Predominance Of Mononuclear Cells Research Articles

#1814 Infection associated pancreatitis in peritoneal dialysis, a case report

Abstract Background and Aims Peritoneal dialysis (PD) patients seem to have a higher incidence of acute alithiasic pancreatitis. Though rare and with some suggested triggers described in the literature, this is still a poorly understood and potentially life-threatening complication. We present a 60 years old woman concluding antimicrobial therapy with an icodextrin night-dwell regimen for peritonitis presenting with epigastric pain. This work reviews our approach to cloudy effluent from non-infectious causes during an infection while managing acute pancreatitis in the PD setting. We report diagnostic difficulties and treatment considerations with a positive outcome. Method We present a 60 years old woman on PD for one year presenting to the emergency room in November of 2023 with severe epigastric pain, nausea and emesis. She suffered from stage 5 chronic kidney disease due to autosomal dominant polycystic kidney disease and had disease complications as anemia and secondary hyperthyroidism controlled within targets. She was on automated PD (APD) with glucose based solutions. She was on the 17th of 21 days antibiogram guided treatment (ceftazidime) for a Enterobacter ludwigii PD-related peritonitis with good clinical evolution and peritoneal effluent (PE) leukocyte count per μl from 1258 to 91 in 5 days. In the previous 3 months she had had 2 other infectious episodes. A bacteremic urinary tract infection to E. coli associated with peritonitis treated with antibiogram guided therapy (ceftazidime) followed by C. difficile colitis treated with oral vancomycin. During each infection period she transitioned from APD to continuous ambulatory peritoneal dialysis with an icodextrin night dwell. On admission she presented with normal vital signs, no fever, and abdominal distention with severe epigastric tenderness to palpation without muscular guarding. Her dwell exchange showed blood-tinged cloudy PE. She had hemoglobin of 11.3 g/dl, otherwise normal blood cell counts, and raised amylase (213 UI/l) and lipase (1467 UI/l). There was no elevation of transaminases, cholestatic enzymes, C-reactive protein or procalcitonin and lipidemia or hyperbilirubinemia were normal. PE cell count showed 213/μl leukocytes and 202/μl erythrocytes. Abdominal ultrasound showed no evidence of an obstructive cause. She was admitted in the surgical care unit for a conservative and watchful approach. Results On presentation we accounted for the peritonitis still under treatment, acute pancreatitis, drug therapy and recently introduced icodextrin solution. The acute alithiasic pancreatitis diagnosis was established but there was still a possible causative role of icodextrin or infection and refractory peritonitis could also not be promptly excluded. The literature suggests icodextrin and other drugs as causes for acute pancreatitis in some patients but also mentions the possibility of cloudy or hemorrhagic effluent due to abdominal inflammation processes. Considering the clinical stability, the multiple possible contributing causative agents and the differential diagnosis of refractory peritonitis we closely monitored PE cell count evolution keeping the icodextrin dwell and ceftazidime prescriptions and collected samples for bacterial and fungal culture. The cultures were negative and stability of leukocyte count and mononuclear cell predominance (Fig. 1) helped us exclude the peritonitis hypothesis and attribute the PE changes to the pancreatitis process. Conclusion Inpatient monitoring and identifying all possible causes are essential to ensure good outcomes in PD patients suffering from acute pancreatitis. Full anamnesis, physical examination and close attention to laboratory findings were key in allowing adequate antibiotic therapy and resolution of the abdominal inflammatory process at hand while maintaining an adequate PD prescription.

Ovine Lungworms Infection in Tiaret (Algeria): Prevalence, Species Involved, and Pathological Findings

Abstract Lungworm infections are known to be frequent and responsible for substantial economic losses in ruminants. They are caused by Dictyocaulus filaria and various species belonging to the Protostrongylidae family of nematodes. This present study was conducted at the Tiaret municipal slaughterhouse and the parasitology laboratory of the veterinary institute for six months, from November 2016 to April 2017. The study aimed to evaluate the occurrence of lungworm infections and the determination of the circulating species affecting sheep in the region with a pathological study of infected pulmonary tissue sections. The overall incidence of the pathology in sheep was 26 % (240/921). The identified species were Muellerius capillaris 43 %, Neostrongylus linearis 8 %, Cystocaulus ocreatus 4 %, Dictyocaulus filaria 3 %, Protostrongylus rufescens 1 %, and mixed infestations 42 %. The histological examination of corresponding lesions has revealed pneumonia-type, and bronchopneumonia, inflammatory lesions, with a predominance of mononuclear cells, necrosis of bronchial epithelium, and pulmonary parenchyma as well as hyperplasia of the bronchiolar epithelium. Prevention and control of these parasites is therefore essential for releasing the potential of sheep production.

