Linfadenitis por Mycobacterium en pacientes inmunocompetentes y viviendo con VIH/sida / Lymphodenitis by Mycobacterium in immunocompetent and living with HIV/AIDS patients

Introducción: La coinfección del virus de inmunodeficiencia humana (VIH) y la tuberculosis ha alterado su presentación histológica, esto es particularmente frecuente en las linfadenitis. Objetivos: Realizar la caracterización etiológica de linfadenopatías producidas por el género Mycobacterium, destacar la importancia del diagnóstico precoz de esta enfermedad para evitar diseminación de la infección, tanto en pacientes inmunocompetentes como inmunodeficientes, específicamente con VIH/sida. Método: Se realizó estudio descriptivo-prospectivo entre enero de 2017 y enero de 2019. Durante este período se recibieron 5640 muestras, de estas 81 obtenidas a partir de tejido ganglionar; la toma de muestra mayoritariamente fue quirúrgica 74 (91,35 por ciento) y 7 (8,64 por ciento) por biopsia aspirativa (BAAF). Del total de muestras, 60 (74,07 por ciento) procedían de pacientes con VIH/sida, las muestras se descontaminaron por el método de ácido sulfúrico al 4 por ciento, se cultivaron en medio sólido Löwenstein-Jensen e incubaron a 37°C. Se realizaron lecturas semanalmente. Para identificar Mycobacterium tuberculosis se realizó la prueba rápida comercial inmunocromatográfica SD TB AgMPT64. Resultados: De 81 muestras analizadas se obtuvieron 22 (27,16 por ciento) aislamientos, 16 (72,72 por ciento) de Mycobacterium tuberculosis, y 6 (27,27 por ciento) de especies no tuberculosas. De estas, 18 (81,81 por ciento) procedían de pacientes con VIH/sida. Conclusión: Por todo lo antes expuesto es importante la vigilancia diagnóstica en este tipo de infección extrapulmonar, tanto para M. tuberculosis como para otras especies no tuberculosas y poder comenzar tempranamente el tratamiento específico evitando la diseminación de la infección, pues esta puede tener consecuencias fatales, sobre todo en pacientes con algún tipo de inmunosupresión, como aquellos con VHI/sida. Si un paciente mantiene fiebre prolongada, con linfadenopatías, sin síntomas respiratorios y no responde a los tratamientos con antibióticos, es necesario pensar en este tipo de infección(AU)

Introduction: The coinfection of human immunodeficiency virus (HIV) and tuberculosis has altered its histological presentation; this is particularly frequent in lymphadenitis. Objective: To carry out the etiological characterization of lymphadenopathies produced by the genus Mycobacterium, highlighting the importance of early diagnosis of this disease to avoid dissemination of the infection, both in immunocompetent and immunodeficient patients, specifically HIV / AIDS. Methods: A descriptive-prospective study was carried out between January 2017 - January 2019. During this period, 5640 samples were received, of these 81 obtained from lymph node tissue, the sample collection was mostly surgical 74 (91.35 percent) and 7 (8.64 percent) by aspiration biopsy (BAAF). Of the total samples, 60 (74.07 percent) were from HIV / AIDS patients, the samples were decontaminated by the 4 percent sulfuric acid method and cultured in solid Löwenstein-Jensen medium and incubated at 370C, the readings were made weekly. For the identification of Mycobacterium tuberculosis, the commercial SD TB AgMPT64 immunochromatographic rapid test was performed. Results: Of 81 samples analyzed, 22 (27.16 percent) isolates were obtained, 16 (72.72 percent) of Mycobacterium tuberculosis (MTB), and 6 (27.27 percent) of non-tuberculous species, of these 18 (81.81%) were from HIV / AIDS patients. Conclusion: For all the above, diagnostic surveillance is important in this type of extrapulmonary infection, both for M tuberculosis and for other non-tuberculous species and to be able to start specific treatment early, avoiding the spread of the infection, since it can have fatal consequences on all in patients with some type of immunosuppression, such as HIV/AIDS. If a patient maintains a prolonged fever, with lymphadenopathy, without respiratory symptoms and does not respond to antibiotic treatment, it is necessary to consider this type of infection(AU)

Clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome: an analysis of 13 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, a polygenic and multifactorial autoinflammatory disease with unknown pathogenesis.@*METHODS@#A retrospective analysis was performed on the medical data of 13 children with PFAPA syndrome.@*RESULTS@#All 13 children had disease onset within the age of 3 years, with a mean age of onset of (14±10) months. They all had periodic fever, with 8-18 attacks each year. The mean interictal period of fever was (30±5) days. Pharyngitis, cervical adenitis, and aphthous stomatitis were the three cardinal symptoms, with incidence rates of 100% (13/13), 85% (11/13), and 38% (5/13) respectively. There were increases in white blood cells, C-reactive protein, and erythrocyte sedimentation rate during fever. Of all the 13 children, 6 underwent whole exome sequencing and 7 underwent panel gene detection for autoinflammatory disease, and the results showed single heterozygous mutations in the @*CONCLUSIONS@#For children with unexplained periodic fever with early onset accompanied by pharyngitis, cervical adenitis, aphthous stomatitis, elevated inflammatory indices, and good response to glucocorticoids, PFAPA syndrome should be considered. This disorder has good prognosis, and early diagnosis can avoid the long-term repeated use of antibiotics.

Sarcoidose como diagnóstico diferencial de mieloma múltiplo / Sarcoidosis as a differential diagnosis of multiple myeloma

A sarcoidose caracteriza-se como doença granulomatosa que acomete diferentes órgãos humanos, especialmente os pulmões, sendo sua patogênese pouco conhecida. No caso em questão, a paciente iniciou com sintomas inespecíficos, como fraqueza, perda ponderal e tosse seca esporádica, sendo internada para extensão da propedêutica. Sugeriu-se como hipótese diagnóstica inicial possível quadro de mieloma múltiplo, tendo em vista a anemia, a disfunção renal, a hipercalcemia e, sobretudo, as lesões osteolíticas apresentadas pela paciente. Todavia, o diagnóstico de sarcoidose foi selado a partir das biópsias de medula óssea e de linfonodo inguinal, que evidenciaram mielite e linfadenite granulomatosas, respectivamente. A terapêutica instituída baseou-se na administração de corticosteroides e em medidas de redução da calcemia. A paciente recebeu alta, com melhora do quadro clínico, para acompanhamento ambulatorial da doença. Conclui-se que a sarcoidose não possui tratamento curativo, mas a terapêutica imunossupressora é eficaz no controle da progressão da enfermidade, fazendo com que o paciente tenha um prognóstico favorável.

Sarcoidosis is characterized as a granulomatous disease that affects different human organs, especially the lungs, and its pathogenesis is little known. In this case, the patient started with nonspecific symptoms, such as weakness, weight loss, and sporadic dry cough, being hospitalized for extension of the propaedeutics. The initial diagnostic hypothesis suggested was a possible case of multiple myeloma, based on the anemia, renal dysfunction, hypercalcemia and, above all, the osteolytic lesions presented by the patient. However, the diagnosis of sarcoidosis was made after bone marrow and inguinal lymph node biopsies that showed granulomatous myelitis and lymphadenitis, respectively. The therapy instituted was based on the administration of corticosteroids and on measures to reduce the level of calcium. The patient was discharged, with clinical improvement, for outpatient follow-up of the disease. It is concluded that sarcoidosis has no curative treatment, but immunosuppressive therapy is effective in controlling the progression of the disease, giving the patient a favorable prognosis.

Síndrome celulitis-adenitis, una forma infrecuente de presentación de la sepsis neonatal tardía: A propósito de dos casos / Adenitis-cellulitis syndrome, an infrequent form of presentation of the late-onset neonatal septicemia: Report of two cases

La sepsis es la principal causa de mortalidad neonatal. La forma precoz, habitualmente, está relacionada con la colonización recto-vaginal u otros factores de riesgo materno. En la forma tardía, es difícil establecer su origen; por lo general, es nosocomial o de la comunidad. El Streptococcus agalactiae (Streptococcus beta-hemolítico del grupo B) es el germen implicado con más frecuencia en la sepsis neonatal en países desarrollados. La forma tardía, generalmente, se presenta con septicemia y meningitis, y, en ocasiones, pueden detectarse infecciones osteoarticulares o de piel y tejidos blandos. El síndrome celulitis-adenitis en la región cervical, forma poco frecuente de presentación, es causado por Staphylococcus aureus y, ocasionalmente, por Streptococcus agalactiae. Se reportan 2 casos de sepsis neonatal tardía con clínica de celulitis-adenitis cervical causados por Streptococcus beta-hemolítico del grupo B, con una evolución satisfactoria con terapia antibiótica de amplio espectro.

