<font size="3" face="Times New Roman">
</font><div style="margin:0cm 0cm 10pt" class="MsoNormal"><span style lang="EN-US"><font face="Calibri"><font size="3">Igor Thiago,</font></font></span></div><div style="margin:0cm 0cm 10pt" class="MsoNormal"><span style lang="EN-US"><font face="Calibri"><font size="3">For the
origin, evolution time and procession of symptomatic illness, I am more in line
with the position of Dr. Carlos Henrique, Dr. Carlos Orduna and Dr. Marcus Lacerda. <span style> </span>And put us within a framework of <strong>Unknown
Origin Fever</strong> or <strong>Prolonged Course Fever</strong>. </font></font></span></div><font size="3" face="Times New Roman">
</font><p style="margin:0cm 0cm 10pt" class="MsoNormal"><span style lang="EN-US"><font face="Calibri"><font size="3">And yet, by
the <strong>patient´s occupation (truck),</strong> he may have acquired the disease elsewhere,
and despite denying risky habits, I would not rule out the possibility of an
<strong>STD involved</strong>, especially AIDS and / or syphilis (two of big “imitators”
diseases), and wouldn’t call me attention to possibly being a <strong>prevalent infectious
disease with atypical manifestation or a rare disease.</strong> Just beyond the immune-molecular
studies, I would suggest to do a <span style> </span><strong>Marrow
Culture <span style> </span>with Ruiz-Castaneda Medium or
Biliar broth</strong> for the isolation of Brucella spp or Salmonella spp. </font></font></span></p><font size="3" face="Times New Roman">
</font><div style="margin:0cm 0cm 10pt" class="MsoNormal"><span style lang="EN-US"><font size="3"><font face="Calibri">I thank
<u><strong>Igor Thiago</strong></u> by gives us the opportunity to think and grow on the marvelous
world of Tropical Medicine.</font></font></span></div><div style="margin:0cm 0cm 10pt" class="MsoNormal"><span style lang="EN-US"><font size="3"><font face="Calibri"></font></font></span> </div><font size="3" face="Times New Roman">
<div style="text-align:center"><strong>Prof. Dr. Marco Tulio A Garcia-Zapata, MD, PhD</strong></div><div style="text-align:center"><strong><font size="1">Medical Tropicalist / Head Professor / Principal Researcher</font></strong></div>
<div style="text-align:center"><font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></div><div style="text-align:center"><font size="1">Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></div>
<div style="text-align:center"><font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></div><div style="text-align:center"><font size="1">Tropical Pathology & Public Health Institute (IPTSP)</font></div>
<div style="text-align:center"><font size="1">Federal University of Goias (UFG)</font></div><div style="text-align:center"><font size="1">Goiania - GO, BRAZIL</font><br><font size="1"> </font></div><div style="text-align:center">
<font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></div><div style="text-align:center"><font size="1">Goiania - GO, 74643-970, Brazil</font></div><div style="text-align:center"><font size="1">Phone: (+2)3269-8219, Fax (+62)3521-1839</font></div>
<div style="text-align:center"><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></div><div style="text-align:center"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank"><font size="1">medicinadeviagem.hc.hdt@gmail.com</font></a></div>
<div style="text-align:center"><a href="mailto:mctulianglobal@gmail.com" target="_blank"><font size="1">mctulianglobal@gmail.com</font></a> </div></font><div style="text-align:center"><br><br></div><div class="gmail_quote">
2012/7/3 Igor Thiago Borges de Queiroz e Silva <span dir="ltr"><<a href="mailto:igorthiago@usp.br" target="_blank">igorthiago@usp.br</a>></span><br><blockquote style="margin:0px 0px 0px 0.8ex;padding-left:1ex;border-left-color:rgb(204,204,204);border-left-width:1px;border-left-style:solid" class="gmail_quote">
Hi, everybody.<br>
I would like some help in a case here in Sao Paulo:<br>
<br>
