Granulomatous Pneumonia Research Articles

Demonstration of Ornithobacterium rhinotracheale in pheasants (Phasianus colchicus) with pneumonia and airsacculitis

Outbreaks of respiratory disease were investigated in reared pheasants (Phasianus colchicus) aged approximately 18 to 32 weeks, released into the semi-wild on four shooting estates in southern England. The clinical signs in the affected birds included swelling of the face and eyes, loss of condition, gasping respirations and coughing. The gross pathology findings included sinusitis, airsacculitis, pleural oedema and lung lesions. The histopathological findings in the affected lungs were characterized by a granulomatous pneumonia. Ornithobacterium rhinotracheale (ORT) was isolated from respiratory tract tissues, and 16S rRNA gene sequencing on three isolates revealed two distinct genotypes, one previously associated with some electrophoretic type (ET) 1 strains and the other a novel genotype that clustered among sequences previously associated with ET 3, ET 4, ET 5 and ET 6 isolates. The localization of ORT within the lung tissue was demonstrated by fluorescent in-situ hybridization in the bronchial exudate of three cases, although not within the granulomatous lesions themselves. In each case, ORT was identified as part of a complex of other respiratory agents including avian paramyxovirus type 2, avian coronavirus, Mycoplasma gallisepticum, Mycoplasma synoviae and other Mycoplasma species, Escherichia coli, Pasteurella multocida, other Pasteurellaceae and Syngamus trachea, suggesting synergism with other agents. Exposure to other intercurrent factors, including adverse weather conditions and internal parasitism, may also have exacerbated the severity of disease.

Granulomatous pneumonia and hepatitis associated with Providencia rettgeri infection in a crocodile monitor lizard (Varanus salvadorii)

The present report describes a case of granulomatous pneumonia and hepatitis in a male crocodile monitor lizard (Varanus salvadorii). During the necropsy of the monitor lizard, multifocal to coalescing pale yellow lesions were observed in both lung lobes, as well as similar, though milder, changes in the liver, and an ulcerative lesion on the food pad of the right hindlimb. Histopathologically, the presence of multiple necrotising, chronic granulomas containing bacterial clumps were observed in the parenchyma of the lung and the liver. By microbiological examination of the pathologically altered lung tissues, Providencia rettgeri was identified. Altogether, our findings indicate that the bacterial infection resulting in extensive chronic necrotising granulomatous inflammation was the primary cause of the reptile's death. To our knowledge, this is the first report of Providencia rettgeri-associated granulomatous pneumonia and hepatitis in the monitor lizard.

A Complicated, Metastatic, Humeral Air Sac Cystadenocarcinoma in a Timneh African Grey Parrot (Psittacus erithacus timneh)

A 9-year-old male timneh African grey parrot (Psittacus erithacus timneh) was presented because of inability to fly and suspected trauma. The owner also had observed dyspnea, with tail bobbing and open-beak breathing. On clinical examination, a hard, painful mass was palpable in the left proximal humerus and axillary area. Radiographs revealed a radiodense soft tissue mass of the left humerus with no bony involvement, multifocal opacities in lung and air sacs, and an enlarged spleen. An asymmetric, vascularized cyst was detected in the mass by ultrasound examination. Results of biopsy of the mass revealed multifocal cysts composed of unilayer isoprismatic cells laying in vascularized connective tissue. Because of the severity of clinical signs and the poor clinical condition, the bird was euthanatized. On postmortem examination, the findings were air sac cystadenocarcinoma involving the humeral air sac with metastases in the spleen and kidneys, atherosclerosis, pneumoconiosis, and mycotic granulomatous pneumonia and airsacculitis with isolation of Aspergillus niger.