Septicemia is the main cause of neonatal mortality. The early-onset neonatal sepsis is usually related to maternal factor risks including recto-vaginal colonization. In the late-onset neonatal septicemia it is more difficult to establish the etiology because the majority of the cases are nosocomial or community related. The Streptococcus agalactiae (beta-hemolytic Streptococcus) is the most frequent germ associated with neonatal sepsis in developed countries. The late-onset form usually occurs with septic symptoms and meningitis and, in a few cases, with osteoarticular, skin and soft tissue infection. Adenitis-cellulitis syndrome is rarely seen, and its main cause is Staphylococcus aureus, followed by Streptococcus agalactiae. We report two cases of group B Streptococcus late-onset neonatal septicemia, both of them with adenitis-cellulitis syndrome. Patients recovered uneventfully after an adequate antibiotic therapy.

Fiebre periódica con estomatitis aftosa, faringitis, y adenitis / Periodical fever with aphthous stomatitis, pharyngitis, and adenitis (PFAPA syndrome)

RESUMEN Se presenta un caso de fiebre periódica con estomatitis aftosa, faringitis, y adenitis síndrome de fiebre periódica con estomatitis aftosa, faringitis, y adenitis, entidad aparentemente infrecuente de la cual no se recoge reporte en el país. La etiología no es todavía bien comprendida, se observa con mayor frecuencia entre los 2 y 5 años, aunque se han descrito casos en adultos. Se caracteriza por fiebre periódica con estomatitis aftosa, faringitis, y adenitis de carácter periódica con una dramática respuesta al uso de esteroide en la mayoría de los casos. El caso que se presenta es un paciente de 5 años de edad, sexo masculino, con cuadros de fiebre periódica asociado a amigdalitis con exudado, adenitis y lesiones aftosas, con respuesta en la fase aguda a la prednisona y con respuesta al tratamiento de mantenimiento con cimetidina. En la actualidad lleva 11 meses en remisión (AU).

ABSTRACT We present a case of periodical fever with aphthous stomatitis, pharyngitis and adenitis (PFAPA syndrome), entity that is apparently infrequent and its report in the country was not found. Its etiology is not still clearly understood. It appears with higher frequency in the ages between 2 and 5 years, though it has been described in adult population. It is characterized by periodical fever with aphthous stomatitis, pharyngitis and adenitis of periodical character, with a dramatic answer to the use of steroids in most of the cases. The case that is presented is the one of a male patient aged 5 years with reiterative periodical fever associated to tonsillitis with exudate, adenitis and aphthous lesions, with answer, in the acute phase, to prednisone, and to cimetidine at the maintenance therapy. Nowadays, he is already 11 months in remission (AU).

Tuberculosis ganglionar / Ganglionar tuberculosis

Introducción: La tuberculosis es una enfermedad que aún se diagnostica en Cuba. Aunque la forma pulmonar predomina, se presentan en ocasiones diversas formas localizadas a otros órganos y tejidos, dentro de ellas la forma ganglionar. Caso clínico: Se presenta una joven de 21 años con fiebre de 15 días de evolución y aumento de volumen no doloroso de los ganglios del cuello y preauricular izquierdo. Luego de tratamiento antibiótico la fiebre desaparece pero las adenopatías persisten. Se hace una primera exéresis ganglionar la cual arroja una adenitis crónica agudizada con abscedación. Se realiza Mantoux el cual arroja un resultado de 32 mm. El Rx de tórax y la tomografía axial computadorizada tóraco-abdominal no arrojaron ninguna alteración. Se hace una nueva exéresis ganglionar cuyo estudio anatomopatológico informa la presencia de granulomas caseificados. El estudio microbiológico del tejido arrojó Mycobacterium tuberculosos, codificación 8. Comentarios: La tuberculosis ganglionar es la primera forma de tuberculosis extrapulmonar en aquellos países con baja incidencia de esta enfermedad. Es más frecuente en mujeres y en la localización cervical. La cutirreacción de Mantoux hiperérgica es orientadora en el diagnóstico, pero se requiere del estudio histológico de un ganglio con la presencia de granulomas caseificados y la demostración del bacilo en este tejido. Se presenta este caso para recordar que esta entidad debe ser tenida en cuenta en el estudio de todo síndrome adénico febril y que es necesario que en el estudio histológico de toda exéresis ganglionar deben realizarse las técnicas necesarias para llegar a este diagnóstico(AU)

