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Candidiasis (moniliasis generic viagra 75mg with amex erectile dysfunction age 60, thrush) This common infection is due to a yeast pathogen (Candida albicans) that resides in the gastrointestinal tract as a commensal generic viagra 75 mg erectile dysfunction blood pressure medication. It is a not infrequent cause of vulvo- vaginitis in pregnant women 75 mg viagra mastercard impotence australia, in women taking oral contraceptives and in those taking broad-spectrum antibiotics for acne. It is also responsible for some cases of stomatitis in infants and the cause of infection of the gastrointestinal tract and elsewhere in immunosuppressed people. It may contribute to the clinical picture in the intertrigo seen in the body folds of the obese and in the napkin area in infancy. Oral and vaginal moniliasis responds to preparations of nystatin and amiphenazole as well as to the imidazoles. Some, such as histoplasmosis, cryptococcosis and coccidioidomycosis, are widespread systemic infections, which only occasionally involve the skin. Actinomycosis, sporotrichosis and blastomycosis infect the skin and subcuta- neous tissues, causing chronically inflamed hyperplastic and sometimes eroded lesions. Sporotrichosis may produce a series of inflamed nodules along the line of lymphatic drainage. Deep fungus infections of this type produce a granulomatous type of inflammation, with many giant cells and histiocytes as well as polymorphs and lymphocytes. Madura foot is a deep fungus infection of the foot and is seen in various coun- tries of the African continent and India. The affected foot is swollen and infil- trated by inflammatory tissue, with many sinuses. The infection spreads throughout the foot, invades bone and is very destructive and disabling. Clinical features Red, sore areas, which may blister, appear on the exposed skin surface (see Fig. Yellowish gold crust surmounts the lesions that appear and spread within a few days. It is, however, not uncommon for the signs of the lesions to appear over an area of eczema. In tropical and subtropical areas, an impetigo-like disorder is spread by flies and biting arthopods. This disorder is more destructive than ordinary impetigo and produces deeper, oozing and crusted sores and is caused mostly by beta- haemolytic streptococci. There have been several outbreaks of acute glomerulonephritis following episodes of this infective disorder. Treatment Local treatment with an antibacterial wash to remove the crust and debris, as well as a topical antimicrobial compound such as betadine or mupirocin are needed in all cases and, unless the area is solitary and very small, a systemic antibiotic such as penicillin V (250 mg 6-hourly for 7 days) is also required. Erysipelas Erysipelas is a severe infective disorder of the skin caused by the beta-haemolytic Streptococcus. There is sudden onset of a well-marginated, painful and swollen erythematous area, usually on the face or lower limbs (Fig. The inflammation may be very intense and the area may become haemorrhagic and even blister. Treatment with antibiotics by mouth (penicillin V, 250 mg 6-hourly) should be rapidly effective. Cellulitis This is a diffuse, inflammatory disorder of the subcutis and skin caused by several different micro-organisms and is of variable severity. It is relatively common, particularly on the limbs, and often occurs on legs affected by venous ulceration or by lymphoedema. There is pain, tenderness, slight swelling and a variable degree of diffuse erythema. Broad-spectrum antibiotics are indicated, as the micro-organisms may be Gram negative in type (e. Cephradine and flucloxacillin (250 mg of each 6-hourly) are one suitable combination. They are much less common now than 30 or even 20 years ago, presumably because of improved levels of hygiene. Nonetheless, there are still families and individuals who are troubled by recurrent boils. In many instances, the patho- genic Staphylococcus colonizes the external nares, the perineum or other body sites and is difficult to dislodge. The lesions are localized, red, tender and painful swellings; carbuncles may be quite large, perhaps 3 or 4 cm in diameter, and rep- resent the infection of several follicles. Systemic antibiotics are required and, whenever possible, their use should be guided by the pattern of sensitivities found by culture. It is spread by farm animals and, because the micro-organism has a resistant spore form, can stay on infected land for years. Several types of skin tuberculosis were once commonly seen, but are now quite rare in developed countries. It often has a thickened psoriasiform appearance, but blanching with a glass microscope slide (diascopy) will reveal grey-green foci (‘apple jelly nodules’) due to the underlying granulomatous inflammation. Treatment is initially with ‘triple therapy’ of rifampicin, pyrazinamide and iso- niazid over a 2-month period, followed by a ‘continuation’ treatment phase with isoniazid and pyrazinamide. Tuberculosis verrucosa cutis (warty tuberculosis) This is seen on the backs of the hands, knees, elbows and buttocks whenever abra- sive contact with the earth and expectorated tubercle bacilli