Typical Granulomas Research Articles

Analysis of nine cases of oral foreign body granuloma related to biomaterials

Foreign bodies can penetrate the interior of soft and, sometimes, hard, tissues in various ways, including through open wounds, lacerations and traumatic accidents. However over the years, evidence of links between the use of dental materials and lately, significant involvement of aesthetic filler materials as foreign bodies in the oral and perioral region have been reported. Foreign body granulomas (FBGs) may develop from this exogenous material, histopathologically characterized by the presence of chronic inflammation and a high amount of macrophages. This study presents nine FBG cases affecting the oral and perioral regions, and carries out a literature review on the main clinical, histopathological and material characteristics used in dental and dermatological procedures related to the appearance of this type of granuloma.

Lichenoid granulomatous dermatitis revisited: A retrospective case series

Lichenoid granulomatous dermatitis (LGD) is an uncommon reaction pattern for which clinical correlates can be difficult to establish. LGD combines vacuolar degeneration with variable types of granulomas. To determine clinical correlates of LGD. The laboratory information systems at the University of Florida, the Medical College of Wisconsin, and Inform Diagnostics Research Institute were queried to identify 56 cases of LGD. Cases were reviewed for information regarding eosinophils, plasma cells, deep perivascular infiltrates, granuloma subtype, parakeratosis, epidermal atrophy, psoriasiform epidermal changes, pseudoepitheliomatous hyperplasia, periadnexal inflammation, vasculitis, and red blood cell extravasation. The most common clinical correlates were drug eruption (39.3%, n=22) and lichenoid keratosis (19.6%, n=11). Tattoo reaction, postherpetic dermatitis, and scabies or postscabietic dermatitis each accounted for 7.1% (n=4) of cases. Pigmented purpuric dermatosis and lichen striatus each accounted for 5.4% (n=3) of cases. Dermal eosinophils (P=.005) and psoriasiform epidermal changes (P=.055) were associated with drug hypersensitivity. Perineural (P=.049) and perifollicular (P=.003) inflammation were associated with tattoo reaction and postherpetic dermatitis. Red blood cell extravasation was helpful in cases of pigmented purpuric dermatosis (P=.049). This study is limited by its retrospective nature and statistical power. Dermal eosinophilia, psoriasiform epidermal changes, periadnexal inflammation, and red blood cell extravasation might aid in the clinical diagnosis of patients with LGD.

Increase of 1,25 dihydroxyvitamin D in sarcoidosis patients with renal dysfunction

In sarcoidosis, renal involvement includes hypercalcemia-related nephrocalcinosis and granulomatous tubulointerstitial nephritis. Hypercalcemia is thought to be due to increased production of 1,25 dihydroxyvitamin D (1-25D), but 1-25D levels have not been evaluated in sarcoidosis patients with renal dysfunction. We enrolled 9 sarcoidosis patients who underwent renal biopsy, and compared the serum 1-25D concentration and eGFR with those in 428 non-sarcoidosis patients who had renal dysfunction (stage 2 or higher CKD with an estimated glomerular filtration rate < 90). Serum calcium and 1-25D levels were significantly higher in the sarcoidosis patients than in the non-sarcoidosis patients (p < 0.01 and p = 0.01, respectively). There was a positive correlation between 1-25D and eGFR in the patients without sarcoidosis (r = 0.693; p < 0.01). As the renal function of sarcoidosis patients was improved by steroid therapy, the serum 1-25D and adjusted serum calcium levels decreased to near the median values in non-sarcoidosis patients. On renal biopsy, CD68 staining was positive for tissue macrophages in all 8 patients who had tubulointerstitial nephritis (with or without typical granulomas), while Von Kossa staining showed calcification of tubules near or inside granulomas in 6 of these 8 patients. While tissue macrophages promote development of tubulointerstitial nephritis and 1-25D overproduction in renal sarcoidosis, hypercalcemia secondary to elevation of 1-25D may be related to renal calcification and granuloma formation.

Pathogenesis of Leprosy: An Insight Into B Lymphocytes and Plasma Cells.