Introduction: Tuberculosis continues to be a disease diagnosed in Cuba. Although the pulmonary form continues to predominate, several localized forms are sometimes presented to other organs and tissues, including the ganglionic form. Clinical case: A 21-year-old girl presented with a fever of 15 days of evolution and a non-painful volume increase of the neck and left preauricular lymph nodes. After antibiotic treatment the fever disappears but the adenopathies persist. A first lymph node excision is performed, which results in acute chronic adenitis with abscess. Mantoux is performed with a result of 32 mm. The chest X-ray and the thoraco-abdominal CT scan did not show any alteration. A new lymph node excision is performed, whose anatomopathological study reports the presence of caseified granulomas. The microbiological study of the tissue resulted tuberculous Mycobacterium, coding 8. Comments: Lymph node tuberculosis is the first form of extrapulmonary tuberculosis in those countries with low incidence of this disease. It is more frequent in women and in the cervical location. The hyperergic Mantoux is a guide in the diagnosis, but the histological study of a ganglion with the presence of caseified granulomas and the demonstration of the bacillus in this tissue is required. This case is presented to remember that this entity must be taken into account in the study of any febrile adenic syndrome and that it is necessary that in the histological study of any lymph node excision the necessary techniques must be performed to reach this diagnosis(AU)

Histoplamosis diseminada en una paciente con hipotiroidismo / Disseminated histoplasmosis in a patient with hypothyroidism

La histoplasmosis es una infección causada por el hongo Histoplasma capsulatum, la incidencia de la enfermedad oscila entre 0.1 a 0.29 casos por cada 100 000 habitantes y de estos 1 de cada 2 000 casos se presenta de forma diseminada, manifestándose en personas con inmunosupresión y de forma infrecuente en personas inmunocompetentes. Objetivo: mostrar la relación existente entre hipotiroidismo e histoplasmosis diseminada. Presentación del caso clínico: paciente de 33 años, procedente de Talanga, Francisco Morazán, Honduras, tratada por hipotiroidismo de 3 años de evolución con levotiroxina 100ug cada día, con tumoración en axila izquierda de hace 2 años, la cual 3 meses previos al ingreso fue tratada por adenitis aguda de forma ambulatoria sin mostrar mejoría. Al examen físico se encontró adenopatía de 2 sospecha de histoplasmosis confirmándose con tinción de Grocott; el examen para virus de inmunodeficiencia humana fue negativo y el perfil inmunológico resultó normal. Conclusión : En este caso la histoplasmosis diseminada se acompañó de hipotiroidismo, no se ha demostrado que conlleve a inmunosupresión, y aún faltan pruebas que establezcan el vínculo de hipotiroidismo como factor predisponente a esta enfermedad...(AU)

Diretrizes de conduta e tratamento de síndromes febris periódicas: síndrome de febre periódica, estomatite aftosa, faringite e adenite / Guidelines for the management and treatment of periodic fever syndromes: periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA). Descrição do método de coleta de evidência: A Diretriz foi elaborada a partir de cinco questões clínicas que foram estruturadas por meio do Pico (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados e avaliados pelo título e resumo 806 trabalhos e selecionados 32 artigos, para sustentar as recomendações. Recomendações: 1. O diagnóstico da PFAPA é clínico e de exclusão, deve a suspeita ser considerada em crianças que apresentam episódios febris de origem indeterminada recorrentes e periódicos ou amidalites de repetição, intercalados com períodos assintomáticos, sobretudo em crianças em bom estado geral e com desenvolvimento pondero-estatural mantido; 2. Os achados laboratoriais são inespecíficos. Não existem alterações patognomônicas nos exames complementares; 3. A evidência que sustenta a indicação do tratamento cirúrgico (tonsilectomia com ou sem adenoidectomia) é baseada em dois ensaios clínicos randomizados não cegos que incluíram pequeno número de pacientes; 4. O uso de prednisona no início do quadro febril em pacientes com PFAPA mostrou ser eficaz. Melhores evidências ainda são necessárias para apoiar seu uso na PFAPA; 5. Apesar de os resultados obtidos de estudos com inibidores de IL-1ß serem promissores, esses são limitados a poucos relatos de casos.

