Adult ; Female ; Humans ; Keratitis ; etiology ; microbiology ; pathology ; Keratomileusis, Laser In Situ ; adverse effects ; Mycobacterium Infections, Nontuberculous ; etiology ; pathology ; Mycobacterium chelonae ; isolation & purification ; Postoperative Complications ; etiology ; microbiology ; pathology

OBJECTIVETo find a fast and simple method for detection of specific pathogens in upper aerodigestive tract.

METHODSSixty-one cases of specific infections in upper aerodigestive tract encountered during a 10-year period in Beijing Tongren Hospital were retrospectively studied. Six histochemical stains, including PAS, Giemsa, Gram, methylene blue, modified Warthin-Starry and acid-fast stains were applied. The morphology of different pathogens was studied and the staining patterns were compared.

RESULTSThere were 23 cases of pharyngeal treponemal infection, 10 cases of short treponemal infection, 4 cases of mycobacterial infection, 4 cases of infection by rhinoscleroma bacilli, 1 case of sinonasal fungal infection, 1 case of combined infection of bacteria and Oidium albicans, 2 cases of tonsillar Actinomycetes and 16 cases of non-specific bacterial infections. Both pharyngeal treponemal infection and infection by rhinoscleroma bacilli could be detected by modified Warthin-Starry stain. As for sinonasal fungal infection, PAS, Giemsa and modified Warthin-Starry stains were useful in differentiating different types of fungi. Mycobacteria were best demonstrated by conventional acid-fast stain.

CONCLUSIONSSpecial histochemical stains performed on histologic sections are useful for diagnosing specific infections in upper aerodigestive tract.

Actinomycosis ; microbiology ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium ; isolation & purification ; Mycobacterium Infections ; microbiology ; pathology ; Palatine Tonsil ; microbiology ; pathology ; Pharyngeal Diseases ; microbiology ; pathology ; Pharynx ; microbiology ; pathology ; Retrospective Studies ; Rhinoscleroma ; microbiology ; pathology ; Staining and Labeling ; Treponema ; isolation & purification ; Treponemal Infections ; microbiology ; pathology ; Young Adult

OBJECTIVETo study the clinicopathologic features of acquired immunodeficiency syndrome (AIDS)-related lymphadenopathy and to elucidate the salient features helpful in achieving a correct pathologic differentiated diagnosis.

METHODSEighteen cases of AIDS-related lymphadenopathy were retrieved from the files of the First Affiliated Hospital of Guangxi Medical University from 2001 to 2004. Histochemical stains, including periodic acid-Schiff, acid-fast, Giemsa, Grocott stains and immunohistochemistry (EnVision method), were used to detect the presence of pathogens in tissue sections and classify them.

RESULTSFifteen of the 18 cases (83%) were stage 4 (i.e. follicular and lymphocytic depletion). Twelve cases were co-infected with Penicillium marneffei and 4 other cases with Mycobacterium, and no pathogen was found in 1. The remaining patient was complicated with diffuse large B-cell lymphoma.

CONCLUSIONSWhen presented in early stages, AIDS-related lymphadenopathy may be overlooked, especially in routine pathology practice. Awareness of the entity in patients with persistent fever and generalized lymphadenopathy is thus crucial. Florid infection with Penicillium marneffei is also considered as an important predictor for underlying AIDS. Thorough understanding of morphologic features of AIDS-related lymphadenopathy, including possible co-infection, is essential in arriving at the correct diagnosis.