Predictive accuracy of histopathological profile and immunohistochemical markers for the aging of abrasion: an autopsy-based study.

Wound age estimation is a crucial medicolegal task for forensic pathologists. The main objective of the current study was to evaluate the ability of the histopathological profile and immunohistochemical markers (CD14 and IL-8) to predict the age of abrasion and, furthermore, identify the relationship between the histopathological profile and immunohistochemical markers in abrasion aging. The study involved postmortem cases (n = 246) of abrasion injuries in which the injury infliction time was known. The test skin samples were taken from the abrasion site, and an adjacent area of uninjured skin was sampled for control. Hematoxylin and eosin stain was applied to tissue sections for the histopathological analysis. The semi-quantitative evaluation was made for expressing immunohistochemical markers CD14 and IL-8 on the infiltrating inflammatory cells. The study showed that the age of abrasion was significantly higher (p < 0.05) among the cases with positive staining than those with negative staining for both CD14 and IL-8. Additionally, the study found a significant association between the age of the abrasion and the IHC staining for IL-8. However, no significant association was seen between the age of abrasion and the CD-14 IHC staining. The odds ratio (95% confidence interval) for more than 72h of the age of abrasion was compared to 0 to 72h of the age of abrasion. The odds ratios were 39.00 (4.177-364.13) for the predominant mononuclear cell infiltration and 84.50 (9.287-768.814) for cases with the appearance of fibroblast, granulation tissue, and collagen deposition when compared to an unremarkable change on histopathological examination. Positive staining of immunohistochemical markers CD14 and IL-8 for the age of abrasion of more than 72h showed a sensitivity of 40% and 80.95%, respectively, and specificity of 71.6% and 52.5%, respectively. The quantification of the histopathological changes of predominant mononuclear cell infiltration and the appearance of fibroblast, granulation tissue formation, and collagen deposition showed a significant correlation for the age of abrasion of more than 72h. The immunohistochemical analysis revealed IL-8 as a more accurate marker than CD14 in identifying abrasions older than 72h.

Absence of cortical lesions after the first seizure in a patient with anti-myelin oligodendrocyte glycoprotein-associated cortical encephalitis

A 31-year-old man developed headache and generalized convulsions. At the time of the first seizure, there was no distinct MRI abnormality. He was admitted to the hospital with repeated seizures, left-sided hemiparesis, and left-sided neglect. He had a slight fever, elevated cerebrospinal fluid (CSF) pressure, and increased CSF cell count with predominance of mononuclear cells. A repeat MRI scan on day 8 after the recurrent seizure showed cortical edema in the right cerebral hemisphere on fluid-attenuated inversion recovery (FLAIR), abnormal high signal on DWI, and decreased apparent diffusion coefficient. The patient was diagnosed with aseptic meningoencephalitis and treated with antiviral drugs and methylprednisolone pulse therapy. Serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody was subsequently detected, and prednisolone was added to treat the FLAIR-hyperintense lesions in anti-MOG antibody associated encephalitis with seizures (FLAMES). It is important to identify the clinical picture and typical images of FLAMES to allow early treatment.

Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn's Disease from a Reference Center in Bahia, Brazil.

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn’s disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn’s disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma.

Macrophage activation in vitro by Parachartergus fraternus venom

Parachartergus fraternus wasp induces inflammation with a predominance of mononuclear cells, that can acquire macrophage functions at the sting site, amplifying the response. These cells can be activated by venomous animals and are involved in destruction of injurious agents and release of inflammatory mediators. The objective of this work was to evaluate the activity of P. fraternus venom (Pfv) on isolated murine macrophage function. The cells were obtained from peritoneal cavity of Swiss male mice and incubated with Pfv (2.5, 5 and 10 μg/mL). Cytotoxicity was determined using MTT assay. Adhesion and detachment were evaluated using violet crystal dye. Spreading was evaluated based on morphological parameters. Phagocytosis was performed with opsonized zymosan. Production of hydrogen peroxide (H2O2) and nitric oxide (NO) were quantified using the phenol red and Griess assays, respectively. Pfv at concentrations evaluated was not cytotoxic in MTT assay and did not cause macrophage detachment in cell culture plates. However, it increased adhesion of macrophage, spreading and phagocytosis of opsonized zymosan, as well as induced production of H2O2 and NO. Therefore, Pfv induces macrophage activation in vitro and the response of these cells can be correlated with the previously reported inflammatory process triggered by this wasp.

Histopathological Characterization of Mitral Valvular Lesions from Patients with Rheumatic Heart Disease.