Abstract Objective: To establish guidelines based on scientific evidence for the management of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome. Description of the evidence collection method: The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 806 articles were retrieved and evaluated by title and abstract; from these, 32 articles were selected to support the recommendations. Recommendations: 1. PFAPA is a diagnosis of exclusion established on clinical grounds, and one must suspect of this problem in children with recurrent and periodic febrile episodes of unknown origin, or with recurrent tonsillitis interspersed with asymptomatic periods, especially in children in good general condition and with preservation of weight and height development. 2. Laboratory findings are nonspecific. Additional tests do not reveal pathognomonic changes. 3. The evidence supporting an indication for surgical treatment (tonsillectomy with or without adenoidectomy), is based on two non-blinded randomized clinical trials with small numbers of patients. 4. The use of prednisone at the onset of fever in patients with PFAPA proved to be an effective strategy. There is still need for more qualified evidence to support its use in patients with PFAPA. 5. Despite promising results obtained in studies with IL-1β inhibitors, such studies are limited to a few case reports.

Extensive cervical lymphadenitis mimicking bacterial adenitis as the first presentation of Kawasaki disease / Extensa linfadenite cervical mimetizando adenite bacteriana como primeira manifestação da doença de Kawasaki

Cervical adenitis >1.5cm in diameter is the less frequently observed criteria in patients with Kawasaki disease and it is usually found in association with other symptoms during the acute phase. Moreover, the finding of fever and lymphadenitis with intense local signs of inflammation and phlegmon is rarely seen as the initial manifestation of Kawasaki disease. We report the case of a 7-year-old boy who had cervical lymphadenitis with adjacent cellulitis and phlegmon mimicking bacterial adenitis as the first presentation of Kawasaki disease. The patient had fever, cervical lymphadenitis with adjacent cellulitis, and severe headache. Cefadroxil was prescribed based on the clinical diagnosis of bacterial adenitis. Because he remained febrile and phlogistic signs worsened, after 1 day of hospitalization, antibiotics were administrated intravenously (ceftriaxone and oxacillin). The computed tomography of the neck showed primary infectious/inflammatory process. On the fourth day, the patient had dry and scaly lips, and treatment with oxacillin was replaced by clindamycin because the patient was still febrile. On the ninth day, he presented non-exudative bilateral conjunctival injection. On the tenth day of febrile disease, a rash appeared on his trunk, hands and feet. Patient’s symptoms resolved after intravenous administration of immunoglobulin (2g/kg/dose), and he was discharged 2 days later. On the 14th day, the patient had lamellar desquamation of fingers. Kawasaki disease should be considered as a differential diagnosis in children with febrile cervical lymphadenitis unresponsive to empiric antibiotics even if they have adjacent cellulitis and phlegmon.

