to present with a wide variety of clinical manifestations. Case Report. A 15-year-old male presented with complaints of moderate grade fever and generalized body swelling. There was no history of cough, weight loss, joint pain, oral ulcerations, skin rash, photosensitivity, loss of hair, pain abdomen, jaundice, or any significant illness in the past. Contrast enhanced computerized tomography of the abdomen revealed hypodense lesions in both liver and spleen (without contrast enhancement, suggestive of granulomas along with few retroperitoneal and mesenteric lymph nodes. On the basis of immunological tests and renal biopsy report, SLE with hepatosplenic granulomatosis diagnosis was made. He was given pulse methylprednisolone 500 mg, for 3 days and he showed dramatic improvement clinically. Conclusion. Hepatic and splenic granulomas are not common in SLE, but this should be kept in differential diagnosis.

  15. Systemic lupus erythematosus with hepatosplenic granuloma: a rare case.

    Science.gov (United States)

    Bharti, Anju; Meena, Lalit Prashant

    2014-01-01

    Background. Systemic lupus erythematosus (SLE) is an autoimmune disease which is known to present with a wide variety of clinical manifestations. Case Report. A 15-year-old male presented with complaints of moderate grade fever and generalized body swelling. There was no history of cough, weight loss, joint pain, oral ulcerations, skin rash, photosensitivity, loss of hair, pain abdomen, jaundice, or any significant illness in the past. Contrast enhanced computerized tomography of the abdomen revealed hypodense lesions in both liver and spleen (without contrast enhancement), suggestive of granulomas along with few retroperitoneal and mesenteric lymph nodes. On the basis of immunological tests and renal biopsy report, SLE with hepatosplenic granulomatosis diagnosis was made. He was given pulse methylprednisolone 500 mg, for 3 days and he showed dramatic improvement clinically. Conclusion. Hepatic and splenic granulomas are not common in SLE, but this should be kept in differential diagnosis.

  16. COMPLEXITY OF ECOLOGICAL SYSTEMS (THE CASE OF MARINE CILIATE COMMUNITY

    Directory of Open Access Journals (Sweden)

    I.V. Burkovsky

    2016-03-01

    Full Text Available The paper analyzes the seasonal and long-term dynamics of marine interstitial ciliates communities as a result of the processes of system self-organization (of increasing complexity in constantly fluctuating environment. The traits of simple structure of ciliate community include substantial variability in the composition (even in case of stable environment and the lack of sustainable combinations of species. The mechanism of the current state maintenance is the lack of energy supply in certain periods or in specific loci of space, as well as large amplitude and unpredictable fluctuations of environmental factors. An indication of the community’s complexity is availability of stable combinations of species in time and space. The mechanisms of formation of stable species combinations are a constant flow of external energy, optimal values and stability of environmental factors (including repeatability of seasonal cycles and the use of space resources by species according the principle of complementarity of ecological niches.

  17. Emergent nested systems a theory of understanding and influencing complex systems as well as case studies in urban systems

    CERN Document Server

    Walloth, Christian

    2016-01-01

    This book presents a theory as well as methods to understand and to purposively influence complex systems. It suggests a theory of complex systems as nested systems, i. e. systems that enclose other systems and that are simultaneously enclosed by even other systems. According to the theory presented, each enclosing system emerges through time from the generative activities of the systems they enclose. Systems are nested and often emerge unplanned, and every system of high dynamics is enclosed by a system of slower dynamics. An understanding of systems with faster dynamics, which are always guided by systems of slower dynamics, opens up not only new ways to understanding systems, but also to effectively influence them. The aim and subject of this book is to lay out these thoughts and explain their relevance to the purposive development of complex systems, which are exemplified in case studies from an urban system. The interested reader, who is not required to be familiar with system-theoretical concepts or wit...

  18. Systemic Mastocytosis: A Rare Case of Increased Liver Stiffness

    Directory of Open Access Journals (Sweden)

    Stefanie Adolf

    2012-01-01

    Full Text Available Assessment of liver stiffness (LS by transient elastography (Fibroscan has significantly improved the noninvasive diagnosis of liver fibrosis. We here report on a 55-year-old patient with drastically increased LS due to previously unknown systemic mastocytosis. The patient initially presented with increased weight loss, nocturnal pruritus, increased transaminases, bilirubinemia, and thrombocytopenia. Abdominal ultrasound showed ascites, hepatomegaly, and splenomegaly. In addition, LS was 75 kPa (IQR 0 kPa clearly exceeding the cut-off value for F4 cirrhosis of 12.5 kPa. However, histological analysis of the liver specimen indicated liver involvement by systemic mastocytosis and excluded liver cirrhosis. An additional CT scan detected disseminated bone lesions. After three months of treatment with Midostaurin, LS slightly decreased down to 31.9 kPa (IQR 8.3 kPa. This case illustrates that diffused sinusoidal neoplastic infiltrates are a pitfall in the non-invasive diagnosis of liver cirrhosis. In conclusion, refined clinical algorithms for increased LS should also include mastocytosis in addition to inflammation, congestion, and biliary obstruction.

  19. A Rare Case of Central Nervous System Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ravish Parekh

    2014-01-01

    Full Text Available Intracranial abscess is an extremely rare form of central nervous system (CNS tuberculosis (TB. We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV enzyme immunoassay (EIA test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.

  20. [A case of systemic lupus erythematosus complicated with psoriasis vulgaris].

    Science.gov (United States)

    Shidara, Kumi; Soejima, Makoto; Shiseki, Mariko; Ohta, Syuji; Nishinarita, Makoto

    2003-12-01

    A 49-years-old female admitted to our hospital because of skin eruptions on the extremities in 1985. She had suffered from polyarthralgia, skin eruptions since 1983. Physical examinations revealed discoid lesion, central nervous system involvement, and polyarthritis. Laboratory tests revealed leukopenia, thrombocytopenia, and hypocomplementemia. Antinuclear antibody, ant-DNA antibody, LE test were positive. From these findings, she was diagnosed as systemic lupus erythematosus (SLE). She developed lupus peritonitis in 1990 and 1994, which was successfully treated by steroid pulse therapy. Since then, the activity of SLE was in good control under administration of prednisolone 10 mg/day. Chilblain lupus was seen from 1993, Raynaud's phenomenon from 1996, and she further developed subcutaneous induration on her chest, back and upper extremities in 1999. Skin biopsy findings were compatible with lupus panniculitis. In 2002, erythematous patches with scales were observed on her right hand and left knee, and these skin lesions were histologically diagnosed as psoriasis vulgaris. An autoimmune response similar to SLE is speculated in psoriasis. We describe a rare case of SLE with various skin lesions including psoriasis vulgaris.

  1. Intelligent Case Based Decision Support System for Online Diagnosis of Automated Production System

    Science.gov (United States)

    Ben Rabah, N.; Saddem, R.; Ben Hmida, F.; Carre-Menetrier, V.; Tagina, M.

    2017-01-01

    Diagnosis of Automated Production System (APS) is a decision-making process designed to detect, locate and identify a particular failure caused by the control law. In the literature, there are three major types of reasoning for industrial diagnosis: the first is model-based, the second is rule-based and the third is case-based. The common and major limitation of the first and the second reasonings is that they do not have automated learning ability. This paper presents an interactive and effective Case Based Decision Support System for online Diagnosis (CB-DSSD) of an APS. It offers a synergy between the Case Based Reasoning (CBR) and the Decision Support System (DSS) in order to support and assist Human Operator of Supervision (HOS) in his/her decision process. Indeed, the experimental evaluation performed on an Interactive Training System for PLC (ITS PLC) that allows the control of a Programmable Logic Controller (PLC), simulating sensors or/and actuators failures and validating the control algorithm through a real time interactive experience, showed the efficiency of our approach.

  2. Intelligent Case Based Decision Support System for Online Diagnosis of Automated Production System

    International Nuclear Information System (INIS)

    Ben Rabah, N; Saddem, R; Carre-Menetrier, V; Ben Hmida, F; Tagina, M

    2017-01-01

    Diagnosis of Automated Production System (APS) is a decision-making process designed to detect, locate and identify a particular failure caused by the control law. In the literature, there are three major types of reasoning for industrial diagnosis: the first is model-based, the second is rule-based and the third is case-based. The common and major limitation of the first and the second reasonings is that they do not have automated learning ability. This paper presents an interactive and effective Case Based Decision Support System for online Diagnosis (CB-DSSD) of an APS. It offers a synergy between the Case Based Reasoning (CBR) and the Decision Support System (DSS) in order to support and assist Human Operator of Supervision (HOS) in his/her decision process. Indeed, the experimental evaluation performed on an Interactive Training System for PLC (ITS PLC) that allows the control of a Programmable Logic Controller (PLC), simulating sensors or/and actuators failures and validating the control algorithm through a real time interactive experience, showed the efficiency of our approach. (paper)

  3. A study of the transferability of influenza case detection systems between two large healthcare systems.

    Directory of Open Access Journals (Sweden)

    Ye Ye

    Full Text Available This study evaluates the accuracy and transferability of Bayesian case detection systems (BCD that use clinical notes from emergency department (ED to detect influenza cases.A BCD uses natural language processing (NLP to infer the presence or absence of clinical findings from ED notes, which are fed into a Bayesain network classifier (BN to infer patients' diagnoses. We developed BCDs at the University of Pittsburgh Medical Center (BCDUPMC and Intermountain Healthcare in Utah (BCDIH. At each site, we manually built a rule-based NLP and trained a Bayesain network classifier from over 40,000 ED encounters between Jan. 2008 and May. 2010 using feature selection, machine learning, and expert debiasing approach. Transferability of a BCD in this study may be impacted by seven factors: development (source institution, development parser, application (target institution, application parser, NLP transfer, BN transfer, and classification task. We employed an ANOVA analysis to study their impacts on BCD performance.Both BCDs discriminated well between influenza and non-influenza on local test cases (AUCs > 0.92. When tested for transferability using the other institution's cases, BCDUPMC discriminations declined minimally (AUC decreased from 0.95 to 0.94, p<0.01, and BCDIH discriminations declined more (from 0.93 to 0.87, p<0.0001. We attributed the BCDIH decline to the lower recall of the IH parser on UPMC notes. The ANOVA analysis showed five significant factors: development parser, application institution, application parser, BN transfer, and classification task.We demonstrated high influenza case detection performance in two large healthcare systems in two geographically separated regions, providing evidentiary support for the use of automated case detection from routinely collected electronic clinical notes in national influenza surveillance. The transferability could be improved by training Bayesian network classifier locally and increasing the

  4. Alternative Views of Case Research in Information Systems

    Directory of Open Access Journals (Sweden)

    Bill Doolin

    1996-05-01

    Full Text Available This paper discusses the differences between a positivist research philosophy and one which is increasingly emerging in IS research - an interpretive research philosophy, as they relate to case research, by examining selected case studies drawn from recent published IS case research. Each perspective places a different emphasis on case research, reflecting different ways of viewing reality and the pursuit of valid knowledge. This is an important realisation that can help us understand the debate that often arises over the nature and stature of case studies as a method for conducting research.

  5. [Peripheral nervous system and panarteritis nodosa. Review of 27 cases].

