Granulomatous Pneumonia Research Articles

A histopathological study in road-killed European badgers (Meles meles) from the English midlands with isolation of novel non-tuberculous atypical mycobacteria

European badgers (Meles meles) play an important role in the epidemiology of bovine tuberculosis (caused by Mycobacterium bovis) in England, but little is known about the prevalence of atypical mycobacteriosis. Badgers are also known to be infected by other infectious agents, and the relationship between mycobacteriosis and concomitant infections needs further investigation. Overall, 88 badger carcasses from the Midlands of England collected between July 2016-August 2017 were selected for histopathological examination based on the degree of autolysis (mild), mycobacterial culture results and a balanced sex ratio. Mycobacteria were cultured from 44 badgers, of which 31 were mycobacteria belonging to the M. tuberculosis complex (MTBC) (based on IS6110 PCR and Hsp64 and/or rRNA PCR and sequencing) and 13 were non-tuberculous atypical mycobacteria (NTM). Mycobacteria were not cultured from the remaining 44 animals. Histologically, the most common findings were silica-laden macrophages (85%), granulomas (53%), sarcocystosis (47%), nephritis (31%), portal/periportal hepatitis (26%), ulcerative dermatitis (18%). Culturable mycobacteriosis was associated with higher prevalence of granulomas (p < 0.001) and lower prevalence of hepatitis (p = 0.003). NTM (M. nonchromogenicum, M. avium complex, M. hassiacum, M. malmoense, M. vaccae.) infections were associated with granulomatous pneumonia, and M. malmoense was associated with pyogranulomatous and ulcerative dermatitis. In conclusion, this study describes, for the first time, histological lesions associated with NTM in badgers, the histomorphology of which was similar to those caused by MTBC. In addition, the negative relationship between mycobacteriosis and periportal hepatitis may indicate a complex relationship between mycobacteriosis and other diseases, as previously observed with tuberculosis.

Experimental infection of ringtail possums (Pseudocheirus peregrinus) with Mycobacterium ulcerans, the agent of Buruli ulcer

Buruli ulcer (BU) is a necrotizing disease of skin and soft tissue caused by the bacterium Mycobacterium ulcerans (MU). In Australia, where the disease is emerging in new geographic areas and human case numbers are increasing, native possum species act as reservoir hosts. To better understand the life history of MU in one of its natural hosts, we conducted intra-dermal challenge of six wild caught, MU-naïve common ringtail possums (Pseudocheirus peregrinus). All six animals developed BU disease consistent with that observed in naturally infected ringtail possums. Time to ulceration varied between 49 and 77 days (mean = 61.8 days). Molecular evidence of systemic infection was detected in five animals and was supported by consistent histopathological findings in four animals. Pathological findings included random, multifocal, granulomatous hepatitis in four possums, one of which also had a mild, multifocal, interstitial granulomatous pneumonia. Acid-fast bacilli were only evident in inflammatory foci beyond the primary inoculation site in one possum. The ringtail possum model of MU infection is an important tool for the investigation of bacterial transmission dynamics, pathogenesis and immune response in a natural host. Data from this model may improve disease risk modelling and help identify intervention points to stop zoonotic transmission and disease spread.

Causes of Admission, Mortality and Pathological Findings in European Hedgehogs: Reports from Two University Centers in Italy and Switzerland.

European hedgehogs (Erinaceus europaeus) are nocturnal insectivores frequently found in urban areas. In the last decades, their population has declined in various European countries and human activities have emerged as significant contributors to this trend. While the literature has mainly focused on trauma as the major cause of mortality, few authors have considered pathological findings. The present study is based on the results of full post-mortem examinations performed on 162 European hedgehogs in Italy and 109 in Switzerland. Unlike in previous studies, the main cause of mortality was infectious diseases (60.5%), followed by traumatic insults (27.7%). The lungs were the main organ affected, showing mostly lymphoplasmacytic (45.9%), granulomatous (18.1%) or suppurative (8.2%) pneumonia. Nematodes were detected in 57.2% of all lungs and were significantly associated with pneumonia (p-value < 0.001). To our knowledge, this is the first study to report infectious diseases as the main cause of hedgehog death, emphasizing the need for wildlife rescue centers to adopt appropriate diagnostic and therapeutic measures. Further research is necessary to determine the broad range of infectious agents that affect this species and elucidate their interplay with the host. Finally, citizen sensitization should be implemented to promote responsible behaviors that could reduce human-related traumatic events.

