Cytological diagnosis of filarial infection in an endemic area where screening and prophylaxis is in place.

OBJECTIVE: Filariasis has a worldwide distribution. However, the disease is often overlooked or misdiagnosed because of its unusual presentations and there may be false-negative results in endemic areas. This study was carried out to assess the role of cytology in the demonstration of filarial parasites in an area where screening and prophylaxis are in place. METHODS: This study was carried out in Wardha district in central India, which is endemic for filarial infection. A total of 9182 smears of cases undergoing cytological evaluation were routinely screened at the time of reporting for the presence of adult filarial worm, microfilarial larvae or their fertilized and unfertilized eggs, irrespective of their original clinical diagnosis. RESULTS: Microfilariae were found incidentally in fine needle aspiration (FNA) smears of patients presenting with other clinical conditions. Smears of seven cases were found to be positive for microfilaria. Four cases presented with subcutaneous nodules in the upper arm, two cases were seen incidentally in axillary lymph node aspirates and microfilariae were found in the pleural fluid in one case. Another case was suspected to have breast cancer, but aspirates from the axillary area showed lymphatic obstruction considered to be due to filariasis. CONCLUSION: FNA cytology is an inexpensive, simple and easy procedure for detecting microfilariae. Detection of microfilariae may not be common even in endemic areas as screening and prophylaxis is routinely performed, and patients may show atypical presentations such as subcutaneous nodules. We believe that careful screening of FNAs, especially those from subcutaneous swellings, as well as serous fluids, is very important in a filariasis-endemic zone.

Quantitative assessment of DNA damage directly in lens epithelial cells from senile cataract patients.

PURPOSE: Most of the studies regarding DNA damage in lens epithelial cells (LECs) of cataract patients have been done on lymphocyte or human LECs cultures. Studies of DNA damage directly in LECs of cataract patients are scanty and, to our knowledge, neither photographic evidence nor has a quantitative assessment of DNA damage have been put forward. In our study, we assessed and quantified DNA damage directly in the LECs of senile cataract patients, right after cataract surgery. METHODS: LECs were taken from different morphologic types of senile cataract patients after surgery and DNA damage was immediately assessed by comet assay. Quantitative assessment of DNA damage was conducted using CometScore ™ software. RESULTS: There were no prominent comets in most of the LECs of the control subjects, but comets were found in cataractous LECs. DNA fragments in the tail of the comet gave smearing (not banded), which was indicative of chemical damage (i.e., not site specific). DNA damage in the LECs of cataract patients was highly significant (p<0.001). DNA damage in cortical cataracts was significant (p<0.01) when compared to that of nuclear or posterior subcapsular cataracts, but the DNA damage between nuclear and posterior subcapsular cataracts was not significant. Furthermore, we found disrupted nuclear membranes in some of the nuclei in LECs of patients, but not in the control subjects. CONCLUSIONS: In senile cataract patients, LECs DNA was randomly damaged and this type of damage was possible by reactive oxygen species (ROS). The damage was found maximally in the cortical type of cataracts. Oxidative DNA damage of the LECs may be one of the etiology of senile cataractogenesis.

Accuracy of a multispecies rapid diagnostic test kit for detection of malarial parasite at the point of care in a low endemicity region.

Although highly accurate rapid diagnostic tests (RDT) for Plasmodium falciparum [based on identification of histidine-rich protein-2 (PfHRP2)] have been developed, the accuracy of non-falciparum tests is relatively poor. Recently, a Plasmodium vivax-specific RDT [based on identification of species-specific lactate dehydrogenase (PvLDH)] became available, which along with PfHRP2 may improve malaria diagnosis by identifying the species correctly. A cross-sectional hospital-based study was designed to evaluate the diagnostic accuracy of FalciVax, a commercially available PfHRP2- and PvLDH-based RDT (index test), using malaria microscopy as a reference standard. All consecutive inpatients who presented with fever underwent both the index test and the reference standard. The study sample included 657 patients and the overall sensitivity and specificity of the RDT for diagnosis of any malarial species were 92.9% and 98.4%, respectively. The diagnostic accuracy estimates for correct species identification were lower (sensitivity 91.8%, specificity 96.8%). The accuracy of the PvLDH test to detect P. vivax was low (sensitivity 76.6%, specificity 98.1%).