Adenite cervical >1,5cm é o critério menos frequentemente observado em pacientes com doença de Kawasaki e manifesta-se habitualmente em associação com os demais sintomas da fase aguda. Entretanto, linfadenite febril isolada com intensos sinais flogísticos e flegmão é raramente observada como primeira manifestação da doença de Kawasaki. Assim, relatou-se aqui um caso de uma criança que apresentou linfadenite cervical com celulite adjacente e flegmão mimetizando adenite bacteriana como primeira manifestação da doença de Kawasaki. Paciente previamente hígido, 7 anos, masculino, iniciou quadro de febre, adenite cervical com celulite adjacente e cefaleia intensa, sendo prescrita cefadroxila devido ao diagnóstico clínico de linfadenite bacteriana. Por se manter febril e com piora dos sinais flogísticos, após 1 dia foi internado para receber antibioticoterapia endovenosa (oxacilina e ceftriaxona). Tomografia computadorizada da região cervical mostrou processo infeccioso/inflamatório primário. No quarto dia, apresentou lábios ressecados e descamativos, sendo a oxacilina substituída por clindamicina devido à persistência da febre e sinais flogísticos. No nono dia, iniciou hiperemia ocular não exsudativa. No décimo dia de febre, apresentou exantema em tronco, membros, mãos e pés. Recebeu gamaglobulina endovenosa (2g/kg/dose), evoluiu com resolução dos sintomas e, após 2 dias, recebeu alta hospitalar. No 14odia, apresentou descamação lamelar dos dedos das mãos. Portanto, doença de Kawasaki deve ser considerada no diagnóstico diferencial das linfadenites cervicais febris na infância não responsivas à antibioticoterapia empírica, mesmo que esteja presentes celulite adjacente e flegmão.

Evaluation of a MPB70-ELISA to differentiate Mycobacterium bovis from M. avium-sensitized swine / Avaliação de um MPB70-ELISA para diferenciar entre suínos sensibilizados com Mycobacterium bovis ou M. avium

Swine are susceptible to different mycobacteria species, being Mycobacterium bovis an agent of tuberculosis, with most significant zoonotic risks, while M. avium determines a granulomatous lymphadenitis with low zoonotic risk. Currently performed intradermal tests present some important limitations, such as the lack of ability to detect anergic animals or to differentiate among mycobacterial species. In order to improve the TB diagnosis, serological assays have been developed, with encouraging results. The purpose of this study was to evaluate the performance of a MPB70-ELISA in 82 piglets divided into four groups: sensitized by inactivated M. bovis, M. avium, inoculated with oil adjuvant, or with saline solution. The test was able to discriminate between an animal sensitized by M. bovis and animals of the three other groups, including M. avium-sensitized animals; for this reason, we suggest that MPB70-ELISA could be used as a complementary tool for discriminating the agent of the mycobacteriosis, and therefore to diagnose tuberculosis in a swine herd.(AU)

Suínos são suscetíveis a diferentes espécies de micobactérias, sendo Mycobacterium bovis agente de tuberculose (TB), com claro risco zoonótico, enquanto M. avium determina uma linfadenite granulomatosa (LG) de baixo risco zoonótico. Os testes intradérmicos atualmente realizados apresentam algumas limitações importantes, como a falta de habilidade em detectar animais anérgicos ou de diferenciar entre as espécies micobacterianas. Com o intuito de melhorar o diagnóstico de TB, testes sorológicos têm sido desenvolvidos, com resultados encorajadores. O objetivo do presente estudo foi avaliar um MPB70-ELISA em 82 leitões divididos em quatro grupos: sensibilizados por M. bovis, por M. avium, inoculados com óleo adjuvante ou com solução salina. O teste foi capaz de discriminar entre os animais sensibilizados com M. bovis dos demais três grupos, incluindo aqueles que foram sensibilizados com M. avium; desta forma, sugere-se que o MPB70-ELISA poderia ser utilizado como ferramenta complementar para discriminar o agente da micobacteriose, e portanto diagnosticar TB em um plantel de suínos.(AU)

Linfadenitis por vacuna BCG / Lymphadenitis due to BCG

La linfadenitis secundaria a la vacunación con BCG (Bacilo Calmette Guérin) mal llamada becegeitis, es un proceso inflamatorio localizado provocado por el bacilo en ganglios linfáticos regionales. Se indica el uso de la ecografía como primer método de diagnóstico por imágenes.

Adenitis tuberculosa por Mycobacterium bovis: reporte de caso / Tuberculous adenitis from Mycobacterium bovis: a case report