MYCOLICIBACTERIUM FORTUITUM INFECTION IN EX SITU EMERALD TREE BOA (Corallus batesii).

Emerald tree boas (Corallus batesii) are boids that in situ occurs in forested habitats in the Amazon Basin. The mycobacterial species can infect reptiles but the species Mycolicibacterium fortuitum was identified only in feces samples of ex situ Python regius and was isolated from granulomatous lesions of an ex situ Iguana iguana when was still part of the genus Mycobacterium. This article aims to report a mycobacteria infection case in a female Corallus batesii kept under human care. The animal presented apathy and 2months of anorexia, being found dead. The necropsy revealed presence of tracheal and pulmonary nodules besides multifocal, bacterial, granulomatous pneumonia. After Fite-Faraco histochemical staining, immunohistochemistry, semi-nested polymerase chain reaction (PCR) and genetic sequencing the Mycolicibacterium fortuitum complex was diagnosed with 99.54% of nucleotide similarity. This mycobacterial species was already pointed out as an important nosocomial pathogen and more studies are necessary to explore their zoonotic potential.

Granulomatous pneumonia caused by Mycobacterium simiae and necroulcerative enteritis caused by Entamoeba spp in a panther chameleon (Furcifer pardalis)

Granulomatous pneumonia caused by Mycobacterium simiae and necroulcerative enteritis caused by Entamoeba spp in a panther chameleon (Furcifer pardalis)

Granulomatous pneumonia in a cow infected with Toxoplasma gondii

We report a confirmed case of Toxoplasma gondii infection in the lungs of a cow exhibiting respiratory symptoms. At slaughter, white nodules were discovered in lung tissue, accompanied by enlarged hilar lymph nodes. Histological examination revealed the disappearance of alveolar structures in nodular areas, replaced by granulomas containing inflammatory cells. Immunohistochemical staining with anti-T. gondii antibody and nucleotide sequencing of 18S rDNA confirmed T. gondii infection. However, the link between T. gondii and observed symptoms remains unclear. Various factors, including host genetics, underlying diseases, infection route, and exposure level, may contribute to these uncommon symptoms. Although T. gondii infections in cattle are traditionally considered asymptomatic, our study suggests the possible existence of clinical symptoms associated with Toxoplasma infection. Beef cattle are generally not assumed to be a relevant source of human T. gondii infection; however, sporadic transmission by infected edible beef to humans cannot be completely excluded and deserves further studies.

Investigation of aspergillosis outbreak in young ducklings: Unraveling the role of hatcheries in Aspergillus fumigatus transmission.

Aspergillosis is a disease that affects several species of birds and causes substantial losses in the poultry business. The purpose of the investigation was to identify the pathogen responsible for a respiratory outbreak among juvenile ducklings. An epidemic of Aspergillosis infected a total of 800 Muscovy ducks that were being reared in El-Beheira Governorate. Tissue samples were obtained to isolate suspected fungi from diseased birds and the hatchery environment. In addition, identification and molecular characterization were performed on the obtained fungal isolates. Affected birds displayed acute respiratory manifestations such as difficulty breathing, gasping for air, nasal discharge, and a mortality rate of up to 28.1%. Postmortem examination revealed bronchitis, tracheitis, congested lungs, air sacculitis, severe multifocal granulomatous pneumonia, a congested, enlarged liver, and a congested kidney with nephritis. Mycological examination revealed seven Aspergillus (A.) spp. isolates from ducklings and six from hatcheries. Isolate colonial morphology and microscopical examination were as follows: A. fumigatus, A. niger, Syncephalastrum racemosum, and four untypable isolates. These isolates were further identified by polymerase chain reaction (PCR), and the internal transcribed spacers (ITSs) gene was detected. Four representative isolates were submitted for sequencing and further phylogenetic analysis. The source of duckling infection might be linked to the hatchery environment due to the observed similarity of isolates from both affected birds and the hatchery, as evidenced by phylogenetic analysis. Our findings demonstrated the significance of appropriate hatchery control in preventing infection in young ducklings. Furthermore, the use of molecular identification techniques would be helpful for tracing the source of infection and rapid diagnosis of Aspergillus in the field.

