Mycobacterium avium-intracellulare and the unpredictable course of hypercalcemia in an AIDS patient

Abstract A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.

Genetic IS901 RFLP diversity among Mycobacterium avium subsp. avium isolates from four pheasant flocks

IS901 RFLP analysis of 36 Mycobacterium avium subsp. avium (MAA) isolates from 15 pheasants (Phasianus colchicus) and two goshawks (Accipiter gentilis) from four pheasant farms was performed. Using this method, six different IS901 RFLP types (E, F, G, M, Q, and V) were identified. The distribution of IS901 RFLP profiles was tightly linked to individual flocks. Matching IS901 RFLP profiles observed in the present study indicate MAA transmission between pheasants and goshawks in the same locality. In two flocks, different pheasants within a flock as well as in various organs of five individual pheasants were found to have two distinct IS901 RFLP profiles.

Diatoms: Role in drowning.

Drowning is a form of asphyxia due to aspiration of fluid into air passages caused by submersion in water or other fluid and is mostly accidental. The main question in case of a body recovered from water is whether the individual was alive at the time he entered water. If a body is found in water is does not necessarily mean, that this person has drowned.Deaths by drowning are difficult to determine and are often diagnosed by eliminating all other potential causes of death. Diatoms found inside the body of a drowned victim may serve as corroborative evidence in the diagnosis of cause of death. It can be ascertained whether the drowning is ante-mortem or post-mortem. The diatom test stands as the only direct screening test for drowning. The present case is one such example wherein the presence of diatoms has helped in arriving at a decision of ante mortem drowning, thereby emphasising its significance.

Bone marrow infection with Mycobacterium fortuitum in a diabetic patient

Incidence and prevalence of Mycobacterium fortuitum infection vary greatly by location and death is very rare except in disseminated disease in immunocompromised individuals. We present what we believe is the first case of bone marrow infection with Mycobacterium fortuitum in an HIV negative patient. Bone marrow examination revealed presence of numerous acid fast bacilli which were confirmed as Mycobacterium fortuitum on culture and by molecular analysis. Patient was managed successfully with amikacin and ciprofloxacin

Disseminated Mycobacterium avium Complex Infection in a Non-HIV-infected Patient Undergoing Continuous Ambulatory Peritoneal Dialysis / 대한진단검사의학회지

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.

Influence of bacterial endotoxins on bone marrow and blood components

Endotoxin [Lipopolysaccharide, LPS] a component of the bacterial wall of gram-negative bacteria, has been recognized as one of the most potent bacterial products in the induction of host inflammatory responses and tissue injury and was used in this study to mimic infections. LPS induces production and release of several cytokines. In response to these cytokines, different effects of endotoxins are seen. The effect of three types of endotoxins [Escherichia coli, Klebsiella pneumoniae and Salmonella typhimurium] on bone marrow, differential counts and peripherial blood parameters were investigated in adult rats. Male spraguo Dawely albino rats weighing 220 - 250 g were used. They were injected i.p. [1 mg/kg body weight] with single dose of 3 types of endotoxins. Blood samples were collected from the experimental animals at 24 and 72 hours of the injection. At 72 hours the bone marrow aspirations were harvested from the femur of the rats for microscopic examination. Endotoxins induced different changes in the cells of bone marrow. Also, lipopolysaccharide caused significant decreases in red blood cells, white blood cells and platelets counts, hemoglobin content and hematocrit percent. Data of the present study point out to the dose of these toxins according to suitable pharmacopeia. Lemulus amebocyte lysate [LAL] test is specificly used for determination of the endotoxin limit. This recommendation should be observed to avoid the toxic effects of endotoxins

Acute abdomen: an unusual presentation of disseminated Penicillium marneffei infection.

Varied clinical presentations of Penicillium marneffei, an opportunistic pathogen in HIV disease has been rarely described in literature. We report a patient with advanced AIDS who presented to us with prolonged fever and had features of an acute abdomen. On radiologic imaging he had features of intestinal obstruction and mesenteric lymphadenitis. A diagnosis was made possible by endoscopic biopsies of the small bowel and bone marrow culture which grew P. Marneffei. He was treated with intravenous amphotericin for 2 weeks followed by oral itraconazole. This case is reported for its rarity and unusual presentation and to sensitise clinicians and microbiologists to consider this as an aetiology in patients with advanced HIV/AIDS who present with acute abdomen, more so in patients from a distinct geographic region--South-East Asia.