has been made. Thickened, warty plaques are present, which are sometimes misdiagnosed as viral warts. Diagnosis is confirmed by biopsy showing tuberculoid granulomata and caseation necrosis. Other forms of cutaneous tuberculosis ● A persistent ulcer may arise at the site of inoculation as a ‘primary’ infection. In papulo- necrotic tuberculide, papules arise and develop central necrosis with a black crust. Erythema induratum is an uncommon, odd disorder, which in many cases appears to fulfil the criterion of being a response to tuberculous infection. It is 46 Bacterial infection of the skin characterized by the development of plaque-like areas of induration and necrosis on the lower calves and occurs predominantly in young women. It has a 3-week incubation period and causes plaques, abscesses and erosions on the elbows and knees in particular. The condition responds to minocycline or a trimethoprimsulphamethoxazole combination. Buruli ulcer Mycobacterium ulcerans is responsible for this disorder occurring in Uganda and south-east Asia. Sarcoidosis is a multi-system disease with manifestations in the respiratory system, the reticuloendothelial system and the skin and occasionally in the bony skeleton and central nervous and cardiovascular systems. In the skin, one of the most common varieties consists of multiple, reddish purple papules (Fig. These types are infiltrated by typical sarcoid tissue (see below), but another manifestation, erythema nodosum (see page 77), is not.

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Immunization of children on long-term aspirin treatment is also recommended to prevent development of Reye syn- drome after influenza infection order viagra from india erectile dysfunction doctor mn. The vaccine should be given each year before influenza is expected in the community; timing of immunization should be based on the seasonal patterns of influenza in different parts of the world (April to September in the southern hemisphere and rainy season in the tropics) buy viagra without a prescription erectile dysfunction drugs free sample. Contraindications: Allergic hypersensitivity to egg pro- tein or other vaccine components is a contraindication cheap generic viagra uk erectile dysfunction pump canada. Subsequent vaccines produced from other virus strains have not been clearly associated with an increased risk of Guillain-Barre´. The use of these drugs should be consid- ered in nonimmunized persons or groups at high risk of complications, such as residents of institutions or nursing homes for the elderly, when an appropriate vaccine is not available or as a supplement to vaccine when immediate maximal protection is desired against influenza A infection. The drug will not interfere with the response to influenza vaccine and should be continued throughout the epidemic. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Reporting outbreaks or laboratory-confirmed cases assists disease surveillance. Re- port identity of the infectious agent as determined by laboratory examination if possible, Class 1 (see Reporting). In epidemics, because of increased patient load, it would be desirable to isolate patients (especially infants and young children) believed to have influenza by placing them in the same room (cohorting) during the initial 5–7 days of illness. Dosages are 5 mg/kg/day in 2 divided doses for ages 1–9, 100 mg twice a day above 9 years (if weight less than 45 kg, 5 mg/kg/day in 2 doses) for 2–5 days. Doses should be reduced for those over 65 or with decreased hepatic or renal function. Neuraminidase inhibitors may also be considered for the treatment of influenza A and B. During treatment with either drug, drug-resistant viruses may emerge late in the course of treatment and be trans- mitted to others; cohorting people on antiviral therapy should be considered, especially in closed populations with many high-risk individuals. Patients should be watched for bacterial complications and only then should antibiotics be administered. Surveillance by health authorities of the extent and progress of outbreaks and reporting of findings to the community are important. Disaster implications: Aggregations of people in emergency shelters will favor outbreaks of disease if the virus is introduced. Identification—An acute febrile, self-limited, systemic vasculitis of early childhood, presumably of infectious or toxic origin. Clinically characterized by a high, spiking fever, unresponsive to antibiotics, associ- ated with pronounced irritability and mood change; usually solitary and frequently unilateral nonsuppurative cervical adenopathy; bilateral non- exudative bulbar conjunctival injection; an enanthem consisting of a “strawberry tongue”, injected oropharynx or dry fissured or erythematous lips; limb changes consisting of oedema, erythema or periungual/general- ized desquamation; and a generalized polymorphous erythematous exan- them that can be truncal or perineal and ranges from morbilliform maculopapular rash to urticarial rash or vasculitic exanthem. Typically there are 3 phases: 1) acute febrile phase of about 10 days characterized by high, spiking fever, rash, adenopathy, peripheral ery- thema or oedema, conjunctivitis