Enlargement Of Superficial Lymph Nodes Research Articles

Tuberculosis in Superficial Lymphadenopathy Based on Fine Needle Aspiration Cytology: A Cross Sectional Study

Objective: To investigate the prevalence of tuberculosis among individuals presenting with superficial lymphadenopathy using Fine Needle Aspiration Cytology (FNAC) as a diagnostic method. Methodology: This cross-sectional research spanned three years, conducted at HBS General Hospital in Islamabad from July 2016 to June 2019. The study enrolled individuals meeting specified inclusion and exclusion criteria, presenting with superficial lymph node enlargement. All participants provided written consent before undergoing fine needle aspiration cytology (FNAC), and the diagnosis of tuberculosis relied on histopathological findings. Results: Among 632 patients aged 15 to 60 years who underwent FNAC following clinical examination and relevant lab investigations, 85.4% (n=540) exhibited cervical lymphadenopathy. Among these, 57.7% (n=312) were diagnosed with tuberculous lymphadenitis, comprising 58.3% females (n=182) and 41.6% males (n=130). Axillary lymphadenopathy was observed in 5.53% (n=35) of patients, among whom 3.64% females (n=23) and 2.1% males (n=13) were diagnosed with tuberculous lymphadenopathy. Generalized lymphadenopathy was seen in 5.1% (n=32) of cases, with 0.94% males (n=6) and 0.79% (n=5) demonstrating histological evidence of TB on FNAC. Inguinal lymphadenopathy was observed in 3.95% (n=25) of patients, including 0.94% males (n=5) and 0.47% females (n=3). Conclusion: Lymphadenopathy, a prevalent clinical condition, encompasses various underlying causes, ranging from manageable tuberculosis to malignant conditions. FNAC serves as a safe and rapid diagnostic technique, reducing the need for excisional biopsies. In this study, cervical lymph nodes were most frequently affected by tuberculous lymphadenopathy, particularly among females.

Case Reports: Clinical features and postmorteum findings of sheep-associated malignant catarrhal fever in a 2-years old bull

Malignant Catarrhal Fever (MCF) is a fatal lymphoproliferative disease of cattle and other ungulates caused by alcelaphine herpesvirus 1 (AlHV-1) and ovine herpesvirus 2 (OvHV-2), the main causative agents of wildebeest-associated MCF (WA-MCF) and sheep-associated MCF (SA-MCF), respectively. The virus is mainly spread by aerosols from pregnant or newborn sheep, goats, and wildebeest to susceptible animals. This case report presents the clinical features and post-mortem findings of an unusual case of malignant catarrhal fever (MCF) in a two-year-old bull brought to the Professor Feseha Gebreab Memorial Veterinary Teaching Hospital in Bishoftu, Ethiopia. The bull was semi-intensively managed, co-housed, and fed with sheep and other domestic animals. The animal was shivering upon arrival, with naso-ocular discharge and clouding of the eyes. The bull was febrile, with a rectal body temperature of 41.4 oC and a respiratory and heart rate of 40 and 48 beats per minute, respectively. On physical examination, the bull was emaciated, with bilateral yellowish mucopurulent naso-ocular discharge, frequent blinking, bilateral corneal opacity, salivation, a foamy mouth, head pressing, and enlargement of superficial lymph nodes. Malignant catarrhal fever was suspected based on the history and clinical signs, and empiric therapy with 10% oxytetracycline, diclofenac, and IV fluid was initiated. The bull died after receiving the third day of treatment. At necropsy, hemorrhages were found in the esophagus, trachea, and small and large intestines. In the kidney, white foci, enlargement, and fatty degeneration were observed. An ulcerated lesion was seen on the abomasum. In the gall bladder, enlargement and vascularization were also noted. The current case report confirms the rare case of clinical SA-MCF based on the history, exhibited clinical pictures, post-mortem findings, and PCR results. Separation of cattle and sheep is strongly advised to prevent SA-MCF, as no vaccine has yet been developed.

Analysis of characteristics of four patients with adrenal unicentric Castleman disease.

