Suppurative Lymphadenitis Research Articles

Atypical large plasma cells in lymph node granulomas in cat-scratch disease

A histological variant of plasma cells found in the granulomas of cat-scratch disease (CSD) lymphadenitis is reported. Though the lesion shows the typical features of suppurative granulomatous lymphadenitis, many atypical giant cells which have abundant basophilic cytoplasm and bizarre nuclei with occasional multinucleated forms are noted among epithelioid histiocytes. The diagnosis of CSD lymphadenitis was confirmed by comparing clinical; histopathological, and histochemical (Warthin-Starry silver impregnation stain) studies on lymph node sections from five cases with features typical of the disease. Histochemical (methyl green-pyronine stain) and immunohistochemical examination provided several lines of evidence indicating that the atypical giant cells in our case were plasmacytic and confirmed that its proliferation was reactive, not neoplastic. Multinucleated giant cells were also occasionally present in the other five cases, but they had histological and immunohistochemical features of Langhans' type giant cells. We stress the importance of distinguishing such atypical large plasma cells from neoplastic cells.

An Outbreak of Suppurative Lymphadenitis Connected with BCG Vaccination in Austria, 1990/1991

"An Outbreak of Suppurative Lymphadenitis Connected with BCG Vaccination in Austria, 1990/1991." American Review of Respiratory Disease, 144(2), p. 469

Yersiniosis in Farmed Deer

Samples from 77 chital (Axis axis), 42 fallow (Dama dama), 26 red (Cervus elaphus), 7 rusa (Cervus timorensis) and 1 sambar deer (Cervus unicolor) were examined. Yersinia pseudotuberculosis infection was diagnosed as the cause of death in 6 (23%) of the red and 23 (30%) of the chital deer. Yersiniosis was the most common infectious cause of death diagnosed. Affected deer were usually found moribund or dead, often with faecal staining of the perineum. Gross pathology in chital included a fibrinous enterocolitis, enlarged congested mesenteric lymph nodes and multiple pale foci through the liver. Gross changes in red deer were limited to intense congestion of the intestinal mucosa and enlargement and congestion of mesenteric lymph nodes. Microscopic intestinal changes in both species consisted of microabscessation or diffuse suppurative inflammation of the intestinal mucosa with numerous bacterial colonies in the lamina propria. Multifocal suppurative mesenteric lymphadenitis was a common finding. Multifocal suppurative or non-suppurative hepatitis was frequently present in the liver of chital but was uncommon in the red deer. Yersiniosis occurred during the cooler months from June to November, with younger age classes most commonly affected. Y. pseudotuberculosis serotypes I, II and III were isolated in the ratio 17:3:0 in the chital deer and 1:1:2 in red deer. The clinical, epidemiological and bacteriological features are similar to those documented previously by New Zealand workers. The increased susceptibility to disease of red deer and chital compared to fallow deer and perhaps other species has not previously been documented.

A Seroepidemiological Investigation of Corynebacterium Pseudotuberculosis Infection in Sheep Flocks in Southern Norway

Corynebacterium pseudotuberculosis causes caseous lymphadenitis, a disease primarily affecting sheep and goats which occurs as a chronic infection characterized by suppurative lymphadenitis (Lovell 1959, Marsh 1965, Jubb & Kennedy 1970, Ayers 1977, Addo & Eid 1978). The disease has an insidious nature and a high prevalence, resulting in large economic losses due to condemnation of carcasses and organs at slaughter (Turner 1973).

Cimetidine Treatment in Hyper-IgM Hypogammaglobulinemia

To the Editor.— Recently, Mayer et al1suggested that hyper-IgM hypogammaglobulinemia might be due to a defect in control of the isotype switch by a specific T-lymphocyte helper cell subpopulation. Report of a Case.— A 33-year-old woman with a clinical history of recurrent respiratory tract infections, cervical suppurative lymphadenitis, and ear drainage came under our observation for hypogammaglobulinemia. On admission she was in good health; results of physical examination and laboratory tests were normal, except for serum immunoglobulin values, which showed the typical pattern of hyper-IgM hypogammaglobulinemia. We found the same immunodeficiency in a living 28-yearold brother; two other brothers had died at the ages of 18 months and 10 years, respectively, from overwhelming infections. The patient's parents, a living 32-year-old brother, and her children (a 5 1/2-year-old girl and a 2 1/2-year-old boy) showed normal immunoglobulin values. Comment.— The inheritance in this family resembles that of the