and enanthem; 2) subacute phase lasting about 2 weeks with thrombocytosis, desquamation, and resolution of fever; 3) lengthy convalescent phase during which clinical signs fade. According to Diagnostic Guidelines of Kawasaki Disease (Japan Kawasaki Disease Research Committee, 2002), at least 5 of the following 6 principal symptoms should be satisfied, although patients with 4 principal symptoms can be diagnosed when coronary aneurysm or dilatation is recognized by two-dimensional echocardiography or coronary angiography: 1) Fever persisting 5 days or more (including cases in whom the fever has subsided before the 5th day in response to treatment); 2) bilateral conjunctival congestion; 3) changes of lips and oral cavity: reddening of lips, strawberry tongue, diffuse injection of oral and pharyn- geal mucosa, 4) polymorphous exanthema, 5) changes of peripheral extremities: reddening of palms and soles, indurative oedema in the initial stage, and membranous desquamation from fingertips in the convalescent stage, 6) acute nonpurulent cervical lymphadenopathy 2. Postulated to be a superantigen bacterial toxin secreted by Staphylococcus aureus or group A strepto- cocci, but this has neither been confirmed nor generally accepted. Occurrence—Worldwide; most cases (around 170 000) reported from Japan, with nationwide epidemics documented in 1979, 1982 and 1986. In Japan, where the disease has been tracked since 1970, peak incidence occurred in 1984–85. Since then, the incidence rate has been steady, about 140 per 100 000 children under 5. Mode of transmission—Unknown; no firm evidence of person-to- person transmission, even within families. Seasonal variation, limitation to the pediatric age group and outbreak occurrence in communities are all consistent with an infectious etiology. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Clusters and epidemics should be reported immediately, Class 5 (see Reporting). Recourse to high doses of aspirin is recom- mended during the acute phase, followed by low doses for at least 2 months. Epidemic measures: Investigate outbreaks and clusters to elucidate etiology and risk factors. Onset is gradual, with malaise, fever, headache, sore throat, cough, nausea, vom- iting, diarrhea, myalgia and chest and abdominal pain; fever is persistent or spikes intermittently. About 80% of human infections are mild or asymptomatic; the remaining cases have severe multisystem disease. In severe cases, hypotension or shock, pleural effusion, hemor- rhage, seizures, encephalopathy and oedema of the face and neck are frequent, often with albuminuria and hemoconcentration. Transient alope- cia and ataxia may occur during convalescence, and eighth cranial nerve deafness occurs in 25% of patients, of whom only half recover some function after 1–3 months. The overall case-fatality rate is about 1%, up to 15% among hospitalized cases and even higher in some epidemics. The rate is particularly high among women in the third trimester of pregnancy and fetuses. Heating serum at 60°C (140°F) for 1 hour will largely inactivate the virus, and the serum can then be used to measure heat-stable substances such as electrolytes, blood urea nitrogen or creati- nine. Infectious agent—Lassa virus, an arenavirus, serologically related to lymphocytic choriomeningitis, Machupo, Junı´n, Guanarito and Sabia´ viruses. Serologically related viruses of lesser virulence for laboratory hosts in Mozambique and Zimbabwe have not yet been associated with human infection or disease. Reservoir—Wild rodents; in western Africa, the multimammate mouse of the Mastomys species complex. Mode of transmission—Primarily through aerosol or direct con- tact with excreta of infected rodents deposited on surfaces such as floors and beds or in food and water. Period of communicability—Person-to-person spread may theo- retically occur during the acute febrile phase when virus is present in the throat. Susceptibility—All ages are susceptible; the duration of immunity following infection is unknown. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Individual cases should be reported, Class 2 (see Reporting). Nosocomial transmission has occurred, and strict procedures for isola- tion of body fluids and excreta must be maintained. Re- course to a negative pressure room and respiratory protec- tion is desirable, if possible. Male patients should refrain from unprotected sexual activity until the semen has been shown to be free of virus or for 3 months. To reduce infectious exposure, laboratory tests should be kept to the minimum necessary for proper diagnosis and patient care, and only performed where full infection control measures are correctly implemented. Technicians must be alerted to the nature of the specimens and supervised to ensure application of appropriate specimen inactivation/isolation procedures. Dead bodies should be sealed in leakproof material and cremated or buried promptly in a sealed casket. Establish close surveillance of contacts as follows: body temperature checks at least 2 times daily for at least 3 weeks after last exposure. Deter- mine patient’s place of residence during 3 weeks prior to onset; search for unreported or undiagnosed cases.