The pathogenesis of leprosy is still not fully understood. Several studies have been performed on the involvement of T cells in leprosy and more recently have focused on genetic factors and innate immune response. There are still only few reports about the role of B cells in active leprosy lesions in different spectral forms of the disease. The literature on tuberculosis suggests that B cells play an important role in the regulation of the granulomas, in cytokine production, T-cell response, and antigen presentation. Only few studies investigated the role of B cell in leprosy. We investigated the distribution of B cells in 85 leprosy biopsies covering all forms of the disease and compared results with 13 biopsies of tuberculosis and atypical mycobacteriosis, expanding the previous experiences. A statistically significant difference in the number of CD20 (P = 0.014) and CD138+ (P = 0.01) cells between the different forms of leprosy was observed. A remarkable amount of CD138+ cells could also be detected in borderline tuberculoid. The median of the CD20 cells decreased from the bacilloscopy-negative samples to the bacilloscopy-positive samples by 50% (P = 0.004). Contrarily, the median of CD138+ cells showed an increase from bacilloscopy-negative to bacilloscopy-positive samples of 966.67% (P = 0.001). In our experience, tuberculoid leprosy showed more B cells and less plasma cells than lepromatous leprosy. Our results show that B cells might be implicated in leprosy pathogenesis, not only in the lepromatous pole as previously postulated, but also in tuberculoid granuloma formation and type 1 reactions.

Comparison of Clinical and Morphologic Findings in Patients With Cardiac Sarcoidosis Severe Enough to Warrant Heart Transplantation in Those With -vs- Those Without Non-Caseating Granulomas in the Explanted Heart (Burnt-Out Sarcoid)

Can cardiac sarcoidosis with heart failure severe enough to warrant orthotopic heart transplantation (OHT) be present without non-caseating granulomas in the explanted heart? The objective is to compare clinical and morphological features in patients with cardiac sarcoidosis severe enough to warrant OHT with -vs-without non-caseating granulomas in the explanted heart. The study was conducted at Baylor University Medical Center in Dallas, Texas. From a total of 671 explanted hearts examined from 1993 to 2018, twenty-five (4%) had gross morphologic features characteristic of cardiac sarcoidosis. At the time of OHT, the patients ranged in age from 50 to 69 years [mean 57]. Cardiac sarcoidosis was diagnosed before OHT in 3 (12%) patients, by percutaneous biopsy of the heart in 2 patients and by histologic examination of the "left ventricular core" in 1 patient who had a left ventricular assist device inserted, and, by examination of the native heart after OHT in the remaining 22 (88%) patients. Of the 25 patients, 16 (64%) had typical sarcoid non-caseating granulomas in the explanted heart, and 9 (36%) had no granulomas in the explanted heart. Comparison of certain clinical and morphologic features in the group with -vs- the group without cardiac granulomas showed no significant differences. In conclusion, of patients with cardiac sarcoidosis severe enough to warrant OHT, some have typical non-caseating granulomas in the explanted heart and some do not. The clinical and gross morphologic features of those with and those without cardiac granulomas are similar.

Granulomatous spondylodiscitis: A case series with focus on histopathological features

Objective: To report a series of Granulomatous Spondylodiscitis (GS) with focus on the histopathological features of the different forms of GS. Design: Case series. Setting: Pathology department of Charles Nicolle’s Hospital of Tunisia Participants: This study included 57 patients diagnosed with GS. There were 44 (77.2%) female patients and 13 (22.8%) male patients (sex ratio = 0.28). Intervention: Not applicable. Outcome measures: Clinical, microbiological and histopathological features were assessed in this study. Results: Fifty-seven patients with GS were enrolled: 51 tuberculous spondylodiscitis (TS), 2 fungal spondylodiscitis (FS), 3 brucellar spondylodiscitis (BS) and 1 case of sarcoidosis. Granulomas with necrosis were seen in 38 (66.6%) cases: 36 TS and 2 FS, while granulomas without necrosis were observed in the remaining 19 cases: 15 TS, 3 BS and 1 sarcoidosis. In all cases of TS, granulomas were epithelioid type, associated with histiocytic type granulomas in 7 cases. Caseous necrosis was seen in 35 cases of TS and suppurative granuloma in one case. The 3 cases of BS exhibited non-necrotizing and histiocytic type granulomas. The 2 cases of FS showed histiocytic, epithelioid and necrotizing granulomas. Necrosis was mixed: suppurative and caseous in both cases of FS. Sarcoidosis was characterized with epithelioid type granulomas without necrosis. Conclusion: Granuloma with caseous necrosis is highly suggestive of TS but does not rule out FS. Certain fungi can exhibit this type of necrosis as do tuberculosis species. Suppurative inflammation, although rare in TS, does exist. Histiocytic type granuloma without necrosis is suggestive of brucellosis.