The pathogenesis of rhodococcus equi pneumonia in foals

The pathogenesis of Rhodococcus equi pneumonia in foals is reviewed. The main routes of infection are respiratory and alimentary. The latter is probably the chief route of exposure in all foals and probably leads to development of specific immunity. Susceptible foals, those whose maternal immunity wanes before generation of their own immune response, readily develop disease if exposed aerogenously to sufficient numbers of R. equi. Management and environmental circumstances have a major role to play in determining the magnitude of this challenge and, therefore, in the prevalence of the disease. Infection of a naive foal leads to severe, suppurative bronchopneumonia with suppurative lymphadenitis of regional nodes and, in ∼50% of animals, to necrotizing enterocolitis. The foal is uniquely susceptible to R. equipneumonia; comparable experimental infections do not produce progressive destructive pulmonary lesions in other animal species. In the naive foal lung, R. equi behaves as a facultative intracellular pathogen, avoiding destruction within the alveolar macrophage by inhibiting phagolysosome fusion and possibly by causing lysosomal degranulation. The role of putative virulence factors, such as equi factor, remains to be elucidated.

Cellular composition of suppurative granulomas: An immunohistochemical study of suppurative granulomatous lymphadenitis

The immunohistochemical findings from an investigation of suppurative granulomatous lymphadenitis (SGL) are presented. With a broad panel of monoclonal and polyclonal antibodies directed against B cells, T cells, monocytes/macrophages, HLA-DR antigens, and the transferrin receptor, early, nonsuppurative granulomas were found to consist of OKM1+ OKIa1+ OKT9+ epithelioid histiocytes and multinucleated giant cells, admixed with variable numbers of OKT4+ Leu-3a+ helper/inducer T cells. These nonsuppurative lesions were surrounded by distinctive cuffs of BA1+ B1+ sIgM+ sIgD+ OKIa1+ lymphocytes. In contrast, suppurative granulomas were bordered by palisades of OKM1+ OKIa1+ OKT9+ epithelioid histiocytes, admixed with some OKT8+ suppressor/cytotoxic T cells. These suppurative lesions lacked distinctive cuffs of B lymphocytes, but half of the lesions were surrounded by numerous plasma cells that expressed cytoplasmic IgA and IgG. Based on these immunohistochemical findings, it is concluded that a shift in the nature of the predominant intragranulomatous T-cell subset occurs during the successive phases of the immune response in SGL. The cause of the central necrosis and suppuration may be related to the excessive numbers of intragranulomatous OKT8+ T cells or to the formation of immune complexes by the surrounding plasma cells.

Xanthogranulomatous Lymphadenitis

A case of an unusual type of granulomatous lymphadenitis, initially suspected of being a malignant lymphoma, is reported. Histologically, this lesion shows a striking xanthomatous appearance, due to collections of foamy histiocytes interspersed with chronic inflammatory cells, and resulting in a storage-like aspect. Evidence indicates that this process merely represents the reabsorption and healing phases of an acute suppurative lymphadenitis, with histopathologic features comparable to those of xanthogranulomatous pyelonephritis. The term xanthogranulomatous lymphadenitis is suggested for this previously inadequately described lesion, and the likely non-specific degenerative character of the xanthomatous response is stressed.

Submandibular Adenitis in a Newborn Caused by Mycoplasma hominis

Despite frequent colonization of the newborn infant with genital mycoplasmas, morbidity due to these organisms has been cited on few occasions. This report describes an infant with suppurative submandibular lymphadenitis from whom Mycoplasma hominis was isolated in pure culture. CASE REPORT A 2,580-gm, firstborn, black, female twin was the product of a 36-week pregnancy in a 15-year-old primigravida in whom mild preeclampsia and fever developed one day prior to delivery. After spontaneous rupture of the membranes and a 12-hour labor, the infant was delivered without complication by low forceps and vacuum extraction. Apgar scores were 7 and 9 at one and five minutes, respectively; findings on routine newborn examination were unremarkable.