Castleman Disease (CD) is a group of diseases with characteristic lymph node histopathology, characterized by marked enlargement of deep or superficial lymph nodes. Adrenal CD is rarely reported, and an accurate preoperative diagnosis of adrenal CD is difficult. We report four cases of CD in the adrenal gland confirmed by pathology and review the characteristics of this rare disease, highlighting the necessity of diagnostic evaluation and follow-up of the patients. All of the patients sought medical advice because of adrenal incidentalomas. No significant abnormalities were presented in the biochemistry or endocrine systems. The imaging suggested a moderate-to-large mass with uneven moderate contrast enhancement of the adrenal region, similar to a pheochromocytoma. All cases were misdiagnosed as pheochromocytomas before operation and finally confirmed by histopathology. Three cases were pathologically diagnosed as hyaline vascular CD, and one case was diagnosed as plasma cell CD. All the patients are alive without recurrence after a median follow-up of 8 years. The adrenal CD should be considered after excluding pheochromocytoma and malignancy in the adrenal region. The long-term prognosis of patients with complete resection of the mass is excellent.

Clinical Features and Prognosis of Patients with Castleman's Disease

To analyze the clinical features and prognosis of patients with Castleman's disease (CD) and improve the diagnosis and treatment of CD. Clinical data of patients diagnosed with CD by pathological biopsy in Gansu Provincial Hospital from January 2009 to November 2020 were retrospectively analyzed. According to clinical classification, the patients were divided into two groups: UCD (unicentric CD) group (n=20) and MCD (multicentric CD) group (n=9). The clinical manifestations, laboratory examination, treatment regimens, pathological examination and follow-up data were statistically analyzed. There were no significant differences in average age and gender ratio between UCD group and MCD group. In UCD patients, 80.0% were hyaline vascular type, and 20.0% were plasma cell type. In MCD patients, 33.3% were hyaline vascular type, 55.6% were plasma cell type, and 11.1% were mixed type. There was significant difference in pathological classification between the two groups (P=0.039). The UCD patients usually presented asymptomatic single lymph node enlargement with mild clinical symptoms, while the MCD patients were characterized by multiple superficial and deep lymph node enlargement throughout the body. The incidences of asthenia, splenomegaly, serous effusion in MCD group were higher than those in UCD group (P<0.05). Meanwhile, the incidences of anemia, hypoproteinemia, increased ESR, elevated serum globulin and elevated β2-microglobulin were significantly higher than those in UCD group too (P<0.05). There was no significant difference in the incidences of abnormal WBC, PLT and elevated LDH between the two groups (P>0.05). Among 20 patients with UCD, 13 cases reached complete remission (CR), 1 case achieved partial remission (PR). Among 9 patients with MCD, 3 cases received CR and 4 cases received PR. Patients with CD requires pathological examination for diagnosis. Patients with UCD show mild clinical symptoms, good surgical treatment effect and good prognosis. Patients with MCD have diversified clinical manifestations and relatively poor prognosis, and these patients require comprehensive treatment.

Clinical, Hematological, and Biochemical Alterations Associated With Early and Late Infection of Lumpy Skin Disease in Cattle in Egypt

This study aimed to investigate clinical, hematological, and biochemical alterations associated with early (during the first week.) and late (after one month) of lumpy skin disease (LSD) infection in cattle infected during an outbreak of LSD in Egypt. Animals which were clinically examined directly after the clinical onset of LSD showed, firm elevated skin nodules that were distributed all over the body, fever (more than 40℃) associated with anorexia, general weakness, reduced milk yield, enlargement of superficial lymph nodes, and edema in the brisket and/or limbs. Examination of the affected animals one month after the disease onset revealed marked weight loss, shrunk of skin nodules and formation of sit fast. There were significant increases in body temperature, pulse and respiratory rate in all animals infected with LSD with significant decrease of ruminal movement compared to control group. DNA extracted from skin samples collected from LSD infected animals showed bands at the expected size (172 base pairs) by partial amplification of viral attachment protein using PCR. Reduced RBCS count, Hb content, HCT, and MCHC values with a significant increase in MCV in all LSD infected cows compared to the control group, while leukogram analysis revealed leucopenia and lymphopenia during the 1st week. Post-infection, however, one month post-infection revealed granulocytic leukocytosis. In addition, all LSD infected cows showed inflammatory thrombocytopenia. Animals during early LSD infection showed significant reduction in total protein, albumin, glucose and TAC and significant increase in ALT, AST, ALP, LDH, CPK, C-troponin-1, total and direct bilirubin, creatinine, K and MDA levels compared to the control group. While animals during late infection showed significant decrease in glucose, ALT, AST, LDH, CPK, C-troponin-1, direct bilirubin, K and MDA levels and significant increase in total protein, albumin and TAC compared to the early infection group. It can be concluded that, LSD infection in cattle revealed critical alterations in some hematological and serum biochemical parameters during both early and late stages of infection with negative impact on different organ functions including skin, muscle, liver, kidney and heart.