    Science.gov (United States)

    Castaigne, P; Brunet, P; Hauw, J J; Léger, J M; Gherardi, R; Guillevin, L

    1984-01-01

    Twenty-seven cases of panarteritis nodosa (PAN) with peripheral neuropathy are reported. Diagnosis was based on pathological criteria of necrotizing vasculitis in 20 patients (group I) and on clinical, biological and sometimes arteriographic data in 7 (group II). The 27 patients (18 women and 9 men), aged between 30 and 78 years (mean: 53.4 years), presented either a mono- or multineuropathy (8 cases), a polyneuropathy (17 cases), or sensory symptoms (2 cases). A neuropathy was the initial feature of the PAN in 15 cases. The CSF, examined in 16 cases, was always normal, and results of electrophysiological investigations constantly suggested the presence of an axonal neuropathy with normal motor nerve conduction rates. Other signs of PAN included fever (81 p. 100 cases) and loss of weight (74 p. 100). The ESR was increased in 70 p. 100 cases and hypereosinophilia was present in 33 p. 100. Quantitative pathology in 13 cases from group I revealed typical findings, and associated microvasculitis in 4 cases. The outcome was fatal in 13 cases while 12 recovered and have been followed up for from 1 to 14 years.

  6. Performance assessment of subsurface drainage systems : case studies from Egypt and Pakistan

    NARCIS (Netherlands)

    Ritzema, H.P.

    2007-01-01

    A case study set-up for the performance assessment of subsurface drainage systems for agricultural land drainage has been developed and 76 case studies from Egypt and Pakistan have been prepared. Based on these case studies, performance indicators for subsurface drainage systems have been derived

  7. Infantile Systemic Hyalinosis: A Case Report with a Novel Mutation

    Directory of Open Access Journals (Sweden)

    Siham Al Sinani

    2013-01-01

    Full Text Available Infantile Systemic Hyalinosis (ISH (OMIM 236490 is a rare, progressive and fatal autosomal recessive disorder characterized by multiple subcutaneous skin nodules, gingival hypertrophy, osteopenia, joint contractures, failure to thrive, diarrhea with protein losing enteropathy, and frequent infections. There is diffuse deposition of hyaline material in the skin, gastrointestinal tract, muscle and endocrine glands. It is caused by mutations in the ANTXR2 (also known as CMG2 gene, which encodes a trans-membranous protein involved in endothelial development and basement membrane-extracellular matrix assembly. We describe a child with classical features of ISH presenting in infancy with severe chronic debilitating pain and progressive joint contractures. The diagnosis was confirmed by molecular DNA sequencing of ANTXR2 gene which revealed a novel homozygous mutation not previously reported; 79 bp deletion of the entire exon 11 (c.867_945del, p.E289DfsX22. Although this is the first reported case of ISH in Oman, we believe that the disease is under-diagnosed since children affected with this lethal disease pass away early in infancy prior to establishing a final diagnosis.

  8. The Aircraft Electric Taxi System: A Qualitative Multi Case Study

    Science.gov (United States)

    Johnson, Thomas Frank

    The problem this research addresses is the airline industry, and the seemingly unwillingness attitude towards adopting ways to taxi aircraft without utilizing thrust from the main engines. The purpose of the study was to get a better understanding of the decision-making process of airline executives, in respect to investing in cost saving technology. A qualitative research method is used from personal interviews with 24 airline executives from two major U.S. airlines, related industry journal articles, and aircraft performance data. The following three research questions are addressed. RQ1. Does the cost of jet fuel influence airline executives' decision of adopting the aircraft electric taxi system technology? RQ2 Does the measurable payback period for a return on investment influence airline executives' decision of adopting ETS technology? RQ3. Does the amount of government assistance influence airline executives' decision of adopting ETS technology? A multi case research study design is used with a triangulation technique. The participant perceptions indicate the need to reduce operating costs, they have concerns about investment risk, and they are in favor of future government sponsored performance improvement projects. Based on the framework, findings and implications of this study, a future research paper could focus on the positive environmental effects of the ETS application. A study could be conducted on current airport area air quality and the effects that aircraft main engine thrust taxiing has on the surrounding air quality.

  9. Mixed reality ultrasound guidance system: a case study in system development and a cautionary tale.

    Science.gov (United States)

    Ameri, Golafsoun; Baxter, John S H; Bainbridge, Daniel; Peters, Terry M; Chen, Elvis C S

    2018-04-01

    Real-time ultrasound has become a crucial aspect of several image-guided interventions. One of the main constraints of such an approach is the difficulty in interpretability of the limited field of view of the image, a problem that has recently been addressed using mixed reality, such as augmented reality and augmented virtuality. The growing popularity and maturity of mixed reality has led to a series of informal guidelines to direct development of new systems and to facilitate regulatory approval. However, the goals of mixed reality image guidance systems and the guidelines for their development have not been thoroughly discussed. The purpose of this paper is to identify and critically examine development guidelines in the context of a mixed reality ultrasound guidance system through a case study. A mixed reality ultrasound guidance system tailored to central line insertions was developed in close collaboration with an expert user. This system outperformed ultrasound-only guidance in a novice user study and has obtained clearance for clinical use in humans. A phantom study with 25 experienced physicians was carried out to compare the performance of the mixed reality ultrasound system against conventional ultrasound-only guidance. Despite the previous promising results, there was no statistically significant difference between the two systems. Guidelines for developing mixed reality image guidance systems cannot be applied indiscriminately. Each design decision, no matter how well justified, should be the subject of scientific and technical investigation. Iterative and small-scale evaluation can readily unearth issues and previously unknown or implicit system requirements. We recommend a wary eye in development of mixed reality ultrasound image guidance systems emphasizing small-scale iterative evaluation alongside system development. Ultimately, we recommend that the image-guided intervention community furthers and deepens this discussion into best practices in

  10. Shifting Diagnostic Systems for Defining Intellectual Disability in Death Penalty Cases: Hall vs. Florida

    Science.gov (United States)

    Mukherjee, Mina; Westphal, Alexander

    2015-01-01

    The case of Hall vs. Florida tested Florida's so called "bright line rule" in determining intellectual disability in capital cases. The Supreme Court Decision reflects a more general trend from categorical to dimensional approaches in psychiatric diagnostic systems.

  11. Systemic lupus erythematosus and thymus persistens: A case report

    Directory of Open Access Journals (Sweden)

    Stević-Carević Silvija

    2017-01-01

    Full Text Available Introduction. Thymus plays an important role in the maturation of T-lymphocytes and in the development of immune tolerance. Its involution comes after puberty. If thymic tissue remains preserved in an advanced age it is considered to be the thymus persistens. According to the available data, 5% of patients with a thymoma have some of the autoimmune disorders. Medical data on the systemic lupus erythematosus (SLE association with the thymus persistens are scarce. Case report. A 29-year-old patient was diagnosed with SLE at the age of 12. She was treated with continuous doses of corticosteroids and an antimalarial drug (chloroquine. After ten years, the first, and then two more recurrences of the disease with the last recurrence in 2011 occurred. The performed laboratory analyses indicated the disease activity. The radiography of thorax showed a change on the right lung, with enlarged mediastinal shadow. Therefore the multislice computed tomography (MSCT of thorax was made. The pathohistology findings confirmed that the change on the right lung was focus of chronic pneumonitis, while the change in mediastinum was thymus persistens. The thymectomy was performed. Due to pneumonitis, the treatment of SLE was continued with corticosteroids, antimalarial drug and pulse doses of cyclophosphamide. The patient received six monthly and six quarterly pulsed doses of the drug. The remission of the disease maintained all the time. Conclusion. The disorder of thymic function should be considered as a possible cause in the development of SLE. Though the effect of thymectomy is difficult to assess, patients should be carefully monitored.

  12. A CASE REPORT OF RETINAL VASCULITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    Shivakumar Mallappa

    2017-09-01

    Full Text Available PRESENTATION OF CASE A 25-year-old patient presented with complaints of swelling of both the eyes, which was insidious in onset, painless and was gradually progressive since last 1 week, which was associated with painless gradually progressive diminution of vision. She also complained of painful oral ulcers and few rashes over the face involving the cheeks and forehead since one week. She gave a history of typhoid fever 1 month back, which was associated with difficulty in breathing and swallowing. On examination, vision in both eyes were reduced to counting fingers from 2 metres with pinhole improvement of 6/24. Anterior segment showed periorbital oedema, swollen eyelids along with congestive conjunctiva and grade 2 chemosis. Cornea was clear with no cataractous changes of lens in both the eyes. Pupil was round, regular and reactive for both the eyes. Schirmer's test showed 12 mm and 10 mm wetting of the paper after 5 minutes for right and left eye respectively, which indicated mild dryness of eyes. Fluorescein staining was normal confirming absence of any corneal epithelial defect. Diplopia charting, noncontact tonometry and perimetry findings were within normal limits. On fundoscopy, there was severe arteriolar attenuation along with presence of few cotton wool spots, hard exudates bilaterally and mild tortuosity of vessels in left eye without any signs of vitreous haemorrhage or retinal detachment. Bscan and OCT scanning findings were normal without any signs of haemorrhage or detachment. On fluorescein angiography, there was capillary dropout, vessel wall staining and leakage from vessels. Systemic examination was normal with no palpable lymphadenopathy.

  13. Case Report: Central nervous system demyelination associated with ...

    African Journals Online (AJOL)

    Her symptoms partially resolved on cessation of the drug. Our case was unusual compared to some previous case reports, as the patient\\'s age at presentation was beyond that for idiopathic multiple sclerosis. This may strengthen the hypothesis of a causal relationship between new onset demyelination and Etanercept; ...

  14. Real Time Locations Systems or Outsourcing: A Case Study

    Science.gov (United States)

    Lawrence, Cameron; Firth, David; Khumalo, Floyd

    2013-01-01

    Information Technology has transformed almost all aspects of modern healthcare and is playing a vital role in the administration of hospitals around the world. This case study examines one hospital's struggle to solve crucial operational problems related to the efficient management of medical equipment inventory. This case study is the result of…

  15. 77 FR 5865 - Privacy Act; System of Records: State-59, Refugee Case Records

    Science.gov (United States)

    2012-02-06

    ... DEPARTMENT OF STATE [Public Notice 7787] Privacy Act; System of Records: State-59, Refugee Case... systems of records, Refugee Case Records, State-59 and Refugee Processing Center Records, State-60... and Budget Circular No. A-130, Appendix I. The consolidated system will be titled State-59, Refugee...

  16. Medico-Legal System in Sexual Assault Cases in India

    Directory of Open Access Journals (Sweden)

    Yuvraj Dilip Patil

    2013-07-01

    Full Text Available Sexual assault is a heinous crime. Man com-mits the act to fulfill his sexual urge, to showhis masculinity, to get control of the victim, totake revenge and various other reasons, out ofabnormal mind, out of ignorance of the law ofthe land or out of opportunity. The mental traumasuffered by the victim may linger till end of herlife [1].Women who wish to pursue a justice againsttheir assailant are usually examined by a doc-tor or in most cases a state-employed districtsurgeon, and obtain a report of their injuries.Expert medical evidence is widely used in sexualassault cases, but its contribution to theprogress of legal cases is unclear.The objectives of the paper are -1. To study the legislative provisions re-lating to medical examination in SexualAssault cases.2. To assess the impact of medico legal evi-dence in sexual assault cases.3. To make suggestions.

  17. Space Shuttle Main Propulsion System Anomaly Detection: A Case Study

    Data.gov (United States)

    National Aeronautics and Space Administration — The space shuttle main engine (SSME) is part of the Main Propnlsion System (MPS) which is an extremely complex system containing several sub-systems and components,...

  18. System Dynamic Modelling for a Balanced Scorecard: A Case Study

    DEFF Research Database (Denmark)

    Nielsen, Steen; Nielsen, Erland Hejn

    and the number of measures. Originality/value - A large number of case studies and surveys are now present in the literature of BSC. However, there is a lack of more theoretical and analytical modelling of the BSC. Our paper just throws a little light to this modelling approach....... variables: skills, customer base and work in process. We are able to show that only minimal changes may create large effects on profit. Research limitations/implications - Our analytical model is based on both assumed but also on case documented assumptions of a concrete model. In every such kind of model......Purpose - The purpose of this research is to make an analytical model of the BSC foundation by using a dynamic simulation approach for a 'hypothetical case' model, based on only part of an actual case study of BSC. Design/methodology/approach - The model includes five perspectives and a number...

