Clinicopathological and radiographic features in 40 cats diagnosed with pulmonary and cutaneous Rhodococcus equi infection (2012-2018).

OBJECTIVES: This retrospective study aimed to describe clinical manifestations, diagnostic options, radiological features, therapeutic plans and outcomes for cats infected with Rhodococcus equi. METHODS: Forty cats aged between 2 months and 11 years old (median 6 months) that were definitively diagnosed with rhodococcosis between 2012 and 2018 were recruited in this study. Medical records were reviewed for information on signalment, history, clinical presentation, diagnostic testing, treatment plans and clinical outcomes. RESULTS: Of the 40 cats, 36 showed the pulmonary form of the disease, with 35 (87.5%) presenting with dyspnoea, while four cats presented with only cutaneous lesions. Mean body temperature was 38.7 ± 0.2°C. Dyspnoea was noted in 87.5% of the cats. Leukocytosis (58.3%) with band neutrophilia (83.3%), monocytosis (58.3%) and thrombocytopenia (55.5%) were prominent findings in the haematology reports. Hyperproteinaemia (61.1%) with hypoalbuminaemia (22.2%) and hyperglobulinaemia (63.8%) with a low albumin:globulin ratio (38.9%) were prominent features of blood biochemistry reports. An alveolar-interstitial pattern was noted in 75% of pre-thoracocentesis radiographs. Pleural effusion, hepatomegaly, thoracic lymphadenopathy and atelectasis of any lung lobe were seen in 88.9%, 75%, 41.7% and 36.1% of cats, respectively. Overall, the mortality rate was 67.5% in both forms. CONCLUSIONS AND RELEVANCE: Clinicians should be aware that feline rhodococcosis manifests as a pulmonary disease at a much higher rate than previously reported. Further studies are required to address the epidemiology, pathophysiology, disease management and prognosis of feline rhodococcosis. The role of immunosuppression as a predisposing factor in feline rhodococcosis requires further investigation.

Clinicodermoscopic study of histoid leprosy: a case series.

BACKGROUND: Histoid leprosy (HL) is a highly bacilliferous form of leprosy which requires early diagnosis and management. Dermoscopy is a noninvasive diagnostic method for various malignant and nonmalignant disorders. The aim of this study was to describe the dermoscopic patterns of various types of HL lesions over different body parts. METHODS: This was a hospital-based observational study which evaluated the clinical and dermoscopic features of a series of patients with the diagnosis of HL. The diagnosis was confirmed clinically, histologically, and through the demonstration of bacilli. A handheld dermatoscope at 10x magnification in polarized mode was employed to examine multiple lesions over various body sites. RESULTS: A total of four patients (three female, one male) were included. Papules were the most common type of lesion, and limbs were most frequently involved. Linear branching vessels and shiny white structures were present in all cases and in all lesion types. The linear branching vessels frequently presented in the form of crown vessels. Ulcerated lesions and umbilicated lesions also showed prominent vascularity. Follicular plugging was observed in the lesions over limbs. CONCLUSION: Dermoscopy may aid in the diagnosis of HL by showing prominent dermoscopic features such as linear branching vessels and shiny white structures.

High accuracy of recognition of common forms of folliculitis by dermoscopy: An observational study.

BACKGROUND: Clinical differentiation of folliculitis types is challenging. Dermoscopy supports the recognition of folliculitis etiology, but its diagnostic accuracy is not known. OBJECTIVE: To assess the diagnostic accuracy of dermoscopy for folliculitis. METHODS: This observational study included patients (N = 240) with folliculitis determined on the basis of clinical and dermoscopic assessments. A dermoscopic image of the most representative lesion was acquired for each patient. Etiology was determined on the basis of cytologic examination, culture, histologic examination, or manual hair removal (when ingrowing hair was detected) by dermatologist A. Dermoscopic images were evaluated according to predefined diagnostic criteria by dermatologist B, who was blinded to the clinical findings. Dermoscopic and definitive diagnoses were compared by dermatologist C. RESULTS: Of the 240 folliculitis lesions examined, 90% were infections and 10% were noninfectious. Infectious folliculitis was caused by parasites (n = 71), fungi (n = 81), bacteria (n = 57), or 7 viruses (n = 7). Noninfectious folliculitis included pseudofolliculitis (n = 14), folliculitis decalvans (n = 7), and eosinophilic folliculitis (n = 3). The overall accuracy of dermoscopy was 73.7%. Dermoscopy showed good diagnostic accuracy for Demodex (88.1%), scabietic (89.7%), and dermatophytic folliculitis (100%), as well as for pseudofolliculitis (92.8%). LIMITATIONS: The diagnostic value of dermoscopy was calculated only for common folliculitis. Diagnostic reliability could not be calculated. CONCLUSION: Dermoscopy is a useful tool for assisting in the diagnosis of some forms of folliculitis.

Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report.

Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.

A unique finding on gallium-67 scintigraphy: widespread fatal skin manifestations of Pseudomonas sepsis.

We report a case of a 25-year-old woman presented with neutropenic fever after chemotherapy for the relapse of acute biphenotypic leukemia. Gallium-67 scintigraphy for the detection of infectious foci demonstrated a unique pattern of numerous foci with intense and varying-sized radioactivity spreading throughout the body. The subsequent skin biopsy and culture proved Pseudomonas infection. Therefore, this unique image, in combination with clinical information, was compatible with cutaneous manifestations of Pseudomonas sepsis. Eventually, the patient died of uncontrolled systemic infection despite the aggressive antibiotic treatment. This case reminded clinicians and nuclear medicine physicians to notice the potentially fatal finding on gallium-67 scan.

Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain?

Soft tissue infections frequently prompt visits to the pediatric emergency department. The incidence of these infections has increased markedly in recent years. The emergence of community-acquired methicillin-resistant Staphylococcus aureus is associated with an increasing morbidity, mortality, and frequency of abscess formation. Bedside ultrasound may have a significant impact in the management of patients that present to the pediatric emergency department with soft tissue infections, including cellulitis, cutaneous abscess, peritonsillar abscess, and necrotizing fasciitis. Ultrasound is an efficient, noninvasive diagnostic tool which can augment the physician's clinical examination. Ultrasound has been shown to be superior to clinical judgment alone in determining the presence or the absence of occult abscess formation, ensuring appropriate management and limiting unnecessary invasive procedures.

Staphylococcal tricuspid valve endocarditis in patients with structurally normal hearts and no evidence of narcotic abuse.

We report four cases of staphylococcal tricuspid valve endocarditis in patients with structurally normal hearts and no evidence of intravenous drug abuse. The only risk factor was superficial skin sepsis in three of these patients. Medical therapy was successful in all four cases.