CD8+ Mycosis Fungoides in Peripheral Blood; A Rare Finding

Cutaneous T cell lymphomas are mature lymphomas of T lymphocyte presenting with skin lesions and/or systemic manifestations. Majority of these cases show CD4+ phenotype and are classified as Mycosis Fungoides (MF)/Sezary syndrome (SS) spectrum.&#x0D; Here we present a case of 74-year-old male patient, having no known comorbid, presented in Dr. Ziauddin Hospital, Karachi OPD with complains of generalized skin lesions, itching for 2 years, generalized weakness for 4 months and no lymphadenopathy or visceromegaly. CBC showed absolute lymphocytosis and absolute eosinophilia. Some lymphocytes exhibited cerebriform nuclei. CT scan neck, chest and abdomen showed bilateral enlarged superficial inguinal lymph nodes and multiple enlarged bilateral axillary lymph nodes. Skin biopsy was inconclusive. Immunophenotyping of peripheral blood was then performed which showed an aberrant T cell population showing positivity for CD3, CD8, CD2, CD25 and negative for CD4, CD45, CD5, CD30, CD56 with variable expression of CD7. Case was finalized as CD8+ Mycosis Fungoides with peripheral blood involvement.&#x0D; These findings are very rare and highlight the importance of integrated approach to clinical course, morphological findings and other ancillary tests to be used in correlation with each other. These findings also highlight the diversity present in T cell malignancies in terms of immunophenotype.

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes.

ObjectivesTo evaluate the diagnostic efficiency and diagnostic threshold of conventional US and shear-wave elastography (SWE) in superficial enlarged lymph nodes (LNs).MethodsA total of 204 patients with superficial enlarged LNs were enrolled in this retrospective study aged 46.0 ± 15.2 years from March 2020 to March 2021. LNs with a long axis larger than 0.7 cm were considered as superficial enlarged. Before the histological biopsy, LNs that were considered suspicious according to both conventional US and SWE were included, while LNs with no or unclear pathological results, or with no satisfactory SWE images, were excluded. The conventional and 2-D SWE examinations were performed with Aplio i800 and Acuson sequoia equipped with i18LX5 linear-array transducer (5-18 MHz) and 10L4 linear-array transducer (4-10 MHz), respectively. Both E Median and Vs Median parameters were investigated by two senior ultrasound physicians. The pathological results were performed as the gold standard.ResultsVariables including transverse axis size, lymphatic hilum, L/T ratio, echogenicity, and color Doppler pattern were considered significant. The mean E Median value in benign, metastatic LNs, and lymphoma were 28.26 ± 8.87 kPa, 77.46 ± 22.85 kPa, and 50.37 ± 5.41 kPa (p <0.001), while Vs Median values were 3.02 ± 0.50 m/s, 4.87 ± 0.90 m/s, and 4.09 ± 0.22 m/s, respectively (p < 0.001). The diagnostic performance indicated the high sensitivity, specificity, PPV, NPV, and overall accuracy of conventional US combined with SWE. The optimal cutoff values of E Median and Vs Median for predicting malignant LNs were 42.90 kPa and 3.73 m/s, respectively. As AUC value, sensitivity, specificity, accuracy, PPV, and NPV revealed, the indexes of E Median were 0.976, 0.927, 0.975, 0.946, 0.983, and 0.897, respectively, while Vs Median were 0.970, 0.927, 0.963, 0.941, 0.975, and 0.895, respectively (p <0.001). The ROC curves of both E Median (AUC=0.976) Vs Median (AUC=0.970) suggested the remarkable diagnostic efficiency in distinguishing benignity between suspected malignant LNs.ConclusionsAbove results indicated that conventional US together with 2-D SWE could elevate the diagnostic performance. Meanwhile, the parameters of 2-D SWE including E Median and Vs Median could effectively assess malignant LNs, which provide valuable differentiating information in superficial enlarged LNs.