Clinical Observations, Identification, and Antimicrobial Susceptibility of Fungi Isolated from Sea Turtles with Histologically Confirmed Mycotic Infections: 20 Cases, 2005–2020

Abstract Fungal infections were histologically confirmed in 20 stranded sea turtles, including 18 Kemp’s ridley turtles (Lepidochelys kempii), one green turtle (Chelonia mydas), and one leatherback turtle (Dermochelys coriacea). Infection was detected antemortem in 6 cases. Gross external findings in live turtles included carapace lesions (n = 3) and dermatitis (n = 1). Radiographs revealed evidence of pneumonia in 18 animals. Bronchoscopy detected excessive fluid, mucus, clotted blood, or caseous material within the bronchi and lungs of 3 turtles. At necropsy, the most common gross lesions were pulmonary granulomas, consolidation, and, or hemorrhage (n = 18), and the most common histologic lesion was severe heterophilic to granulomatous pneumonia (n = 18). Nine animals had fungal infection at sites outside of the lung. The most commonly identified genera were Purpureocillium, Beauveria, and Fusarium. Other isolates included Metarhizium sp., Trichoderma sp., Clavispora lusitaniae (Candida lusitaniae), Leptospherulina sp., Penicillium chrysogenum, Mucor sp., and Aspergillus section Nigri. Antifungal susceptibility performed for 10 isolates indicated minimum inhibitory concentrations (mg/L) for fluconazole ranging from 8 to &amp;gt;64, often &amp;gt;32; itraconazole 0.06 to 16, often ≤1; voriconazole 0.06 to 2, often ≤0.5; terbinafine 0.06 to &amp;gt;2, often ≤2. These data indicate that fluconazole resistance is common among the fungi that cause infection in sea turtles. Based on susceptibility data, itraconazole, voriconazole, or terbinafine may be appropriate for treatment of such infections, but additional clinical research is needed. Results of this study indicate that fungal infections can be difficult to diagnose antemortem in sea turtles, and more aggressive methods of diagnosis, such as lung biopsy, may be indicated for suspected cases.

Mycobacterium gordonae infection in a free-ranging green turtle (Chelonia mydas), Brazil

Mycobacteriosis is a well-known disease that has been reported in a variety of reptiles species. However, the occurrence of mycobacteriosis in sea turtles has been rarely documented, and most reports are from captive-reared animals. A juvenile green turtle (Chelonia mydas) was found stranded in March 2020, in Guanabara Bay, one of the most urbanized and polluted coastal areas in Rio de Janeiro, Southeastern Brazil. The turtle was in fair body condition and exhibited multiple cutaneous fibropapillomas, covering almost 60% of its body. Despite continued medical therapy, the animal died 60 days after initial supportive care. Necropsy revealed granulomatous pneumonia, hydropericardium, small granulomas in the myocardium, liver, spleen, thyroid and brain and caseous exudate in the meninges of the brain. The histopathological analysis showed disseminated granulomatous inflammation in various organs examined during necropsy. Intrahistiocytic acid-fast bacteria were observed in the liver, heart, lungs, kidneys, spleen, brain and adrenals. The blood culture collected shortly after the animal was admitted tested positive for Mycobacterium gordonae, after an 8-week incubation period; however, the animal had already died by the time the results were obtained. Postmortem examination confirmed systemic mycobacteriosis, identified as M. gordonae in blood, liver and lung cultures and by PCR amplification of DNA extracts from frozen tissue samples. This is the first report of a disseminated infection caused by M. gordonae in a free-ranging sea turtle. Although the source of this Mycobacterium remains unknown, it could potentially be related to anthropogenic activities (e.g., waste dumping or leakage from landfill sites). Increasing surveillance of Mycobacterium in wild sea turtles is of paramount importance to better understand the role of mycobacterial species as causative agents of infections in marine species.

