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P259 Tegumentary histoplasmosis: report of 4 cases
S108
Poster Presentations
[TMA] assay, APTIMA Combo 2 [AC2], is available for the detection of CT and GC RNA in clinical specimens and positives can be confirmed in alternate individual TMA tests [ACT and AGC]. We evaluated the utility of performing AC2 testing for GC on specimens submitted for GC culture or CT TMA. Methods: From March to August 2008, a total of 81,405 samples from men and women attending doctors’ offices, in Ontario, were inoculated onto modified Thayer-Martin medium and a second sample collected for TMA was tested for GC RNA by AC2 [Gen-Probe] by direct tube sampling [DTS 1600] or on the TIGRIS instrument [group A]. A second group of swabs [n = 14,667] which had no GC culture ordered but were submitted for CT testing in AC2 were tested for GC RNA [group B]. A proportion of AC2-GC positive samples with sufficient volume [n = 66] were retrieved and retested by AGC [confirmatory testing]. Results: The GC prevalence rate by culture was 0.2% [6.0% men/ 0.09% women]. Ninety-nine percent of the samples were from women. The AC2 test for GC in group A detected all culture positives and 67 additional positives from the culture-negative group, increasing the prevalence rate to 0.25. Seventy-five AC2-GC positives were found in group B. Confirmatory testing of representative samples from Groups A and B with AGC found 97% [64/66] positive. Conclusion: Sixty-seven extra cases of N. gonorrhoeae infections were diagnosed by AC2 testing samples submitted for culture. GC positives were also found in 75 (0.5%) of samples submitted for AC2 CT testing without an order for GC. Ninety-seven percent of samples retested by an AGC test confirmed positive. AC2 testing enabled identification and treatment of 142 cases of gonorrhea which would have been reported negative or would not have been investigated.
P260 Necrotizing hepatitis and acute cholecystitis associated to histoplasmosis S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , L. Ayala1 , E. Zucker1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela Objective: Necrotizing hepatitis and acute cholecystitis associated to histoplasmosis is an extremely rare condition. In this report we describe the major findings related to a recently seen clinical case. Methods: Case Report. Case corresponded to a female, 66 y-old, presenting as an incipient, acalculous acute cholecystitis, in which an inflammatory clinical aspect of the liver during the surgical procedure suggest a liver disease, which was later identified during the frozensection was identified as a granulomatous liver disease. Results: The histopathology confirmed the diagnosis of histoplasmosis as the cause of a necrotizing hepatitis. Additionally the patient presented a necrotizing lymphadenitis due to Histoplasma capsulatum. The histopathology shown small fragments of liver parenchyma with necrosis areas, microabscesses and histiocytes in which were identified abundant mycotic spores unigemant of 3 to 5 x mm, stained with Grocott, identified as Histoplasma capsulatum. Zielh-Neelsen staining was negative. Conclusion: Histoplasma capsulatum is an uncommon cause of liver disease, and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated infection.
Travel medicine and tropical diseases
P261 Multiple furuncular myiasis due to Dermatobia hominis in a traveler to the Venezuelan Amazonian Jungle
P259 Tegumentary histoplasmosis: report of 4 cases
S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , Y. Milgram1 , E. Zucker1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela
S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela Objective: Histoplasmosis is usually a lung infection due to Histoplasma capsulatum var capsulatum. Skin lesions are present in 10 to 17% of cases and it appears to have higher prevalence in some countries of Latin America. In other cases, primary cutaneous histoplasmosis is extremely rare. Methods: In this report we described 4 cases of tegumentary histoplasmosis, 3 corresponding to cutaneous histoplasmosis and 1 to mucose histoplasmosis, diagnosed at our institution between 2006 and 2008. Results: Three cases corresponded to female patients and one to a male patient. The mean age was 40 y-old. From the cutaneous histoplasmosis cases, two were immunosupressed with also disseminated histoplasmosis and one case was an immunocompetent patient with a primary cutaneous histoplasmosis. Finally, the mucose histoplasmosis case was an HIV negative patient with a lesion in the hard palate simulating a tumoral lesion, but also was a primary histoplasmosis lesion without pulmonary or disseminated compromise. Conclusion: The pathologist and tropical and ID clinicians should be aware to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with immunosupression, but in sometimes also in inmunocompetent patients may suggest disseminated histoplasmosis. The value of skin biopsy is very relevant in this setting.
