Pancytopenia in the setting of disseminated histoplasmosis is sparsely described in the literature. We investigated the underlying mechanisms of pancytopenia in disseminated histoplasmosis and highlighted clinical outcomes. We conducted a scoping review of cases and series on disseminated histoplasmosis presenting with pancytopenia published between 2001 and 2024. PubMed database was used for the search. The search terms were (disseminated histoplasmosis) AND (pancytopenia OR haemophagocytic syndrome OR lymphohistiocytosis). We identified 72 cases. Forty-four (61.1

Background: Deep mycoses are serious fungal diseases commonly associated with the immunocompromised but can also present in the immunocompetent following severe exposure to fungal pathogens. Included in this group are subcutaneous and systemic fungal infections. Objectives: Reviews highlighting skin involvement in patients with deep mycosis in the Nigerian setting are sparse in the literature. This systematic review summarized the clinical presentation, risk factors, and diagnosis of deep mycosis presenting with cutaneous manifestations in Nigerians. Design: This was a systematic review conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Data sources and methods: PubMed, Google Scholar, and the African Journal Online database were searched from inception to February 2024 to identify published articles from Nigeria on deep mycoses with cutaneous manifestations. We included single case reports and case series on cutaneous involvement in deep fungal infections in Nigeria. Review articles, guidelines, meta-analyses, animal studies, and fungal studies not relating to the Nigerian setting were excluded. Results: We identified 16 well-documented articles on deep cutaneous mycoses published in Nigeria over the past six decades which amounted to 137 cases; 102 (74.5%) cases were reported before the year 2000, while the remainder were published within the past two decades. The 137 cases were majorly histoplasmosis ( n = 87, 63.5%) and eumycetoma ( n = 19, 13.9%) and predominant risk factors, farming ( n = 13, 9.5%) and diabetes mellitus ( n = 3, 2.2%), The diagnosis of cases was predominantly via histopathology ( n =131, 95.6%) with a few cases diagnosed by fungal culture ( n = 15, 10.9%), and antigen assay ( n = 1, 0.7%) respectively. Twenty-one (15.3%) were clinically diagnosed as cancers including a case of carcinoma of the skin, and one each (0.7%) as skin tuberculosis or neurofibromatosis but all histologically confirmed as deep cutaneous mycoses. Conclusion: The decline of reports on deep cutaneous mycoses in recent times suggests neglect or a low index of suspicion from attending clinicians. This is further buttressed in the misdiagnosis of cases as other clinical entities. Ensuring a histological diagnosis of skin lesions, especially in at-risk patients will mitigate these gaps.

Abstract Reports on cases of strongyloidiasis and tuberculosis or aspergillosis coinfection are fragmented in the literature and no large-scale reviews are describing its occurrence across the globe. We identified a total of 230 cases of strongyloidiasis and tuberculosis coinfection amongst 2376 participants with tuberculosis disease from eight epidemiological surveys conducted in Ethiopia (n = 4, 50%); Tanzania (n = 3, 37.5%) and Malaysia (n = 1, 12.5%). Clinical outcomes in these studies were not stated as they were largely descriptive. In addition, there were ten individual case reports of strongyloidiasis and tuberculosis coinfection. Of the ten, four were from the USA (40%), two each from India (20%) and Japan (20%), and one each from the UK (10%) and Argentina (10%). Of the ten, six had favourable outcomes, two were fatal and outcomes were unclear in the remainder. Ten cases of strongyloidiasis and aspergillosis coinfection were identified, five were reported from the USA (50%), and one each from the Netherlands (10%), China (10%), Iran (10%), Colombia (10%) and Italy (10%). Five each had favourable and fatal outcomes. Fatal outcomes in strongyloidiasis and tuberculosis or aspergillosis coinfection were associated with steroid therapy (n = 3), decline for treatment (n = 1), delayed diagnosis (n = 2) and delayed presentation (n = 1). Our findings suggest a significant proportion of individuals living with tuberculosis are also affected with strongyloidiasis, especially in sub-Saharan Africa. However, more studies are required to ascertain the burden of strongyloidiasis and tuberculosis coinfection as few cases were reported from other highly burdened tuberculosis regions. In addition, the role of the attending clinician is critical to reduce morbidities from the coexistence of these clinical entities as a significant number of cases with documented outcomes were fatal.