Spontaneous pneumothorax secondary to granulomatous pneumonia caused by Angiostrongylus vasorum in a dog in Denmark

Angiostrongylosis was diagnosed in a 2-year-old whippet which was presented with spontaneous pneumothorax based on detection of Angiostrongylus vasorum first-stage larvae on lung histology and in faeces. Thoracic radiographs and computed tomography imaging revealed bilateral pneumothorax with a gas-filled bulla in the right caudal lung lobe. On thoracotomy, continuous air leakage was observed from the bulla. Histologic examination of lobectomised tissue confirmed the diagnosis of chronic granulomatous pneumonia due to A. vasorum infection. The dog was treated with fenbendazole until negative for larvae on faecal examination and recovered completely. The most commonly reported clinical signs of angiostrongylosis are related to the respiratory tract, including cough and dyspnoea leading to exercise intolerance, and rarely haemothorax (Chapman et al. 2004, Sasanelli et al. 2008, Koch and Willesen 2009). Pneumothorax has been mentioned in association with angiostrongylosis (Martin et al. 1993, Gallagher et al. 2012), but has not been described in detail so far. Identification of the underlying cause is important for the prognosis and treatment of pneumothorax. Angiostrongylosis should be considered as a possible aetiological cause of spontaneous pneumothorax in dogs even in the absence of radiological changes supportive of an A. vasorum infection. E. H. Spodsberg, J. E. Miles, F. J. McEvoy and J. L. Willesen University Hospital for Companion Animals, Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Reversible pulmonary hypertension associated with lungworm infection in a young cat

Two ten-week-old kittens presented with dyspnea. Two weeks later dyspnea had worsened and both kittens had developed a heart murmur. One kitten died and necropsy showed severe granulomatous pneumonia and moderate bronchi(oli)tis and peribronchi(oli)tis caused by Aelurostrongylus abstrusus. The results from echocardiography, thoracic radiography and the other kitten's fecal examination were interpreted as severe parasitic pneumonia caused by A. abstrusus infection with pulmonary hypertension. Repeated administration of milbemycine-oxime and praziquantel resulted in cessation of larvae shedding and resolution of clinical, radiographic and echocardiographic signs of bronchopneumonia and pulmonary hypertension.

육용오리에서 aspergillosis 증례

A case of aspergillosis was observed in a flock of 5~10 days old commercial domestic ducks in Jeongeup. The clinical signs were depression and breathing by gasping or rapid opening of the bill. Grossly, lung was attached to pleura with white cheesy plaques. Numerous nodules was found in lung. Histopathologically, severe granulomatous pneumonia with intralesional fungal hypha were observed in the lung. Aspergillus spp. colonies was isolated from fungal culture and identified by polymer chain reaction.

Long-term survival and onset of granulomatous pneumonia after lung metastasectomy in a patient with non-muscle-invasive bladder cancer

This case report describes a first case of granulomatous pneumonia occurring at the same site of the previous lung metastasectomy in a patient with high-grade non-muscle-invasive bladder cancer (NMIBC), which was treated with bladder preservation therapy despite multiple recurrences and failure of intravesical bacillus Calmette-Guẻrin (BCG) therapy. We report a 52-year-old woman who underwent transurethral surgery and BCG therapy for pT1, G3 bladder cancer. Although cystectomy was recommended after BCG failure, the operation was not performed because of the patient's wish for bladder preservation. Eighteen months after the first surgery, computed tomography (CT) revealed solitary lung mass. Partial lobectomy which the patient underwent after chemotherapy revealed G3 metastatic urothelial carcinoma. Three years after lung metastasectomy, CT revealed lung mass at the same site of the previous lung metastasectomy. Dynamic contrast-enhanced magnetic resonance imaging showed the significantly enhanced lung mass, which indicated lung metastasis. However, lobectomy of the remnant lobe revealed that the lung mass was granulomatous pneumonia. Although no additional specific treatment was carried out, the patient remains free of disease for 53 months after surgery. Lung metastasis from NMIBC rarely occurs. Our case report confirms that lung metastasectomy in highly selected patients may contribute to long-term disease control. Moreover, our case report suggests that mycobacterial lung infections along the staple-suture line rarely occur, and percutaneous biopsy should be considered under these circumstances to avoid the unnecessary operation.