Diagnostic dilemma of an isolated inguinal clinical cold abscess - ? Suppurative,? EPTB, ? NTM infection- a rare and interesting case report

Cold abscess is an abscess without local pain and warmth and it usually accompanies Tuberculosis. The site varied depending upon the organ affected and cervical region is the commonly affected one. Cyto-morphology of cold abscess usually showed caseation type of necrosis, lymphocytes and granuloma with degenerated epithelioid cells. Here we presented an inguinal cold abscess in 9 years old girl with unique cyto-morphology of plenty of neutrophils, foam cells and lymphocytes in fine needle aspiration smear without caseation necrosis and epithelioid cells. Presence of Mycobacterium in the aspirated pus was proved by Ziehl-Neelsen as well as Auramine fluorescent staining. This characteristic cyto-morphology of mycobacterium infection mimicking pyogenic abscess emphasizes the importance of Ziehl-Neelsen staining in all abscess for early specific diagnosis and effective treatment.

Clinical, laboratory and radiological characteristics of HIV infection associated with tuberculosis and treatment of such patients

Objective: to analyze and explain the clinical, laboratory and radiological features of HIV infection associated with tuberculosis (HIV/TB) and on this basis to argue the principles of treatment of such patients.The development of active tuberculosis (TB) in HIV-infected patients is accompanied by an increase, while during its treatment, on the contrary, — a decrease in the concentration of viral RNA in the blood. The release of the virus into the blood is due to the activation of lymphocytes caused by mycobacterium tuberculosis (MBT). Therefore, the clinical manifestations of HIV infection and TB in the early stages are similar. TB increases the degree of immunodeficiency in HIV-positive patients, which leads to the associated opportunistic diseases: esophageal candidiasis, cryptococcal meningitis, pneumocystic pneumonia, Kaposhi sarcoma, and etc.With the development of immunodeficiency, the clinical picture of tuberculosis also changes. This is due to the fact that in the context of lowering the immune response, no typical tuberculosis granuloma is formed, the MBT easier spreads to other organs and systems. Therefore, in HIV-positive patientsthere are primary, extra-pulmonary and generalized forms of tuberculosis. According to chest X‑ray, tuberculous changes in HIV-infected patients (as in primary infections) are characterized by more frequent development of adenopathy of hilus, miliary rash, the presence of predominantly interstitial changes and the formation of pleural effusion. At the same time, they are reliably less likely to affect the upper lung parts, not so often formed destruction cavities and atelectasis. Over the past few years, approaches to the providing of antiretroviral treatment (ART) have changed dramatically in patients with HIV/TB. It has been shown that the use of ART in the first 2–8 weeks of treatment for tuberculosis significantly increases the patient's chances of recovery. Currently, ART is administered to all patients with TBregardless of the number of CD4 + T‑lymphocytes.Conclusions. So, the clinical manifestations of HIV infection and TB in the early stages are similar. However, with the development of immunodeficiency, the clinical picture of tuberculosis also changes. In HIV-infected diseases, TB increases the degree of immunodeficiency, which leads to association of other opportunistic diseases. When radiographing the chest cavity, changes in HIV-infected patients are characterized by frequent development of adenopathy of hilus, miliary rash, the presence of predominantly interstitial changes and the formation of pleural effusion. Also in recent years, approaches to prescribing antiretroviral therapy (ART) for patients with HIV/TB have changed. So, the relationship between HIV infection and tuberculosis at the cellular level appears to be very complex and insufficiently studied. Clinical and laboratory, especially immunological, aspects of the development of tuberculosis as a secondary disease in HIV-infected patients require additional studies.