Introducción. La linfadenitis tuberculosa, que en la actualidad es producida con mayor frecuencia por Mycobacterium tuberculosis, alguna vez fue causada esencialmente por Mycobacterium bovis. Objetivo. Describir un caso clínico con adenitis tuberculosa por Mycobacterium bovis que resulta infrecuente. Caso Clínico. Mujer con antecedentes de salud y costumbre de ingerir leche cruda y derivados de la leche caseros no supervisados desde el punto de vista sanitario con adenitis cervical de más de 5 meses de evolución sin otro síntoma. El diagnóstico de adenitis tuberculosa por Mycobacterium bovis se realizó por biopsia, ELISA, RCP y cultivo. Discusión. Aproximadamente del 11 al 25 por ciento de todos los casos de TB son exclusivamente extrapulmonares. La linfadenitis cervical es la presentación periférica más frecuente de esta enfermedad. El tratamiento es aconsejable con 4 fármacos. La cirugía queda reservada para los procedimientos diagnósticos y las complicaciones. Conclusiones. La infección por Mycobacterium bovis es infrecuente en nuestro medio, no obstante debe tenerse en cuenta en la valoración diagnóstica de todo paciente con un síndrome adénico de localización cervical y elementos epidemiológicos.

Introduction. Tuberculous lymphadenitis, which currently is most often caused by Mycobacterium tuberculosis, was once mainly caused by Mycobacterium bovis. Objective. To describe an unusual case of tuberculous adenitis from Mycobacterium bovis. Case report. A woman with a history of consuming raw milk and unsupervised dairy home-made products presents with cervical adenitis of 5 month course unassociated to other symptoms. A diagnosis of Mycobacterium bovis tuberculous adenitis was made by biopsy, ELISA, PCR and culture. Discussion. Approximately 11 to 25 percent of all TB cases are extrapulmonary exclusively. Cervical lymphadenitis is the most common presentation of peripheral disease. Treatment usually is based on four drugs. Surgery is indicated for diagnostic procedures and complications. Conclusion. Mycobacterium bovis infection is uncommon in our environment, but must be considered in the diagnostic evaluation of all patients with cervical adenitis and epidemiological correlations.

FNAC of Lymph Node Disorders.

Introduction: Fine needle aspiration cytology (=FNAC) is most popular diagnostic aid in patients with lymphadenopathy. This paper proves it to be highly sensitive also. Materials and Methods: The study comprises 300 lymph node aspirates done at Shri Mahant Indiresh Hospital of SGRR Medical College during a period of two years from January 2009 to December 2010. Results: Cytology was unsatisfactory in 3.3% (n=3) cases; showed reactive non specific lymphadenitis in 41.7% (n=125) cases; tuberculosis in 31.7% (n=95) cases; primary lymphomas in 6.3% (n=19) cases and metastatic tumor in 10.7% (n=32) cases. Conclusion: FNAC is a very sensitive procedure in patients with lymphadenopathy; sensitivity of 96.7% reported in our study.

Fine needle aspiration cytology in the diagnosis of superficial lymphadenopathy in children and adolescents: an analysis of 869 cases

Fine needle aspiration cytology [FNAC] in children has gained acceptance gradually and is currently used extensively as an initial diagnostic tool. This study was undertaken to determine the value of FANC in peripheral lymphadenopathy in pediatric and adolescent patients in Kuwait. Retrospective. Mubarak Al-Kabeer Hospital, Kuwait. Eight hundred and sixty-nine children and adolescents [ranging from five months to 20 years] from January 2000 to September 2009. FNAC. The spectrum of disease of lymph nodes in pediatric and adolescent age groups, using FNAC. Out of the 4116 lymph node aspirates performed, the cytology reports of 869 [21.1%] pediatric aspirates were reviewed. There were 409 [51.3%] male and 388 [48.7%] female patients. Seventy-two [8.3%] were considered unsatisfactory. Out of the 797 [91.7%] satisfactory aspirates, reactive lymphoid tissue was reported in 616 cases [77.3%], lymphadenitis in 115 [14.4%], atypical cytology in 18 [2.3%], lymphoreticular malignancy in 46 [5.7%] and metastatic tumor in 2 [0.3%]. The lymphadenitis included 8, 66, 23 and 18 cases of necrosis only, granulomatous lymphadenitis, necrotizing granulomatous lymphadenitis and tuberculous lymphadenitis [where acid fast bacilli were detected respectively. FNAC of lymph nodes in children and adolescents is feasible and reliable. Majority of the nodes revealed reactive lymphoid tissue and helped allay the fears of parents thereby preventing unnecessary surgery