ResumoFundamentos:Os mecanismos subjacentes pelos quais a doença cardíaca reumática (DCR) levam à disfunção valvar grave não são totalmente compreendidos.Objetivo:O presente estudo avaliou as alterações histopatológicas nas valvas mitrais (VM) buscando uma associação entre o padrão de disfunção valvar predominante e os achados histopatológicos.Métodos:Em 40 pacientes submetidos à troca da VM devido a DCR e em 20 controles submetidos a transplante cardíaco, foram analisados os aspectos histológicos da VM excisada. Dados clínicos e ecocardiográficos também foram coletados. As análises histológicas foram realizadas usando coloração com hematoxilina-eosina. Determinou-se inflamação, fibrose, neoangiogênese, calcificação e metaplasia adiposa. Valores de p<0,05 foram considerados estatisticamente significativos.Resultados:A idade média dos pacientes com DCR foi de 53±13 anos, sendo 36 (90%) do sexo feminino, enquanto a idade média dos controles foi de 50±12 anos, semelhante aos casos, sendo a maioria do sexo masculino (70%). O endocárdio valvar reumático apresentou espessura maior que os controles (1,3±0,5 mm versus 0,90±0,4 mm, p=0,003, respectivamente), e infiltrado inflamatório mais intenso no endocárdio (78% versus 36%; p=0,004), com predominância de células mononucleares. Ocorreu fibrose moderada a acentuada mais frequentemente em válvulas reumáticas do que em válvulas controle (100% vs. 29%; p<0,001). Ocorreu calcificação em 35% das valvas reumáticas, principalmente entre as valvas estenóticas, associada à área valvar mitral (p=0,003).Conclusões:Apesar do intenso grau de fibrose, o processo inflamatório permanece ativo na valva mitral reumática, mesmo em doença tardia com disfunção valvar. A calcificação predominou em valvas estenóticas e em pacientes com disfunção ventricular direita.

Eosinophilic Meningomyelitis Probably Associated with Toxoplasmosis in a Cat

Background: The cerebrospinal fluid (CSF) of healthy cats presents up to 5 cells/µL, with predominance of mononuclear cells and the presence of more than 1% eosinophils is rare and should always be considered an abnormal finding. There is no consensus on the term eosinophilic pleocytosis, as it is used to indicate the presence of more than 10 eosinophils/µL or more than 10% of the total neutrophils. The increase in eosinophils in the CSF may result from infectious, inflammatory, neoplastic and idiopathic diseases. The objective of this paper is to report a case of marked pleocytosis in CSF, with 84% eosinophils, probably due to toxoplasmosis, in a cat with paraparesis and diffuse spinal pain.Case: A mixed breed female cat, neutered, adult and domiciled in a rural area was presented due to gait abnormalities in the pelvic limbs that started one day before presentation. The general physical examination was unremarkable. On neurological examination it was observed asymmetric deficit of postural reactions in pelvic limbs, patellar reflex normal to increased and pain elicited on palpation of the thoracic and lumbar spine. Based on these findings, the neurological syndrome was classified as thoracolumbar, but with diffuse pain, and the main differential diagnoses were inflammatory/infectious and neoplastic diseases. The leukogram showed eosinophilia and the serum biochemistry showed no significant changes. Serological assays for feline immunodeficiency virus and feline leukemia virus were negative. Analysis of cerebrospinal fluid (CSF) identified marked pleocytosis with 84% eosinophils and increase in protein concentration. Myelography showed no compressive or expansive changes. Fungal culture for CSF cryptococcosis was negative. Serum immunofluorescence antibody titer for Toxoplasma gondii (IgG) was 1:256. There was a marked improvement after treatment with sulfametoxazole/trimethoprim and pyrimethamine and after 3 weeks of treatment, there was almost complete recovery of neurological signs and after 9 months the cat was neurologically normal.Discussion: The most common causes of acute-onset thoracolumbar spinal cord syndrome in cats, with diffuse pain on spinal palpation, are meningomyelitis of inflammatory/infectious origin, such as feline infectious peritonitis (FIP) and neoplasms such as lymphoma. Other meningomyelitis of inflammatory origin, such as infectious and immune-mediated meningomyelitis of unknown origin are considered uncommon in cats. Although the clinical, systemic and neurological signs of FIP and toxoplasmosis may have similarities, in the present case FIP was not considered responsible for the observed signs, as the evolution of the case and the analysis of the CSF tend to be different. The peripheral eosinophilia, the cytological analysis of the CSF, characterized by marked eosinophilic pleocytosis, associated with a positive titer for toxoplasmosis, good response to treatment and improvement in the neurological condition, with survival for more than 9 months after treatment, rules out the possibility of FIP. Neurological signs observed in the absence of systemic signs are more common in cases of protozoan reactivation, which probably occurred in the present case. The possibility of toxoplasmosis in the patient in this report was reinforced by the fact that the animal came from a rural area. Eosinophilia of CSF is most commonly associated with parasitic infections, although it can be caused by a variety of infectious agents, but in the cat of the present report, the marked eosinophilic pleocytosis was likely due to toxoplasmosis, which is a rare occurrence in this specie. In conclusion, toxoplasmosis should be considered in the differential diagnosis of focal spinal cord lesions in cats. The identification of laboratory findings as well as the appropriate therapy favored the good evolution of the condition.Keywords: eosinophilic pleocytosis, feline, Toxoplasma gondii, cerebrospinal fluid.Descritores: pleocitose eosinofílica, felino, Toxoplasma gondii, líquido cerebroespinhal.