Chronic pulmonary aspergillosis is increasingly being diagnosed in Nigeria due to the thriving awareness of fungal infections and efforts to improve fungal diagnostics. However, much still needs to be done as cases of Chronic pulmonary aspergillosis are being misdiagnosed as tuberculosis with attendant problems including unnecessary initiation of anti-tuberculosis therapy, delay of appropriate diagnosis, economic losses and worsening morbidity. These challenges typified this case report, a 40-year-old woman with complaints of recurrent haemoptysis of 10 years duration. She had been treated for pulmonary tuberculosis 20 years ago after which she was affirmed to be acid-fast bacilli negative and cured of TB. On presenting at a peripheral centre, anti-tuberculosis regimen was repeated despite lacking evidence of a diagnosis of tuberculosis. She failed to improve with this second tuberculosis treatment. She was referred to the University of Calabar Teaching Hospital where a diagnosis of chronic pulmonary aspergillosis was made following a positive Aspergillus immunoglobulin G and galactomannan assay and chest radiological findings suggestive of pulmonary aspergillosis. She was commenced on itraconazole dosage of 200mg b.d and observed to have improved with the resolution of hemoptysis. Post-tuberculosis-treated patients should be routinely investigated for Chronic pulmonary aspergillosis, and appropriate and timely treatment initiated where necessary.

Background: Massive pulmonary embolism is a life-threatening emergency associated with high mortality if prompt diagnosis and urgent intervention is delayed, especially in patients presenting in obstructive shock. It usually requires advanced therapies such as systemic thrombolysis, pharmacomechanical catheter-directed therapy, surgical embolectomy and inferior vena cava filter placement. The dearth in skilled manpower, delay in diagnosis, relative unavailability and high cost of fibrinolytics especially in resource poor environments may account for poor clinical outcomes and eventually death in such patients.

BackgroundLarge numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.Case presentationA 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month's follow-up visit.ConclusionPE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.

Subacute invasive pulmonary aspergillosis is a form of chronic pulmonary aspergillosis (CPA) with rapid progression. The clinical features of CPA mimic tuberculosis (TB) and may lead to delayed and/or misdiagnosis. We report a 39-year-old Nigerian previously managed in a peripheral hospital as a case of TB despite negative Gene-X pert results with no resolution of symptoms. Chest X-ray and computer tomography findings were suggestive of CPA and galactomannan assay positive. Symptoms resolved 2 months into itraconazole treatment. There is a dire need to drive awareness of CPA among clinicians, especially in our primary and secondary healthcare facilities where the knowledge base and expertise in the management of fungal infections is still at a rudimentary level or perhaps not available at all.

Introduction: Urinary tract infection is a major reason for hospital visits and a common clinical condition encountered by clinicians. The causative agents of urinary tract infection and their resistant pattern vary globally. The aim of this study was to highlight the profile of pathogens associated with urinary tract infections in our locality. The objective was to investigate the resistant pattern of these microbial isolates from patients with urinary tract infection and offer recommendations for effective treatment. Materials and methods: We retrospectively analyzed the urine culture and antimicrobial sensitivity reports of patients with suspected urinary tract infection at the University of Calabar Teaching Hospital, Calabar, Nigeria, from September 2019 to August 2020. Methicillin resistance was detected by disk diffusion method using 30 µg cefoxitin disk. Production of Extended spectrum beta lactamases was detected by the Combination disk and the double-disk synergy method. Results: Of 979 urine culture and sensitivity reports, 306 (31.26%) were positive for microbial growth. Two microbial isolates each were recovered from urine samples of 5 patients giving a total number of 311 isolates from 306 patients. 45.75% of positive results were in males. The predominant isolate was Escherichia coli (n=97, 31.19%). Extended Spectrum Beta Lactamases (ESBL) producing strains comprised 10.08% (10/238) of Gram-negative group of organisms, while 47.39% (145/306) of all bacterial isolates in our study were multi drug resistant (MDR). 14.29% (6/42) of S. aureus isolates were methicillin resistant S. aureus, while 33.33% (2/6) of methicillin resistant S. aureus (MRSA) were multi drug resistant. Conclusion: Urinary tract infection caused by antimicrobial resistant organisms is common among studied patients. This emphasizes the need for urine culture and sensitivity tests in the management of urinary tract infection.