Tuberculous lymphadenitis in southwestern Ethiopia

Tuberculosis is a public health problem in Ethiopia and is one of the major causes of deaths. The present study is aiming at the clinic-pathological interpretation of tuberculosis cervical lymphadenopathy and to apply cheap methods to confirm the presence of Mycobacterium tuberculosis acid fast bacilli in the lymphoid tissues. Sixty cases with cervical lymphadenitis were included, clinical data was obtained from the medical records. Hematoxylin and Eosin staining was done to evaluate the morphological criteria of tuberculous cervical lymphadenitis also the specimens were studied for recognizing the Acid Fast Bacilli. In our study the positive presence of the Acid Fast Bacilli showed a significant statistical associations with the presence of pulmonary tuberculosis; caseation necrosis and HIV serologically positive [p=0.00001, 0.0082 and 0.0272 respectively]; meanwhile there was no significant associations with the age, sex of patient or the family history of tuberculosis [p=0.2011, 0.2330 and 0.2276 respectively]. We conclude that the Iight microscopic assessment is a useful screening method to diagnose tuberculosis in cases of cervical lymphadenitis; moreover, the efficacy of diagnosis was improved when combined with identifying the infecting organism. The procedure in the present study is a cheap reliable method that can he useful in the diagnosis of tuberculosis lymphadenitis and also it can help] in the proper therapeutic approach

Approach of lymphadenopathy in children

Appropriate approach of the lymphadenopathy in children as a common finding is necessary .The proper time for following and checking up the palpable lymph node and its biopsy are significant considerations of approaching lymphadenopathy in children that are described in this review study. The lymphadenopathy could be properly studied using the correct patient history, physical examination and the characteristics of lymph nodes including: generalized or localized and associated signs and symptoms such as organomegaly, skin and mucosal lesions, fever, weight lose and sweating. The lymphadenopathy in children could be resulted from a common and insignificant finding following upper respiratory tract infections to a serious malignant etiology. The correct evaluation of unimportant and serious forms of lymphadenopathy can inhibits the wasting in money and refers on time

Comparação genotípica de isolados de Corynebacterium pseudotuberculosis de caprinos e ovinos do sertão de Pernambuco / Genotypic comparison between Corynebacterium pseudotuberculosis samples obtained from sheep and goats with caseous lymphadenitis, raised in the semi-arid region of Pernambuco

Objetivou-se com este estudo comparar genotipicamente 35 isolados de Corynebacterium pseudotuberculosis recuperados de conteúdo de abscessos de caprinos e ovinos com linfadenite caseosa, procedentes de cinco municípios localizados no Sertão de Pernambuco, Brasil. Utilizou-se a técnica de fingerprint RFLP-PCR com as enzimas de restrição Hpy-Ch4 e Msp1 aplicada ao gene rpoB e as enzimas Pst I e Msp I para o gene pld. Não houve diferença nos padrões de fragmentos de bandas entre os isolados, independente da espécie hospedeira ou da área geográfica estudada, definindo-se um padrão genotípico homogêneo de C. pseudotuberculosis responsável por abscessos superficiais na região.(AU)

The objective was to genotypically compare 35 samples of Corynebacterium pseudotuberculosis obtained from abscesses of sheep and goats diagnosed with caseous lymphadenitis originated from 5 different municipalities in the semi-arid region of Pernambuco, Brazil. The RFLP-PCR technique with Hpy-Ch4 and Msp I and Pst I Msp I restriction enzimes was used to fingerprint the genes rpoB and pld, respectively. The results demonstrate that there was no difference on the fragments banding pattern among samples, independently of the host species or geographic area studied, defining a homogeneous profile of C. pseudotuberculosis responsible for superficial abscesses for the region.(AU)

pattern and frequency of diseases associated with lymphadenopathy

A study of 351 patients of lymphadenopathy was carried out to observe the pattern of various diseases with which these patients were affected. There were 168 male and 183 female patients with male to female ratio of 1:1.09. The youngest patient was 1 year old and the oldest was 80 years of age. The commonest lesion found was tuberculosis in 165 [47%] followed by reactive hyperplasia in 121 [34.5%], metastatic carcinoma in 36 cases [10.3%], malignant lymphoma in 27 cases [7.7%], kikuchi's lymphadenitis in one case [0.28%], and fungal lymphadenitis in one [0.28%]