Pro-inflammatory response induced by the venom of Parachartergus fraternus wasp

The sting of different wasp species triggers local and systemic reactions in victims that can lead to death. Parachartergus fraternus is responsible for frequent accidents in Latin America; however, few studies have been conducted on this insect and its venom. In this study, the inflammatory process induced by the venom of the P. fraternus wasp (Pfv; 100, 200, and 400 μg/kg) was characterized. Mice were used to assess paw edema, vascular permeability, mast cell degranulation, leukocyte influx, nitric oxide (NO) production, expression of inflammatory genes, and histopathological changes. Pfv triggered edema formation with a peak dose of 200 μg/kg at 10 min. There was an increase in permeability in all periods and doses evaluated, with no differences between them. The 200 μg/kg dose induced mast cell degranulation in all periods, with a peak at 15 min. This same dose induced leukocyte influx with a predominance of mononuclear cells and triggered a peak in NO production in the 12th hour. The increase in COX-2, iNOS, and IFN-γ mRNA expression occurred after 1 and 6 h, and there was an increase in IL-10 expression after 48 h. In addition, Pfv triggered edema and induced an influx of macrophages and mast cells into the injection site. Therefore, Pfv induces an inflammatory process from the first 5 min of inoculation that can persist for up to 48 h.

Pathogenetic Value of pVM82 Plasmid of Yersinia Pseudotuberculosis, Causative Agent of Far Eastern Scarlet-Like Fever

The Far Eastern scarlet-like fever (FESLF) is the clinical-epidemic manifestation of pseudotuberculosis infection in humans is associated with a specific clonal lineage of the causative agent. Purpose of the study: to determine the pathogenetic value of the pVM82 plasmid of the FESLF causative agent, on the basis of a comparative analysis of the innate immunity cells metabolic activity and peculiarities of the inflammatory reaction during experimental infection, caused by different plasmid types of Yersinia pseudotuberculosis. Materials and Methods. The following Y. pseudotuberculosis plasmid types were used for the infection of mice: (1) H-5015 T+ strain (82+:48+) containing two plasmids pVM82 and pYV; (2) H-5015 T– strain (82+:48–) containing single pVM82 plasmid; (3) H-5013 T+ strain (48+) containing single pYV plasmid; (4) H-5013 T– plasmid-free strain (82–:48–). Peritoneal exudate cells and samples of liver, spleen and mesenteric lymph nodes were taken from infected animals at 1, 3, 5 and 7 days post infection. The functional state of the innate immunity cells was assessed by the activity of lactate dehydrogenase (LDH) and by the level of nitric oxide (NO) metabolites. The samples of target organs were embedded in paraffin, sections were stained with hematoxylin and eosin. Results. It was found that only Y. pseudotuberculosis strains containing pVM82 plasmid had a stimulating effect the innate immunity cells. The more pronounced increase in the LDH activity, an oxygen-dependent metabolism enzyme, and the level of NO metabolites occurred in response to infection of cells with bacteria containing single pVM82 plasmid, compared with plasmid type containing additional plasmid virulence pYV. In experimental animals infected with plasmid type pYV–: pVM82+ of Y. pseudotuberculosis, the disease pathology usually manifested less acute inflammation with a predominance of mononuclear cells and minor pathogen-associated destructive changes in organs. The mortality in animals infected with Y. pseudotuberculosis strains containing plasmid pVM82 (plasmid types 82+:48+ and 82+:48–) was lower compared to a strain carrying only the virulence plasmid pYV (plasmid type 48+),—40, 30 and 80%, respectively. Conclusions. Thus, the pVM82 plasmid of Y. pseudotuberculosis determined the effective immune defense of organism, mainly through nitroxide-dependent bactericidal mechanisms of innate immunity cells. Moreover, the restriction of a generalized inflammatory reaction and induction of granulomatous inflammation were associated with this plasmid.

Chylothorax with Transudate: An Unusual Presentation of Tuberculosis.