Objective: Myiasis is the infestation by Diptera larvae. Dermatobia hominis is an obligate Diptera which feed on the host organs and fluids to complete its development. Furuncular myiasis is the infestation of the skin caused by these larvae. Methods: Case Report. Case: An immunocompetent young woman 23 y-old, born and living in Caracas, traveled to La Gran Sabana, an area of the Venezuelan Amazonian jungle, where she had multiple haematophagal Diptera punctures, which is rare, developing retroauricular and frontal eritematous nodules with a central puncture exuding a serosanguinous discharge. Results: Dermatobia hominis larvae were identified after their mechanical remove. Macroscopic and histopathological study of the larvae confirms the Diptera etiology. Conclusion: Dermatobia hominis lays the eggs on the bodies of other insects or in the human tissues, in this case in two body regions. Misdiagnosis can occurs related to limited knowledge of the condition outside endemic areas, such as Caracas, the capital city of Venezuela, where this case was diagnosed and treated. Public health: Public health and community-acquired infections P262 Self or parent-collected nasal mid-turbinate flocked swabs versus nasopharyngeal swabs for influenza diagnosis in a community-based study M. Smieja1 *, P. Singh1 , L. Moss1 , K. Pabbaraju2 , S. Wong3 , J. Fox4 , M. Loeb1 . 1 McMaster University, Hamilton, Canada, 2 ProvLab, Calgary, Canada, 3 Provincial Laboratory For Public Health (Microbiology), Calgary, Canada, 4 University of Calgary, Calgary, Canada Background: We previously tested the new Copan mid-turbinate nasal flocked swab (NS) in volunteers, and demonstrated equivalence to flocked nasopharyngeal swabs (NPS) for sampling respiratory tract
Poster Presentations
[TMA] assay, APTIMA Combo 2 [AC2], is available for the detection of CT and GC RNA in clinical specimens and positives can be confirmed in alternate individual TMA tests [ACT and AGC]. We evaluated the utility of performing AC2 testing for GC on specimens submitted for GC culture or CT TMA. Methods: From March to August 2008, a total of 81,405 samples from men and women attending doctors’ offices, in Ontario, were inoculated onto modified Thayer-Martin medium and a second sample collected for TMA was tested for GC RNA by AC2 [Gen-Probe] by direct tube sampling [DTS 1600] or on the TIGRIS instrument [group A]. A second group of swabs [n = 14,667] which had no GC culture ordered but were submitted for CT testing in AC2 were tested for GC RNA [group B]. A proportion of AC2-GC positive samples with sufficient volume [n = 66] were retrieved and retested by AGC [confirmatory testing]. Results: The GC prevalence rate by culture was 0.2% [6.0% men/ 0.09% women]. Ninety-nine percent of the samples were from women. The AC2 test for GC in group A detected all culture positives and 67 additional positives from the culture-negative group, increasing the prevalence rate to 0.25. Seventy-five AC2-GC positives were found in group B. Confirmatory testing of representative samples from Groups A and B with AGC found 97% [64/66] positive. Conclusion: Sixty-seven extra cases of N. gonorrhoeae infections were diagnosed by AC2 testing samples submitted for culture. GC positives were also found in 75 (0.5%) of samples submitted for AC2 CT testing without an order for GC. Ninety-seven percent of samples retested by an AGC test confirmed positive. AC2 testing enabled identification and treatment of 142 cases of gonorrhea which would have been reported negative or would not have been investigated.