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Special ‘spas’ have been estab- lished at the Dead Sea in Israel buy cheapest viagra and viagra erectile dysfunction drugs at gnc, around the Black Sea and elsewhere purchase viagra 100 mg without a prescription erectile dysfunction injection therapy. The oral drug used is mostly 8-methoxy psoralen discount 100 mg viagra free shipping erectile dysfunction protocol free, given in a dose of approxi- mately 0. Usually, treatment is given two or three times per week, starting at a low dose and gradually increasing the dose until a good effect is obtained. Patients with T-cell lymphoma of the skin (mycosis fungoides, Sézary syndrome) and some with atopic eczema also benefit. Burning is a danger, and sun-sensitive patients must be treated very carefully with low doses. Male patients need to cover their exter- nal genitalia because of the risk of neoplasia. Rarely, patients may harbour a delusion ● Imidazoles and povidone iodine preparations are that their skin is infested by insects. In addition, surgical techniques, laser treatments ● In general, ointments are used for chronic scaling and cryotherapy have become increasingly disorders, whereas creams and lotions are used sophisticated. They soothe, smooth and soften the oral retinoids, methotrexate, azathioprine, the skin. They are helpful for ● Oral antifungal agents include terbinafine, patients with eczema, psoriasis and ichthyosis. Usage subject to terms and conditions of license Pocket Atlas of ral Diseases George Laskaris, M. Associate Professor of Oral Medicine Medical School, University of Athens Athens, Greece Head of Oral Medicine Department of Dermatology “A. Usage subject to terms and conditions of license Library of Congress Cataloging-in-Publication Important note: Medicine isan ever-chang- Data ing science undergoing continual develop- Laskaris, George ment. Research and clinical experience are Pocket atlas of oral diseases / George Las- continually expanding our knowledge, in karis. Every user is requested to examine carefully the manu- facturers’ leaflets accompanying each drug and to check, if necessary in consultation 1st English edition 1998 with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufac- turers differ from the statements made in the present book. Such examination is par- ticularly important with drugs that are ei- ther rarely used or have been newly re- leased on the market. Every dosage sched- ule or every formof application used is en- tirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publish- ers any discrepancies or inaccuracies no- ticed. This book, including all parts thereof, is le- Cover design by Cyclus, Stuttgart gally protected by copyright. Hurler, ploitation, or commercialization outside Notzingen, Germany the narrow limits set by copyright legisla- Printed in Germany by Druckhaus Götz, tion, without the publisher’s consent, is ille- Ludwigsburg gal and liable to prosecution. Usage subject to terms and conditions of license Dedication To my wife, Vivi, for her love and her continuous support of my efforts Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. A number of existing illustrations have been replaced by more representative high-quality color plates. The original text has been revised and updated to keep pace with the latest concepts in oral medicine. For more clinical information, readers may refer to my major book Color Atlas of Oral Diseases, third edition, 2003, and for treatment details to my recent book Treatment of Oral Diseases, 2005, both published by Georg Thieme Publishers. Usage subject to terms and conditions of license Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license 1 1 hite Lesions White lesions of the oral mucosa are a multifactorial group of disorders, the color of which is produced by the scattering of the light through an altered epithelial surface. The diagnosis and differential diagnosis of oral white lesions should be made on the basis of the medical history, clinical features, and laboratory tests. O Leukoplakia O Materia alba of the gingiva O Hairy leukoplakia O Fordyce’s granules O Lichen planus O Leukoedema O Lichenoid reactions O White sponge nevus O Linea alba O Dyskeratosis congenita O Nicotinic stomatitis O Pachyonychia congenita O Uremic stomatitis O Focal palmoplantar and oral O Cinnamon contact stomatitis mucosa hyperkeratosis syn- O Chemical burn drome O Candidiasis O Papilloma O Chronic biting O Verrucous carcinoma O Geographic tongue O Squamous-cell carcinoma O Hairy tongue O Skin and mucosal grafts O Furred tongue O Epithelial peeling Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license 2 White Lesions Leukoplakia Definition Leukoplakia is a clinical term, and the lesion is defined as a white patch or plaque, firmly attached to the oral