  19. Case studies in geographic information systems for internet portals

    Science.gov (United States)

    2012-06-30

    The following report investigates the experiences of transportation agencies in the deployment of Internet-based mapping portals based on GIS. It presents background information, a series of case studies, and a summary of conclusions given the experi...

  20. [Clinical analysis of 234 cases with congenital malformations of respiratory system].

    Science.gov (United States)

    Zhang, Wei-xi; Zhang, Hai-lin; Li, Chang-chong; Luo, Yun-chun; Cheng, Jian-min; Huang, Lei; Bai, Guang-hui

    2009-06-01

    To explore clinical characteristics, radiographic findings and diagnostic methods of patients with congenital malformations of respiratory system for enhancing the diagnosis of congenital malformations of respiratory system in children. Totally 234 patients with congenital malformations of respiratory system were chosen from the inpatient department of Yuying Children's Hospital Affiliated to Wenzhou Medical College from July 2003 to June 2008. The clinical presentations and radiographic findings of these children were analyzed. Of the 234 patients with congenital malformations of respiratory system, the age at diagnosis was between the first day and 14 years of age, mean age was 1.12 years. The main symptoms were persistent laryngeal stridor, recurrent wheezing, recurrent respiratory tract infections and dyspnea. Through the use of chest X-ray, spiral CT 3D reconstructions, fiberoptic bronchoscopy and other laboratory techniques, 213 cases were diagnosed as having single malformation and 21 cases were found to have multiple malformations. Of the 213 cases with single malformation, 97 cases had laryngeal malformation (congenital laryngeal stridor in 90 cases, congenital laryngeal webs in 5 cases and congenital laryngeal cyst in 2 cases), 35 cases had tracheal-bronchial malformation (congenital tracheobronchial stenosis in 17 cases, congenital abnormal bronchial origin in 7 cases, tracheobronchomalacia in 10 cases and tracheoesophageal fistula in 1 case), 43 cases had lung malformation (pulmonary sequestration in 5 cases, congenital lung cysts in 22 cases, congenital lobar emphysema in 1 case, agenesis of lung and hypoplasia of lung in 8 cases and congenital cystic adenomatoid malformation in 7 cases), 38 cases had diaphragm malformation, 28 cases had congenital tracheal-bronchial stenosis as confirmed by spiral CT 3D reconstructions and fiberoptic bronchoscopy. Ten cases with congenital abnormal bronchial origin were diagnosed with spiral CT 3D reconstructions

  1. Paracoctidioidomicose: atendimento a nível de assistência primária a saúde The treatment of paracoccidioidomycosis at primary health level

    Directory of Open Access Journals (Sweden)

    Sérgio Pripas

    1988-06-01

    Full Text Available Discute-se o tratamento de pacientes com paracoccidioidomicose a nível de assistência primária a saúde. Foram tratados 8 pacientes no Centro de Saúde I, de São Carlos, SP (Brasil, empregando-se o cetoconazol, durante um ano, na dose de 400 mg diários, em uma única tomada. Em todos os pacientes tratados, houve remissão do quadro clínico e melhora dos exames laboratoriais. Não houve relato de efeitos colaterais. Conclui com proposta de tratamento da paracoccidioidomicose, a nível de rede básica de saúde.The treatment of paracoccidioidomycosis, with ketoconazole, at public health level is discussed. Eight patients were treated with single daily doses of 400 mg of ketoconazole for one year. The patients were treated at Health Center I in S. Carlos, Brazil. All patients treated showed clinical remission and an improvement in radiological findings. No side-effects were reported. The benefits of this treatment at Health Centers, under the administrative, social and economic aspects are stressed.

  2. A case study of the Maintenance Decision Support System (MDSS) in Maine.

    Science.gov (United States)

    2007-09-10

    This report presents the results of a case study evaluation of a Maintenance Decision Support System (MDSS) project under a program funded by the U.S. Department of Transportations (USDOT) Intelligent Transportation Systems (ITS) Joint Program Off...

  3. Using a Recommendation System to Support Problem Solving and Case-Based Reasoning Retrieval

    Science.gov (United States)

    Tawfik, Andrew A.; Alhoori, Hamed; Keene, Charles Wayne; Bailey, Christian; Hogan, Maureen

    2018-01-01

    In case library learning environments, learners are presented with an array of narratives that can be used to guide their problem solving. However, according to theorists, learners struggle to identify and retrieve the optimal case to solve a new problem. Given the challenges novice face during case retrieval, recommender systems can be embedded…

  4. A Textual Case-Based Mobile Phone Diagnosis Support System

    African Journals Online (AJOL)

    acer

    2005) is an artificial intelligence methodology that solves problems by using ... jCOLIBRI is a free and open source object oriented framework .... The source codes of some classes in jColibri framework were modified and integrated within the new system to suit the purpose of the proposed system. The system components ...

  5. Human Mobile Inverted Pendulum Transporter - a Mechatronic System Case Study

    DEFF Research Database (Denmark)

    Bech, Michael Møller; Hansen, Anders Hedegaard; Pedersen, Henrik C.

    2011-01-01

    It is an inherent property of a mechatronic system that it involves several interacting sub-systems and the design process for such systems involves an in depth understanding of a number of engineering disciplines. A truly mechatronic design requires use of advanced models during the design...

  6. Open Source Course Management Systems: A Case Study

    Science.gov (United States)

    Remy, Eric

    2005-01-01

    In Fall 2003, Randolph-Macon Woman's College rolled out Claroline, an Open Source course management system for all the classes on campus. This document will cover some background on both Open Source in general and course management systems in specific, discuss technical challenges in the introduction and integration of the system and give some…

  7. Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

    DEFF Research Database (Denmark)

    Tsushima, Y; Kanal, E; Thomsen, H S

    2010-01-01

    and meeting abstracts were included, and cases with biopsy confirmation were selected. 14 biopsy-verified NSF cases were found. In seven of eight patients reported after the association between gadolinium-based contrast agent (GBCA) and NSF was proposed, GBCA administration was documented: five received only...... gadodiamide; two received both gadodiamide and gadopentetate dimeglumine. In four cases, the amounts of contrast agent were registered: two received only a single dose (0.1 mmol kg(-1) body weight) whereas the other two received 7-15 ml (the body weight was not disclosed) for each MR examination. Five...... patients had multiple injections of GBCA before NSF developed. Except for one patient in whom renal assessment was not reported, none of the patients had an estimated glomerular filtration rate >30 ml min(-1) 1.73 m(-2) and all received dialysis. 5 of the 8 patients (63%) in whom GBCA exposure...

  8. Battery energy storage systems life cycle costs case studies

    Energy Technology Data Exchange (ETDEWEB)

    Swaminathan, S.; Miller, N.F.; Sen, R.K. [SENTECH, Inc., Bethesda, MD (United States)

    1998-08-01

    This report presents a comparison of life cycle costs between battery energy storage systems and alternative mature technologies that could serve the same utility-scale applications. Two of the battery energy storage systems presented in this report are located on the supply side, providing spinning reserve and system stability benefits. These systems are compared with the alternative technologies of oil-fired combustion turbines and diesel generators. The other two battery energy storage systems are located on the demand side for use in power quality applications. These are compared with available uninterruptible power supply technologies.

  9. Societal Constraints, Systemic Disadvantages and Homelessness: An Individual Case Study

    OpenAIRE

    Carol Kauppi; Henri Pallard; George Stephen; Wayne Neegan

    2013-01-01

    Research utilizing the individual case study method examined the complex issues related to pathways into and out of home-lessness for an Aboriginal man from a First Nation community on the western James Bay in Canada. This instrumental case study focused on an individual's story, rather than on a site or a group of individuals, an incident or a series of incidents, or a program [6] [15]. First, as a research tool, it provides insight into the issue of homelessness and some of its causes from ...

  10. Exploring the business case for ambulatory electronic health record system adoption.

    Science.gov (United States)

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

  11. Primary idiopathic systemic amyloidosis – rare classical cases with fatal outcome

    Directory of Open Access Journals (Sweden)

    Shivakumar Patil

    2016-07-01

    Full Text Available Primary systemic amyloidosis is a rare condition. We report two cases of primary systemic amyloidosis. Both the cases were without any hematological abnormality. Cutaneous features were the predominant presenting symptoms in these patients. The patients presented with typical waxy lesions on face and macroglossia. Diagnosis was confirmed by histopathology with haematoxylin and eosin staining and Congo red staining

  12. Making System Dynamics Cool II : New Hot Teaching and Testing Cases of Increasing Complexity

    NARCIS (Netherlands)

    Pruyt, E.

    2010-01-01

    This follow-up paper presents several actual cases for testing and teaching System Dynamics. The cases were developed between April 2009 and January 2010 for the Introductory System Dynamics courses at Delft University of Technology in the Netherlands. They can be used for teaching and testing

  13. Building a Collaborative Governance System: A Comparative Case Analysis

    Science.gov (United States)

    2015-06-01

    additional resources. Bandwagon effects occur. As the process emerges and appears to be achieving success, more resources are attracted. Consensus...97 C. WHAT ARE THE ENABLERS AND BARRIERS TO EFFECTIVE COLLABORATION IN THIS CASE...seems as though the challenges are getting bigger as well as more frequent, across many disciplines.”1 Effective incident response requires command

  14. Development of plant maintenance management system (pmms): a case study

    Science.gov (United States)

    Che Azhar, N. A.; Mansor, M. A.

    2013-12-01

    In large plant industry, it is not easy to maintain machine performance without using any method such as checklist system. Manual checklist is a common maintenance checklist used in industry. All machine, equipment and parts that need to be checked will be written down for the employee to do maintenance checks. Converting the manual checklist to the Plant Maintenance Management System (PMMS) can improve the way of employees work and make plant management easier. Therefore, a new system was designed to maintain the equipment so that the activities are more efficient and cost effective. The system consists of three frames that connect to each other. The frames divide to section, equipment and checklist. This system also builds to prevent data from arbitrarily changes. Only certain officers or staffs are permitted to make modifications to data. Using this system, a company can make the office environment a paperless environment.

  15. Systemic Mastocytosis with Smoldering Multiple Myeloma: Report of a Case

    OpenAIRE

    Ghanem, Sassine; Garcia, Gwenalyn; Ying, Liu; Hurford, Matthew; Odaimi, Marcel

    2016-01-01

    Systemic mastocytosis (SM) is a disease characterized by a clonal infiltration of mast cells affecting various tissues of the body. It is grouped into six different subtypes according to the World Health Organization classification. It is called indolent systemic mastocytosis (ISM) when there is no evidence of end organ dysfunction, while the presence of end organ dysfunction defines aggressive systemic mastocytosis (ASM). When SM coexists with a clonal hematological disorder, it is classifie...

  16. Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

    International Nuclear Information System (INIS)

    Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

    2015-01-01

    Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system. (paper)

  17. Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

    Science.gov (United States)

    Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

    2015-05-01

    Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

  18. Attacks on biometric systems: a case study in fingerprints

    Science.gov (United States)

    Uludag, Umut; Jain, Anil K.

    2004-06-01

    In spite of numerous advantages of biometrics-based personal authentication systems over traditional security systems based on token or knowledge, they are vulnerable to attacks that can decrease their security considerably. In this paper, we analyze these attacks in the realm of a fingerprint biometric system. We propose an attack system that uses a hill climbing procedure to synthesize the target minutia templates and evaluate its feasibility with extensive experimental results conducted on a large fingerprint database. Several measures that can be utilized to decrease the probability of such attacks and their ramifications are also presented.