Tick-Borne Tularemia Presenting as Ulcerative Lymphadenitis

In a patient with suppurative lymphadenitis who fails to respond to antibiotics routinely used for pyogenic adenitis, the diagnosis of tularemia should be considered if there is good evidence for recent tick or other insect exposure. A trial of streptomycin therapy may be indicated, pending culture and serology results, in any patient whose signs and symptoms strongly suggest this diagnosis.

The cervical lymph nodes inStreptococcus pyogenes, group A, type 50, infection in mice

Streptococcus pyogenes, group A, type 50, one of the few group A streptococcal types naturally occuring in mice, proved highly virulent in this species after experimental infection. Intranasal infection of 96 mice (Swiss albino, NMRI, and CBA) with this microorganism induced profound reactions in the cervical lymph nodes of 69% of the animals. Histologically, two different forms of reaction were distinguishable. In 61 mice, the lymph nodes exhibited follicular and lymphoplasmacellular hyperplasia and in 9 animals suppurative lymphadenitis was present. The ability of type 50 streptococci to persist in the pharynx of mice, and the similarity of the morphological changes induced by this organism appear to make intranasal murine group A, type 50, streptococcal infection a suitable model for human streptococcal pharyngitis.

Regional suppurative lymphadenitis after BCG vaccination (author's transl)

In the first half of 1975 there occurred in the Federal Republic of Germany an unusual rise in the incidence of suppurative inguinal lymphadenitis after BCG vaccination of newborns, in immediate time relation with change of the vaccine by its manufacturers, Behringwerke. The attenuated daughter strain Göteborg had been replaced by the effective but also rather aggressive strain Copenhagen 1331. The complication rate was 1.5% in West Berlin. Clinical course, operative technique as well as microbiological and histomorphological features of these cases were analyzed in a joint study. Since it is likely that, after re-admission of the Copenhagen vaccine, such complications may again occur despite reduced micro-organism count, vaccination of newborns should in future be restricted to those at risk.

Chronic lymphoglandular enlargement and toxoplasmosis in children.

Serum antitoxoplasma titres were determined simultaneously by the direct agglutination and the indirect immunofluorescent tests in 52 children aged 2 to 16 years having chronic lymph node enlargement, mainly cervical. Direct agglutination titres were raised (64 to 4096) in 22 children (42%), but rarely in the control groups of children with acute suppurative lymphadenitis, and healthy children, adults, nurses, and physicians. It is concluded that toxoplasmosis is commoner in Greek children than previously believed, and that it should be included in the differential diagnosis of lymphoglandular enlargement. Clinically the condition is mild and may be self-limited, but it should be treated promptly with trimethoprim-sulphamethoxazole, in order to prevent reactivation in adult life.

Observations on a BCG vaccine causing adverse reactions in newborns

A BCG vaccine was produced from strain 1331 to replace a vaccine from strain Goteborg that had been in use in the Federal Republic of Germany for approximately 20 years. The latter vaccine neither corresponded to international nor to national requirements, whereas the former did so. The ‘new’ vaccine contained less viable units and had less dry weight than the ‘old’ vaccine. Field trials with the ‘new’ vaccine in schoolchildren and newborns resulted in satisfactory conversion rates. Although schoolchildren tolerated the ‘new’ formula well, it caused four times more lymphadenitis in newborns than did the Goteborg vaccine. One case of suppurative lymphadenitis after the ‘new’ vaccine was statistically indistinguishable from the absence of such a case after the ‘old’ vaccine. Adverse reactions after general use correlated in their frequency with the number of viable units in the vaccine but there was no such correlation with the dry weight. Among the in vitro and in vivo tests a correlation was found between viable units and skin reactivity in guinea-pigs. Within the licensed limits in routine manufacture no correlation between viable units and dry weight was observed, while in lower than licensed ranges both parameters correlated. In consequence it appears decisive for the manufacture and control of BCG vaccines that: 1. (i) the parameters to be included in the method of manufacture be shown to correlate within the licensed range and 2. (ii) field trials be performed to prove the dose-response relationship both for efficacy and safety before the vaccine is given a general release.