The Role of Contrast-Enhanced Ultrasound in Differentiating Splenic Tuberculosis From Splenic Lymphoma.

AimTo summarize the features of splenic tuberculosis and splenic lymphoma by contrast-enhanced ultrasound (CEUS) and examine the application of CEUS in differentiating splenic tuberculosis from splenic lymphoma.MethodsThe ultrasound and CEUS manifestations of 30 cases of splenic tuberculosis and 19 cases of splenic lymphoma were retrospectively analyzed, and the number of lesions, degree of splenomegaly, internal echogenicity, color blood flow signal, and CEUS manifestations of the two diseases were statistically determined.ResultsA significant difference was noted in the internal echogenicity between splenic tuberculosis and splenic lymphoma lesions, particularly the strip-shaped hyperechoic areas of the lesions. The ultrasound features of perisplenic, retroperitoneal, and superficial lymph node enlargement were found to overlap (p < 0.05). Splenic tuberculosis showed heterogeneous enhancement and non-enhancement, whereas lymphoma showed low enhancement and high enhancement, and CEUS findings were statistically significant in distinguishing both, p < 0.05.ConclusionSplenic tuberculosis is characterized by a lack of blood supply, mostly heterogeneous enhancement, and non-enhancement noted in CEUS. Splenic lymphoma lesions are often characterized by a rich blood supply and homogeneous enhancement on CEUS. CEUS can help identify the microcirculation of lesions in both patients with splenic lymphoma and patients with splenic tuberculosis. Thus, CEUS has great application value.

Clinicopathological Characteristics of Lymphadenitis Caused by Talaromyces marneffei Diagnosed by Core Needle Biopsy

Objective To analyze the clinicopathological characteristics of lymphadenitis caused by Talaromyces marneffei (TM).Method s The clinical data,pathological features,pathogen examination,and treatment of 15 cases of TM-caused lymphadenitis were analyzed retrospectively.Results The 15 cases included 14 males and 1 females,who were aged 26-67 years,with an average age of (49.1±11.87) years.The 15 cases,including 13 cases of acquired immunodeficiency syndrome and 2 cases of diabetes mellitus,were accompanied by superficial lymph node enlargement in the neck and supraclavicular,axillary,and inguinal regions.The structure of cord-like lymph node tissue punctured by thick needle was completely or partially replaced by inflammatory lesions. Under microscope,8 cases showed mainly diffuse infiltration of phagocytes with pathogens;5 cases presented mainly extensive coagulation necrosis with a small amount of pathogens and nuclear debris;2 cases were characterized by small nodular hyperplasia of fibroblasts,formation of granulomatous structure,and scattered distribution of a few multinucleated giant cells.The pathogens were relatively consistent in size and shape,which were round,oval or sausage-shaped and clustered like mulberry.Diastase periodic acid-Schiff staining and hexamine silver staining highlighted the bacterial structure with transverse septum.TM growth was detected in the blood,alveolar lavage fluid,sputum or lymph node extract fungal culture of the 15 patients.Owing to the adequate antifungal treatment in time,these 15 patients were discharged after their conditions were improved.Conclusion Lymphadenitis is one of the major manifestations of the systemic invasion of TM at the late stage,which is tended to be misdiagnosed.Through core needle biopsy of lymph node,it can be diagnosed as soon as possible to avoid delayed treatment and improve the cure rate.

Application of Contrast-Enhanced Ultrasound Combined with Elastic Imaging Technology in Differential Diagnosis of Salivary Gland Tumors.