mucosa, that cannot be classified as any other disease entity. Tobacco, alcohol, chronic local friction, and Candida albicans are important predisposing factors. Speckled and verrucous leukoplakia have a greater risk for malignant transformation than the homogeneous form. The average percentage of malignant transformation for leukoplakia varies between 4% and 6%. The buccal mucosa, tongue, floor of the mouth, gingiva, and lower lip are the most commonly affected sites. Differential diagnosis Lichen planus, cinnamon contact stomatitis, candidiasis, hairy leukoplakia, lichen planus reactions, chronic biting, tobacco pouch keratosis, leukoedema, chemical burn, uremic stomatitis, skin graft, some genodermatoses and discoid lupus erythematosus. Treatment Elimination or discontinuation of predisposing factors, sys- temic retinoid compounds. Rarely, it can also appear in immunosuppressed patients after organ transplan- tation. Clinical features Hairy leukoplakia presents as a white asymptomatic, often elevated and unremovable patch. The lesion is almost always found bilaterally on the lateral margins of the tongue, and may spread to the dorsumand the ventral surface (Fig. Characteristically, the surface of the lesion is corrugated with a vertical orientation. Differential diagnosis Chronic biting, lichen planus, frictional kerato- sis, cinnamon contact stomatitis, uremic stomatitis, candidiasis. Treatment Not required; however, in some cases aciclovir or valaci- clovir can be used with success. Lichen Planus Definition Lichen planus is a relatively common chronic inflammatory disease of the oral mucosa and skin. Etiology Although the cause is not well known, T cell-mediated auto- immune phenomena are involved in the pathogenesis of lichen planus. Clinical features White papules that usually coalesce, forming a net- work of lines (Wickman’s striae), are the characteristic oral lesions of the disease. Six forms of the disease are recognized in the oral mucosa, classified according to frequency: the common (reticular, erosive, Figs. Middle-aged individuals are more com- Laskaris, Pocket Atlas of Oral Diseases © 2006 Thieme All rights reserved. Usage subject to terms and conditions of license 6 White Lesions monly affected (the ratio of women to men ratio is 3 : 2). The skin lesions characteristically appear as polygonal purple, pruritic papules, usually affecting the flexor surfaces of the extremities. The prognosis of lichen planus is usually good, and malignant transformation (particularly of the erosive form) remains controversial. Direct immunofluorescence can also be used, although the features are not specific.

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Other less frequent microorganisms like Salmonella buy cheap viagra 50 mg on line erectile dysfunction pills viagra, Candida order viagra 50 mg line sublingual erectile dysfunction pills,orCorynebacterium urealyticum pose specific manage- ment problems in this population (162) buy viagra 50 mg on line erectile dysfunction increases with age. It is also important to remember the possibility of infection caused by unusual pathogens like Mycoplasma hominis, M. Tenderness, erythema, fluctuance, or increase in the allograft size may indicate the presence of a deep infection or rejection. Prolonged administration of broad-spectrum antimicrobial therapy has been classically recommended for the treatment of early infections, although no double-blind, comparative study is available (155). Gastrointestinal Infections Abdominal pain and/or diarrhea are detected in up to 20% of organ transplant recipients (135). Possible manifestations include gastrointestinal bleeding, diarrhea, abdominal pain, jaundice, nausea or vomiting, odynophagia, dysphagia, or just weight loss (166). Clostridium difficile should be suspected in patients who present with nosocomial or community-acquired diarrhea. It is more common in transplant population who frequently receive antimicrobial agents, and up to 20% to 25% of patients may experience a relapse (173–175). The most important factor in the pathogenesis of disease is exposure to antibiotics that disturb the homeostasis of the colonic flora. Most common clinical presentation is diarrhea, but clinical presentation may be unusually severe (176,177). Occasionally, patients present with an acute abdomen (179) or inflammatory pseudotumor (180). The reference method for diagnosis is the cell culture cytotoxin test that detects toxin B in a cellular culture of human fibroblasts (181). Culture in specific media is also recommended since it allows resistance study, molecular analysis of the strains, and the performance of a “second- look” cell culture assay that enhances the potential for diagnosis (182). Comparison of metronidazole’s activity with that of vancomycin in patients with moderately