  19. Teaching Case: IS Security Requirements Identification from Conceptual Models in Systems Analysis and Design: The Fun & Fitness, Inc. Case

    Science.gov (United States)

    Spears, Janine L.; Parrish, James L., Jr.

    2013-01-01

    This teaching case introduces students to a relatively simple approach to identifying and documenting security requirements within conceptual models that are commonly taught in systems analysis and design courses. An introduction to information security is provided, followed by a classroom example of a fictitious company, "Fun &…

  20. Fire protection system management in nuclear facilities: strengthening factor of integrated management system - a case study

    International Nuclear Information System (INIS)

    Santos, Joao Regis dos

    2005-01-01

    The present study investigated and analyzed the importance of a system of integrated safety manage, environment and health in a nuclear installation, having as perspective, the fire protection manage. The inquiry was made using a qualitative research involving a case study, where the considered environment was the Reconversion and UO 2 Plant of the Industrias Nucleares do Brasil (INB), located in Resende, Rio de Janeiro and the studied population, the managers and the staff directly involved with the aspects related to the safety of the industrial complex of the related company. The motivation for the research was the search of a bigger interaction of the questions related to the safety, environment and health in the nuclear industry having, as axle of the investigation, the fire protection. As a result, it was observed that in a nuclear installation, although dealing with diversified safety processes, integration is possible and necessary, since there are more reasons for integration than otherwise. (author)

  1. Haga su diagnostico Case for diagnosis

    Directory of Open Access Journals (Sweden)

    Victoria Rivelli

    2008-08-01

    Full Text Available Comunicamos un paciente joven, que presentaba una inmunodepresión atribuida al alcohol y la desnutrición, que consultó por numerosas lesiones. Luego de los estudios auxiliares se llegó al diagnóstico y mostró buena respuesta al tratamiento convencional para esta leishmaniasis. Las lesiones polimorfas obligaron a varios diagnósticos diferenciales, entre ellos histoplasmosis, paracoccidioidomicosis, ectima, linfoma.We report the case of a patient with alcohol intake and malnutrition-related immunosuppression who sought medical attention for multiple ulcerated lesions. Laboratory tests revealed the diagnosis and the patient responded well to conventional anti-leishmaniasis therapy. Polymorphous lesions prompted differential diagnoses such as histoplasmosis, paracoccidioidomycosis, ecthyma and lymphoma.

  2. Fish Culture Systems and Management Implications: A Case Study ...

    African Journals Online (AJOL)

    Fish farming was introduced three decades ago in Gulu district with the interest of improving the livelihood of the community. A random survey was done to assess the fish farming systems design, management, and physico – chemical variables and primary production of the systems in Gulu district. Results show that the ...

  3. Scheduling vehicles in automated transportation systems : algorithms and case study

    NARCIS (Netherlands)

    van der Heijden, Matthijs C.; Ebben, Mark; Gademann, Noud; van Harten, Aart

    2000-01-01

    One of the major planning issues in large scale automated transportation systems is so-called empty vehicle management, the timely supply of vehicles to terminals in order to reduce cargo waiting times. Motivated by a Dutch pilot project on an underground cargo transportation system using Automated

  4. Preferences in Interactive Systems: Technical Challenges and Case Studies

    OpenAIRE

    Peintner, Bart; Viappiani, Paolo; Yorke-Smith, Neil

    2008-01-01

    Interactive artificial intelligence systems employ preferences in both their reasoning and their interaction with the user. This survey considers preference handling in applications such as recommender systems, personal assistant agents, and personalized user interfaces. We survey the major questions and approaches, present illustrative examples, and give an outlook on potential benefits and challenges.

  5. Timing of Technology Upgrades: A Case of Enterprise Systems

    Science.gov (United States)

    Claybaugh, Craig C.

    2010-01-01

    Technology upgrades are an inevitable part of dealing with any man-made invention utilized for productive gain. One key technology used for productive gain within a firm is enterprise software, specifically a firm's Enterprise Resource Planning (ERP) system. After the adoption of an ERP system, an organization is perpetually faced with the…

  6. Case Report: Systemic Lupus Erythematosus Presenting as Acute ...

    African Journals Online (AJOL)

    Systemic lupus erythematosus is a complex autoimmune disease with multisystem involvement with varied presentation. Autoimmune adrenal disease, on the other hand, can be associated with other autoimmune diseases. Adrenal insufficiency as a presenting feature of Systemic lupus erythematosus is a rare occurrence.

  7. Eliciting user requirements for ambient intelligent systems: a case study

    NARCIS (Netherlands)

    Ivanovic, A.; Matysiak, Aga; Sikkel, Nicolaas; Wieringa, Roelf J.

    2005-01-01

    Ambient intelligent (AmI) systems are electronic environments that are responsive and sensitive to the presence of people (Weiser, 1991). Eliciting requirements for AmI systems, like for any novel technology, is hard because of high uncertainties, such as: 1) both the users and use context are

  8. Eliciting User Requirements for Ambient Intelligent Systems: A Case Study

    NARCIS (Netherlands)

    Ivanovic, A.; Matysiak, Aga; Sikkel, Nicolaas; Wieringa, Roelf J.

    Ambient intelligent (AmI) systems are electronic environments that are responsive and sensitive to the presence of people (Weiser, 1991). Eliciting requirements for AmI systems, like for any novel technology, is hard because of high uncertainties, such as: 1) both the users and use context are

  9. Developing of a Computerized Brain Diagnosing System for Case ...

    African Journals Online (AJOL)

    The main purpose of this project is to design a computerized brain diagnosing system that would be used in carrying out the daily diagnosing activity in the clinic. The developed computerized system has numerous advantages over manual operation which is very tedious and time consuming. As part of the research method ...

  10. Private and Public Pension Systems Worldwide: Case of Russia

    Directory of Open Access Journals (Sweden)

    Aleksei V. Pudovkin

    2016-01-01

    Full Text Available The article deals with the Russian pension system and make recommendations for its further development on the basis of international experience. The Russian pension system is in a state of transition. The reform of 2013-2015 is not completed, since in its current state pension system is still characterized by very low replacement rate value at a very high level of government spending. Moratorium on pension accumulation introduced in the course of recent reforms calls into question the future of the mandatory funded pension system. Review of international pension systems formation suggests that the most successful of them are not limited solely to public system, and use a combination of distribution and accumulation units. When choosing between mandatory or voluntary options they are guided by the characteristics of the national economy. Studying the successes and mistakes of world practice of voluntary and mandatory funded pension systems is of great scientific and practical interest, since it can contribute to a more accurate choice of the future path of development of the national pension system.

  11. Systems Thinking: A Case for Second-Order-Learning

    Science.gov (United States)

    Gharajedaghi, Jamshid

    2007-01-01

    Purpose: The purpose of this paper is to show that changes in social systems do not occur randomly. They are consistent with what has gone on before, with the history and identity of the system. As long as the organizing principles of a dominant culture remain unchallenged, behavior of all the social-units originating from this culture will remain…

  12. Neuropsychiatric Symptoms in Systemic Lupus Erythematosus - Case Report

    Directory of Open Access Journals (Sweden)

    Sandra Almeida

    2014-10-01

    Full Text Available Systemic lupus erythematosus (SLE is a chronic inflammatory autoimmune disease of unknown etiology, with episodic course. It is characterized by periods of relative quiescence and periods of exacerbations which may involve any organ or system. About a young woman with a clinical delirium state, we revised the clinical neuropsychiatric features of SLE in the literature.

  13. Case study: evaluation of clinker griding systems using radioactive tracers

    International Nuclear Information System (INIS)

    Sebastian, C.; Maghella, G.; Mamani, E.

    2000-12-01

    This work was carried out in a clinker grinding system, during operation. A small amount of La 2 O 3 was irradiated to produce the gamma emitter radioisotope Lanthanum-140. The radioactive dust of La 2 O 3 was agglomerated with rapid setting cement to obtain a radiotracer with mechanical properties similar to the ones of the clinker. The time of passage of the mill feed material, the retention time distribution in the grinding system and a radiotracer balance in the system, allow us to find the milling hold up and the efficiency of the milling system with recirculation of gross particles into the mill. The fine particles, (dust) obtained as a find product are taken into account to verify the efficiency of the system

  14. Fulminant systemic vasculitis in systemic lupus erythematosus. Case report and review of the literature.

    Science.gov (United States)

    Medina, G; González-Pérez, D; Vázquez-Juárez, C; Sánchez-Uribe, M; Saavedra, M A; Jara, L J

    2014-11-01

    Vasculitis in systemic lupus erythematosus (SLE) has a broad spectrum of clinical manifestations from cutaneous to visceral involvement and its prognosis ranges from mild to life-threatening. We report the case of a previously healthy 17-year-old woman with eight months' history of arthralgias and myalgias. Subsequently, she developed facial and lower limbs edema, and hair loss. Two weeks before admission to a secondary level hospital, she developed fever up to 40°C followed by abdominal pain, rectal bleeding, hematemesis and blisters on both legs, reason for which she was hospitalized. With active bullous SLE with rapidly progressive glomerulonephritis suspected, she was treated with methylprednisolone pulses without response. After one week of treatment, she was transferred to a tertiary level hospital. On admission she presented acute arterial insufficiency of the lower extremities, respiratory failure with apnea, metabolic acidosis and shock; six hours later she died. Autopsy findings showed active diffuse lupus nephritis and diffuse systemic vasculitis that involved vessels from the skin, brain, myocardium, spleen, iliac and renal arteries. In addition, serositis of the small intestine and colon, acute and chronic pericarditis, pericardial effusion and myocarditis were found. Immunologic tests confirmed SLE diagnosis. In this case the fulminant course was the result of SLE high disease activity, visceral vasculitis of several organs and late diagnosis, referral and treatment. Early diagnosis, and opportune referral to the rheumatologist for intensive treatment can improve the outlook in these patients. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  15. Heat shield manifold system for a midframe case of a gas turbine engine

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, Clinton A.; Eng, Jesse; Schopf, Cheryl A.

    2017-07-25

    A heat shield manifold system for an inner casing between a compressor and turbine assembly is disclosed. The heat shield manifold system protects the outer case from high temperature compressor discharge air, thereby enabling the outer case extending between a compressor and a turbine assembly to be formed from less expensive materials than otherwise would be required. In addition, the heat shield manifold system may be configured such that compressor bleed air is passed from the compressor into the heat shield manifold system without passing through a conventional flange to flange joint that is susceptible to leakage.

  16. On the safety of aircraft systems: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Guridi, G.; Hall, R.E.; Fullwood, R.R.

    1997-05-14

    An airplane is a highly engineered system incorporating control- and feedback-loops which often, and realistically, are non-linear because the equations describing such feedback contain products of state variables, trigonometric or square-root functions, or other types of non-linear terms. The feedback provided by the pilot (crew) of the airplane also is typically non-linear because it has the same mathematical characteristics. An airplane is designed with systems to prevent and mitigate undesired events. If an undesired triggering event occurs, an accident may process in different ways depending on the effectiveness of such systems. In addition, the progression of some accidents requires that the operating crew take corrective action(s), which may modify the configuration of some systems. The safety assessment of an aircraft system typically is carried out using ARP (Aerospace Recommended Practice) 4761 (SAE, 1995) methods, such as Fault Tree Analysis (FTA) and Failure Mode and Effects Analysis (FMEA). Such methods may be called static because they model an aircraft system on its nominal configuration during a mission time, but they do not incorporate the action(s) taken by the operating crew, nor the dynamic behavior (non-linearities) of the system (airplane) as a function of time. Probabilistic Safety Assessment (PSA), also known as Probabilistic Risk Assessment (PRA), has been applied to highly engineered systems, such as aircraft and nuclear power plants. PSA encompasses a wide variety of methods, including event tree analysis (ETA), FTA, and common-cause analysis, among others. PSA should not be confused with ARP 4761`s proposed PSSA (Preliminary System Safety Assessment); as its name implies, PSSA is a preliminary assessment at the system level consisting of FTA and FMEA.

