Dear Colleagues, Here are the case studies for April, 2010. The images look best when your monitor is set for a screen resolution of 800 x 600 or higher and your colors are set for 16 bit or better. Please contact your IT support personnel or DPDx if you need assistance in verifying or changing these settings.Case 273A 68-year-old man underwent a routine colonoscopy at a local VA Medical Center. He had no complaints of illness but had recently traveled to Ethiopia. A worm-like object measuring approximately 30 millimeters in length was observed and recovered. Figures A and B show the whole worm viewed with a dissecting microscope. Figures C and D show what was observed using a compound microscope at 200x magnification. What is your diagnosis? Based on what criteria? Acknowledgements: this case and the specimen from which images were takes are courtesy of the Philadelphia V. A. Medical Center.<> <> <> <> Case 274A patient from Pakistan was admitted to a medical facility with non-cirrhosit portal hypertension, hepatic vein thrombosis, IVC stenosis and respiratory failure. No eosinophilia was reported at the time patient was admitted, but was present at 7% the next day. A blood smear was made at midnight and stained with Wright-Giemsa. Figure A shows what was observed by the attending pathologist at 1000x magnification. What is your diagnosis? Based on what criteria? <> You can also view the case studies on the DPDx Web site. Go to http://www.dpd.cdc.gov/dpdx/HTML/Cases.htm and click on the link for "This Month's Case Study." Neste trabalho em publicacao:Eur J Intern Med. 2009 Dec;20(8):744-8. Epub 2009 Sep 27. " Prevention of strongyloides hyperinfection syndrome: a rheumatological point of view." Santiago M, Leitao B.Escola Bahiana de Medicina e Saude Publica, Salvador, Bahia, Brazil. mitter@svn.com.brE abordada a infeccao pela larva de Strongyloides stercoralis, que eh um parasita que infecta o homem e na condicao de immunodeficiencia sofre disseminacao, causando a sindrome da hiperinfeccao por strongyloides (SHS)potentialmente fatal.Neste trabalho eh feita uma revisao da literatura evidenciando profilaxia da SHS em pacientes imunosuprimidos com doencas reumatologicas, atraves do acesso a database do MEDLINE (de 1966 a 2008) com a seguintes base de dados: "strongyloidiasis", "disseminated strongyloidiasis", "Strongyloides stercoralis", "Strongyloides stercoralis dissemination", "strongyloides hyperinfection" e "syndrome", "treatment", "prophylaxis", "prevention", "immunocompromised", "immunodepression", "immunosuppressed", "immunosuppression", "corticosteroids", "glucocorticoids", "lupus erythematosus", "rheumatoid arthritis", "rheumatic diseases". Tambem foi feita a procura dos estudos de terapeutica usando os mesmos termos. Os resultados foram que no estudo de profilaxia da SHS foram identificados os pacientes reumaticos imunossuprimidos, mas em dois artigos estudados com diferentes opcoes de tratamento para a estrongiloidiase foram identificados e apresentados outros casos de imunodepressao. Como nao ha evidencia de que se deva fazer profilaxia de SHS em pacientes reumaticos immunosuprimidos, o esquema sugerido para que a profilaxia possa contar com resultados pode contar com resultados obtidos de estudos terapeuticos. Ivermectina tem a melhor performance,menor custo e maior eficacia, podendo ser a droga de escolha para a SHS em tais pacientes. Apesar de um esquema profilatico definitivo ter diso ainda definido , a opcao de 200 microg/kg/dia durante 2 dias, repetindo dentro de