Primary Tuberculous Complex of the Skin

A 7-YEAR-OLD girl who had symptoms of suppurative inguinal lymphadenitis proved to have an unusual type of skin tuberculosis: a primary complex involving the skin of the foot and the draining inguinal lymph nodes. This case is being reported because of the rarity of this lesion and the consequences of an incorrect diagnosis. A primary (Ghon) complex involving skin and inguinal lymph nodes is encountered infrequently.¹The skin lesion may be insignificant and easily overlooked; the associated lymphadenopathy is difficult to differentiate from that produced by other diseases. Children are most often affected.²Incorrect diagnosis may lead to chronicity of symptoms, inappropriate surgical procedures, and dissemination of the disease. The identification of tuberculous contacts is important for the detection of tuberculosis. <h3>Report of a Case</h3> A 7-year-old girl was admitted to the Miriam Hospital with a painful lump in the right groin, which had been present for four

Suppurative mesenteric lymphadenitis, a forgotten clinical entity: Report of two cases

Suppurative mesenteric lymphadenitis, a forgotten clinical entity: Report of two cases

Intralymphatic injection of BCG into rhesus monkeys.

Since the route of administration of BCG may have an important function in immunotherapy, we investigated intralymphatic administration to direct BCG to the lymph nodes. Multiple injections of high doses of BCG were administered to 6 rhesus monkeys via the dorsal lymphatics of the lower limb. A suppurative lymphadenitis was observed along the lower limb and in the inguinal area in 5 of the 6 monkeys. However, many of the complications reported with other routes of administration were not observed. Granulomatous reactions and histiocytic responses developed in lymph nodes on the injected sides of the pelvis and distant nodes as well as in the liver. The intralymphatic route is the method by which high doses of nonspecific immunostimulants were delivered to regional lymph nodes. The efficacy of this approach remains to be established in tumor-bearing animals and humans.

Yersinia pseudotuberculosis mesenteric adenitis

Yersinia pseudotuberculosis, one of the most ubiquitous of animal pathogens, is world wide in distribution. Several hundred isolations of this organism have been made from the mesenteric lymph nodes of European and Scandinavian children who presented with fever, vomiting, right lower quadrant pain, and leukocytosis. A suppurative ileocecal lymphadenitis is commonly found at operation; the appendix is rarely involved. Recovery is usually spontaneous and uneventful without antibiotic therapy. Septicemia, typhoidal syndromes, acute and chronic diarrheal disease, terminal ileitis, arthritis, and erythema nodosum have all been associated with infection with Y. pseudotuberculosis and the closely related Y. enterocolitica. Although Yersinia organisms are readily grown by standard culturing techniques, they are easily confused with other, more common, nonpathogenic Enterobacteriaceae and thus ignored or overlooked.

DEFECTIVE NEUTROPHIL CHEMOTAXIS, SEVERE STAPHYLOCOCCAL INFECTION AND HYPERMMUNOGLOBULINEMIA E

Neutrophil granulocyte function was determined in three patients with severe staphylococcal infection, clinical manifestations of allergic disease, and hyperimmunoglobulinemia E. Each of the patients had urticarial skin rashes before or at the time of development of staphylococcal suppurative lymphadenitis, pneumonia or sepsis. Neutrophil chemotaxis, random migration, phagocytosis and bactericidal capacity were assessed to determine if an abnormality in these functions might have contributed to the development of severe staphylococcal infection. Each of the 3 patients with increased IgE was found to have a marked defect in neutrophil chemotaxis. The mean chemotactic index of the patients was 12±4 while that of 20 controls was 72±17. Neutrophil random migration, phagocytosis and bactericidal capacity were normal in each patient. We have shown in previous studies that patients with eczema who suffer recurrent cutaneous staphylococcal infections may have defective neutrophil chemotaxis in association with increased IgE and have demonstrated that defective neutrophil function may result from chemical mediators such as histamine. The present patients with clinical evidence of systemic histamine release, abnormal chemotaxis and severe staphylococcal infections suggest an important relationship between allergic phenomena and the host defense mechanism.

Retroperitoneal iliac fossa abscess: A complication of suppurative iliac lymphadenitis

The clinicopathologic manifestations in four patients with staphylococcal abscess localized to the retroperitoneal iliac fossa are presented. This type of abscess may represent a distinct entity and is most likely a complication of suppurative iliac lymphadenitis. Retroperitoneal abscesses localized to the iliac fossa rarely have any osseous component. Extraperitoneal drainage is curative.