BACKGROUND: Tinea unguium is a common problem seen in clinical practice. Considering the many differential diagnoses of dystrophic nails, it is important to make a definitive diagnosis of dermatophyte infection before the initiation of antifungal therapy. Potassium hydroxide (KOH) preparation and fungal culture, which are commonly used in the diagnosis of these infections, often yield false-negative results. Recent reports have suggested that nail plate biopsy (Bx) using periodic acid-Schiff (PAS) (Bx/PAS) stain may be a very sensitive technique for the diagnosis of tinea unguium. OBJECTIVE: The purpose of this study was to evaluate the usefulness of PAS and Grocott's methenamine silver (GMS) staining of nail specimen in the diagnosis of tinea unguium as a standard method. METHODS: We evaluated 75 nail specimens from suspected tinea unguium using KOH preparation, biopsy using periodic acid-Schiff stain, and Grocott's methenamine silver stain. RESULTS: Of the 75 nails which were negative on potassium hydroxide mounting, 43 and 39 cases were tested positive respectively on periodic acid-Schiff stain and Grocott's methenamine silver stain. CONCLUSION: Bx/PAS and Bx/GMS are the sensitive methods for the diagnosis of tinea unguium. They are indicated if clinical suspicion of onychomycosis is high and KOH preparation shows no fungal elements.
Arthrodermataceae ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Methenamine ; Onychomycosis* ; Potassium ; Rabbits ; Tinea*

. We present herein a case of pseudofungi incidentally found in the mediastinal lymph nodes of a 31-year-old woman who had a left pneumonectomy for a pulmonary blastoma. The pseudofungi were located in the subcapsular sinuses of the lymph nodes with an associated granulomatous reaction. They revealed yellowish-brown hyphae-like structures with pseudosepta and irregular branching at various angles intermingled with round yeast-like forms. These structures stained positively with periodic acid-Schiff and Gomori methenamine silver, but also stained strongly positive for Prussian blue suggesting that they contain iron. The characteristic morphological features of pseudofungi are discussed with emphasis on the features that distinguish them from true fungal organisms.
Adult ; Female ; Granuloma ; Humans ; Hyphae ; Iron ; Lymph Nodes* ; Methenamine ; Pneumonectomy ; Pulmonary Blastoma

Pneumocystis carinii is an established cause of pulmonary infections in immuno- compromised hosts. Several cytological stains, such as Papanicolaou, Gomori methenamine silver(GMS) and Diff-Quik have been used for detection of the organism, but occasionally can be laborious and, due to a degree of nonspecificity, may be misleading. We evaluated the diagnostic utility of immunocytochemical stains that recognize P. carinii in bronchoalveolar lavage from experimentally induced P. carinii pneumonia rats(n=15). In addition to routine stains for diagnosis by morphologic recognition of P. carinii on Papanicolaou, GMS and Diff-Quik stains, bronchoalveolar lavage samples were reacted with immunocytochemical stains using monoclonal antibodies(MAB) 092 and 902. In bronchoalveolar lavage P. carinii organisms were detected in 9 of 10 cases (90%) using each MAB 092 and 902, whereas GMS and Diff-Quik stains demonstrated P. carinii in 13(86%) and 11(73%) of 15 cases respectively. In lung tissue specimens(n=15) P. carinii organisms were well identified on GMS stain and immunohistochemical stains using MAB 092 and 902 in all cases. We believe that the immunocytochemical staining using MAB 092 and/or 902 is a very useful and diagnostic tool in addition to GMS and Diff-Quik stain to detect P. carinii organisms in bronchoalveolar lavage.
Bronchoalveolar Lavage* ; Coloring Agents ; Diagnosis ; Lung ; Methenamine ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia

Nocardia, aerobic members of the order of Actinomycetaceae, produces infections in human lung. Nocardial infection is associated with underlying diseases of immuno-suppression or treatment with corticosteroid. It is difficult to detect Nocardia by sputum examination or histologic sections and it has rarely been diagnosed by fine needle aspiration of the lung. We describe a case of pulmonary nocardiosis in a 72 year-old man. diagnosed by fine needle aspiration, which was confirmed by culture of aspirates. The aspirates showed neutrophil-predominant inflammatory cells with microoganisms demonstrated by Gomori methenamine silver and Gram stain. The organisms had characteristic long branching filamentous strucutres. The lesions on chest x-ray were in resolution with antimicrobial therapy.
Actinomycetaceae ; Aged ; Biopsy, Fine-Needle* ; Humans ; Lung ; Methenamine ; Nocardia ; Nocardia Infections* ; Sputum ; Thorax

Actinomycosis is a chronic bacterial infection characterized by suppurative, fibrosing inflammation, and sinus tracts draining sulfur granules. It usually involves the head, neck, thorax and abdomen. Actinomycosis involving the inguinal area is extremely rare. A 55-year-old man presented with an asymptomatic, erythematous, hard, nontender nodule in his left inguinal area. A biopsy taken from the nodule showed an abscess and sulfur granules in the dermis. Gram staining and methenamine silver staining demonstrated a mesh of branching rods. Cultures of the pus and tissue specimens failed to grow any organisms. Based on the histopathologic findings, we diagnosed this case as actinomycosis of the inguinal area and treated it with a surgical method.
Abdomen ; Abscess ; Actinomycosis* ; Bacterial Infections ; Biopsy ; Dermis ; Head ; Humans ; Inflammation ; Methenamine ; Middle Aged ; Neck ; Sulfur ; Suppuration ; Thorax