IntroductionTwenty-five per cent of tuberculosis patients have pleural tuberculosis, which is the third most common form of presentation. Most cases present as an exudative pleural effusion with just few cases reported as chylothorax in the literature. All pleural effusions from confirmed cases, including tuberculous chylothorax, had exudate features.AimTo describe a patient with Mycobacterium tuberculosis affecting the lungs and pleura, which laboratory testing demonstrated had features of transudate chylothorax.Patient and methodsA 70-year-old man presented with constitutional symptoms, progressive exertional dyspnoea and right pleural effusion with fibrocavitary changes on chest imaging. Thoracentesis and pleural fluid analysis revealed chylous fluid with transudate features, high triglycerides, low cholesterol content and mononuclear cell predominance. Acid-fast sputum stains and pleural fluid were negative for Mycobacterium tuberculosis as was an adenosine deaminase test for pleural effusion. Tomography-directed lung biopsy sampling of a lung nodule revealed a chronic granulomatous inflammatory process associated with the presence of acid-fast bacilli.DiscussionTuberculosis-associated chylothorax is an uncommon presentation of the disease. A recent review found only 37 cases of confirmed tuberculous chylothorax had been reported in the literature. All cases had exudate characteristics. The diagnosis of pleural tuberculosis was made through culture or testing of sputum, pleural fluid or biopsy samples in 72.2% of cases, with the rest identified by histopathology.LEARNING POINTSThe main cause of non-traumatic chylothorax is malignancy, which is found in 39–72% of cases.Few cases of transudative chylothorax have been reported in the literature; the main aetiology is chronic hepatopathy.Tuberculosis-associated chylothorax is a rare presentation of infection caused by Mycobacterium tuberculosis, an uncommon aetiology.

Streptobacillus moniliformis bacteraemia and septic arthritis in a child

Streptobacillus species are zoonotic pathogens colonising the oral cavity and upper respiratory tract of rats and other rodents.1 Transmission occurs via bites or scratches, referred to as rat-bite fever, or ingestion of contaminated food or water, referred to as Haverhill fever.1,2 Streptobacillus species are rarely isolated due to fastidious growth requirements, inhibition by sodium polyanethol sulfonate anticoagulant in blood culture bottles, and susceptibility to commonly-used antibiotics.1 A 12-year-old immunocompetent female with pet mice and rats presented with fever, left shoulder pain, and rash for five days. Examination demonstrated left axillary lymphadenopathy and left glenohumeral joint restricted range of motion, swelling, and warmth. Ultrasound confirmed a moderate glenohumeral joint effusion and subacromial bursitis. Arthroscopic washout of the joint revealed diffuse, non-purulent, synovitis. The synovial fluid cell count was 15,300×106/L with a mononuclear cell predominance. Streptobacillus moniliformis was isolated in culture of blood (paediatric blood culture bottle) and synovial fluid specimens after approximately 72 hours at the microbiology laboratory at Nepean Hospital. The patient admitted to kissing her pet rodents on their mouths and sustaining scratches to the skin of her hands whilst bathing them. She recovered completely with intravenous ceftriaxone for one week then oral amoxycillin for three weeks.

Immunohistochemical Assessment of the Diagnostic Utility of PD-L1 (Clone SP142) for Methotrexate-Associated Lymphoproliferative Disorders With an Emphasis of Neoplastic PD-L1 (Clone SP142)-Positive Classic Hodgkin Lymphoma Type.

We describe results of programmed death ligand 1 (PD-L1) immunohistochemical assessment in methotrexate (MTX)-associated lymphoproliferative disorders (LPDs) and highlight the characteristics of classic Hodgkin lymphoma (CHL) type MTX-LPD. Fifty cases of MTX-LPD, including CHL type (n = 9), diffuse large B-cell lymphoma type (n = 15), and polymorphic B-cell LPD (n = 21), were investigated. Staining with anti-PD-L1 clone SP142 was exclusively found in CHL type (89%) but not in the others. Cases of CHL type MTX-LPD involved nodal disease and were associated with Epstein-Barr virus. They were histopathologically characterized by a vaguely nodular pattern, predominance of mononuclear cells, and strong expression of at least one pan-B-cell marker. Their clinical course was variable, with spontaneous regression in 5 patients, relapse in 2, and a fatal course in 1. The PD-L1 (clone SP142) workup aids the diagnostic approach to patients with MTX-LPD. CHL type MTX-LPD appears to represent a unique morphologic variant of CHL.