  17. A premolar extraction case using the Invisalign system.

    Science.gov (United States)

    Hönn, Mirjam; Göz, Gernot

    2006-09-01

    Invisalign therapy is an orthodontic treatment method using removable transparent polyurethane splints. Its applicability in extraction cases is limited. This case report documents the treatment with Invisalign of a patient in whom four premolars had to be extracted due to dental crowding. The patient's primary objective was to undergo treatment to resolve her anterior crowding as esthetically inconspicuously as possible. Diagnostic findings were: constriction of the maxillary and mandibular arch with anterior dental crowding; proclination and anteposition of the anteriors; neutroclusion with an overjet of 6 mm and an overbite of 1 mm. The radiographs showed a mesial tilt of the lower canines and premolars and a mild skeletal Class II relationship with a vertical craniofacial configuration. Treatment was initiated by extracting the four first premolars and placing the attachments (Tetric Ceram composite). After the Invisalign aligners had been worn, the anterior segment was uprighted and retracted, the crowding resolved, and the arches well-aligned. The patient's neutroclusion was maintained, physiological anterior relations in the sagittal and vertical planes were achieved, and the lower canines and premolars were uprighted. Active treatment lasted 1 year and 8 1/2 months and involved 43 maxillary and 28 mandibular aligners. Particularly in cases with an extended indication for this new treatment modality, due consideration must be given to the importance of comprehensive and meticulous diagnostics and treatment planning, and a solid grasp of the biological and mechanical fundamentals.

  18. The Case for A Hierarchal System Model for Linux Clusters

    Energy Technology Data Exchange (ETDEWEB)

    Seager, M; Gorda, B

    2009-06-05

    The computer industry today is no longer driven, as it was in the 40s, 50s and 60s, by High-performance computing requirements. Rather, HPC systems, especially Leadership class systems, sit on top of a pyramid investment mode. Figure 1 shows a representative pyramid investment model for systems hardware. At the base of the pyramid is the huge investment (order 10s of Billions of US Dollars per year) in semiconductor fabrication and process technologies. These costs, which are approximately doubling with every generation, are funded from investments multiple markets: enterprise, desktops, games, embedded and specialized devices. Over and above these base technology investments are investments for critical technology elements such as microprocessor, chipsets and memory ASIC components. Investments for these components are spread across the same markets as the base semiconductor processes investments. These second tier investments are approximately half the size of the lower level of the pyramid. The next technology investment layer up, tier 3, is more focused on scalable computing systems such as those needed for HPC and other markets. These tier 3 technology elements include networking (SAN, WAN and LAN), interconnects and large scalable SMP designs. Above these is tier 4 are relatively small investments necessary to build very large, scalable systems high-end or Leadership class systems. Primary among these are the specialized network designs of vertically integrated systems, etc.

  19. Model of sustainable development of energy system, case of Hamedan

    International Nuclear Information System (INIS)

    Sahabmanesh, Aref; Saboohi, Yadollah

    2017-01-01

    Sustainable economic growth and improvement of the social welfare depend upon the sufficient supply of energy resources, while the utilization of energy resources is one of the main factors of environmental degradation. This research is involved with development of a sustainable energy system model and a new method for sustainability assessment. This model represents the flow of energy from primary resources through processing, conversion, and end-use technologies in an optimization framework where the useful energy demand in various social and economic sectors is met. The impact of energy supply and consumption chain on the environment at each level of energy system is also embedded in the model structure. A multi-criteria analysis of changes is then applied and sustainable development indices of the whole system are concluded. Finally, effects of the energy subsidy policy and high economic growth rate on sustainability of the energy system in three scenarios are analyzed. Results demonstrate that energy subsidy decelerates the improvement rate of the total sustainability index. Also, when a high economic growth is accompanied with the energy subsidy this index reduces considerably. Results show that how penetration of renewable energy potentials changes the sustainability situation of energy systems. - Highlights: • Developing a new model for sustainable energy systems. • Presenting a new method for sustainability assessment of energy systems. • Optimizing the energy flow and capacity expansion of Hamedan energy system. • Utilizing an MCDA approach to obtain sustainability indices of the whole system. • Analysis of energy subsidy and high economic growth on energy sustainability.

  20. Similarity of fluctuations in correlated systems: The case of seismicity

    International Nuclear Information System (INIS)

    Varotsos, P.A.; Sarlis, N.V.; Tanaka, H.K.; Skordas, E.S.

    2005-01-01

    We report a similarity of fluctuations in equilibrium critical phenomena and nonequilibrium systems, which is based on the concept of natural time. The worldwide seismicity as well as that of the San Andreas fault system and Japan are analyzed. An order parameter is chosen and its fluctuations relative to the standard deviation of the distribution are studied. We find that the scaled distributions fall on the same curve, which interestingly exhibits, over four orders of magnitude, features similar to those in several equilibrium critical phenomena (e.g., two-dimensional Ising model) as well as in nonequilibrium systems (e.g., three-dimensional turbulent flow)

  1. Technology Solutions Case Study: Hydronic Systems: Designing for Setback Operation

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-05-01

    For years, conventional wisdom surrounding space heating has specified two points: size the mechanical systems to the heating loads, and setting the thermostat back at night will result in energy savings. The problem is these two recommendations oppose each other. A system that is properly sized to the heating load will not have the extra capacity necessary to recover from a thermostat setback, especially at design conditions. Properly designing a hydronic system for setback operation can be accomplished but depends on several factors. Determining the appropriateness of setback for a particular project is the first step. This is followed by proper sizing of the boiler and baseboard to ensure the needed capacity can be met. Finally, control settings must be chosen that result in the most efficient and responsive performance. This guide provides step-by-step instructions for heating contractors and hydronic designers for selecting the proper control settings to maximize system performance and improve response time when using a thermostat setback.

  2. Advances in Geologic Disposal System Modeling and Shale Reference Cases

    Energy Technology Data Exchange (ETDEWEB)

    Mariner, Paul E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Stein, Emily R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Frederick, Jennifer M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Sevougian, S. David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hammond, Glenn Edward [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-09-22

    The Spent Fuel and Waste Science and Technology (SFWST) Campaign of the U.S. Department of Energy (DOE) Office of Nuclear Energy (NE), Office of Fuel Cycle Technology (OFCT) is conducting research and development (R&D) on geologic disposal of spent nuclear fuel (SNF) and high level nuclear waste (HLW). Two high priorities for SFWST disposal R&D are design concept development and disposal system modeling (DOE 2011, Table 6). These priorities are directly addressed in the SFWST Generic Disposal Systems Analysis (GDSA) work package, which is charged with developing a disposal system modeling and analysis capability for evaluating disposal system performance for nuclear waste in geologic media (e.g., salt, granite, shale, and deep borehole disposal).

  3. CVISN business case (commercial vehicle information systems and networks)

    Science.gov (United States)

    2007-10-15

    The objective was to evaluate economic justifications and institutional issues affecting motor carriers and State transportation agencies regarding the deployment of CVISN technologies. CVISN (Commercial Vehicle Information Systems and Networks) incl...

  4. Case studies in geographic information systems for environmental streamlining

    Science.gov (United States)

    2012-05-31

    This 2012 summary report addresses the current use of geographic information systems (GIS) and related technologies by State Departments of Transportation (DOTs) for environmental streamlining and stewardship, particularly in relation to the National...

  5. Prognostics for Ground Support Systems: Case Study on Pneumatic Valves

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics technologies determine the health (or damage) state of a component or sub- system, and make end of life (EOL) and remaining useful life (RUL)...

  6. CASE STUDY ON WATER QUALITY CONTROL IN AN AQUAPONIC SYSTEM

    Directory of Open Access Journals (Sweden)

    Radu Mihai Filep

    2016-07-01

    Full Text Available Aquaponic systems are integrated systems that combine fish farming and different types of plants. It involves a dynamic interaction between fish plants and bacteria. Fish and plants are dependent the equilibrium of dissolved nutrients and water quality. Only by striking a balance between dissolved nutrients and water quality we can achieve a large production of plants and healthy fish. Thus, control of water quality in an aquaponic system is essential in order to obtain performance in raising fish and plants. The experiment was conducted in the laboratory of Fisheries and Aquaculture of the Faculty of Animal Science of the University of Agronomic Sciences and Veterinary Medicine of Bucharest within a period of 30 days. The system used for the experiment was designed and developed in the laboratory mentioned above. The plant used for water treatment in the system was basil (Ocimum basilicum. Fish species grown in the system was culture carp (Cyprinus carpio. Indicators measured to assess water quality in the system were: temperature, pH, dissolved oxygen, total ammonia, nitrites, nitrates and phosphates. The values determined pH 7.4-7.6, dissolved oxygen 8-10 mg / l, NH4 0.05-05 mg/ l, NO2 0.1-3.2 mg / l, NO3 0-80 mg / l, 0.02-0.3 mg, PO4 0.02-0.3 mg/l were not too high. In conclusion it was demonstrated that water quality in the aquaponic system studied is propitious to the growth and welfare of fish the registered values are not to be harmful.

  7. Hopeful Losers? A Moral Case for Mixed Electoral Systems

    Directory of Open Access Journals (Sweden)

    Loren King

    2015-06-01

    Full Text Available Liberal democracies encourage citizen participation and protect our freedoms, yet these regimes elect politicians and decide important issues with electoral and legislative systems that are less inclusive than other arrangements. Some citizens inevitably have more influence than others. Is this a problem? Yes, because similarly just but more inclusive systems are possible. Political theorists and philosophers should be arguing for particular institutional forms, with particular geographies, consistent with justice.

  8. District health information system assessment: a case study in iran.

    Science.gov (United States)

    Raeisi, Ahmad Reza; Saghaeiannejad, Sakineh; Karimi, Saeed; Ehteshami, Asghar; Kasaei, Mahtab

    2013-03-01

    Health care managers and personnel should be aware and literate of health information system in order to increase the efficiency and effectiveness in their organization. Since accurate, appropriate, precise, timely, valid information and interpretation of information is required and is the basis for policy planning and decision making in various levels of the organization. This study was conducted to assess the district health information system evolution in Iran according to WHO framework. This research is an applied, descriptive cross sectional study, in which a total of twelve urban and eight rural facilities, and the district health center at Falavarjan region were surveyed by using a questionnaire with 334 items. Content and constructive validity and reliability of the questionnaire were confirmed with correlation coefficient of 0.99. Obtained data were analyzed with SPSS 16 software and descriptive statistics were used to examine measures of WHO compliance. The analysis of data revealed that the mean score of compliance of district health information system framework was 35.75 percent. The maximum score of compliance with district health information system belonged to the data collection process (70 percent). The minimum score of compliance with district health information system belonged to information based decision making process with a score of 10 percent. District Health Information System Criteria in Isfahan province do not completely comply with WHO framework. Consequently, it seems that health system managers engaged with underlying policy and decision making processes at district health level should try to restructure and decentralize district health information system and develop training management programs for their managers.

  9. Ljubljana quality selection (LQS) - innovative case of restaurant assessment system

    OpenAIRE

    Maja Uran Maravić; Daniela Gračan; Zrinka Zadel

    2014-01-01

    The purpose – The purpose of this paper is to briefly present the most well-known restaurant assessment systems where restaurant are assessed by experts. The aim is to highlight the strengths and weaknesses of each system. Design –The special focus is to give answers on questions: how are the restaurants assessed by experts, which are the elements and standards of assessment and whether they are consistent with the quality dimensions as advocated in the theory of service quality. Methodology ...