Granulosa cell tumour in a harbour porpoise (Phocoena phocoena) from German waters

Neoplastic diseases in harbour porpoises Phocoena phocoena have rarely been described, and there are no reported gonadal stromal tumours. A 12 yr old female harbour porpoise was stranded on the North Sea coast of Schleswig-Holstein, Germany. Necropsy findings included a severe granulomatous pneumonia, pregnancy and a left ovarian tumour. Respiratory insufficiency was the likely cause of death. There was a multinodular mass composed of cords with peripherally palisading cells within the left ovary. The histological and cytological appearance of the neoplasm was suggestive of a granulosa cell tumour; supportive immunohistochemical stains, including those for vimentin, cytokeration, carcinoembryonic antigen, c-kit, chromogranin and α-smooth muscle action, were negative.

Disseminated Pulmonary Adiaspiromycosis in a Crested Porcupine (Hystrix cristata Linnaeus, 1758)

Adiaspiromycosis is primarily a necrotizing granulomatous pneumonia caused by a dimorphic fungus of the genus Emmonsia. A young crested porcupine (Hystrix cristata) found dead showed multiple fractures, chronic pleuritis, and granulomatous pneumonia. Microscopically, cystic structures were consistent with adiaspiromycosis by Emmonsia crescens. The diagnosis was confirmed using molecular methods.

Infection in a female Komodo dragon (Varanus komodoensis) caused by Mycobacterium intracellulare: a case report

In early 2002, a bean-like whitish nodule 2 × 1 × 1 cm in size was diagnosed on the tongue of a female Komodo dragon (Varanus komodoensis) kept in a zoological garden in the Czech Republic. The nodule was removed at surgery and histopathological examination revealed a specific granulomatous inflammation. The granuloma contained a necrotic mass surrounded by a variable layer of palisading epithelioid macrophages and multinucleated giant cells with a variable admixture of lymphocytes and plasma cells. Signs of mineralisation within the granuloma were not observed. Using Ziehl-Neelsen (ZN) staining the presence of acid-fast rods (AFR) was determined and the presence of mycobacteria was confirmed by PCR. Four years later, this female died after multiple injuries caused by a male during mating. Necropsy and histopathological examinations revealed granulomatous pneumonia and myocarditis with ZN-positive AFR within granulomas. Mycobacteria were cultured from 13 of 19 tissue samples: Mycobacterium intracellulare was confirmed by sequencing of isolates from multiple affected organs including the respiratory tract, tail muscle, inguinal lymph nodes and blood; Mycobacterium sp. were also isolated from the tongue. In addition, mycobacteria were detected in 15 (46.9%) of 32 environmental samples examined in both years. M. intracellulare was detected in water sediment from the female’s terrarium in 2002, and in faeces and peat from the terrarium and in water sediment from the male terrarium in 2006. Except for M. intracellulare (n = 4), M. smegmatis (n = 1), M. a. hominissuis (n = 3), M. fortuitum (n = 2), M. interjectum (n = 1), M. peregrinum/alvei/septicum (n = 1) and Mycobacterium sp. (n = 2) were also isolated from different environmental samples.    

Cryptococcal Pneumonia and Meningitis in a Horse

Gross and microscopic evidence of Cryptococcus neoformans in the lungs and central nervous system of a mature Thoroughbred horse presenting with granulomatous pneumonia and meningitis has been described in this article.

Granulomatös-nekrotisierende Pneumonie durch Schimmelpilzinfektion bei einer Ziege

This case report describes the clinical and postmortem findings in a 2.5-year-old goat with necrotizing granulomatous pneumonia. The goat was referred to our clinic because of swelling of the head and neck, which was unresponsive to treatment, dysphagia, and deterioration in general condition. Thoracic radiographs showed two soft tissue densities, about 10 cm in diameter, in the left caudodorsal lung. The goat was euthanized and a necropsy was carried out. The two lesions in the left caudodorsal lung were round, firm and clearly demarcated from the surrounding lung tissue. They contained purulent material and compromised about 70 % of the diaphragmatic lung lobe. Histological examination of the lesions revealed a dense network of hyphae characteristic of Mucorales spp.