Is the Angiostrongylus vasorum infection in domestic dogs underestimated or misdiagnosed? A comprehensive presentation of four lethal cases.

Angiostrongylus vasorum (A. vasorum) is a widely distributed gastropod-borne nematode, causing severe cardio-pulmonary disorders in dogs. In Romania, A. vasorum was detected in foxes and serologically confirmed in domestic dogs, but no clinical cases are currently diagnosed. Four dogs with clinical history of respiratory distress, originating from different geographical regions of Romania, were included in the study. One dog (case 1) was clinically evaluated using thoracic radiology and cardiac ultrasound; examination of feces and PCR were also performed for the etiologic diagnosis. The postmortem exam was performed in the other three cases, followed by parasitological and molecular analyses. In the first case, parasitic pneumonia was suspected based on the radiographic examination of the thorax and the infection with A. vasorum was confirmed by L1 morphological identification and PCR. The main postmortem changes included large, coalescing, dark red areas of pulmonary consolidation (n = 3) and numerous adult nematodes in the pulmonary arteries (n = 2). The histopathological examination of the lungs showed necrotizing and granulomatous pneumonia with severe hemorrhages and chronic pulmonary arterial changes. Intralesional nematodes were seen in all necropsied cases. Additional inflammatory changes related to A. vasorum infection were identified in the brain and tracheobronchial and mediastinal lymph nodes (n = 2). Identification of larvae, histopathology and PCR confirmed the infection with A. vasorum. This study describes the first cases of canine cardiopulmonary angiostrongylosis in domestic dogs in Romania, and focuses on clinical presentation, pathological findings and molecular analysis. Angiostrongylosis should be included on the list of differential diagnoses of canine cardiopulmonary distress and/or haemorrhagic diathesis in Romania and awareness should be raised among clinicians to avoid post-mortem diagnosis in the future.

Abstract #1406508: A Rare Case of Calcitriol-mediated Hypercalcemia in a Patient with Pneumocystis Jiroveci Pneumonia and the Role of Steroids in its Management

Calcitriol-mediated hypercalcemia is an uncommon complication of Pneumocystis jiroveci pneumonia (PJP). Some cases of PJP have been reported in patients with solid organ transplants and AIDS. Here we present a case of calcitriol-mediated hypercalcemia due to granulomatous Pneumocystis jiroveci pneumonia in a patient with a history of multiple sclerosis. A 45-year-old man with a medical history of multiple sclerosis, spondyloarthritis, smoking, and bipolar disorder was admitted for the evaluation of fever, fatigue, constipation, confusion, and weight loss of 10 Lbs over three months. His medications include rituximab, methotrexate, vitamin D-4000 IU, lithium, and calcium carbonate-600 mg. Laboratory evaluation showed elevated serum calcium (15 mg/dl) with a suppressed parathyroid hormone (9 pg/mL). Other pertinent findings include mildly elevated 25-hydroxyvitamin D (87 ng/ml), significantly elevated 1,25-dihydroxyvitamin D (381 pg/ml), and normal PTHrP (<2 pmol/L), vitamin A (0.82 mg/L) and TSH (1.31 mU/L). Extensive workup including AFB smear for tuberculosis, ACE level for sarcoidosis, SPEP for multiple myeloma, leukemia-lymphoma flow cytometry, and CT chest and PET-CT for malignancy were unremarkable. Treatment with large-volume intravenous fluids, calcitonin, and zoledronic acid followed by denosumab showed a transient reduction in serum calcium level to 10.5 mg/dl in 2 days and a rebound to a peak of 15.4 mg/dl in a week. Bronchoscopy with bronchoalveolar lavage which was done for persistent fever and new onset hypoxia revealed PJP confirmed by PCR. With this new finding, the diagnosis of PJP-induced calcitriol-mediated hypercalcemia was considered. He was then treated with Bactrim and prednisone 60 mg daily. Due to the severity of hypercalcemia, he required a hemodialysis session while waiting for the medications to take effect. His calcium normalized a week after the initiation of steroids and antibiotics and he was discharged on a slow prednisone taper. Clinic follow-up 4 weeks after discharge showed normal calcium, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D levels. Discontinuation of prednisone was attempted but resulted in rebound elevation of 1,25-dihydroxyvitamin D requiring continuation of low-dose prednisone 5 mg. Our immunocompromised patient developed hypercalcemia induced by PJP infection due to granulomatous production of 1α-hydroxylase resulting in increased calcitriol formation. Steroids unsurprisingly appear to have the best impact on PJP-induced hypercalcemia because of their anti-inflammatory property. In this clinical entity, it inhibits inflammation and granuloma formation leading to a reduction in the release of 1α-hydroxylase and 1,25-dihydroxyvitamin D levels. It is essential to consider PJP as an etiology of hypercalcemia, especially in immunosuppressed patients. Steroid appears to be effective medical therapy in this setting. The timing and duration of treatment, and the efficacy of bisphosphonates and denosumab, require further studies.

