The Distinction between Dematiaceous Molds and Non-Dematiaceous Fungi in Clinical and Spiked Samples Treated with Hydrogen Peroxide Using Direct Fluorescence Microscopy.

Dematiaceous fungi are pigmented molds with a high content of melanin in their cell walls that can cause fatal infections in immunocompromised hosts. Direct microscopy is the main method for the rapid diagnosis of dematiaceous fungi in clinical specimens. However, it is often difficult to distinguish their hyphae from non-dematiaceous hyphae and yeast pseudohyphae. Our aim was to develop a fluorescence staining method that targets melanin for the detection of dematiaceous molds in clinical specimens. Glass slide smears of clinical samples and sterile bronchoalveolar lavage spiked with dematiaceous and non-dematiaceous fungi were treated with hydrogen peroxide, and digital images were recorded using direct microscopy with different fluorescent filters. The images of fungi were compared for their fluorescence intensity using the NIS-Elements software. The fluorescent signal between dematiaceous and non-dematiaceous fungi demonstrated a markedly increased mean intensity for dematiaceous molds following hydrogen peroxide treatment (7510.3 ± 10,427.6 vs. 0.3 ± 3.1, respectively, p < 0.0001). No fluorescent signal was detected in the absence of hydrogen peroxide. "Staining" fungal clinical specimens with hydrogen peroxide, followed by fluorescence microscopy examination, can differentiate between dematiaceous and non-dematiaceous fungi. This finding can be used for the detection of dematiaceous molds in clinical specimens and enables the early and appropriate treatment of infections.

Pleurisy Can Cause Chest Wall Tenderness: A Case Report.

Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also. LEARNING POINTS: Pleuritic chest pain may be associated with local tenderness and guarding.These unrecognized features of pleurisy supposedly reflect a spinal reflex, initiated by nociceptors in the parietal pleura.Local pain inflicted upon palpation and guarding may not serve as unequivocal indicators of musculoskeletal chest pain.

The role of placental histopathological lesions in predicting recurrence of preeclampsia.

OBJECTIVE: We aimed to study the role of placental pathology in the prediction of preeclampsia (PE) recurrence. METHODS: The medical records and pathological placental reports of all women diagnosed with PE, during 2008-2015, were reviewed. The study population was divided according to the outcome of their subsequent pregnancy: those who did (recurrence group) or did not (no-recurrence group) develop recurrent PE. Data regarding maternal characteristics and placental maternal/fetal vascular malperfusion lesions, of the initial pregnancies, were compared. Two prediction models were generated for PE recurrence. RESULTS: Compared to the no-recurrence group (n = 130), the recurrence group (n = 96) was characterized by lower gestational age (p < 0.001), longer inter-pregnancy interval (p = 0.012), and higher rate of severe features (p < 0.001). By logistic regression analysis composite maternal (aOR = 3.05, 95%CI 1.39-6.71, p = 0.005), fetal (aOR = 9.31, 95%CI 3.9-22.1, p < 0.001), and concurrent maternal + fetal (aOR = 13.94, 95%CI 5.08-38.21, p < 0.001), vascular malperfusion lesions were found to be independently associated with recurrence. A clinical prediction model accounted for 20.8% of PE recurrence (R2 = 0.208, AUC = 0.732), while a clinical-pathological model accounted for 34.2% of recurrence (R2 = 0.342, AUC = 0.80). CONCLUSION: Placental maternal and fetal vascular malperfusion lesions are independently associated with increased risk for PE recurrence. A clinical-pathological prediction model for recurrence of PE is superior to a prediction model based merely on clinical factors. © 2016 John Wiley & Sons, Ltd.