  10. Implementation of hybrid parallel kanban-CONWIP system: A case study

    Directory of Open Access Journals (Sweden)

    Joshua Prakash

    2014-12-01

    Full Text Available The most common form of production control strategy in lean management is the pull system. One emerging form of pull system uses kanban and CONWIP systems to handle products with different demand patterns. Case studies have protractedly depicted the actual implementation of pull systems; however, the use of hybrid systems is rare. This paper examines the procedures involved in implementing a hybrid system in a low variety/low volume shop floor. This paper presents discussions on shop floor constraints in the proposed system and how the simplicity of a pull system is able to reduce work-in-process inventory by 23%. Guidelines for the replication of the system for similar production environments are also provided. The case study proves that pull systems can be successfully implemented in production environments that do not conform to the typical prerequisites of the kanban system.

  11. Evaluation of hybrid power system alternatives: a case study

    International Nuclear Information System (INIS)

    Rosenthal, Andrew L.

    1999-01-01

    Pursuant to executive and statutory policies, the National Park Service (NPS) has been evaluating the use of photovoltaic (PV) hybrid power systems, for many of its remote, off-grid areas. This paper reports the results of a detailed technical and economic evaluation for one such area: the Needles District of Canyonlands National Park. The study evaluates the presented power systems and five alternative power generation configurations, four of which utilise PV. Projections are provided for the generator run-time and fuel use associated with each configuration as well as all initial and future costs. Included in the study are specific recommendations for energy efficiency improvements at the site. Results show that the generation systems presently in use, two full-time diesel generators, has the lowest conventional 20-year life cycle costs (LCC) of the six systems evaluated. However, when emissions costs are included (per NPS guidelines), several of the PV hybrid alternatives attain a lower LCC than the diesel-only systems. General discussion of the effects of initial versus future costs of PV hybrids as they compare with engine generator system is presented. (Author)

  12. Electrical Energy Storage Systems Feasibility; the Case of Terceira Island

    Directory of Open Access Journals (Sweden)

    Ana Rodrigues

    2017-07-01

    Full Text Available The Azores Regional Government, through the Sustainable Energy Action Plan for the Azorean Islands, assumed that by the year 2018, 60% of electricity would be generated from renewable energy sources. Nevertheless, by increasing renewable energy sources share in the electricity mix, peak energy that exceeds grid capacity cannot be used unless when considering energy storage systems. Therefore, this article aims at determining, among batteries and Pumped Hydro Systems, the most cost-effective energy storage system to deploy in Terceira Island, along with geothermal, wind, thermal and bio waste energy, while considering demand and supply constraints. It is concluded that a pumped hydro system sited in Serra do Morião-Nasce Água is the best option for storage of the excess generated energy when compared with batteries. However, further studies should analyze environmental constraints. It is demonstrated that by increasing the storage power capacity, a pumped hydro system improves its cost efficiency when compared with batteries. It is also demonstrated that, to ensure quality, economic feasibility, reliability and a reduction of external costs, it is preferable to replace fuel-oil by wind to generate electricity up to a conceivable technical limit, while building a pumped hydro system, or dumping the excess peak energy generated.

  13. Solar Hot Water System Matter in Turkey (Mersin Case

    Directory of Open Access Journals (Sweden)

    Müjgan ŞEREFHANOĞLU SÖZEN

    2010-01-01

    Full Text Available When the effects of sustainability on the construction sector have been taken into consideration, solar active systems on buildings emerge as an important design issue in the context of renewal energy usage. Solar hot water systems such as those widely used in Turkey are inefficient and have a negative effect on a building’s aesthetic and the urban view in general because of the poor quality of installation. Natural circulated open loop systems are commonly used, particularly in the south of Turkey, as they are highly economical and require no regulation to install. Solar hot water systems tend to be clustered together on the roofs, causing visual pollution, and this situation arises largely because are not considered part of the architectural design. It is therefore important to consider the negative effects of such systems in the form of treatment studies. This study aims to determine the positive effects that will be gained by the renovation of solar hot water systems in Mersin, a city in the southern region of Turkey.

  14. Security And Privacy Issues in Healthcare Monitoring Systems: A Case Study

    DEFF Research Database (Denmark)

    Handler, Daniel Tolboe; Hauge, Lotte; Spognardi, Angelo

    2017-01-01

    Security and privacy issues are rarely taken into account in automated systems for monitoring elderly people in their home, exposing inhabitants to a number of threats they are usually not aware of. As a case study to expose the major vulnerabilities these systems are exposed to, this paper reviews...... a generic example of automated healthcare monitoring system. The security and privacy issues identified in this case study can be easily generalised and regarded as alarm bells for all the pervasive healthcare professionals....

  15. Systemic lupus erythematosus associated with sickle-cell disease: a case report and literature review

    OpenAIRE

    Maamar, Mouna; Tazi-Mezalek, Zoubida; Harmouche, Hicham; Mounfaloti, Wafaa; Adnaoui, Mohammed; Aouni, Mohammed

    2012-01-01

    Abstract Introduction The occurrence of systemic lupus erythematosus has been only rarely reported in patients with sickle-cell disease. Case presentation We describe the case of a 23-year-old North-African woman with sickle-cell disease and systemic lupus erythematosus, and discuss the pointers to the diagnosis of this combination of conditions and also present a review of literature. The diagnosis of systemic lupus erythematosus was delayed because our patient’s symptoms were initially attr...

  16. Enhancing Collaborative Case Diagnoses Through Unified Medical Language System-Based Disambiguation: A Case Study of the Zika Virus.

    Science.gov (United States)

    Moreira, Albert; Alonso-Calvo, Raúl; Muñoz, Alberto; Crespo, José

    2017-07-01

    During clinical case diagnoses, especially in low-resourced areas, the use of vocabularies within Unified Medical Language System (UMLS) can strengthen discussions between health professionals and, in certain cases, eliminate the need, enabling faster treatment. This article presents the benefits of using UMLS as a collaborative discussion tool and verifies its impact. The Sanar system has been improved by UMLS when using text retrieval to extract relevant medical concepts from cases investigated by the user and to provide contextualized searches of related articles. An experiment was conducted, focused on team engagement and discussion of a Zika virus case using Sanar, both with and without UMLS contextualization. The use of the tool was measured, and it was determined that the discussion in the group with UMLS support was more complete based on better information and inclusion of more variables. Clinicians involved responded to a questionnaire evaluating the relevance of functions. From the questionnaire showed that most of the group supported UMLS as important in complex diagnostics; the use of knowledge extraction before discussion is relevant to align knowledge of participants with more variables, such as the Zika virus, and to minimize the need for interaction in widely discussed cases. Based on the results obtained with the questionnaire, the use of UMLS provides acceleration in the diagnostic process that precedes interaction with other health professionals through clinical discussion tools. For future work, a mobile version will support offline navigation for locations with limited Internet access.

  17. A second case of pericardial mesothelioma mimicking systemic lupus erythematosus in the literature in over 30 years: a case report.

    Science.gov (United States)

    Mensi, Carolina; Romano, Alessandro; Berti, Alvise; Dore, Roberto; Riboldi, Luciano

    2017-03-29

    Mesothelioma is a rare neoplasm which commonly develops in the pleura of people exposed to asbestos. Pericardial mesothelioma accounts for only 0.7 % of all malignant mesotheliomas and it usually presents with pericardial effusion, mimicking serositis. To date, there are approximately 200 cases of pericardial mesothelioma described in the medical literature, and little knowledge exists about the systemic manifestations of this pathology. The first and only described case of pericardial mesothelioma with autoimmune features dates back to 1984 and, in our case report, we describe the second. We report a case of a 45-year-old white woman whose pericardial mesothelioma was initially misdiagnosed as pericardial involvement of an autoimmune disease (systemic lupus erythematosus). After several relapses of pericardial effusion, a computed tomography scan and a biopsy with histological analysis were performed revealing neoplastic growth. We describe a rare case of pericardial mesothelioma in a patient with a clinical presentation compatible with lupus serositis. Clinicians should consider malignant mesothelioma in the differential diagnosis of pericardial effusion, especially when it is recurrent and not clearly explained by other causes. Cytological samples should always be obtained and, if imaging tools are suggestive for solid processes, histological confirmation is mandatory.

  18. Improvability of assembly systems II: Improvability indicators and case study

    Directory of Open Access Journals (Sweden)

    S.-Y. Chiang

    2000-01-01

    Full Text Available Based on the performance analysis technique developed in Part I, this paper presents improvability indicators for assembly lines with unreliable machines. In particular, it shows that assembly lines are unimprovable with respect to workforce re-distribution if each buffer is, on the average, close to being half full. These lines are unimprovable with respect to buffer capacity re-distribution if each machine is starved and blocked with almost equal frequency. In addition, the paper provides indicators for identification of bottleneck machines and bottleneck buffers. Finally, the paper reports on an application of these improvability indicators in a case study at an automotive components plant.

  19. The Role of Information Systems and Technology in Case Management: a case study in health and welfare insurance

    Directory of Open Access Journals (Sweden)

    Helen Richardson

    2003-05-01

    Full Text Available This study reports the role of information system and technology (IST in supporting case management at the Accident Compensation Corporation (ACC of New Zealand. Case management is a managerial approach that seeks to gain improved business performance by enhancing both employee and customer satisfaction. Despite millions of dollars spent annually by health, social, and insurance agencies in automating case management, little research has been conducted into the role of IST in this practice. The findings of this study show that for ACC, IST’s most valuable role is enhancing the relationship between client and case manager rather than replacing it for, even after the addition of IST, the most valuable knowledge continues to accrue from the face to face interaction of client and case manager. The findings also show two distinct phases to the development of case managers as knowledge workers. The first phase focuses on control of the processes and the second on the delivery and sharing of information resources.

  20. Case history: Vertical barrier wall system for Superfund Site

    International Nuclear Information System (INIS)

    Koelling, M.A.; Kovac, C.P.; Norris, J.E.

    1997-01-01

    Design considerations and construction aspects are presented for the installation of a vertical barrier wall system for the Boeing Company at a Superfund Site near Seattle, WA. The construction was performed during 1996. The vertical barrier wall system included: (1) a soil-bentonite (SB) slurry wall, approximately 670 meters (2200 feet) in length, ranging from 12 to 21 meters (40 to 70 feet) in depth; (2) expansion of a cover system over the area enclosed by the SB wall; and (3) surface drainage improvements. Design and construction of the system addressed requirements of a Consent Decree for the site issued in 1993. The paper discusses the development of the design to meet remedial performance goals of preventing migration of contaminants in the soil/groundwater system and aiding aquifer restoration. Secondly, the paper details installation of the SB wall, highlighting the more significant construction issues, which included excavation of the wall through glacially deposited cobbles/boulders/till as well as addressing the severe elevation changes along the wall alignment. Thirdly, the paper presents Quality Assurance (QA) monitoring and testing performed during the construction phase

  1. Solar energy system case study: Telex Communications, Blue Earth, Minnesota

    Energy Technology Data Exchange (ETDEWEB)

    Raymond, M.G.

    1984-09-01

    A study is made of a solar energy system for space heating a 97,000-square-foot office, factory, and warehouse building owned by Telex Communications, Inc. in Blue Earth, Minnesota. The solar system has 11,520 square feet of ground-oriented flat-plate collectors and a 20,000-gallon storage tank inside the building. Freeze protection is by drainback. Solar heated water from the storage tank circulates around the clock throughout the heating season to heating coils in the ducts. The system achieves its design solar fraction, is efficient, and generally reliable, but not cost-effective. Performance data for the solar system was collected by the National Solar Data Network for three heating seasons from 1978 to 1981. Because of a freeze-up of the collector array in December 1978, the solar system was only partially operational in the 1978 to 1979 heating season. The data in this report were collected in the 1979 to 1980 and 1980 to 1981 heating seasons.