Gross and histopathological studies on pulmonary lesions of camel (Camelus dromedarius) slaughtered at Addis Ababa abattoir, Ethiopia

This study was carried out with the aim of identifying types of gross and histopathological lesions in lungs of camels slaughtered between October 2009 and April 2010 at Addis Ababa abattoir enterprise, Ethiopia. All camels were originated from Borana and Kereyu areas. A total of 387 slaughtered camel lungs were inspected during the study period. Of which, one or more gross lesions were encountered on 300 lungs. Lesions were further subjected for detail gross and histopathological examinations. The occurrence of pulmonary lesions was 77.5%. The gross and histopathological examination of these lesions had revealed 60.2% emphysema, 21.2% hydatidosis, 18.6% pneumonia, 10.6% atelectasis, 4.9% aspiration of blood, 3.9% pneumoconiosis, 2.6% pulmonary edema and congestion, 1.6% abscess, 1% pleurisy, and 0.8% granulomatous pneumonia. Most camels had one or more pulmonary lesions on postmortem examination, but they were apparently healthy during antemortem inspection. Therefore, the prevailing stressful environmental condition coupled with the existing poor level of veterinary service in camel-rearing areas of the country might reverse these hidden inactive lesions and thereby contributed for the higher occurrence of respiratory diseases in camels.

Mycobacterium avium subsp. hominissuis Infection in a Captive-Bred Kiang (Equus kiang)

Equids are considered highly resistant to mycobacterial infections and clinical cases have been described in domestic horses only. Mycobacterium bovis is the most common species reported, although a single report exists of disease due to definitively diagnosed infection with Mycobacterium avium subsp. hominissuis in two domestic horses. This is the first report of a mycobacterial infection in a kiang (Equus kiang), or indeed any wild equid. The animal had chronic loss of condition and serum biochemical changes suggestive of liver disease and chronic infection. Further investigation showed a chronic granulomatous enteritis, lymphadenitis and hepatitis with focal granulomatous pneumonia due to systemic infection with M. avium subsp. hominissuis. The distribution and severity of the lesions suggested that the route of infection was alimentary.

Manejo higiênico-sanitário e lesões pulmonares em suínos na Região Metropolitana de Recife e Zona da Mata de Pernambuco, Brasil

The objective of the present study was to determine the main lesions found during the sanitary inspection of the lungs of slaughtered pigs. The study was carried out at three slaughterhouses registered with the Pernambuco State Inspection System located in metropolitan Recife and the coastal zone of the state of Pernambuco, Brazil. A total of 715 pig lungs were inspected from July 2008 to May 2009. Pulmonary lesions were detected in all herds studied. Among the total number of animals evaluated, 43.8% (313/715) had some type of lung injury. Pneumonia was the most common finding, recorded in 93.0% (291/313) of damaged lungs, followed by petechial hemorrhaging (6.7%; 21/313) and blood aspiration (3.5%; 11/313). Among the lungs submitted to histopathology, the most frequent microscopic finding was granulomatous pneumonia with 32.2% (49/152), followed by 21.7% (33/152) of interstitial pneumonia and 3.2% (14/152) fibrinous bronchopneumonia. There was a significant association between the occurrence of lung lesions and all variables related to the environment in which the animals were raised as well as the type of operation and nutritional status.