This paper proposes the effect of contrast-enhanced ultrasound combined with real-time elastic imaging technology in the differential diagnosis of salivary gland tumors. 200 patients were selected, including 120 males and 60 females. The age ranged from 9 to 83 years, with an average of 55.4 years. Among the 200 cases, there were 90 cases of single parotid gland on the right, 77 cases of single parotid gland on the left, 2 cases of bilateral (single parotid gland on each side), 2 cases of multiple parotid gland on the right (2 lesions), 1 case of 2 lesions on the left and 1 lesion on the right, and 1 case of multiple parotid gland on the left (4 lesions). 135 cases were located in the superficial lobe (78%) and 38 cases (22%) in the deep lobe of parotid gland. The ARIETTA 70 color Doppler ultrasound diagnostic instrument is used. The equipment is equipped with high-frequency contrast probe, real-time elastic imaging technology, and related software. The results showed that the detection rate of salivary gland tumors by ultrasound was 100% and the diagnostic coincidence rate was 71% (123/173). Ultrasound can not only identify the tumors in and around the parotid gland but also identify the location, size, and internal structure of the tumors. Combined with CDFI, it can make qualitative diagnosis of most benign and malignant salivary gland tumors and provide help for clinical treatment and operation plan. It is proved that contrast-enhanced ultrasound and real-time elastic imaging technology have advantages over gray-scale ultrasound in differentiating benign and malignant superficial enlarged lymph nodes, and the combined use can effectively improve the diagnostic efficiency.

Study of prevalence of theileriosis in cattle and evaluation of therapeutic efficacy of different commercially available drugs

The present study was carried out to detect the prevalence of theileriosis in cattle of Sadar, Singair and Ghior upazila in Manikganj district of Bangladesh and evaluate the therapeutic efficacy of Imidocarb dipropionate (Babenil®), Oxytetracycline (Renamycine®) and Gentamicin (Acigent®). The study was conducted for six months and during this study period a total of 150 cattle were examined, 10 were found to be infected with Theileria spp. On Geimsa stained blood smear examination, it was observed that the overall prevalence of theileriosis in cattle was recorded as 6.67%. Animals were screened on the basis of clinical signs like fever, anorexia, with or without superficial lymph node enlargement and blood smear examination for presence of Theileria spp. The prevalence of theileriosis in female was non significantly higher (7.50 %) than male (5.71%). In case of age group, the significantly highest prevalence (13.3%) was in adult cattle above 3 years age, followed by 4.00 % in the age group of 2 to less than 3 years old and 0.00 % in 6 months to 2 years which was not significant(p&gt;0.05). The prevalence of theileriosis in respect of breed was non significantly (p&gt;0.05) maximum in cross breed cattle (7.05 %) than in indigenous cattle (6.15%). After identification of causal agent, therapeutic effect of imidocarb dipropionate, oxytetracycline and gentamicin were tested and where highest recovery was found by administration of imidocarb dipropionate (70 %) can be successfully used in the treatment of theileriosis. Asian J. Med. Biol. Res. 2022, 8 (1), 1-8

Clinical Features and Prognostic Risk Prediction of Non-Hodgkin Lymphoma-Associated Hemophagocytic Syndrome.

BackgroundMalignancies, especially lymphoma, are a common cause of adult secondary HLH and an independent risk factor for the prognosis of HLH patients.MethodsPatients with lymphoma alone or concurrent lymphoma-associated phagocytic syndrome (LAHS) admitted to Beijing Friendship Hospital from January 2016 to December 2020 were enrolled in this study.FindingsThere were 348 lymphoma patients, 104 concurrent with LAHS. The pathological type of lymphoma without LAHS was dominated by B-cell lymphoma, while those with LAHS were T/NK-cell lymphoma predominantly (p < 0.001). Superficial lymph node enlargement was more significant in patients with B-LAHS (p = 0.006), while patients with T/NK-LAHS had lower neutrophil counts (p = 0.005), lower fibrinogen levels (p < 0.001), higher transaminase levels, and more co-infection with EBV (p < 0.001). B-LAHS had significantly higher IL-10 levels than with T/NK-LAHS (p = 0.006), and NK/T-LAHS had significantly higher IP-10 levels than other T-LAHS (p = 0.008). Age, platelet count, IPI, history of NK/T lymphoma, and no remission of HLH were independent risk factors for prognosis in patients with non-Hodgkin lymphoma-associated phagocytic syndrome (NHL-LAHS), and a prognostic risk score model for NHL-LAHS was developed.ConclusionLAHS is a life-threatening disease with a poor prognosis. The prognostic risk score model for NHL-LAHS with a good fit and validation for the test has value for clinical application.