Mycobacterium genavense splenitis in a pet rabbit (Oryctolagus cuniculus) presented for fracture

Mycobacteriosis is an uncommon infection that has been sporadically described among wild, farmed and pet rabbits. To date, only one case of Mycobacterium genavense infection has been reported in a dwarf rabbit presenting with granulomatous pneumonia. This new case report describes granulomatous splenitis caused by M. genavense in a pet rabbit brought in for lameness caused by a femoral fracture. The initial blood test, X-ray, abdominal ultrasound, and bone marrow and spleen cytology results were consistent with a diagnosis of a metastatic giant-cell tumour. The rabbit underwent successful femoral osteosynthesis, and six months later, following the occurrence of a second spontaneous fracture and a worsening of overall health, the patient was euthanised. The postmortem histological examination showed severe granulomatous splenitis caused by acid-fast bacilli identified as M. genavense by real-time PCR analysis. The route of infection remains unknown, yet the lack of pulmonary involvement likely rules out airborne transmission. M. genavense infection, although rarely described in pet rabbits, appears to be an emerging pathogen and should be included among the differential diagnoses for pneumonia and splenomegaly.

Diagnosis and treatment of a novel Mycobacterium haemophilum associated pneumonia in an African pygmy hedgehog (Atelerix albiventris)

AbstractAn unknown age (at least 1.5‐year old), male, entire African pygmy hedgehog (Atelerix albiventris) was presented for decreased appetite, lethargy and laboured breathing. Pulmonary radiographic lesions consistent with pneumonia were noted in serial computed tomography scans. The hedgehog initially responded well to treatment with azithromycin and orbifloxacin for several months, but its health declined upon discontinuation of treatment. After continued decline despite resumed antibiotic therapy, the patient was humanely euthanised. A postmortem examination was performed, and histologic examination identified severe granulomatous bronchointerstitial pneumonia with intralesional acid‐fast staining bacteria. Samples from the lung and liver were positive for Mycobacterium haemophilum by PCR and further DNA sequencing. This report describes the clinical presentation, diagnosis, treatment and outcome of a pulmonary infection caused by M. haemophilum in a hedgehog.

Pathomorphological changes of serous membranes in cats

Pathomorphological examination is an important method of diagnosing various animal diseases. Autopsy results provide a preliminary diagnosis of the disease, are important for differential diagnosis, and in combination with histological examination may be sufficient to establish a final diagnosis.The serous membranes lining the internal cavities of the body produce and absorb a specific serous fluid that supports the dynamic qualities of internal organs; perform a protective function.Pathologoanatomic changes of the pleura and peritoneum were studied in six cats, the histological picture in two animals.Pathologoanatomic changes in four cats were characteristic for infectious peritonitis – the main cause of damage to serous membranes in this animal species. The exudative form of the disease was detected in one cat as subacute serofibrinous peritonitis. The mixed form was observed in three individuals with the phenomena of subacute serous pleurisy and peritonitis, fibrinous perigepatitis, bilateral granulomatous nephritis, granulomatous pleurisy and pericarditis, lobar granulomatous pneumonia. The damage of the peritoneum was noted in all four cases, the pleura – in two of these.Upon autopsy of the corpse of one animal, a combination of subacute sero-fibrinous pleurisy and subacute focal necrotic pneumonia of the cranial lobes of the lungs against the background of panleukopenia was diagnosed. These changes could have both bacterial and viral origin.One cat had a tumor of the left horn of the uterus with single neoplasms in the pleura of the diaphragm and multiple ones in the mesentery of the small intestine, thicker than the pleura, lung. Histological examination revealed that this is a tubular-papillary carcinoma with metastases. Under the microscope, tubular structures are noticeable, the lumen of which is made by papillary outgrowths of densely arranged atypical polymorphic cells.