Cerebrospinal Fluid Analysis in Dogs and Cats with Neurological Diseases

Background:Cerebrospinal fluid (CSF) analysis is of great importance for evaluation of patients with central nervous system problems, because it helps to confirm or exclude many diseases when evaluated together with other relevant clinical and ancillary laboratory tests. As there are few studies in Brazil describing results of CSF analysis in dogs and cats, the objective of the present study was to evaluate results of CSF analysis in a period of ten years, grouping the changes observed, mainly total and differential cell count and total protein concentration, according to the following etiological categories of diseases: inflammatory, degenerative, traumatic, neoplastic and vascular disorders.Materials, Methods &amp;Results:Medical records of dogs and cats with neurological diseases that had CSF collected and analyzed at a Veterinary Teaching Hospital between 2008 and 2017 were retrospectively reviewed. Patient data included breed, sex, body weight, age at presentation, findings of clinical and neurological examination, results of CSF analysis, diagnostic imaging and other laboratory tests results including PCR and serologies for infectious diseases. A total of 245 CSF exams were studied (240 dogs and five cats). The established normal range for protein concentration was less than 25 mg/dL for cisternal collection and less than 45 mg/dL for lumbar puncture. Total nucleated cell count was considered normal when less than 5 cells/µL, with a predominance of mononuclear cells. Both pleocytosis and increased concentration of the protein level were classified as discrete, moderate and marked, and the pleocytosis was further classified as mononuclear, neutrophilic and mixed cell pleocytosis. The information obtained was analyzed in relation to the neurological syndromes and etiological categories of neurological diseases. The most frequent syndrome was thoracolumbar and the less frequent was cerebellar. Regarding the etiological categories, the most frequent in decreasing order were inflammatory, infectious, degenerative, neoplastic, traumatic, vascular and episodic. CSF examination was abnormal in 72% of cases. In viral infectious diseases, there was predominantly mononuclear pleocytosis with a slight increase of protein, whereas in dogs with presumptive diagnosis of meningoencephalitis of unknown origin (MUO), marked mononuclear and mixed pleocytosis predominated with moderate to marked protein increase. In degenerative diseases, however, the absence of pleocytosis or mild pleocytosis, with normal to slightly increased protein was most observed. In neoplastic diseases there was a high frequency of mild to moderate pleocytosis, with and without albuminocytological dissociation, while in spinal trauma there was mainly mononuclear pleocytosis. A slight increase in protein was observed mainly in infectious, degenerative, neoplastic and traumatic diseases, while moderate to marked increase was more observed in cases of presumptive diagnosis of MUO. Albuminocytological dissociation was observed in half of the cases of neoplasia and less frequently in degenerative, infectious and traumatic diseases.Discussion: The exam was altered in a considerable number of patientsand provided important information even when normal. The diseases with more abnormalities were inflammatory/infectious and neoplastic diseases. When the exam was normal, the most frequent condition was degenerative diseases. Although the changes were not specific for each class of neurological disease, there were certain trends regarding pleocytosis type and protein increase in some of them. Based on the results of this retrospective study, result of CSF analysis, when interpreted along with signalment, etiological categories of diseases, neurological syndromes, and results of other complementary tests, provided support for the diagnosis of various neurological diseases.

Characteristics of synovial fluid in patients with juvenile idiopathic arthritis

Synovial fluid (SF) analysis is an important tool for the diagnosis of patients with juvenile idiopathic arthritis (JIA). A retrospective analysis was carried out of cytological features of SF samples obtained from patients with JIA during the period 2008-2016. A total of 102 SF samples from 59 patients were analysed. JIA was more common in females (66%). The most frequent form was persistent oligoarticular JIA (52.5%). The median age at onset was 5 years (IQR 2.4-11.8). SF usually showed an inflammatory pattern (median white blood cells count 11,757/mm3; IQR 4,543-18,800), with a predominance of polymorphonuclear (PMN) cells (61%; IQR 30-75). Eight patients (14%) had white blood cells counts of less than 2,000 cells/mm3, with predominance of mononuclear cells (80%), whereas 3 patients (5%) had white blood cells counts higher than 50,000 cells/mm3, with a predominance of PMN cells (90%). Synovial white blood cells count did not show significant differences among the different forms of JIA. The median synovial white blood cells count in ANA-positive patients was 20% lower than in ANA-negative (9,340 vs. 11,600/mm3; P=.23). The proportion of PMN increased with increasing levels of ESR (P<.001) and/or CRP (P=.03). No significant correlation was found between JADAS-10 and synovial white blood cells count (P=.4). SF obtained from different joints in simultaneous arthrocentesis showed a significant correlation P=.001). SF from JIA patients usually had inflammatory characteristics, although 19% of the patients showed white blood cells counts below 2,000cells/mm3 or higher than 50,000cells/mm3. SF cell count was non-significantly lower in ANA-positive patients, and the proportion of PMN increased with increasing levels of ESR/CRP.