The Exophthalmos of Eyes as An Unusual and Unregistered Sign of Mycoplasma wenyonii Infection in Newborn Calves in Basrah, Iraq

Exophthalmos with bulging and edema of both eyes was detected as an unusual and unregistered sign of Mycoplasma wenyonii infection in cross-bred newborn calves in Basrah, Iraq. Three male cross-bred calves 4- 10 days old, show different clinical signs, A blood sample of 2.5 mL was drawn from the jugular vein of each newborn calf in. The blood was mixed with EDTA to obtain the total erythrocyte count, level of Hemoglobin, packed cell volume, total leukocyte count using automatic fully digital cell counter. The stained blood smears were used for detection of the microorganism, Moreover, the microorganism was confirmed by the polymerase chain reaction technique . Exophthalmos in diseased newborn calves can affect both eyes (bilateral) or only one eye (unilateral). Furthermore, calves also showed increased abdominal respiration with panting, recumbency, inability to stand, pale mucus membranes, small hemorrhagic patches on the skin, and enlargement of superficial lymph nodes. Vital signs were also increased (body temperature, respiratory and heart rates). It has been concluded that the exophalmous of eyes in infected animals with Mycoplasma wenyonii should be added as a new clinical sign through which the disease can be suspected and inferred.

Virological and molecular investigation on specimens from buffaloes suspected to be infected by buffalopox virus in Egypt 2019

In this study, skin lesions from buffaloes showing clinical signs of buffalopox infection were tested to isolate and identify the buffalopox virus (BPXV). Clinical examination of infected buffaloes was performed and visible clinical signs recorded. Skin scabs from infected buffaloes were collected and used for virus isolation on embryonated chicken egg (ECE) and tissue culture cell lines. The isolated BPXV was identified and characterized using polymerase chain reaction (PCR). The infected buffaloes displayed fever, skin eruptions, enlargement of superficial lymph nodes, emaciation and drop in milk yield. The ECE inoculated with the prepared skin scab samples showed clear raised white pock lesions on the chorioallantoic membrane (CAM). The inoculated tissue cultures (VERO and BHK cell lines) revealed a cytopathic effect (CPE) including rounding, clumping with cytoplasmic granulation and cluster formation. PCR for the C18L specific BPXV gene was carried out on the virus infected tissue culture produced 368 bp bands. Human infection with BPXV was also recorded. It was concluded that BPXV is circulating in Egyptian buffaloes, causing economical losses and infection in contact humans.

Clinical and biological features of mantle cell lymphoma patients with co-expression of CD10 and BCL-6: a retrospective study.

BackgroundMantle cell lymphoma (MCL) with co-expression of CD10 and BCL-6 was scarcely reported, and its biological features were largely remained unknown. Thus, this study aimed to describe the clinical and biological features, as well as outcome of MCL patients with co-expression of CD10 and BCL-6.MethodsA total of 104 cases of MCL who were admitted to our hospital between January 2011 and October 2018 were recruited. Those patients were diagnosed according to the 2016 World Health Organization (WHO) classification system for tumors of the hematopoietic and lymphoid tissues, in compliance with the results of cytomorphology and immunohistochemical analysis. Patients were followed up through telephone interviews, medical records. Differences in age, gender, leukocyte count, lactate dehydrogenase (LDH) level, beta-2 microglobulin (β2-MG) level and results of immunohistochemistry were analyzed. Then the event-free survival (EFS) rate and overall survival (OS) rate were performed by the Kaplan-Meier method and log-rank test.ResultsThe results showed that, in total, 5 patients had superficial lymph node enlargement, 2 patients suffered from abdominal discomfort, and 1 patient’s red blood cell (RBC) count was abnormal at the time of diagnosis. All patients were in stage IV, 75% had bone marrow involvement, and 75% and 100% of patients had elevated levels of LDH and β2-MG, respectively. Three classic genes and five variants were involved in the 8 patients. MCL patients with the co-expression of CD10 and BCL-6 had higher Ki-67 index, white blood cell (WBC) count, LDH level, and β2-MG level than those of without co-expression of CD10 and BCL-6 (P=0.025, 0.038, 0.015, and 0.021, respectively). Besides, MCL patients with CD10 and BCL-6 co-expression had shorter OS and EFS (χ2=6.401 and 5.975; P=0.011 and 0.015, respectively), indicating patients’ susceptibility to get complex karyotype and TP53 abnormality.ConclusionsMCL patients with co-expression of CD10 and BCL-6 were more likely to have bone marrow involvement, higher Ki-67 index, increased WBC count, and elevated levels of LDH and β2-MG at the time of diagnosis, then might has complex cytogenetic and poor prognosis.