Leprosy in a Midwestern Dermatology Clinic: Report of 9 Patients

ObjectiveTo describe the clinical features and epidemiology of leprosy in patients evaluated in a Midwestern dermatology clinic. Patients and MethodsWe performed a retrospective review of clinical and laboratory data from patients with leprosy who were evaluated in the Department of Dermatology at Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2017. ResultsNine patients, 7 male and 2 female, were identified, ranging in age from 15 to 63 years (mean age, 38 years). Six of the 9 patients (67%) were foreign-born: 3 from Oceania (2 from Micronesia and 1 from Guam), 1 from Southeast Asia (Indonesia), and 2 from Mexico. Three patients were born in the United States. All 9 patients presented with skin lesions (granulomatous histopathologic type), and 8 had neuropathy. Leprosy was multibacillary in 8 patients and paucibacillary in 1. Two patients experienced a type 1 treatment reaction, and 5 had type 2 reactions. Three of the 9 patients had speciation by polymerase chain reaction (Mycobacterium leprae in 2 and Mycobacterium lepromatosis in 1). ConclusionDespite its rarity in the United States, leprosy should be considered in the differential diagnosis when evaluating both foreign- and US-born patients with granulomatous dermatitis and peripheral neuropathy. Because M lepromatosis was not identified until 2008 and requires polymerase chain reaction for diagnosis, the incidence of this species among patients with leprosy diagnosed in earlier years is unknown.

Study of tissue inflammatory response in different mice strains infected by dematiaceous fungi Fonsecaea pedrosoi

Background:Diseases caused by melanized fungi include mycetoma, chromoblastomycosis and phaeohyphomycosis. This broad clinical spectrum depends on the dynamic interactions between etiologic agent and host. The immune status of the host influences on the development of the disease, as, an exemple. phaeohyphomicosis is more frequently observed in immunocompromised patients. Objectives:Examine the histological inflammatory response induced by Fonsecaea pedrosoi in several different strains of mice (BALB/c, C57BL/6, Nude and SCID, and reconstituted Nude). Methods:Fonsecaea pedrosoi was cultivated on agar gel and a fragment of this gel was implanted subcutaneously in the abdominal region of female adult mice. After infection has been obtained, tissue fragment was studied histopathologically. Results:There were significant changes across the strains, with the nodular lesion more persistent in Nude and SCID mice, whereas in immunocompetent mice the lesion progressed to ulceration and healing. The histopathological analysis showed a significant acute inflammatory reaction which consisted mainly of neutrophils in the initial phase that was subsequently followed by a tuberculoid type granuloma in immunocompetent mice. Study limitations:There is no a suitable animal model for chromoblastomycosis. Conclusions:The neutrophilic infiltration had an important role in the containment of infection to prevent fungal spreading, including in immunodeficient mice. The fungal elimination was dependent on T lymphocytes. The re-exposure of C57BL/6 mice to Fonsecaea pedrosoi caused a delay in resolving the infection, and appearance of muriform cells, which may indicate that re-exposure to fungi, might lead to chronicity of infection.