Characteristics of synovial fluid in patients with juvenile idiopathic arthritis

IntroductionSynovial fluid (SF) analysis is an important tool for the diagnosis of patients with juvenile idiopathic arthritis (JIA). Patients and methodsA retrospective analysis was carried out of cytological features of SF samples obtained from patients with JIA during the period 2008–2016. ResultsA total of 102 SF samples from 59 patients were analysed. JIA was more common in females (66%). The most frequent form was persistent oligoarticular JIA (52.5%). The median age at onset was 5 years (IQR 2.4–11.8). SF usually showed an inflammatory pattern (median white blood cells count 11,757/mm3; IQR 4,543–18,800), with a predominance of polymorphonuclear (PMN) cells (61%; IQR 30–75). Eight patients (14%) had white blood cells counts of less than 2000cells/mm3, with predominance of mononuclear cells (80%), whereas 3 patients (5%) had white blood cells counts higher than 50,000cells/mm3, with a predominance of PMN cells (90%). Synovial white blood cells count did not show significant differences among the different forms of JIA. The median synovial white blood cells count in ANA-positive patients was 20% lower than in ANA-negative (9,340 vs. 11,600/mm3; P=.23). The proportion of PMN increased with increasing levels of ESR (P<.001) and/or CRP (P=.03). No significant correlation was found between JADAS-10 and synovial white blood cells count (P=.4). SF obtained from different joints in simultaneous arthrocentesis showed a significant correlation P=.001). ConclusionSF from JIA patients usually had inflammatory characteristics, although 19% of the patients showed white blood cells counts below 2000cells/mm3 or higher than 50,000cells/mm3. SF cell count was non-significantly lower in ANA-positive patients, and the proportion of PMN increased with increasing levels of ESR/CRP.

Diagnostic Performance of a Temporal Artery Biopsy for the Diagnosis of Giant Cell Arteritis in Japan-A Single-center Retrospective Cohort Study.

Objectives To investigate the sensitivity and specificity of a temporal artery biopsy (TAB) in the diagnosis of giant cell arteritis (GCA) in a single-center retrospective cohort in Japan. Methods A retrospective chart review was performed on consecutive patients who visited our hospital between April 2009 and October 2018 and underwent a TAB. The sensitivity and specificity were calculated for the three pathological standards for a TAB, predetermined according to the pathological criterion of the 1990 American College of Rheumatology (ACR) criteria: A) vasculitis characterized by predominant mononuclear cell infiltration; B) vasculitis with granulomatous inflammation; and C) vasculitis with multinucleated giant cells. We also analyzed the clinical parameters predicting the diagnosis of GCA and the impact of a diagnostic delay of ≥3 months on cardiovascular complications of GCA. Results Our study population was 16 cases in the GCA group and 13 in the non-GCA group. The sensitivity and specificity for Standard A of a TAB were 81% and 85%, respectively, while those for stricter Standards B or C were identical, at 75% and 100%, respectively. These pathological standards, but not any other parameters, significantly predicted the diagnosis. A diagnostic delay tended to cause cardiovascular complications (p=0.057). Conclusion The sensitivity and specificity of the pathological standards of a TAB were favorable in our cohort and were the only predictors for the diagnosis of GCA. Considering the possible impact of a diagnostic delay on cardiovascular complications, the early recognition and prompt initiation of glucocorticoid therapy is needed, even in Japan, where GCA is uncommon.

Clinical and laboratory characteristics of neuroinvasive viral zoonoses detected in continental Croatian regions, 2017-2018

Purpose: To analyze clinical and laboratory characteristics of neuroinvasive viral zoonoses detected in Croatia during 2017-2018. Methods & Materials: From April 2017 to June 2018, a total of 120 patients with neuroinvasive disease from continental Croatian regions were tested for the presence of neuroinvasive zoonotic viruses: tick-borne encephalitis virus (TBEV), West Nile virus (WNV), Usutu virus (USUV), Toscana virus (TOSV), Tahyna virus (TAHV) and lymphocytic choriomeningitis virus (LCMV). Cerebrospinal fluid (CSF) and urine samples were tested for the presence of viral RNA using a real-time RT-PCR and/or nested RT-PCR. Serological tests of serum/CSF samples (IgM/IgG antibodies, IgG avidity) were performed using ELISA (TBEV, WNV, USUV), IFA (TOSV, LCMV) and virus neutralization test (WNV). Results: Etiology was confirmed in 28/23.3% patients: TBEV in 20/16.7% and WNV in 8/6.6% patients by detection of IgM and IgG antibodies of low avidity and/or detection of viral RNA in CSF and urine. Majority of patients with TBEV infection were males (15/75.0%). Although infections were detected in all age groups, 15/75.0% patients were less than 60 years of age. The main clinical symptoms were headache (18/90.0%), weakness (18/90.0%), nausea (12/60.0%) and vomiting (8/40.0%). Fever >39 °C was noted in 16/80.0% patients. CSF leukocyte count ranged from 41-3520/mm3 with mononuclear cell predominance in 15/75.0% patients. All but one patient fully recovered. WNV infection was reported in 5/62.5% males and 3/37.5% females. All but one patient (7/87.5%) were older than 60 years. Majority of patients reported underlying diseases: hypertension (3/37.5%) and cerebrovascular disease (3/37.5%). The main clinical symptoms were headache (5/62.5%) and weakness (5/62.5%), while fever >39 °C was noted in 4/50.0% patients. CSF leukocyte count ranged from 56-1096/mm3 with mononuclear cell predominance in 4/50.0% patients. One patient died. USUV, TOSV, TAHV and LCMV infections were not detected during the tested period. Conclusion: TBEV infections were more common in patients less than 60 years of age, while WNV infections were most common in elderly. High fever was noted in 80.0% TBEV cases compared to 50.0% WNV cases. CSF pleocytosis was higher in TBEV infection.