Diagnosis of Aspergillosis in Horses.

Invasive pulmonary aspergillosis (IPA) may be a rare cause of granulomatous pneumonia in horses. The mortality of IPA is almost 100%; direct diagnostic tools in horses are needed. Bronchoalveolar lavage fluid (BALF) and serum samples were collected from 18 horses, including individuals suffering from IPA (n = 1), equine asthma (EA, n = 12), and 5 healthy controls. Serum samples were collected from another 6 healthy controls. Samples of BALF (n = 18) were analyzed for Aspergillus spp. DNA, fungal galactomannan (GM), ferricrocin (Fc), triacetylfusarinin C (TafC), and gliotoxin (Gtx). Analysis of 24 serum samples for (1,3)-β-D-glucan (BDG) and GM was performed. Median serum BDG levels were 131 pg/mL in controls and 1142 pg/mL in IPA. Similar trends were observed in BALF samples for GM (Area under the Curve (AUC) = 0.941) and DNA (AUC = 0.941). The fungal secondary metabolite Gtx was detected in IPA BALF and lung tissue samples (86 ng/mL and 2.17 ng/mg, AUC = 1).

Infections by entomopathogenic fungi in common green iguanas (Iguana iguana) in captivity in Brazil

Entomopathogenic fungi, widely available biological agents used to control agricultural pests, are sporadically reported to cause focal or disseminated infection in reptiles and mammals, including humans. This study summarizes the clinical presentation, histopathological and molecular findings by panfungal polymerase chain reaction and sequencing of four cases of hypocrealean fungal infections in captive common green iguanas (Iguana, iguana). One case of granulomatous pneumonia, hepatitis and serositis was related to Metarhizium flavoviride complex infection. Two disseminated fungal infection cases, with scarce inflammatory cell infiltration, were caused by Beauveria bassiana while there was one case of multifocal granulomatous and necrotizing pneumonia by Purpureocillium spp. To the best of our knowledge, this is the first report of fatal mycosis infection due to entomopathogenic fungi in captive common green iguanas.

Anatomopathological findings and identification of Cryptococcus gattii in a captive African pygmy hedgehog (Atelerix albiventris)

The African pygmy hedgehog (Atelerix albiventris) is becoming increasingly common in zoological collection and as pets, increasing the risk of disease transmission. Here, we describe a case of cryptococcosis caused by Cryptococcus gattii in a captive African pygmy hedgehog and the other anatomopathological findings. The macroscopic analysis of the lung found white-yellowish masses of gelatinous consistency. The microscopic analysis of the lung revealed severe pulmonary involvement resulting from granulomatous pneumonia caused by C. gattii yeasts, identified through polymerase chain reaction and sequencing. Other histopathological findings included hepatic steatosis, biliary hyperplasia, and renal lesions with deposition of hyaline cylinders in the lumen of tubular epithelial cells, glomerulopathy, and tubular necrosis. Our findings demonstrate the importance of anatomopathological studies in diagnosing relevant diseases in the context of one health. We emphasize that adequate environmental management is essential to avoid the emergence of certain diseases in captivity.

Immunohistochemical investigation of parainfluenza 3 virus in sheep pneumonia.