Cutaneous Sarcoidosis- A not so Rare Entity in Pakistan

Objective: To study the demographic characteristics, clinicopathological features and radiological stage of cutaneous sarcoidosis in a public sector tertiary care hospital of the largest metropolitan city of Pakistan. Methods: A case series was conducted from August 2014 to July 2017 at the Dermatology department of Civil Hospital Karachi. Case records of cutaneous sarcoidosis patients with a histopathological diagnosis of noncaseating sarcoidal granuloma on skin biopsy were reviewed. Diagnosis was done based on clinical manifestations, radiologic examinations and pathologic data. Results: Mean age at the time of diagnosis was 35.8 years, while the mean duration of disease was 31.6 months. Plaques were found in five patients (50%), one of whom had coexistent plaques and nodules. Three patients (30%) displayed subcutaneous lesions, whereas two patients (20%) had maculopapules. Extracutaneous involvement occurred in six patients (60%), affecting mainly lungs and lymph nodes. Skin biopsy revealed typical sarcoid non-caseating granulomas in nine cases (90%). Radiological evaluation revealed Stage 0 in six patients (60%), Stage 1 and 3 in one patient (10%), while two patients (20%) showed Stage 2 involvement. The mainstay of treatment was topical or systemic corticosteroids to which a good response was achieved. Conclusion: Our study concurred with the literature in that sarcoid plaques are the most common lesions while the involvement of the lungs and lymph nodes are the commonest extracutaneous features. Moreover, since cutaneous sarcoidosis leads to a diverse range of presentation, diagnosis in countries like Pakistan, where tuberculosis is endemic can be overlooked. Therefore, further studies are needed to overcome this diagnostic dilemma.

A Microtube Array Membrane (MTAM) Encapsulated Live Fermenting Staphylococcus epidermidis as a Skin Probiotic Patch against Cutibacterium acnes.

Antibiotics without selectivity for acne treatment may destroy the beneficial microbes in the human microbiome that helps to fight Cutibacterium acnes (C. acnes), a bacterium associated with inflammatory acne vulgaris. Probiotic treatment by direct application of live Staphylococcus epidermidis (S. epidermidis) onto the open acne lesions may run the risk of bloodstream infections. Here, we fabricated the polysulfone microtube array membranes (PSF MTAM) to encapsulate probiotic S. epidermidis. We demonstrate that the application of the encapsulation of S. epidermidis in PSF MTAM enhanced the glycerol fermentation activities of S. epidermidis. To mimic the granulomatous type of acne inflammatory acne vulgaris, the ears of mice were injected intradermally with C. acnes to induce the secretion of macrophage inflammatory protein-2 (MIP-2), a murine counterpart of human interleukin (IL)-8. The C. acnes-injected mouse ears were covered with a PST MTAM encapsulated with or without S. epidermidis in the presence of glycerol. The application of S. epidermidis-encapsulated PST MTAM plus glycerol onto the C. acnes-injected mouse ears considerably reduced the growth of C. acnes and the production of MIP-2. Furthermore, no S. epidermidis leaked from PSF MTAM into mouse skin. The S. epidermidis-encapsulated PST MTAM functions as a probiotic acne patch.

Pulmonary Sarcoidosis Presenting with Miliary Opacities

Lung lesions often appear in patients with sarcoidosis; however, miliary opacities are rare. We present the case of a 55-year-old Indian man who presented with dyspnea and low-grade fever. Miliary Tuberculosis (TB) was initially suspected, despite the direct microscopic examination from bronchoalveolar lavage was negative for acid-fast bacilli because imaging showed miliary opacities, and transbronchial lung biopsy revealed the presence of typical caseating granulomas. Antitubercular treatment with the classic four-drug regimen was initiated. However, the patient did not improve and cultures were negative for Mycobacterium growth. The diagnosis of sarcoidosis was made only after a negative culture and clinical and histopathological re-evaluation of the case. Although miliary sarcoidosis is rare, physicians should consider sarcoidosis in the differential diagnosis with conditions like tuberculosis, malignancy, and pneumoconiosis when patients present with miliary opacities who do not respond to the traditional treatment.

Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not?

BackgroundChronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial.MethodsWe retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons.ResultsAmong 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference.ConclusionsDespite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.