P260 Necrotizing hepatitis and acute cholecystitis associated to histoplasmosis S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , L. Ayala1 , E. Zucker1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela Objective: Necrotizing hepatitis and acute cholecystitis associated to histoplasmosis is an extremely rare condition. In this report we describe the major findings related to a recently seen clinical case. Methods: Case Report. Case corresponded to a female, 66 y-old, presenting as an incipient, acalculous acute cholecystitis, in which an inflammatory clinical aspect of the liver during the surgical procedure suggest a liver disease, which was later identified during the frozensection was identified as a granulomatous liver disease. Results: The histopathology confirmed the diagnosis of histoplasmosis as the cause of a necrotizing hepatitis. Additionally the patient presented a necrotizing lymphadenitis due to Histoplasma capsulatum. The histopathology shown small fragments of liver parenchyma with necrosis areas, microabscesses and histiocytes in which were identified abundant mycotic spores unigemant of 3 to 5 x mm, stained with Grocott, identified as Histoplasma capsulatum. Zielh-Neelsen staining was negative. Conclusion: Histoplasma capsulatum is an uncommon cause of liver disease, and with its protean clinical presentation, a high index of suspicion is needed to make the diagnosis and avoid the potentially high fatality rate associated with disseminated infection.
Travel medicine and tropical diseases
P261 Multiple furuncular myiasis due to Dermatobia hominis in a traveler to the Venezuelan Amazonian Jungle
P259 Tegumentary histoplasmosis: report of 4 cases
S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , Y. Milgram1 , E. Zucker1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela
S. Dickson-Gonzalez1 , M. Lunar de Uribe1 , A. Rodriguez-Morales *. 1 Universidad Central de Venezuela/Hospital de Clinicas Caracas, Caracas, Venezuela Objective: Histoplasmosis is usually a lung infection due to Histoplasma capsulatum var capsulatum. Skin lesions are present in 10 to 17% of cases and it appears to have higher prevalence in some countries of Latin America. In other cases, primary cutaneous histoplasmosis is extremely rare. Methods: In this report we described 4 cases of tegumentary histoplasmosis, 3 corresponding to cutaneous histoplasmosis and 1 to mucose histoplasmosis, diagnosed at our institution between 2006 and 2008. Results: Three cases corresponded to female patients and one to a male patient. The mean age was 40 y-old. From the cutaneous histoplasmosis cases, two were immunosupressed with also disseminated histoplasmosis and one case was an immunocompetent patient with a primary cutaneous histoplasmosis. Finally, the mucose histoplasmosis case was an HIV negative patient with a lesion in the hard palate simulating a tumoral lesion, but also was a primary histoplasmosis lesion without pulmonary or disseminated compromise. Conclusion: The pathologist and tropical and ID clinicians should be aware to the fact that in areas endemic for Histoplasma capsulatum maculopapular rash in patients with immunosupression, but in sometimes also in inmunocompetent patients may suggest disseminated histoplasmosis. The value of skin biopsy is very relevant in this setting.
Objective: Myiasis is the infestation by Diptera larvae. Dermatobia hominis is an obligate Diptera which feed on the host organs and fluids to complete its development. Furuncular myiasis is the infestation of the skin caused by these larvae. Methods: Case Report. Case: An immunocompetent young woman 23 y-old, born and living in Caracas, traveled to La Gran Sabana, an area of the Venezuelan Amazonian jungle, where she had multiple haematophagal Diptera punctures, which is rare, developing retroauricular and frontal eritematous nodules with a central puncture exuding a serosanguinous discharge. Results: Dermatobia hominis larvae were identified after their mechanical remove. Macroscopic and histopathological study of the larvae confirms the Diptera etiology. Conclusion: Dermatobia hominis lays the eggs on the bodies of other insects or in the human tissues, in this case in two body regions. Misdiagnosis can occurs related to limited knowledge of the condition outside endemic areas, such as Caracas, the capital city of Venezuela, where this case was diagnosed and treated. Public health: Public health and community-acquired infections P262 Self or parent-collected nasal mid-turbinate flocked swabs versus nasopharyngeal swabs for influenza diagnosis in a community-based study M. Smieja1 *, P. Singh1 , L. Moss1 , K. Pabbaraju2 , S. Wong3 , J. Fox4 , M. Loeb1 . 1 McMaster University, Hamilton, Canada, 2 ProvLab, Calgary, Canada, 3 Provincial Laboratory For Public Health (Microbiology), Calgary, Canada, 4 University of Calgary, Calgary, Canada Background: We previously tested the new Copan mid-turbinate nasal flocked swab (NS) in volunteers, and demonstrated equivalence to flocked nasopharyngeal swabs (NPS) for sampling respiratory tract