The aim of this study was to determine the prevalence of parainfluenza 3 (PI3) virus antigen through histopathological and immunohistochemical (IHC) methods in sheep lung samples collected from Erzurum province, Türkiye. Between August and November 2017, 1462 sheep were dissected in the slaughterhouse and their lungs were examined macroscopically. In total, 100 of the lung samples with pneumonia were selected. Routine histopathological and IHC analyses of the collected lung tissues with pneumonia were performed. Pneumonia observed through macroscopical and histopathological examinations of the lung samples was classified as purulent-catarrhal bronchopneumonia (14.00%), fibrinous bronchopneumonia (23.00%), interstitial pneumonia (69.00%), granulomatous pneumonia (7.00%), verminous pneumonia (19.00%) and pulmonary adenomatosis (6.00%). Two or three types of pneumonia were observed in many of the same cases. The PI3 virus antigen positivity rate in the IHC analysis of sheep lung samples was 19.00%. In the IHC tracing, positivities were found mostly in the alveolar macrophages and cytoplasm of bronchial, bronchiolar and alveolar epithelial cells. As a result, the prevalence of PI3 virus in sheep in Erzurum province, Türkiye, was determined to be 19.00% using KLN BVB IHC method.

Late-Onset Granulomatous Pneumocystis jirovecii Pneumonia in A Renal Transplant Recipient: A Clinical Grand Round Conference Case in 2022.

Late-onset Pneumocystis jirovecii pneumonia (PCP) can be developed in solid organ transplant (SOT) patients. Granulomatous P. jirovecii pneumonia (GPCP) can occur in immunocompromised patients, but has rarely been reported in SOT recipients. The diagnosis of GPCP is difficult since the sensitivity of sputum and bronchoalveolar lavage is low and atypical patterns are shown. A 60-year-old man, who had undergone renal transplantation 24 years ago presented with nodular and patchy lung lesions. He was asymptomatic and stable. After empirical treatment with a fluoroquinolone, the condition partially resolved but relapsed 4 months later. The pulmonary nodule was resected, and GPCP was confirmed. The pathogenesis of GPCP remains unclear, but in SOT recipients presenting with an atypical lung pattern, GPCP should be considered. This case was discussed at the Grand Clinical Ground of the Korean Society of Infectious Disease conference on November 3, 2022.

Patologia de metazoários e protozoários em gambás selvagens (Didelphis Virginiana) no México

ABSTRACT: The aim was to describe the incidence and lesions caused by metazoan and protozoan parasites in Didelphis virginiana opossums in Mexico. From 2019 to 2021, twenty D. virginiana were collected from the state of Colima, Mexico. Post mortem, parasitological, and histopathological studies were performed to identify and describe their lesions and findings. All opossums(20/20) presented at least one type of parasite of the twelve found; the most abundant were nematodes 58.33% (7/12) Didelphostrongylus hayesi, Turgida turgida, Cruzia sp., Viannaia sp., Trichuris didelphis, Trichostrongylidae and Gnathostoma sp. Protozoa 25% (3/12), including Sarcocystis sp., Besnoitia sp., and Sarcocystis sp. A single specimen of Mathevotaenia sp., 8.3% (1/12), and Paragonimus mexicanus 8.3%, were identified (1/12). The most affected systems were the digestive, respiratory, and musculoskeletal. The most abundant parasites were Turgida turgida (20/20) 100%, Cruzia sp., (16/20) 80%, and Viannaia sp. (6/20) 30%, followed by Sarcocystis sp. cysts, (6/20) 30%. The associated parasitic lesions were: D. hayesi produce eosinophilic granulomatous bronchopneumonia, P. mexicanus eosinophilic focal granulomatous pneumonia, and Besnoitia sp., focal eosinophilic lymphoplasmacytic interstitial pneumonia. Gnathostoma and T. turgida caused severe eosinophilic granulomatous focal gastritis. Viannaia sp., Sarcocystis sp., Mathevotaenia sp., and Trichostrongylidae; caused diffuse eosinophilic mucosal enteritis. Cruzia sp., and T. didelphis, induced diffuse eosinophilic mucosal typhlitis. Sarcocystis sp. cysts were detected in the cytoplasm of muscle fibers without histological changes.