  2. Complex interferometry potential in case of sufficiently stable diagnostic system

    Science.gov (United States)

    Kalal, M.

    2016-06-01

    Classical interferometry is one of the key methods among active optical diagnostics. Its more advanced version, which allows recording and subsequent reconstruction of up to three sets of data using just one data object —a complex interferogram—was developed in the past and became known as complex interferometry. Employing this diagnostics, not only the usual phase shift, but also the amplitude of the probing beam as well as the fringe contrast (leading directly to the phase shift time derivative) can be reconstructed simultaneously from such a complex interferogram. In this paper it will be demonstrated that even in the case of a not particularly good diagnostic beam quality these three quantities can be reconstructed with a high degree of accuracy provided both the diagnostic beam as well as the corresponding optical line feature a reasonable stability. Such stability requirement is important as in an ideal case four shots need to be gradually recorded (one by one): the signal complex interferogram, the reference interferogram as well as the intensity structures of the signal and reference part of the diagnostic beam. Two examples of complex interferograms obtained in experiments will be analyzed: the laser produced plasma (spark in the air) and the high pressure gas jet. A general ray-tracing based iterative algorithm will be outlined in order to increase a precision of the index of refraction spatial profile taking into account refraction effects (omitted in the Abel inversion) and employing the original reconstructed phase shift and amplitude.

  3. Systemic relational therapy and the case from the clinical practice

    Directory of Open Access Journals (Sweden)

    Tatjana Rožič

    2003-06-01

    Full Text Available In the present article are represented the principal guidelines of the systemic relational model of psychotherapy and an example of clinical practice where the pacient was incluced in this kind of therapy. In the essence of systemic relational model there is a person which is captured in the repetition of old patterns in spite of its painfulness and hardness. Captured and helpless in old patterns, the person not only repeats but also recreates them, because they promise safety, belonging and connectedness. From the review of the therapy it is evident that behind the pacient's concrete problems stands her family system to which she is loyal in the way that only deepens her distress. By the increasing the responsability for herself, for her feelings and her acts, it increases the pacient's funcionality, too.

  4. Estimation of EMI Filter Performance for the "Worst Case" System

    Directory of Open Access Journals (Sweden)

    J. Svacina

    2006-12-01

    Full Text Available This paper deals with the performance problem of the EMC filters. The core of this problem in EMC filter is the uncertainty of impedances that are connected to the input and output of a filter. In addition, an estimation technique is presented that gives approximate insertion loss of the filter. The performance of this technique was tested on several filters and the data obtained were checked by insertion loss measurement. The heart of the matter is based on the L C equivalent circuits, which are described by Y parameters. The estimation gives pretty good results for the 0.1 Ω/100 Ω and vice-versa systems and also for other systems. Also discussed are system configurations with the Δ (delta and (Y star topologies of terminating impedances which better approximate the real situation on the input and output terminals of filter.

  5. Systems Engineering Education Development(SEED)Case Study

    Science.gov (United States)

    Bagg, Thomas C., III; Brumfield, Mark D.; Jamison, Donald E.; Granata, Raymond L.; Casey, Carolyn A.

    2003-01-01

    The Systems Engineering Development Program (SEED) was initiated to help Goddard resolve a Systems Engineering skill shortage. The chronology of events and the experiences of the pilot program are outlined to describe the development of the present program. The program goals are included in order to give a focus on what the developers saw as the program drivers. Lessons learned from a pilot program were incorporated into the present program. This program is constantly learning from its past efforts and looks for continuous improvement. We list several future ideas for improvement and change.

  6. Standardization of computer systems for logging operative cases.

    Science.gov (United States)

    Feldman, M D; Lowry, L D; Wisnicki, H J

    1988-10-01

    With the advent of extremely rapid, powerful, compact, and inexpensive microcomputers, a revolution in data manipulation is ongoing. We have customized and used for over two years prepackaged software to track residents' operative experiences in the Department of Otolaryngology at Jefferson Medical College of Thomas Jefferson University, Philadelphia. An attempt is presently being made to develop a similar system that might be utilized by all otolaryngology teaching programs and thus enable the collection and review of residents' operative experiences nationally. A basic, relational database system is proposed for entering resident caseload data and generating reports for periodic review.

  7. Coincident systemic lupus erythematosus and psoriasis vulgaris: a case report.

    Science.gov (United States)

    Wang, Y; Da, G; Yu, Y; Han, J; Li, H

    2015-12-01

    Psoriasis vulgaris is an autoimmune chronic inflammatory skin disease, but its association with other typical autoimmune disease such as systemic lupus erythematosus has only occasionally been reported. We presented a 25-year-old female who developed systemic lupus erythematosus associated with psoriasis vulgaris. Her conditions were in good control after she got administration of prednisolone (5 mg/day) and Tripterygium Wilfordii Hook (20 mg/day). It is necessary to integrate past history and physical examination to diagnose coincident SLE and psoriasis, and combined treatment with prednisolone and Tripterygium Wilfordii Hook proves effective.

  8. Laboratory Information Management System (LIMS): A case study

    Science.gov (United States)

    Crandall, Karen S.; Auping, Judith V.; Megargle, Robert G.

    1987-01-01

    In the late 70's, a refurbishment of the analytical laboratories serving the Materials Division at NASA Lewis Research Center was undertaken. As part of the modernization efforts, a Laboratory Information Management System (LIMS) was to be included. Preliminary studies indicated a custom-designed system as the best choice in order to satisfy all of the requirements. A scaled down version of the original design has been in operation since 1984. The LIMS, a combination of computer hardware, provides the chemical characterization laboratory with an information data base, a report generator, a user interface, and networking capabilities. This paper is an account of the processes involved in designing and implementing that LIMS.

  9. Designing a performance measurement system: A case study

    NARCIS (Netherlands)

    Lohman, Clemens; Fortuin, Leonard; Wouters, Marc

    2004-01-01

    Performance measurement (PM) by means of local performance indicators (PIs) is developing into performance management at a company-wide scale. But how should PIs at various levels in the organization be incorporated into one system that can help managers, working at levels that range from

  10. Practicing Technology Implementation: The Case of an Enterprise System

    Science.gov (United States)

    Awazu, Yukika

    2013-01-01

    Drawing on four theories of practice--Communities of Practice (CoP), Bourdieu's theory of practice, Pickering's mangle of practice, and Actor Network Theory (ANT), the study provides an in-depth understanding about technology implementation practice. Analysis of an Enterprise System implementation project in a software manufacturing…

  11. Dynamics of Technological Innovation Systems : The case of biomass energy

    NARCIS (Netherlands)

    Negro, S.O.

    2007-01-01

    The starting point is that the current energy system is largely dependant on fossil fuels. This phenomenon, which is labelled as carbon lock-in by Unruh (2000), makes the breakthrough of renewable energies long, slow, and tedious. The most suitable theoretical approach to analyse the development,

  12. Systemic lupus erythematosus: 2 case reports from Eritrea

    African Journals Online (AJOL)

    Introduction. Systemic Lupus Erythematosus is a chronic inflammatory disease of unknown etiology, but is probably of multi-factorial origin, including a variable genetic predisposition and environmental factors that trigger the disease. It is much common among certain races including population groups including Africans,.

  13. Sustainable development indicators for urban water systems: a case ...

    African Journals Online (AJOL)

    In the light of the increasing pressures on the world's freshwater resources, changes in the present and future urban water systems are called for in order to achieve sustainable development. The transformation from unsustainable practices demands tools that measure progress and can warn of future trends. Sustainable ...

  14. Urban lake system eutrophication – A case study | MAMA | Journal ...

    African Journals Online (AJOL)

    The dynamic eutrophication process study of Yamoussoukro lake system in Côte d'Ivoire was carried out from February 1997 to January 1998. It appeared that this phenomenon is related to the nutriments that are phosphorus mainly and nitrogen. It was shown that the fluctuations of these nutriments depend on the climatic ...

  15. The Case of Lesotho's Mixed Member Proportional System | Kapa ...

    African Journals Online (AJOL)

    preparation of the 2002 poll, prominent among which has been the introduction of the Mixed Member Proportional (MMP) electoral system. Through this model, Lesotho enjoyed a large degree of political stability as almost all parties that contested the poll got representation in the national parliament. However, following the ...

  16. Making sense of indigenous knowledge systems: the case of ...

    African Journals Online (AJOL)

    I also suggest that this is a particularly urgent need in regard to indigenous or traditional medical systems which are still widely practised but often insufficiently understood in the modern biomedical context. I use the cognitive linguistic approach to analyse some central models and key terms in traditional Chinese medicine ...

  17. Information Systems Education: The Case for the Academic Cloud

    Science.gov (United States)

    Mew, Lionel

    2016-01-01

    This paper discusses how cloud computing can be leveraged to add value to academic programs in information systems and other fields by improving financial sustainment models for institutional technology and academic departments, relieving the strain on overworked technology support resources, while adding richness and improving pedagogical…

  18. Human Mobile Inverted Pendulum Transporter - a Mechatronic System Case Study

    DEFF Research Database (Denmark)

    Bech, Michael Møller; Hansen, Anders Hedegaard; Pedersen, Henrik C.

    2011-01-01

    , which nevertheless illustrates the potentials of unifying classical engineering technologies (mechanics, electronics, control systems) with modern high-efficient inverter-fed permanent magnet AC motors and the latest MEMS sensor technology. A full-scale fully operational prototype of a two-wheel mobile...... inverted pendulum has been built based on the presented design....

  19. Advanced control of a water supply system : A case study

    NARCIS (Netherlands)

    Bakker, M.; Rajewicz, T.; Kien, H.; Vreeburg, J.H.G.; Rietveld, L.C.

    2014-01-01

    Conventional automatic production flow control and pump pressure control of water supply systems are robust and simple: production flow is controlled based on the level in the clear water reservoir and pump pressure is controlled on a static set-point. Recently, more advanced computer-based control

  20. Organic Dairy Production Systems in Pennsylvania: A Case Study Evaluation

    NARCIS (Netherlands)

    Rotz, C.A.; Kamphuis, G.H.; Karsten, H.D.; Weaver, R.D.

    2007-01-01

    The current market demand and price for organic milk is encouraging dairy producers, particularly those on smaller farms, to consider organic production as a means for improving the economic viability of their operations. Organic production systems vary widely in scale, in practices, and across

  1. Reactive power management in electric power systems - A case ...

    African Journals Online (AJOL)

    The reactive power consumption by industrial plants and generation patterns in the Ethiopian Electric Light and Power Authority's (EELPA) system is critically evaluated. The flaws in the incentive mechanism for reactive power compensation are identified and recommendations made. Further, the voltage profile at the ...

  2. Does financial system influence tax revenue? The case of Nigeria ...

    African Journals Online (AJOL)

    We examined the influence of financial system activities on tax revenue collection in Nigeria for the period of 1981-2014. After given consideration for the period of banking crisis with the employment of ARDL/ Bound test, causality test, variance decomposition and impulse response techniques, our analysis showed that ...

  3. Automatic Verification of Railway Interlocking Systems: A Case Study

    DEFF Research Database (Denmark)

    Petersen, Jakob Lyng

    1998-01-01

    This paper presents experiences in applying formal verification to a large industrial piece of software. The are of application is railway interlocking systems. We try to prove requirements of the program controlling the Swedish railway Station Alingsås by using the decision procedure which is ba...