Adenocarcinoma of the rete testis with uncommon presentation as haematocele.

Adenocarcinoma of the rete testis was encountered in a 62-year-old man. The tumour was localised in the region of the testicular hilum as a greyish-white nodule that showed no involvement of the adjacent testicular parenchyma or the epididymis. On microscopical examination, there was a well-differentiated adenocarcinoma separated by fibrovascular stroma, entirely confined to the testicular hilum. This primary carcinoma of the rete testis presented as a haematocele.

Study of M. tuberculosis ES-31 and ES-20 antigen levels in different pathogenic grades of lymph node tuberculosis.

OBJECTIVE: To study tuberculous excretory-secretory (ES) 31 and ES-20 antigens in different pathogenic grades of lymph node tuberculosis (TB). DESIGN: The study group included lymph node TB patients showing granuloma with mature epithelioid cells based on cytology findings (strong immune response group, SI) and patients showing no granuloma formation and acellular necrosis (weak immune response group, WI). Sandwich ELISA was performed using affinity purified antibodies against Mycobacterium tuberculosis ES-31 and ES-20 antigens to assay free and immune complexed antigen levels in the serum of these patients. RESULTS: Higher levels of immune complexed ES-31 (geometric mean titre [GMT] 848) and ES-20 (GMT 1818) antigens than free ES-31 (GMT 462) and ES-20 (GMT 647) were observed in WI patients. There were higher levels of immune complexed ES-20 antigen levels (GMT 1818) in WI patients than in SI lymph node TB patients; the difference was significant (P < 0.05). CONCLUSION: Elevated levels of immune complexed ES-20 antigen in patient's serum may be a useful immunological marker for weak immune response patients in lymph node TB.

Sero-reactivity of two different antigenic protein fractions of M.tb H37Ra excretory-secretory antigen in pulmonary and extra-pulmonary tuberculosis.

Excretory-secretory proteins of Mycobacterium tuberculosis H37Ra, have been of diagnostic interest in pulmonary (PTB) and extrapulmonary tuberculosis (EPTB). Two different excretory-secretory antigenic proteins of M.tbH37Ra viz., EST-DE1 (a 6% TCA soluble and DEAE anion exchange purified antigen) and ESAS-7 (50% ammonium sulphate solubilized and SDS-PAGE fractionated antigen) were studied in stick-indirect penicillinase ELISA for detecting tuberculous IgG antibodies in serum samples of pulmonary as well as extrapulmonary tuberculosis (tuberculous lymphadenopathy (TBLN), tuberculous meningitis (TBM), bone & joint tuberculosis (B&J TB), abdominal tuberculosis (Abd. TB) patients. The ESAS-7 antigen has shown comparatively better seroreactivity (90%) than that of EST-DE1 antigen in pulmonary tuberculosis cases. The overall specificity of 93.2% using ESAS-7 antigen was also found better compared to 86.4% obtained using EST-DE1 antigen. Further, in extra pulmonary tuberculosis group, using ESAS-7 antigen 84% (21/25) of histopathologically confirmed TBLN cases and 90% (9/10) clinically diagnosed and ATT responded TBM cases showed positive reaction for tuberculous IgG antibody. The per cent positivity using EST-DE1 antigen was however comparatively low in TBLN and TBM cases, (76% and 80% respectively). In histopathologically proven bone and joint tuberculosis and abdominal tuberculosis cases EST-DE1 antigen showed better sensitivity of 75% and 83.3% respectively in IgG antibody detection compared to that of ESAS-7 antigen (50% and 66% respectively). From the present study, it can be envisaged that ESAS-7 antigenic fraction has a good potential in the diagnosis of pulmonary and certain extra-pulmonary tuberculosis infection (TBLN & TBM) whereas EST-DE1 was found to be better in detecting specific antibodies in bone & joint and abdominal tuberculosis.

Myospherulosis of maxillary sinus--a case report with review of literature.

Myospherulosis is a rare condition. The authors report a unique case of this entity arising in paranasal sinus. The review of literature with emphasis on pathogenesis is also discussed.