A histopathological study of granulomatous lesions

Background: Granulomas are the commonest lesions that the pathologists come across in routine practice. Granulomatous inflammation is a special type of chronic inflammation that is a manifestation of many infective, toxic, allergic, autoimmune and neoplastic diseases and also conditions of unknown etiology. The aim of this study is to analyze different granulomatous lesions and to find the frequency and etiology of all granulomatous lesions.Materials and Methods: The study included a total of 218 granulomatous lesions, received over a period of one year from July 2013 to June 2014 in the department of pathology, TUTH. Special stains like Ziehl-Neelsen, PAS and Wade- Fite- Faraco were done whenever required.Results: Granulomatous lesion accounted for 3% of all biopsies. The median age of the patients was 29 years and the majority of the patients were in the age group of 20-29 years with no sex predilection. Majority of granulomas were seen in lymph nodes (32.1%), followed by skin and subcutis (29.4%), and bones and joints (11%). Tuberculosis was the most common cause of granuloma with 143 (65.6%) cases, followed by leprosy, foreign body and fungal infection. The most common type of granuloma was epithelioid (87.2%), followed by epithelioid with suppuration, histiocytic, foreign body and mixed inflammatory.Conclusion: The granulomatous lesion is common in third decade of life with no sex predominance. The commonest site is lymph node with tuberculosis being the most common cause followed by leprosy. The epithelioid type was the most common type of granuloma.

Clinicoradiological and demographic pattern in diffuse parenchymal lung diseases: An observational study

Introduction: Diffuse parenchymal disease is a group of lung disease affecting alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissue. It includes many diseases like IPF, Sarcoidosis, BOOP, COP, LAM etc. it is still under diagnosed entirety. Many patients die due to lack of awareness and investigating modalities. Aims and objective: This study is to see Demographic pattern of DPLD, its clinical pattern and radiological findings in different type of ILDs. Study Type: It is a Prospective Observational Study done over a period of 1 year. Material & Method: Patients studied over20 years of age and having respiratory symptoms. We excluded patients of other diseases like COPD, Tuberculosis etc. Total 75 patients were diagnosed as a case of DPLD by clinical findings, and investigations like X ray chest, HRCT thorax, Bronchoscopy. Results: Most common ILD (Interstitial lung Disease) is IPF 40.0% followed by Sarcoidosis etc. Most common clinical symptom was breathlessness (100.00%) in IPF, Fever & Chest Pain are common in Granulomatous type. Conclusion: DPLD (Diffuse Paranchymal lung Disease) is a chronic lung disease characterized by progressive decline in lung function. IPF is most common in DPLD and leads to fast deterioration of lung function. HRCT (High Resolution computed tomography) is very important to assess type of disease. Spirometry, Broncoscopy are important for diagnosis of ILD and lung function.

Relationship between the pathology of bovine intestinal tissue and current diagnostic tests for Johne’s disease

Johne’s disease is an enteric disease caused by the intracellular pathogen Mycobacterium avium subsp. paratuberculosis (MAP). Upon translocation from the lumen of the small intestine, mycobacteria have the ability to thwart innate defense mechanisms and persist within the macrophage in the lamina propria. In an effort to understand how the pathology of disease is reflected in current diagnostic tests, immunofluorescent (IFA) labeling was performed to quantitate macrophage and MAP numbers in the ileum of infected cattle and correlate results with common methods for diagnosis of MAP infection; including ELISA, IFN-γ assay, RT-PCR, culture of MAP, and histological classification of tissue sections. Predictive models for clinical and subclinical disease states, histopathology acid-fast (AF), MAP location, granulomatous inflammation and type classifications, as well as macrophage, MAP and macrophages with intracellular MAP IFA labeling were successfully developed. The combination of macrophage number and ELISA were the best predictors of clinical disease state, while macrophage number was the best and only significant predictor of subclinical disease state. Fecal culture and number of MAP were the best predictors of granulomatous inflammation, and of combined AF, MAP location and granuloma type, respectively. Additionally, fecal culture and tissue culture were the best predictors of numbers of macrophages and MAP, respectively, while both ELISA and tissue culture were the best predictors of number of macrophages with intracellular MAP.