"Patient, 60 years, male, married, with no comorbidities, retired truck driver, coming from Manaus / AM, where he lives in urban area and has a place in the jungle.<br>
He arrived at the referring hospital with fever, myalgia, headache and dysphagia for 4 days, when it came to travel. On examination, revealed hepatomegaly (2 cm) and splenomegaly (below the left costal margin). Normal cardiac and pulmonary auscultation. No palpable lymphadenopathy.<br>
Reported contact with flood water, where had rats in peridomicile. Confirmed vaccination against yellow fever (2009). Social drinking, denied smoking or illicit drug use. One sexual partner (wife). He denied domestic animals, neither contact with birds or bats.<br>
Laboratory revealed pancytopenia, normal renal function, elevated transaminase levels (300-400) and canalicular enzymes, total bilirrubins (3) with predominance of direct fraction (2). USG confirmed homogeneous hepatosplenomegaly.<br>
Serology: Anti-HAV IgG+, HBsAg negative, anti-HCV negative, anti-HIV negative, schistosomiasis IgM and IgG negative, blood smear with negative plasmodium research, test for leishmaniasis (rK39) negative. Dengue IgM negative and IgG positive, IgM negative for leptospirosis (confirmed one week later). Bone marrow aspirate without significant changes (only karyolysis) and without the presence of parasites. Immunohistochemistry unchanged.<br>
Evolves with persistence of fever, with the biggest increase of the spleen in relation to the liver, confirmed by computed tomography. He was transferred to ICU because of pneumonia and respiratory failure after 15 days of hospitalization. Today, even without definitive diagnosis after one month of research, he persists with fever!"<br>
<br>
Any suggestions?<br>
<br>
Hug´s<br>
<br>
-- <br>
Igor Thiago Borges de Queiroz e Silva<br>
Infectologista do Hospital Giselda Trigueiro - SESAP - Natal/RN<br>
Infectologista do Hospital ABC Unidade Cirúrgica - São Bernardo do Campo/SP<br>
Mestrando do Departamento de Doenças Infecciosas e Parasitárias - FMUSP<br>
Laboratório de Soroepidemiologia e Imunobiologia (LIM38) - IMT/USP<br>
<a href="mailto:igorthiago@usp.br" target="_blank">igorthiago@usp.br</a><br>
<br>
<br>
<br>
<br>
<br>
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</blockquote></div><br><br clear="all"><br>-- <br><div style="text-align:center"><strong>Prof. Marco Tulio A Garcia-Zapata, MD, PhD</strong></div><div style="text-align:center"><strong><font size="1">Medical Tropicalist / Head Professor / Principal Researcher</font></strong></div>
<div style="text-align:center"><font size="1">Tropical Medicine & Dermatology Department (DMTD)</font></div><div style="text-align:center"><font size="1">Center for Studies and Research in (Re)Emerging Diseases (NUPEREME)</font></div>
<div style="text-align:center"><font size="1">Reference Sentry Unit for International and Travel Medicine (USCREMIVI)</font></div><div style="text-align:center"><font size="1">Tropical Pathology & Public Health Institute (IPTSP)</font></div>
<div style="text-align:center"><font size="1">Federal University of Goias (UFG)</font></div><div style="text-align:center"><font size="1">Goiania - GO, BRAZIL</font><br><font size="1"> </font></div><div style="text-align:center">
<font size="1">Caixa Postal 12911 - Setor Leste Vila Nova</font></div><div style="text-align:center"><font size="1">Goiania - GO, 74643-970, Brazil</font></div><div style="text-align:center"><font size="1">Phone: (+2)3269-8219, Fax (+62)3521-1839</font></div>
<div style="text-align:center"><font size="1">E-mail: <a href="mailto:nupereme@gmail.com" target="_blank">nupereme@gmail.com</a> </font></div><div style="text-align:center"><a href="mailto:medicinadeviagem.hc.hdt@gmail.com" target="_blank"><font size="1">medicinadeviagem.hc.hdt@gmail.com</font></a></div>
<div style="text-align:center"><a href="mailto:mctulianglobal@gmail.com" target="_blank"><font size="1">mctulianglobal@gmail.com</font></a> </div><br>