| Ch 16 | Page 16 / 16 | |
| Cancer emergency |
Parasitic infections | |
In this chapter, we will only discuss opportunistic parasitic infections which can be observed in our country and not those observed in subjects residing in countries harbouring endemic parasitic infections.
Pneumocystis carinii provokes pneumonia generally related to reactivation of latent infection but occasionally representing acquired infection. It is observed in immunodepressed patients (such as AIDS sufferers or after intensive chemotherapy).
The clinical onset is insidious: coughing, progressively severe dyspnoea, cyanosis.
Clinical examination is non significant and radiological x-ray pictures are non specific (interstitial diffuse reticular images).
Some authors propose a Gallium gammagraphy.
Diagnosis is made by alveolar washings during bronchoscopy or pulmonary biopsy.
Treatment is difficult and involves pentamidine, and an association of sulfamethoxazole-trimethroprime and atovaquone.
This is a rare complication seen in immunodepressed patients after intensive chemotherapy or during Hodgkin’s disease.
Neurological involvement includes meningoencephalitis with confusion, headache, vomiting, seizures and various pareses.
Cerebral CT scan is normal. RMI scan shows disperse zones of demyelination.
Diagnosis is based on serologic findings (specific IgM by ELISA technique).
Treatment involves various drugs: pyrimethamine, sulfadiazine, cotrimoxazole and spiramycine.
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