Evaluation of Viral Migration of Different Variants of Equid Alphaherpesvirus 1 in the Central Nervous System of Hamsters by Immunohistochemistry

The intranasal inoculation of equid alphaherpesvirus1 (EHV-1) Brazilian variants A4/72, A9/92, A3/97, Iso72/10 and the Argentine variant AR4 in a Syrian hamster model <i>Mesocricetus auratus</i> induced severe encephalitis. Clinical signs included weight loss, lethargy, somnolence, anorexia, and intense salivation two days post-inoculation (dpi), followed by neurological signs such as loss of proprioception, walking in circles, spastic paralysis, seizures, recumbency and death at 3^rd dpi (A9/92 and A4/72 variants) and 4^th dpi. Respiratory signs such as dyspnea and serosanguinous nasal discharge were also observed. Histopathological changes in brain included mixed inflammatory infiltrate with predominance of mononuclear cells, neuronal degeneration, liquefactive necrosis, hemorrhagic foci, leptomeningitis, perivascular edema, mononuclear infiltration, and perivascular cuffing. Immunohistochemical examination showed viral replication in neurons restrict predominantly to olfactory bulb and frontal cortex (variants AR4 and A3/97) and in groups of cells from distant regions, such as the caudal diencephalon and rostral mesencephalon (variants Iso72/10) and absence of viral antigen labeling of variants A9/92 and A4/72 despite these variants were the most neurovirulent, so new experiments not staggered in days but in hours post inoculation are needed to better understand the viral migration of these variants.

Tuberculous Meningitis – retrospective observational cohort in a university hospital

Background: Although tuberculous meningitis (TM) represents near 1% of the cases of tuberculosis disease, it is the most severe form of tuberculosis, with high mortality rate. Purpose: Description of tuberculosis meningitis cases and evaluation of infection outcome. Methods & Materials: Retrospective observational study in adults diagnosed with tuberculous meningitis at Centro Hospitalar do Porto, between January 2009 and October 2016. Results: During that period, 21 patients had a diagnosis of tuberculous meningitis, 81% (n = 17) were males and the mean age was 52,6 years-old (min 22; max 84). More prevalent risk factors identified were: chronic alcoholism (>60 g/day) in 23,8% (n = 5), drug use in 14,3% (n = 3) and iatrogenic immunosuppression in 14,3%. HIV infection was present in 28,6% (n = 6) On hospital admission, 23,8% (n = 5) patients had a stage III on BMRC score (British Medical Research Council). Regarding the cerebrospinal fluid (CSF), the mean protein level was 2,06 g/L (min. 0,30; max 4,53) and mean glucose de 0,34 g/L (min. 0,06; max. 0,81), mean pleocitosis of 233 cels/uL (mín. 0; máx. 911) with predominance of mononuclear cells (mean 140/uL; min. 0; max. 594). Microbiological diagnosis was based in PCR-assay (47,4%, n = 9), followed by culture (38,9%, n = 7). There was concomitant pulmonary tuberculosis in 19,0% (n = 4) of patients and 19,0% with disseminated disease. Tuberculostatic drugs were started in 20 patients (one died early) and 89,5% of them with adjunctive corticosteroids. External ventricular drain was needed in 42,9% (n = 9). Ischemic stroke (28,6%; n = 6) was the most common complication. Mortality rate at two-years was 47,6% (n = 10), with 6 deaths during hospitalization, 5 of them TM-related. At discharge, 9 of surviving patients had neurological sequelae with loss of autonomy. Conclusion: Even though it was a rare diagnosis in hospitalized patients, TM had a high mortality rate with significant loss of autonomy.