severe disease shows similar response rates. The former is preferred because of its reduced risk of vancomycin-resistance induction and lower cost. However, recent reports of severe clinical forms suggest that vancomycin may be preferable for these especially virulent strains. The administration of probiotics such as Saccharomyces boulardii or Lactobacillus spp. As mentioned, a substantial proportion of patients (10–25%) have a relapse usually 3–10 days after treatment has been discontinued, even with no further antibiotic therapy. The frequency of relapses does not seem to be affected by the antibiotic selected for treatment, the dose of these drugs, or the duration of treatment. Several measures have been suggested: gradual tapering of the dosage of vancomycin over one to two months, administration of “pulse-dose” vancomycin, use of anion-exchange resins to absorb C. Infectious enteritis is especially frequent in intestinal transplant recipients (39%). The bacterial infections tended to present earlier than the viral infections, and the most frequent presenting symptom was diarrhea (186). Immunosuppressive drugs such as mycophenolate mofetil, cyclosporine A, tacrolimus, and sirolimus are all known to be associated with diarrhea. Accordingly, the first step of the management of a patient with fever and diarrhea or abdominal pain should be directed to exclude these pathogens. However, the cause of acute diarrhea remains unidentified in one of three patients (188). Fever, headache, altered mental status, seizures, focal neurological deficit, or a combination of them should prompt a neuroimaging study (135). Noninfectious causes include immunosuppressive-associated leukoencephalopathy (199), toxic and metabolic etiologies, stroke, and malignancies (200). Most common cause of meningoencephalitis in organ transplant recipients are herpes viruses, followed by L. Less commonly, and particularly in organ transplant recipients, it may cause hepatitis, bone marrow suppression, interstitial pneumonitis, and meningoencephalitis (201–207). Mental status changes ranging from confusion to coma (92%), seizures (25%), and headache (25%) were the predominant clinical presentations. Magnetic resonance images of the brain may reveal multiple bilateral foci of signal abnormality (nonenhancing involving both gray and white matter). It may affect the brain (diffuse encephalitis, ventriculoencephalitis, cerebral mass lesions) or the spinal cord (transverse myelitis, polyradiculomyelitis). Diagnosis is very difficult and should be based on clinical presentation, results of imaging, and virological markers. Patients who experience clinical improvement or stabilization during induction therapy should be given maintenance therapy (209). Ten patients developed meningoencephalitis, which in three cases was associated with acute flaccid paralysis. Magnetic resonance images of the brain were abnormal in seven of eight tested patients, and electroencephalograms were abnormal in seven of seven, with two showing periodic lateralized epileptiform discharges. This viral infection should be considered in all transplant recipients who present with a febrile illness associated with neurological symptoms (212–214). The incidence has significantly been reduced since prophylaxis with cotrimoxazole is used (111). Listeria infections may present as isolated bacteremia or with associated meningitis (216,217). Brainstem encephalitis or rhomboencephalitis have been characteristi- cally described in patients with listeriosis in which cranial nerve palsies or pontomedullary signs may be observed. Cryptococcus is mostly a cause of meningitis, pneumonia, and skin lesions (224–227). Diagnosis was made with liver biopsy and with cryptococcal antigen in serum (229). Cryptococcosis is usually a late disease after transplantation, although rare fulminant early cases have been reported (230). Focal brain infection (seizures or focal neurological abnormalities) may be caused by Listeria, T. Fever is not common and was documented in only 45% of the liver transplant recipients with brain abscesses. As discussed herein, the characteristics that may help in the differential diagnosis are the time of appearance of the lesion and the presence of concomitant extraneural disease (predominantly pulmonary), which is very frequent in patients with fungal brain abscesses (70%). If extraneural involvement is not documented, a brain biopsy should be performed to establish the etiological diagnosis. Aspergillus brain abscesses usually occur in the early posttransplantation period. Most of the patients present with simultaneous lung lesions that allow an easier diagnostic way. Brain abscesses due to dematiaceous fungi are described a median of three months posttransplantation, but may occur as late as two years later (239).