Vinita Agrawal | PubMed Health

PubMed2005

Invasive fungal infections in renal allograft recipients.

Invasive fungal infections contribute significantly to morbidity and mortality in renal allograft recipients. We identified 29 cases of invasive mycoses on histological and/or cytological examination, out of the total 1231 renal transplants performed at our centre over a period of last 15 yrs (1989-2003). A detailed clinical analysis was performed. The time interval between transplant and the occurrence of invasive fungal infection ranged from 15 days to 10.5 yrs. Candida and Aspergillus were the most frequent offenders (66%); Candida alone accounting for 45% of the cases. The most common risk factors were post transplant Cytomegalovirus infection, diabetes mellitus and episodes of acute rejection. Fine needle aspiration cytology, bronchoalveolar lavage and esophageal brush smears aided in prompt diagnosis. Disseminated infection was associated with a high mortality (80%). Management of renal transplant recipients requires identification of risk factors and early clinical suspicion of infection. The role of prophylaxis needs further evaluation.

Adult↗

PubMedDate not supplied

Liver involvement in tuberculosis--an autopsy study.

OBJECTIVE: To study the spectrum of histopathological changes in the liver in cases of tuberculosis. MATERIALS & METHODS: This is an autopsy study consisting of 150 adult cases of tuberculosis over a period of 3 years. The diagnosis of tuberculosis was made on the basis of caseating granulomas or acid fast bacilli in the tissue. Cases showing only healed foci of tuberculosis at autopsy were excluded. Clinical details of all cases were obtained from hospital records. At autopsy, gross examination was done meticulously with special emphasis on the liver and extrahepatic biliary tree. Sections from the liver were processed routinely and histopathological findings were analyzed in detail. RESULTS: Patients were between 21 to 60 years of age with a male: female ratio of 2.1:1. Fever was the commonest symptom (62%). On gross examination, at autopsy, pulmonary and extrapulmonary tuberculosis was seen in 79 (52.6%) and 71 (47.4%) cases respectively. Liver involvement was mainly secondary except in one case. The extrahepatic biliary tree was involved in 18 cases, in the form of external compression of the common bile duct by a group of enlarged caseating, matted lymph nodes. The spectrum of histopathological changes of the liver showed epitheloid cell granulomas in 63 (42%), fatty changes in 49 (32.6%), inflammation in 60 (40%), sinusoidal congestion in 48 (32%) and fibrosis in 24 (16%) cases. Of the 63 cases of liver granulomas, 12 (19%) were cases of extensive pulmonary tuberculosis and the remaining were extrapulmonary tuberculosis. Granulomas were caseating in 58.7%, noncaseating in 23.8% and atypical in 17.5% cases. Fatty change ranged from mild to severe. Inflammation was mainly mild to moderate. Stage I and II fibrosis was seen in 13 (8.6%) and stage III and IV in 11 (7.3%) cases. On comparing the granuloma and non-granuloma cases histological features, it was found that fatty changes and inflammation were more with granuloma formation but there was no difference in the degree of fibrosis in the two groups. CONCLUSION: Liver involvement was mainly in the form of secondary tuberculosis. On histopathology, epitheloid cell granulomas were seen in 42% cases, other changes were non-specific. Significant fibrosis was seen in 7.3% cases however the finding of tuberculosis as a cause of significant fibrosis was not consistent.

Adolescent↗