Role of histology in the diagnosis of infectious causes of granulomatous lung disease

Histologic examination and microbiologic cultures are the gold standards for the diagnosis of infectious granulomatous lung diseases. Although biopsies require invasive procedures, they often yield information that cannot be obtained by other methods. The aims of this article are to outline the major infections that cause granulomatous inflammation in the lung and to familiarize clinicians with the utility of histologic examination in their diagnosis. The histopathologic features of acute pulmonary histoplasmosis and granulomatous Pneumocystis pneumonia have been described in detail, the relative contributions of histology and microbiologic cultures in the diagnosis of blastomycosis have been delineated, and Cryptococcus gattii has emerged as a significant cause of granulomatous pulmonary nodules. The major infectious causes of granulomatous lung disease are mycobacteria and fungi. Histologic examination is particularly important in the diagnosis of pulmonary granulomatous infections when clinical, radiologic and serologic findings are nonspecific. Histology and microbiology play complementary but distinct roles in diagnosis. For organisms that grow slowly in cultures, histology has the additional advantage of being able to provide a rapid diagnosis.

Histopathology of Aspiration Pneumonia Not Associated With Food or Other Particulate Matter

Aspiration pneumonia most often presents in surgical lung biopsies as a granulomatous pneumonia with acute inflammation, microabscesses, and a granulomatous reaction to food or other particulate matter. In this study of 10 patients with clinical aspiration in whom surgical lung biopsy was performed, 3 additional patterns of lung injury were seen: organizing pneumonia (4 patients); acute diffuse alveolar damage (3 patients); and chronic bronchiolitis (3 patients), in whom 2 had evidence of extensive pleuropulmonary fibrosis and scarring. This study adds to the earlier described literature on granulomatous reactions to food and particulate matter in the lung by alerting pathologists to other histopathologic manifestations of aspiration-induced lung injury in surgical lung biopsies.

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Systemic mycosis caused by Trichophyton spp. in an olive ridley sea turtle (Lepidochelys olivacea): An immunohistochemical study

CASE HISTORY: A sub-adult female olive ridley sea turtle (Lepidochelys olivacea) was found floating off the coast of Gran Canaria, Canary Islands, Spain. CLINICAL AND PATHOLOGICAL FINDINGS: The turtle was lethargic and weak, and died one day after it was found. Necropsy was performed and selected samples of lung and liver were routinely processed for histopathological and immunohistological studies. Grossly, round, ulcerative lesions were observed on the rear flippers. The liver, spleen, coelomic wall, gastric serosa, lungs and urinary bladder were covered by various amounts of fibrin and small granulomas. Histopathologically, a severe fibrinous and granulomatous polyserositis (liver, spleen, stomach, urinary bladder, coelomic wall), severe fibrinous pleuritis and severe multifocal granulomatous pneumonia were diagnosed. Numerous fungal hyphae were observed associated with the lesions. Specific monoclonal and heterologously absorbed polyclonal antibodies served as the primary reagents for identification of aspergillosis, candidiasis, fusariosis, geotricosis, dermatophytosis, scedosporiosis, and zygomycosis. All hyphae were identified as Trichophyton spp., because a strong and uniform reactivity was obtained only with an heterologously absorbed polyclonal antibody raised against somatic antigens of Trichophyton spp. DIAGNOSIS: Systemic mycosis caused by Trichophyton spp. CLINICAL RELEVANCE: There are no known previous reports of Trichophyton spp. causing skin disease or systemic mycotic infection in sea turtles. The usefulness of immunohistochemistry for identifying fungi in sea turtles is reinforced.

Disseminated angiostrongylosis with massive cardiac and cerebral involvement in a dog from Italy

A case of disseminated angiostrongylosis caused by Angiostrongylus vasorum in a dog living in Italy is here described. The dog was referred for severe respiratory distress and epileptic seizures; clinicopathological findings were consistent with severe pneumonia associated with right-sided heart failure and multifocal involvement of the brain. Bronchoalveolar fluid analysis identified a multitude of nematode larvae, identified as A. vasorum by conventional and biomolecular (PCR) methods. The major anatomo-histopathological lesions were chronic granulomatous pneumonia, a severe multifocal granulomatous myocarditis and multifocal mild vascular and inflammatory disease in the brain. A. vasorum should be included among the differentials of dogs with cardiovascular and neurologic disease.