Sensitivity and specificity of polymerase chain reaction in Giemsa-stained slides for diagnosis of visceral leishmaniasis in children

The aim of this study was to evaluate the sensitivity and specificity of polymerase chain reaction (PCR) in the detection of Leishmania DNA in archived Giemsa-stained bone marrow slides for diagnosis of visceral leishmaniasis (VL), and to compare PCR with conventional diagnostic techniques, like direct microscopy and parasite culture. Specimens of archived Giemsa-stained bone marrow slides from 91 patients with VL and from 79 controls with other diseases or conditions were studied. PCR showed the highest sensitivity (92.3 percent) and had good specificity (97.5 percent). Direct examination detected 79.1 percent and culture 59 percent of positive samples. In addition, PCR was able to detect VL in 16 of 19 patients (84.2 percent) with negative microscopy. PCR in Giemsa-stained bone marrow slides is a suitable tool for confirming diagnosis in patients with VL and may be useful in the diagnosis of difficult cases. Slide smears are easily stored, do not require special storage conditions such as low temperatures, and can be easily mailed to centers where PCR is available, making it an excellent option for diagnosis in the field.

Disseminated Histoplasmosis and Tuberculosis in a Patient with HIV Infection

Histoplasmosis is a very rare disease in Korea. Clinical manifestations are very similar to those of tuberculosis. This is the first case report of combined disseminated histoplasmosis and tuberculosis in a patient with HIV infection in Korea. A 42-year-old Korean with Acquired Immunodeficiency Syndrome (AIDS) was diagnosed with tuberculosis. He had lived in Guatemala for the past five years. Upon diagnosis of disseminated tuberculosis with HIV infection, he was treated with anti-tuberculosis medications and anti-retroviral agents. Fever, weakness, hepatosplenomegaly and pancytopenia were persistent despite treatment. The patient's history of living in Guatemala caused us to seek opportunistic infectious organisms other than tuberculosis. Bone marrow aspiration and biopsy were performed and the result revealed numerous intracellular organisms consistent with Histoplasma capsulatum; therefore, the diagnosis of disseminated histoplasmosis was made.

Disseminated histoplamosis.

A case of disseminated histoplasmosis in a 45-year-old male patient with acquired immunodeficiency syndrome (AIDS) from Pune is reported. The patient presented with high-grade fever and pain in hypochondrium. Clinical signs were pallor and hepatosplenomegaly. Bone marrow and splenic aspirate revealed numerous intracellular oval shaped yeast forms. Histoplasma capsulatum was isolated from the bone marrow and splenic aspirate. H. capsulatum infection is an opportunistic infection usually reported from patient with AIDS in areas endemic for H. capsulatum. The present case highlights the fact that histoplasmosis could be an emerging opportunistic infection in India.

Disseminated cryptococcosis in a patient with nephrotic syndrome.

Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared.

Disseminated histoplasmosis in an immunocompetent individual--a case report.

We report a rare case of disseminated histoplasmosis in a immunocompetent young adult person involving bone marrow, liver, spleen and oral cavity. He presented with oral ulcers, weight loss and pancytopenia. His bone marrow aspiration examination revealed Histoplasma capsulatum.

Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis.

Morphological evaluation of 140 bone marrow aspirations received in haematopathology laboratory with serologically established HIV infection, along with other relevant special haematological tests, was done during 1st Jan 1999 - 31st Dec 2002 at state government run tertiary care General Hospital in Maharashtra state, India. Out of 140 cases: 118 (84.28%) patients had anaemia, 25 (17.86%) had leukopenia, while 13 (9.28%) were thrombocytopenic. Dyserythropoiesis was present in 18 (12.86%) cases, dysmyelopoiesis 37 (26.43%) and micromegakaryocytes were noted in 44 (31.43%) cases. Haemophagocytosis was evident in 8 (5.71%) cases. Plasmacytosis encountered in 120 (85.71%) cases was a common feature. Based on clinical profile and results of other investigations 56 (40%) patients were clinically diagnosed to be of Mycobacterium tuberculosis (TB). Of these, 18 (12.86%) bone marrow aspirates were positive for AFB, Mycobacterium tuberculosis. In 4 cases cryptococci were demonstrated (Mucicarmine stain). There was one case each of Histoplasma capsulatum and leishmaniasis. One patient showed dense parasitemia with Plasmodium falciparum. One patient had immunoblastic lymphoma and showed bone marrow infiltration. Findings in this study strongly indicate that in HIV/AIDS, AFB stain should be done on each marrow aspirate to rule out tuberculosis in countries like India; where TB and AIDS are marching together.

