Systemic scleroderma (SSc) is a multisystem disease with microvascular abnormalities, autoimmune disorders, excessive collagen production and deposition, and fibrosis of the skin and internal organs. According to the simplest, though incomplete classification, there are two forms of SSc: diffuse and limited (formerly acrosclerosis). CREST syndrome is a subtype of limited SSc, characterized by: calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. We present a patient with all the features of the CREST syndrome, which appeared at the age of 43 and lasted for 23 years. The patient presented with a gradual development of symptoms during the first ten years, from Raynaud’s phenomenon, skin sclerosis, calcinosis, telangiectasia, and esophageal dysmotility. The diagnosis was based on clinical findings and relevant diagnostic procedures. The article presents a literature review on the epidemiology, etiology, pathophysiology, clinical manifestations, various attempts at classification, diagnostic criteria, and therapeutic modalities.
When classifying systemic scleroderma into two main types — diffuse and limited, with CREST syndrome as a variant of the latter, it should be pointed out that both types represent clinical forms of systemic sclerosis, share similar visceral involvement, laboratory abnormalities and course which is variable, as was the case in our patient.
The aim of this study was to determine the pathological, mycological and molecular findings in turkey poults with different immunological status experimentally infected with Aspergillus fumigatus. The investigation was carried out 1, 3, 7, 14 and 21 days after intratracheal inoculation of 5.056×107 spores of A. fumigatus to 14-day-old turkey poults in group G-1, as well as to turkey poults in group G-2 which were treated prior to infection with dexamethasone. A. fumigatus was isolated on day 1 p.i. in both groups, but the number of positive samples was bigger in group G-1. A. fumigatus was isolated from the respiratory organs of group G-1as early as on day 1 and 3 p.i. in 4 out of 12 examined specimens (33%). On day 7 p.i. A. fumigatus was possible to isolate from the respiratory organs of 50% of infected birds, on day 14 in 83.33% and on day 21 p.i. A. fumigatus was isolated in 6 out of 6 sacrificed turkey poults (100%). In dexamethasone-treated group A. fumigatus isolates from the respiratory organs on day 1 and 3 p.i. were same as in group G-1, whereas on days 7 and 14 p.i. the number of turkey poults positive to A. fumigatus increased in comparison with the untreated G-1 group. The histopathological lesions in turkey poults treated with dexamethasone developed earlier, were more intensive and extensive. The mycological and nested PCR results revealed a higher number of samples positive for the presence of A. fumigatus DNA in the group G-2, pretreated with dexamethasone.