Histopathology and culturable bacteria associated with “big belly” and “skin nodule” syndromes in ornamental Siamese fighting fish, Betta splendens

The Siamese fighting fish (Betta splendens) is one of the popular aquarium ornamental fish in the global trade. Large numbers of ornamental fish farmed in central Thailand suffered from two common syndromes; preliminarily named skin nodule syndrome (SNS) and big belly syndrome (BBS): they showed noticeable clinical signs of abnormal appearances resulting in depressed saleability. Since very few specifics are known about causative agents of these syndromes, this study aimed at investigating histopathological features and culturable bacteria associated with these fish infected in the process of farming. Histopathologically, SNS fish consistently exhibited necrosis and severe melanization in the muscles and multiple internal organs. Whereas BBS fish exhibited either typical granulomas or tissue damage associated with acid-fast stained bacteria and Gram negative bacteria, respectively. Six different Gram negative bacterial species were recovered from BBS fish while 23 bacterial species belonging to 14 genera were recovered from fish suffering from SNS. Most of the culturable bacteria are new to betta fish and some of them are known to be marine bacteria, suggesting possible entry route via a contaminated live feed, commercial Artemia shrimp. The true causative agents of these syndromes remain unclear. However, histopathological changes and existence of a wide range of bacteria associated with the naturally diseased fish suggest involvement of multiple bacterial infections.

Effects of ostium granulomas and intralesional steroid injections on the surgical outcome in endoscopic dacryocystorhinostomy.

To determine the effect of granuloma formation in the ostium and intralesional steroid injections (ISIs) on the surgical outcome after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). One hundred and eighty-three cases involving 142 patients were enrolled. The ostium granulomas were classified according to their location relative to the internal common opening (superior, anterior, and posterior positions) and to the vicinity of the ostium (inner, edge, and extra types). If an ostium granuloma was observed during the follow-up and its size increased, ISIs were performed using 0.3ml of 40mg/ml triamcinolone acetonide. The surgical outcomes were compared between cases with and without ostium granulomas and also between each granuloma position and type. Ostium granulomas occurred in 71 (38.8%) of the 183 cases, and an ISI was applied in 65 cases with a mean of 2.1 injections. All of the granulomas regressed successfully after ISIs, with the success rate not differing between the cases with (85.9%) and without (83.9%) granuloma. There was no association between granuloma location and surgical outcome. However, the functional outcome was worse (60%) for inner granulomas (which are located within the ostial base) than for extra (87.8%) and edge (98%) granulomas. ISIs can be easily applied by a surgeon to help regress an ostium granuloma and improve the ostial patency after DCR. Inner ostium granulomas are associated with a worse functional outcome, and the initiation of an early corrective intervention such as an ISI should be considered.

Immunohistochemical characterization of tuberculous lesions in sheep naturally infected with Mycobacterium bovis

BackgroundSheep have been traditionally considered as less susceptible to Mycobacterium bovis (Mbovis) infection than other domestic ruminants such as cattle and goats. However, there is increasing evidence for the role of this species as a domestic Mbovis reservoir, mostly when sheep share grazing fields with infected cattle and goats. Nevertheless, there is a lack of information about the pathogenesis and the immune response of Mbovis infection in sheep. The goals of this study were to characterize the granuloma stages produced by the natural infection of Mbovis in sheep, to compare them with other species and to identify possible differences in the sheep immune response. Samples from bronchial lymph nodes from twelve Mbovis-naturally infected sheep were used. Four immunohistochemical protocols for the specific detection of T-lymphocytes, B-lymphocytes, plasma cells and macrophages were performed to study the local immune reaction within the granulomas.ResultsDifferences were observed in the predominant cell type present in each type of granuloma, as well as differences and similarities with the development of tuberculous granulomas in other species. Very low numbers of T-lymphocytes were observed in all granuloma types indicating that specific cellular immune response mediated by T-cells might not be of much importance in sheep in the early stages of infection, when macrophages are the predominant cell type within lesions. Plasma cells and mainly B lymphocytes increased considerably as the granuloma developed being attracted to the lesions in a shift towards a Th2 response against the increasing amounts of mycobacteria. Therefore, we have proposed that the granulomas could be defined as initial, developed and terminal.ConclusionsResults showed that the study of the lymphoid tissue granulomata reinforces the view that the three different types of granuloma represent stages of lesion progression and suggest an explanation to the higher resistance of sheep based on a higher effective innate immune response to control tuberculosis infection.