Infecciones bacterianas y fúngicas en pacientes transplantados de médula ósea que acudieron al laboratorio clínico "César Sánchez Font" Valencia estado Carabobo Venezuela en el período enero/octubre de 2003 / Bacterial and fungical infections in patients transplanted of bone marrow who came to the clinical laboratory

Luego de un transplante de médula ósea, excepto por los problemas médicos y quirúrgicos asociados al funcionalismo y rechazo del transplante, las infecciones por diversos microorganismos son la principal complicación, debido al estado de inmunosupresión de los pacientes. El objetivo de este trabajo fue determinar las infecciones bacterianas y fúngicas asociadas con pacientes transplantados de médula ósea y los patrones de sensibilidad y resistencia frente a los antimicrobianos. Se analizaron 79 muestras de pacientes transplantados de médula ósea, mediante coloraciones y cultivos en: agar, sangre, McConkey, chocolate con polienriquecimiento, y B. D. Bactec, pruebas bioquímicas para identificación y antibiograma por la técnica de difusión del disco Bauver-Kirby, siguiendo las normas de la NCCLS, utilizando patrón de McFarland (0.5) y cepas controles ATCC. Los resultados obtenidos fueron: 29,11 por ciento (23/79) cultivos positivos, 82,61 por ciento (19/23) infecciones bacterianas, cocos Gram-positivos: 89,48 por ciento (17/19), 52,94 por ciento (9/17) S. auerus, 47,06 por ciento (8/17) C. coagulasa-negativos; 4,35 por ciento (1/19), bacilos Gram-negativos: P. mirabilis 4,35 por ciento (1/19) bacilos Gram-positivos: Bacillus sp. y 17,39 por ciento (4/23) por hongos: Aspergillus sp. En cuento a la sensibilidad de los antimicrobianos se pudo observar que S. aureus fue sensible a: vancomicina, clindamicina, trimetoprim-sulfametaxol, oxacilina y amikacina; S. epidermis sensible a: rifampicina, tetraciclina, vancomicina y trimetoprim-sulfametoxazol. En conclusión el S. aureus y S. epidermis fueron los principales agentes causales de infección en estos pacientes, observando que vancomicina y trimetoprim-sulfametoxazol fueron los que presentaron mayor porcentaje de sensibilidad en ambos microorganismos

Brucella isolated from bone marrow.

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.

Análise microbiológica de ossos de cäes conservados por longo período de tempo na glicerina a 98 por cento à temperatura ambiente, objetivando a enxertia óssea / Microbiology analysis of dog bones stocked for long period of time on glycerin 98 percent at room temperature, aiming allograft bone surgery

Objetivo: Verificar crescimento de microorganismos em amostras de glicerina e ossos armazenados durante nove anos. Métodos: Realizou-se a análise microbiológica da epífise e da medula de ossos conservados na glicerina a 98 por cento, bem como da própria glicerina que os contêm. Resultado: O crescimento microbiano observado não foi estatisticamente significante. Conclusão: A glicerina é um excelente meio para conservação de tecido ósseo por longo período de tempo.

Disseminated histoplasmosis in an AIDS patient diagnosed on bone marrow.

A 29 year old male drug addict, who was HIV positive presented with fever and hepatosplenomegaly. Bone marrow examination revealed Histoplasma capsulatum confirmed by PAS & GMS stains. However patient had a rapid downhill course with multiorgan failure and died before specific treatment could be instituted.

Early histopathological changes in bone marrow of Paracoccidioides brasiliensis-infected mice

The involvement of bone marrow in the pathology of experimental P. brasiliensis infection in BALB/c mice was investigated. The histopathological features of bone marrow induced by the fungus were correlated with hematological changes in peripheral blood from 1 to 28 days post-infection. Intense lymphopenia and moderate neutrophilia were detected. The early changes in bone marrow included (i) maturation arrest characterized by an increase immature blood cell precursors, mainly of granulocytic origin, (ii) intense vascular congestion when compared with the vessels of normal marrow, and (iii) an increased number of megakaryocytes. The normal histological pattern of bone marrow was restored by 28 days post-infection. No histologically recognizable lesion, such as granuloma formation or an abnormal cellular infiltrate, which could indicate the presence of the P. brasiliensis in bone marrow, was observed. In addition, special stains were unable to detect the fungus. The mechanisms responsible for the alterations described here are still unclear but are probably related to more general phenomena affecting the host rather than the direct damage of the precursors cells by P. brasiliensis.

Bone marrow examination for identifying malaria in fever of unknown origin.

To determine the utility of bone marrow examination for the diagnosis of malaria in patients with persistent fever for prolonged duration, we prospectively studied individuals undergoing diagnostic bone marrow examinations between January 1992 to December 1996. All marrow examinations of patients were examined microbiologically and resulted in diagnosis of malaria in 6.6% of the total patients studied. No case of bacterial, mycobacterial or fungal infection was diagnosed. The diagnostic efficacy of bone marrow for evidence of malaria was very useful in febrile individuals for whom the diagnosis was otherwise unknown.