A case report of community-acquired Raoultella ornithinolytica infection in a healthy, young individual

BackgroundRaoultella ornithinolytica is a Gram-negative bacillus that resembles Klebsiella. This bacterium is present in many soil and aquatic environments and is a major causative agent of healthcare-associated infections (HAIs) in medical staff. Clinically, it has been reported to contribute to nosocomial infections in patients that include but are not limited to gastrointestinal, skin, and genitourinary tract infections. These complications are most common in hospitalized patients with underlying immunodeficiency, multiple comorbidities, or those receiving invasive surgery.Case presentationWe present a case of a 25-year-old patient with a R. ornithinolytica infection. The patient had no history of any disease. Her main complaints were high fever, a scattered maculopapular rash, and superficial lymph node enlargement (SLNE). Peripheral blood samples were collected for high-throughput sequencing analysis to identify pathogenic microorganisms. The results confirmed a R. ornithinolytica infection, which was treated successfully using meropenem. Loratadine was also administered to treat the patient’s compromised skin condition caused by an allergic reaction.ConclusionsTo our knowledge, this is the first case of a systemic maculopapular rash and superficial lymphadenopathy caused by a R. ornithinolytica infection acquired at the community level. Based on this case, we recommend a combination of antibiotic and antiallergic drugs to treat a R. ornithinolytica infection and associated allergic reaction to the bacteria.

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: Our experience at a tertiary care center

Peripheral lymphadenopathy is frequently due to a local or systemic benign infectious disease. However, it could be a manifestation of underlying malignancy. Fine needle aspiration cytology (FNAC) acting as a reliable diagnostic tool to find out the cause underlying the lymphadenopathy enables the clinician to plan appropriate management for each patient.The present study was undertaken to assess the utility of FNAC in evaluation of peripheral lymphadenopathy cases in different age groups and sex and to study the cytomorphological patterns in these cases.A retrospective and prospective observational study was conducted in the Department of Pathology, Hind Institute of Medical Sciences over the duration of 2 years. A total of 331 lymph node FNA aspirates were studied. Aspirated material was routinely stained with Haematoxylin &amp; Eosin and Papanicolauo stains. Ziehl Neelsen stain was used wherever required.Most of the patients were in the age group of ≤15 years (117/331). Cervical lymphnodes were the most commonly involved sites (222/331). The largest group of lesions belonged to the non-neoplastic category (227/331). Only 54/331 cases were in the neoplastic category. Amongst the non-neoplastic lesions, granulomatous lymphadenitis comprised the majority (128/277). Amongst the neoplastic lesions, 8 cases showed features of non-Hodgkin’s lymphoma (NHL); where as 3 cases were of Hodgkin’s lymphoma (HL). Non-neoplastic lesions were more common in the younger age group (117/257); where as neoplastic lesions were more common in the older age group (27/54).FNAC is a reliable method of diagnosing the pathology underlying enlarged superficial lymph nodes; thus acting as a triage to distinguish the cases with a suspicion of significant disease. At the same time, it also provides material for ancillary studies especially in lymphoproliferative lesions.

Mycobacterial spindle cell pseudotumor in children: a clinicopathological study of two cases