AIDS-Related Complex ; microbiology ; pathology ; AIDS-Related Opportunistic Infections ; microbiology ; pathology ; Adult ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphoma, AIDS-Related ; pathology ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Male ; Middle Aged ; Mycobacterium ; isolation & purification ; Mycobacterium Infections ; microbiology ; pathology ; Mycoses ; microbiology ; pathology ; Penicillium ; isolation & purification ; Retrospective Studies

Acid-fast microorganisms were isolated from 240 soil samples collected at two areas, Hiroshima, Japan and Seoul, Korea. The biological and biochemical characteristics of the isolated mycobacteria were tested and compared with those of 36 reference mycobacteria Strains. The isolation rate and distribution of these mycobacterial species from soil were compared using three kinds of media with emphasis on the two methods of isolation between the different geographical areas. One Strain from each of the 10 species among atypical mycobacteria isolated from soil in both areas was inoculated into ddY mice and the pathogenicity compared with that of Mycobacterium tuberculosis H37Rv up to 6 weeks. Susceptibility of the reisolated acid-fast bacilli to antimycobacterial agents was tested in vitro. Antibody responses against various mycobacterial antigens were tested using lepromatous type and tuberculoid type patient sera by the agar gel immunodiffusion. 1) No significant differences in the distribution of acid-fast bacilli were observed between soil samples from the two regions. 2) Rapid growers were by far the most frequent acid-fast bacilli isolated while no photochromogens were isolated from these soil samples. In addition, a minimal number of fastidious mycobacteria were isolated but not cultivable in subcultures. 3) Some of these soil acid-fast bacilli were capable of inducing only transient bacteriological and pathologic changes in mouse organs. 4) Acid-fast bacilli reisolated from organs of these infected mice were, in general, found to be resistant to antimycobacterial agents. 5) M. scrofulaceum antigen showed a precipitation reaction in agar gel immunodiffusion with the highest number of sera from leprosy patients.
Animal ; Leprosy/immunology ; Mice ; Mycobacteria, Atypical/drug effects ; Mycobacteria, Atypical/isolation & purification* ; Mycobacteria, Atypical/pathogenicity ; Mycobacterium/isolation & purification* ; Mycobacterium Infections/pathology ; Soil Microbiology*

We herein report a case in which the recently characterized species Mycobacterium monacense was isolated from the sputum of an Iranian patient. This case represents the first isolation of M. monacense from Iran. The isolate was identified by conventional and molecular techniques. Our findings show that M. monacense infection is not restricted to developed countries.
Bacterial Proteins/genetics ; Chaperonin 60/genetics ; Chronic Disease ; Female ; Humans ; Iran ; Lung Diseases/diagnosis/*microbiology ; Middle Aged ; Mycobacterium/classification/*genetics/isolation & purification ; Mycobacterium Infections/*microbiology/pathology ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics ; Sputum/microbiology

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Bone Marrow/microbiology/pathology ; Diagnosis, Differential ; Female ; HIV Infections/diagnosis ; Humans ; Kidney Failure, Chronic/therapy ; *Mycobacterium avium Complex/genetics/isolation &purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/drug therapy/microbiology ; *Peritoneal Dialysis, Continuous Ambulatory ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis, DNA

Mycobacterium longobardum is a slow-growing, nontuberculous mycobacterium that was first characterized from the M. terrae complex in 2012. We report a case of M. longobardum induced chronic osteomyelitis. A 71-yr-old man presented with inflammation in the left elbow and he underwent a surgery under the suspicion of tuberculous osteomyelitis. The pathologic tissue culture grew M. longobardum which was identified by analysis of the 65-kDa heat shock protein and full-length 16S rRNA genes. The patient was cured with the medication of clarithromycin and ethambutol without further complications. To the best of our knowledge, this is the first report of a M. longobardum infection worldwide.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Chaperonin 60/genetics ; Clarithromycin/therapeutic use ; Elbow/pathology ; Ethambutol/therapeutic use ; Humans ; Male ; Mycobacterium Infections, Nontuberculous/*microbiology ; Nontuberculous Mycobacteria/classification/genetics/*isolation & purification ; Osteomyelitis/diagnosis/drug therapy/*microbiology/pathology ; RNA, Ribosomal, 16S/genetics ; Treatment Outcome

Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii infection associated with multiple skin lesions in a 48-yr-old male with myelodysplastic syndrome. The patient continuously had taken glucocorticoid during 21 months and had multiple skin lesions developed before 9 months without complete resolution until admission. Skin and mediastinoscopic paratracheal lymph node (LN) biopsies showed necrotizing granuloma with many acid-fast bacilli. M. kansasii was cultured from skin, sputum, and paratracheal LNs. The patient had been treated successfully with isoniazid, rifampin, ethmabutol, and clarithromycin, but died due to small bowel obstruction. Our case emphasizes that chronic skin lesions can lead to severe, disseminated M. kansasii infection in an immunocompromised patient. All available cases of disseminated M. kansasii infection in non HIV-infected patients reported since 1953 are comprehensively reviewed.
Antitubercular Agents/therapeutic use ; Clarithromycin/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Immunocompromised Host ; Isoniazid/therapeutic use ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous/*diagnosis/drug therapy/immunology ; *Mycobacterium kansasii/isolation & purification ; Myelodysplastic Syndromes/drug therapy ; Rifampin/therapeutic use ; Skin Diseases, Bacterial/*diagnosis/immunology/pathology ; Sputum/microbiology ; Sweet Syndrome/diagnosis

OBJECTIVETo analyze the clinical manifestation of interferon gamma receptor 1 deficiency (IFN-γR1 deficiency) and to improve the recognition of this disease in children, decrease diagnostic errors and missed diagnosis.

METHODThe information of one case with IFN-γR1 deficiency (past history of illness, clinical manifestation, laboratory examination and treatment) were analyzed.

RESULTThe patient was a 19-month-old girl with IFN-γR1 deficiency, 1-2 weeks after she was vaccinated with BCG at the age of 18 months, she manifested with lymph nodes at the same site as vaccination site, and repeated rash. Examination found a mass in the right armpit, the size was 3 cm × 3 cm, protruded on the skin, tenacious in nature, poorly mobile. B-mode ultrasound showed right armpit chest heterogeneous hypoechoic mass; abdominal B-mode ultrasound showed pancreatic lymph nodes around the abdominal aorta and mild swelling; chest X-ray showed right axillary lymph nodes, increased double markings. Initial diagnosis was (1) bronchitis, (2) BCG vaccination reaction, (3) Sepsis? . After admission, the patient was given rifampicin + isoniazid + latamoxef + amoxicillin and clavulanate potassium, and then changed to meropenem and Fusidic acid, but treatment showed no improvement. After adding the treatment with anti-inflammatory treatment, i.e., gamma globulin and methylprednisolone, the fever subsided. Conventional treatment with rifampicin + isoniazid 3 months after discharge from hospital were effective, and the axillary lymph nodes were not palpable. Six months after BCG vaccination bone tuberculosis occurred. CT of left hip and left knee showed bilateral hip joint effusion, left distal femur and left proximal tibia bone destruction. Gene detection showed the presence of homozygous IFNγ-R1 gene mutation of c.114_135del(p.E38fsX54). Her parents are consanguinity, both were carriers. In the literature, 99 cases with IFN-γR1 deficiency were reported, 95% of the cases had disseminated tuberculosis, and in 60 cases the dissemination occurred after BCG vaccination.

CONCLUSIONIFN-γR1 is an extremely rare disease in children. If disseminated tuberculosis infection occured, especially after BCG vaccination, or if there were focal/multifocal bone tuberculosis, immune function with conventional detection is considered normal, then IFN-γR1 deficiency should be considered, and early genetic testing for confirming the diagnosis and selecting the appropriate treatment are needed.

Antitubercular Agents ; therapeutic use ; BCG Vaccine ; adverse effects ; Female ; Humans ; Infant ; Lymph Nodes ; diagnostic imaging ; pathology ; Mutation ; genetics ; Mycobacterium Infections ; diagnosis ; drug therapy ; microbiology ; Receptors, Interferon ; deficiency ; genetics ; Tomography, X-Ray Computed ; Tuberculosis, Osteoarticular ; diagnosis ; drug therapy ; microbiology ; Vaccination ; adverse effects