BACKGROUND: Histoplasmosis (HP) is diagnosed by visualizing intracellular microorganisms in biopsy and/or culture. Periodic-acid Schiff (PAS) and Gomori methenamine silver (GMS) staining methods are routinely used for identification. The acid-fast property of Histoplasma was identified decades ago, but acid-fast staining has not been practiced in current surgical pathology. Awareness of the acid-fast property of Histoplasma, which is due to mycolic acid in the cell wall, is important in distinguishing Histoplasma from other infective microorganisms. Here, we examined acid-fastness in previously diagnosed cases of Histoplasma using the Ziehl-Neelsen (ZN) stain and correlated those findings with other known fungal stains. METHODS: All cases diagnosed as HP were retrieved and reviewed along with ZN staining and other fungal stains. We also stained cases diagnosed with Cryptococcus and Leishmania as controls for comparison. RESULTS: A total of 54 patients ranging in age from 11 to 69 years were examined. The most common sites of infection were the skin, adrenal tissue, and respiratory tract. Of the total 43 tissue samples, 20 (46.5%) stained positive with the ZN stain. In viable cases, a significant proportion of microorganisms were positive while necrotic cases showed only rare ZN-positive yeasts. In comparison to PAS and GMS stains, there was a low burden of ZN-positive yeasts. Cryptococcus showed characteristic ZN staining and all cases of Leishmania were negative. CONCLUSIONS: Although the morphology of fungal organisms is the foundation of identification, surgical pathologists should be aware of the acid-fast property of fungi, particularly when there is the potential for confusion with other infective organisms.
Biopsy ; Cell Wall ; Coloring Agents ; Cryptococcus ; Fungi ; Histoplasma* ; Histoplasmosis ; Humans ; Leishmania ; Methenamine ; Mycolic Acids ; Pathology, Surgical* ; Respiratory System ; Skin ; Yeasts

Candida famata previously called Torulopsis famata or Debaryomyces hansenii, is usually found in natural substrates. It was earlier considered nonpathogenic in humans; however, a number of clinical cases of human infection have been reported showing isolation of this yeast. Dermatologic literature contains only a few reports regarding cutaneous infection caused by Candida famata. An 18-year old woman presented with a 4-month history of a 4.0×3.0 cm sized erythematous erosive patch on her left sole. A skin biopsy revealed numerous spores and hyphae in the epidermis. Histopathological specimens showed positive findings using the Periodic acid-Schiff and Gomori methenamine silver stains but negative findings using acid-fast bacilli stain. Cultures from skin scrapings yielded numerous colonies. Identification of the fungus was processed up to species level using VITEK 2 (bioMérieux, Inc. Hazelwood, MO, USA), and Candida famata was isolated. She was administered itraconazole at a dose of 200 mg once daily, and following 5 weeks of therapy, the erosive lesion was noted to have completely healed with postinflammatory hyperpigmentation.
Biopsy ; Candida* ; Candidiasis, Cutaneous ; Coloring Agents ; Epidermis ; Female ; Fungi ; Humans ; Hyperpigmentation ; Hyphae ; Itraconazole ; Methenamine ; Skin ; Spores ; Yeasts

Cryptococcus neoformans is the most common microorganism found in cerebrospinal fluid (CSF) cytology and causes life-threatening infections in immunocompromised hosts. Although its cytomorphologic features in conventional smear cytology have been well described, those in liquid-based cytology have rarely been. A 73-year-old woman with diffuse large B-cell lymphoma presented with mental confusion and a spiking fever. To rule out infectious conditions, CSF examination was performed. A cytology slide that was prepared using the ThinPrep method showed numerous spherical yeast-form organisms with diameters of 4–11 μm and thick capsules. Occasional asymmetrical, narrow-based budding but no true hyphae or pseudohyphae were observed. Gomori methenamine silver staining was positive. Cryptococcosis was confirmed in blood and CSF through the cryptococcal antigen test and culture. Liquid-based cytology allows for a clean background and additional slides for ancillary testing, facilitating the detection of microorganisms in CSF specimens, particularly when the number of organisms is small.
Aged ; Capsules ; Cerebrospinal Fluid ; Cryptococcosis ; Cryptococcus neoformans ; Female ; Fever ; Humans ; Hyphae ; Immunocompromised Host ; Lymphoma, B-Cell ; Meningitis, Cryptococcal ; Methenamine ; Methods

methenamine silver(CMS) stains showed more prominent inclusions. The immunohistochemical stain using cytomegalovirus antibody(CMV Ab) showed strong positivity So it seems to us that was a good example of oral CMV infection in AIDS patient. Therefore we report one case of CMV stomatitis in AIDS patient.]]>
Coloring Agents ; Cytomegalovirus ; Endothelial Cells ; Humans ; Intranuclear Inclusion Bodies ; Male ; Methenamine ; Mouth ; Oral Manifestations ; Stomatitis ; Tongue ; Ulcer

Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.
Acquired Immunodeficiency Syndrome ; Bronchoalveolar Lavage ; HIV ; Humans ; Incidence ; Mediastinal Emphysema* ; Methenamine ; Pneumocystis jirovecii* ; Pneumonia* ; Pneumopericardium* ; Pneumothorax* ; Respiratory Insufficiency*