Objective: To study the clinicopathologic features, and the diagnosis and differential diagnosis of mycobacterial spindle cell pseudotumor in children. Methods: The clinical data, histopathological features, immunophenotype and special staining of 2 mycobacterial spindle cell pseudotumors were analyzed. The related literatures were reviewed. Results: The age of the two boys was 11 months and 22 months respectively, but their clinical symptoms became apparent at the age of about 4 months. The lesions involved lymph nodes and skin. The first patient also had fever for more than 4 months. Both patients received anti-inflammatory treatment in the outside hospital, but had no obvious improvements of the symptoms. A tumor resection was performed at the outside hospital. Histologically, mycobacterial spindle cell pseudotumor consisted of bland spindle cells, which formed fascicles, without any obvious atypia and mitoses. The cell nuclei were vesicular, with small nucleoli and abundant cytoplasm in some of the cases. The spindle cells expressed histiocyte-associated markers, such as CD68. The Ki-67 proliferation index was low. The mycobacteria were usually readily highlighted by acid-fast staining, which located in the cytoplasm of proliferative spindle cells. In the first case, there was obstructive jaundice because of the progressive enlargement of live portal lymph nodes and systemic disseminated lesions. The second patient had disease recurrence after only operation, and gradually developed other skin nodules and superficial lymph node enlargement. The high-throughput molecular analysis of the skin biopsy confirmed the diagnosis of mycobacterium tuberculosis. After 11 days of anti-tuberculosis treatment, the patient's condition improved significantly. Conclusions: Mycobacterial spindle cell pseudotumor in children is a very rare benign lesion. It is characterized by spindle-histiocyte proliferation caused by mycobacterium infection. An acid-fast stain appears necessary for confirming the diagnosis.

Atypical Case of Chronic Myeloid Leukemia (CML) in A Native Shepherd Dog in Duhok Province, Iraq

A typical case of a 7-years-old Kurdish male shepherd dog was referred with two weeks history of lethargy, restlessness, anorexia and severe emaciation. Physical examination of the dog revealed generalized lymphadenopathy, strong pale mucous membrane, systolic murmur of the heart, vomiting, bloody diarrhea and fever. Hematological abnormalities indicated moderate to marked leukocytosis characterized by 89% neutrophilia with a left shift to progranulocytes and 1.6% presumptive myeloid blasts, marked thrombocytopenia, marked non-regenerative normocytic hypochromic anemia and dysplasia in platelets and neutrophils. The histopathological examination revealed excessive infiltration with neoplastic myeloid cells that invaded all the internal organs. Bone marrow analysis revealed marked hypercellularity with a predominance of immature cells, marked myeloid 6.2%, dysplasia of neutrophils lineage and rare erythroid progenitors and numerous megakaryocytes. Enlargement of superficial and visceral lymph nodes and internal body organs, especially liver and spleen were observed in the autopsy after animal euthanasia. Our results confirmed that this dog was suffering from chronic myeloid leukemia. Statistically, there was a significant difference (P 0.05) was found between the mean values of leukocytic ratio in peripheral circulation and bone marrow. This is the first case report study that has been recorded in a native shepherd dog in a rural area around Duhok province/ Iraq.

Analysis of the epidemiological and clinical characteristics of 65 patients with scrub typhus on the east coast of China.

The present study set out to investigate the epidemiological and clinical characteristics of 65 patients with tsutsugamushi disease. The clinical data of 65 patients with tsutsugamushi disease, who were admitted to the Affiliated Hospital of Nantong University were retrospectively analyzed. The clinical symptoms, laboratory examination results, clinical treatment plans, treatments, and outcomes of the patients were analyzed. The 65 patients with tsutsugamushi disease, included 40 males (61.54%) and 25 females (38.46%). The patients were aged from 1 year and 7 months to 88 years old, and the peak age was 60-70 years old. Geographically, the patients were concentrated in Rugao and Tongzhou District. Infections were most common between October and December (categorized as "autumn type"), and peaked in November. Farmers had the highest infection rate of any occupation (66%). All patients had the symptom of fever, with the body temperature of 60 (92.31%) patients exceeding 38.5 °C, while 58 (89%) and 51 (78%) patients had characteristic eschar and skin rash, respectively. There were 56 (86.15%) patients with varying degrees of liver damage, 8 (12.31%) cases of elevated D-dimer, 3 (4.62%) cases of myocardial injury, 38 (58.46%) cases of superficial lymph node enlargement, 8 (12.31%) cases of splenomegaly, and 2 cases (3.08%) of bulbar conjunctival congestion. Of the 65 patients enrolled, the overall misdiagnosis rate of first medical contact was 64.62. Tsutsugamushi disease, infection has obvious seasonality and a susceptible population, especially among farmers and the elderly.