  4. Characterization of Awassi lamb fattening systems: a Syrian case study.

    Science.gov (United States)

    Hartwell, Birgitte Wiedemann; Iñiguez, Luis; Mueller, Joaquin; Wurzinger, Maria; Knaus, W F

    2010-10-01

    Intensive lamb fattening systems are evolving in developing Middle Eastern countries due to high demand for lambs at favorable prices; however, little is known about their characteristics and constraints. A survey was conducted in Syria involving 241 farmers to characterize the fattening production systems and main constraints, with emphasis on feeding, management, labor, and marketing. Most farmers (90%) considered the income from fattening to be from medium to high, and 57% expressed that lamb fattening along with alternative income sources compose the family's livelihood strategies. Fattening systems offer employment to family members. Market price was the main decision factor to buy and sell lambs, but this was only part of various marketing aspects. Male lambs usually bought at markets at the mean age of 4 months (mean weight of 31 kg) are sold after fattening at a 50-60 kg weight range. The average yearly fattening cycle was 2.7 batches, and the average number of lambs per batch was 232. For 65% (n = 241) of the farmers the major constraint to fattening was feeding cost, and for about a half of farmers (51%, n = 241), disease outbreaks and prices for veterinarian services constituted the second important constraint. Research on least-cost fattening diets and curbing disease problems to increase farmer's income margins is needed. It is expected that due to existing commonalities, the information emerging from this study regarding major constraints to Awassi lamb fattening systems could be useful for an across-synthesis on Awassi fattening production in the region.

  5. Design and analysis of control systems case studies

    CERN Document Server

    Stein Shiromoto, Humberto

    2017-01-01

    This book provides methods to unify different approaches to tackle stability theory problems. In particular, it presents a methodology to blend approaches obtained from measure theory with methods obtained from Lyapunov’s stability theory. The author summarizes recent works on how different analysis/design methods can be unified and employed for systems that do not belong to either of domains of validity.

  6. System Dynamics Project : The case of Electricity in Shanghai

    NARCIS (Netherlands)

    Yang, Q.; Zhenpeng, Z.

    2014-01-01

    The increasing energy demand in China due to urbanization has made the study of different energy policies in big cities a crucial topic of discussion. This is a complex problem since the electricity market is a multi-actor system where various actors may have a great influence on the main issue we

  7. Systemic lupus Erythematosus: 2 case reports from Eritrea | Zerai ...

    African Journals Online (AJOL)

    Systemic Lupus Erythematosus is an autoimmune disorder, occurring predominantly in women during reproductive age and characterized by the presence of antibodies in the serum against the nuclear components (ANA), leading to inflammation in kidney, brain, and skin manifestations. The diversity of the disease the ...

  8. Use of standalone photovoltaic system for office building: the case ...

    African Journals Online (AJOL)

    This paper presents the design of a cost effective energy system for National Centre for Hydropower Research and Development (NACHRED) building to supply its daily energy requirements. The daily hourly load demand of the building was measured with FLUKE 434 Series II Energy Analyzer. The measurement was ...

  9. Analysis and Perspective from the Complex Aerospace Systems Exchange (CASE) 2013

    Science.gov (United States)

    Jones, Kennie H.; Parker, Peter A.; Detweiler, Kurt N.; McGowan, Anna-Maria R.; Dress, David A.; Kimmel, William M.

    2014-01-01

    NASA Langley Research Center embedded four rapporteurs at the Complex Aerospace Systems Exchange (CASE) held in August 2013 with the objective to capture the essence of the conference presentations and discussions. CASE was established to provide a discussion forum among chief engineers, program managers, and systems engineers on challenges in the engineering of complex aerospace systems. The meeting consists of invited presentations and panels from industry, academia, and government followed by discussions among attendees. This report presents the major and reoccurring themes captured throughout the meeting and provides analysis and insights to further the CASE mission.

  10. The advocacy of an appraisal system for teachers: a case study ...

    African Journals Online (AJOL)

    Education systems all over the world, like all other organisations, have certain organisational goals that they set and wish to achieve. It is argued that for increased pupil performance, in the case of education systems, teachers must work harder and smarter. A performance system is regarded as part of the process to achieve ...

  11. COST BENEFIT ANALYSIS OF A DG INTEGRATED SYSTEM: CASE STUDY

    Directory of Open Access Journals (Sweden)

    Ch. V. S. S. SAILAJA

    2017-09-01

    Full Text Available Distributed Generation is capable of meeting the load of the consumers partially or completely. Depending on the type of DG involved it can be operated in interconnected mode and islanded mode. The availability of numerous alternatives present for the DG technologies and large initial investments necessitates a detailed cost benefit analysis for the implementation of DG technologies. In this work an attempt has been made to study the costs involved in implementing the DG technologies. A practical system having two kinds of distributed generation i.e., Diesel Generator and solar photovoltaic system for its back up purpose is considered. A detailed cost analysis of the two DG technologies is carried out.

  12. Systemic inflammatory response syndrome: a case of septic shock

    Directory of Open Access Journals (Sweden)

    Nicolò Gentiloni Silveri

    2008-09-01

    Full Text Available An elderly, diabetic male, with severe sepsis, swiftly treated with antibiotics that were efficacious in vitro against the E. Coli isolated in his blood, rapidly slides into multiple organ dysfunction syndrome and dies of septic shock after a month in intensive care, despite receiving appropriate pain relief and aetiopathogenetic therapy. This event provides us with the opportunity to take a new look at systemic inflammatory response syndrome and a critical review of the relative therapy

  13. Validating unit commitment models: A case for benchmark test systems

    OpenAIRE

    Melhorn, Alexander C.; Li, Mingsong; Carroll, Paula; Flynn, Damian

    2016-01-01

    Due to increasing penetration of non-traditional power system resources; e.g. renewable generation, electric vehicles, demand response, etc. and computational power there has been an increased interest in research on unit commitment. It therefore may be important to take another look at how unit commitment models and algorithms are validated especially as improvements in solutions and algorithmic performance are desired to combat the added complexity of additional constraints. This paper expl...

  14. Information System Model as a Mobbing Prevention: A Case Study

    Directory of Open Access Journals (Sweden)

    Ersin Karaman

    2014-06-01

    Full Text Available In this study, it is aimed to detect mobbing issues in Atatürk University, Economics and Administrative Science Facultyand provide an information system model to prevent mobbing and reduce the risk. The study consists of two parts;i detect mobbing situation via questionnaire and ii design an information system based on the findings of the first part. The questionnaire was applied to research assistants in the faculty. Five factors were analyzed and it is concluded that research assistants have not been exposed to mobbing except the fact that they have mobbing perception about task assignment process. Results show that task operational difficulty, task time and task period are the common mobbing issues.  In order to develop an information system to cope with these issues,   assignment of exam proctor process is addressed. Exam time, instructor location, classroom location and exam duration are the considered as decision variables to developed linear programming (LP model. Coefficients of these variables and constraints about the LP model are specified in accordance with the findings. It is recommended that research assistants entrusting process should be conducted by using this method to prevent and reduce the risk of mobbing perception in the organization.

  15. Ebola cases and health system demand in Liberia.

    Directory of Open Access Journals (Sweden)

    John M Drake

    2015-01-01

    Full Text Available In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the

  16. Case Studies in Systems Chemistry. Final Report. [Includes Complete Case Study, Carboxylic Acid Equilibria

    Science.gov (United States)

    Fleck, George

    This publication was produced as a teaching tool for college chemistry. The book is a text for a computer-based unit on the chemistry of acid-base titrations, and is designed for use with FORTRAN or BASIC computer systems, and with a programmable electronic calculator, in a variety of educational settings. The text attempts to present computer…

  17. Acute Central Nervous System Infection : a Case Report

    Directory of Open Access Journals (Sweden)

    Masfiyah Masfiyah

    2012-12-01

    Case report : A 15-month-old girl was admitted with fever of 39,4°C, generalized seizures, and petechiae after suffered high fever and cough in previous day. This was her first episode of seizures. She has no past history of growth and developmental disorder. She became rapidly deteriorated after few hours being hospitalized in Kariadi. Brain CT-scan was not done due to her conditions. She had anemia, normal white blood count, monocytosis, thrombocytopenia (4000/mm3, low CD4 count (99 cell/mm3, hipoalbuminemia (1.4 g/dl, increased lactate (2.5 mmol/L and procalcitonin (>200.00 ng/ml. Cerebrospinal fluid analysis revealed normal cells count and glucose but increased protein level (375.2 mg/dL. Meningococcal infection was suspected due to clinical appearance, and ceftriaxone was given. Bacteriological and fungal culture of CSF and blood showed no growth. Despite of cardiorespiratory support given, she died after 4 days of admission. Discussion : Features of seizure and general ecchymosis do not belong exclusively to meningococcal infection. There are other possible etiological agent such as Haemophylus influenza, Streptococcal infection and viral infection. Shortage of available diagnostic tools such as Polymerase Chain Reaction (PCR made it difficult to confirm the etiological agent (Sains Medika, 4(2:204-209. Question Remarks : What agent which you think cause the infection?

  18. Improving enterprise system support - a case-based approach

    DEFF Research Database (Denmark)

    Wognum, P.M.; Krabbendam, J.J.; Buhl, Henrik

    2004-01-01

    of a comprehensive reference framework. After this step a tool has been developed to support a consultant in assessing the maturity of a company to start an enterprise system implementation project. The knowledge, used directly in the tool, makes it possible to suggest improvement actions sensitive to the situation...... organisational change. Success and failure factors and do's and don'ts, as can be found in the literature, provide necessary, but not sufficient, preconditions for starting an implementation project. The complexity of such a project makes full anticipation and control of potential problems impossible...

  19. A Human Work Interaction Design (HWID) Case Study in E-Government and Public Information Systems

    DEFF Research Database (Denmark)

    Clemmensen, Torkil

    2011-01-01

    This paper first outlines a revised version of the general HWID framework, with a focus on what connects empirical work analysis and interaction design, and then presents a case study of the Danish government one-for-all authentication system NemID. The case is briefly analyzed, using ethnomethod...

  20. Telemedicine using an image transfer system in the treatment of neurosurgical emergent cases

    International Nuclear Information System (INIS)

    Saito, Atsushi; Numagami, Yoshihiro; Kamiyama, Hironaga; Furuno, Yuuichi; Nishimura, Shinjitsu; Nishijima, Michiharu

    2007-01-01

    Our department is located in the Tsugaru district, which is famous for heavy snow fall, and the small number of neurosurgeon centers in the urban areas leads to an inadequate distribution of neurosurgeons for patients in this region. Such geographical and social constraints have made it difficult to offer sufficient neurosurgical care to all patients in the region. We describe the usefulness of a telemedicine triage system using an image transfer system in the treatment of neurosurgical emergent cases. Image transfer systems have been installed at our hospital and 11 regional hospitals in the Tsugaru district, and have been utilized for teleconsultation regarding neurosurgical patients via transferred computed tomography images since 1989. Consultations regarding 2,858 cases were directed to our department between 1989 and 2006, including 1,615 cases of stroke, 869 cases of head trauma, 97 cases of brain tumor, and 277 cases with other disorders. 84% of subarachnoid hemorrhage cases and 22% of head trauma cases needed emergent transfer. The state of consciousness in intracerebral hemorrhage, and the state of consciousness and time of consultation in head trauma were statistically significant factors for emergent transfer. The presert telemedicine triage system was useful for ensuring correct diagnosis and appropriate primary neurosurgical care in the regional hospitals without neurosurgical units, resulting in a reinforcement of the relationships among the regional hospitals and the efficient transfer of emergent neurosurgical patients. (author)