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The relative motion between the plates on each side of the East African Rift Valley can be obtained from the opening of the Red Sea and the Gulf of Aden. The calculated direction of relative motion agrees well with fault plane solutions for earthquakes north of the equator.
Fine needle aspiration cytology of suspected tuberculous lymphadenitis The aims of this cross-sectional study were to describe the distributional patterns of tuberculous lymphadenitis and to assess the correlation between fine needle aspiration cytology (FNAC) and the Ziehl Neelsen staining technique in diagnosing tuberculous lymphadenitis. Romanowsky's method (Wright's stain) for cytological diagnosis and Ziehl Neelsen (hot method) for the identification of acid-fast bacilli were utilized. Out of one hundred and twenty-eight consecutive patients attending the cytological diagnostic service of the Department of Pathology within Jimma University, 89 (69.6%) of the patients were younger than 30 years of age. The male to female ratio was 1.3 : 1. The cervical region was the most common site and involved 95 cases (74.2%), followed by the axillary and inguinal lymph node regions (20.3% and 4.3%, respectively). The Wright's-stained cytology smears were grouped into three categories: epithelioid granulomas without necrosis, epithelioid granulomas with caseous necrosis and necrosis without epithelioid granulomas. The Ziehl Neelsen stains were undertaken on separate slides: 20.0% of the cases showing epithelioid granulomas without necrosis, 61.9% of those with epithelioid granulomas with necrosis/abscesses and 69.7% of those with necrosis without granulomas were found to be positive for acid-fast bacilli. The overall positivity for the ZiehlNeelsen stained cases was 59.4%. It can therefore be concluded that FNAC is a reliable diagnostic tool in helping to avert the more invasive surgical procedures undertaken in the diagnosis of tuberculous adenitis. The ZiehlNeelsen stain for identification of acid-fast bacilli should be incorporated as an adjunct to increase the diagnostic accuracy of tuberculous lymphadenitis.
Cell-mediated immunity plays a key role in containing the growth of Mycobacterium tuberculosis in the host. The induction of an antibody response or a mixed cell-mediated and humoral response is frequently associated with tuberculosis disease or a decrease in the ability to control M. tuberculosis load. We recently reported the induction of similar immune responses and protection by rectal, subcutaneous (SC) or intradermal administration of Mycobacterium bovis BCG in adult mice, guinea pigs and macaques. The rectal immunization, which did not induce the side-effects associated with parenteral routes (axillary adenitis) and which could be used to reduce the risks of viral transmission associated with unsafe injections in the developing world, was analysed and compared in newborn and adult BALB/c mice. The rectal and SC immunization induced, in mice immunized as newborns or as adults, a mixed T helper 1/T helper 2 (Th1/Th2) immune response; however, particularly in adult mice, after SC administration of BCG, the level of Th2 immune response is significantly higher than it is by the rectal route. Six months after immunization with BCG, rectal and SC delivery induced similar levels of protective immunity against a virulent challenge with M. tuberculosis strain (H37Rv) in mice immunized as adults, but the rectal BCG delivery triggered stronger protection than the SC delivery if mice were immunized as newborns.
Cyclosporin has been increasingly used for the treatment of skin diseases in small animals. Reported uses include the treatment of atopy, cutaneous lupus erythematosus, feline acquired alopecia resembling pseudopelade of humans, pemphigus erythematosus, pemphigus foliaceus, perianal fistulae and sebaceous adenitis. In addition, cyclosporin has been used anecdotally for several other skin diseases. Few side effects have been noted at doses therapeutic for dermatologic diseases. Current suggestions for monitoring, and the value of trough cyclosporin serum concentrations for prediction of toxicity and efficacy are discussed.
In developing countries, many sputum-negative suspects of pulmonary tuberculosis (PTB) are given antituberculous medication just because tuberculosis (TB) could not be excluded in them. Many studies have shown that BCG test is nearly 100% sensitive, except in those with severe malnutrition, steroid therapy and other causes of immunosuppression. The aim of the present study was to find out the proportion of PTB suspects in whom BCG test may be useful in excluding diagnosis of TB. The study was carried out on adult subjects attending District Tuberculosis Clinic (DTC), Pali, Rajasthan, India. Out of 104 subjects studied, all 18 sputum-positive subjects showed a positive BCG test indicating 100% sensitivity of the test. The result of BCG test was negative in 16.28% of 86 sputum-negative suspects of TB. The BCG test did not show any adverse reactions among these cases except for adenitis of axillary or cervical lymph nodes in 6.7% subjects. The study raises the possibility that BCG test may be useful in excluding diagnosis of tuberculosis in a proportion of adult sputum negative-suspects of PTB in developing countries like India. More studies are needed in this direction.
A case is reported of epithelioid-cell granulomatous inflammation in the neck with fustula formation and cervical lymph-adenitis, resembling tuberculosis. After neck dissection, histological examination of the removed tissue revealed parasitic infection (organism not identified) as the cause.
In a retrospective study we evaluated clinical features and diagnostic impact of sonography, white blood cell count, C-reactive protein as well as bacterial etiology of children treated surgically for bacterial cervical lymphadenitis. We report on 38 children at the age between 2.5 months and 14 years who were admitted in our departments between 1990 and June 2002. Leukocytosis (median 16.5 Gpt/l) and/or elevated concentrations of C-reactive protein (median 27 mg/l) occurred in the majority of patients. Clinical appearance and the result of ultrasound examination were relevant for diagnosis of suppurative inflammation. Treatment included incision and drainage in 29 cases, aspiration was performed in 4 children and in 5 cases the affected lymph nodes were removed. We found a predominance of infections due to S. aureus (37%) and group A streptococci (16%). A mixed aerobic-anaerobic infection was observed in 2 (5%) children and atypical mycobacteriosis in 3 (8%) cases. In conclusion, suppurative cervical adenitis has to be taken into account in children with cervical lymph node enlargement. In these cases surgical drainage is a key to appropriate resolution.
BACKGROUND: Yersinia infections other than plaque are caused by Yersinia pseudotuberculosis and Yersinia enterocolitica. Food and water contamination as well as animal-to-person and person-to-person contact are common pathways of transmission. Clinical manifestations include enteritis, enterocolitis, acute appendicitis, inflammation of the terminal ileum, and mesenteric adenitis. Y. enterocolitica may cause bacteremia with subsequent septicemia predominantly in patients with underlying illnesses such as diabetes mellitus or malignancy. More frequently enteritis is followed by immunological post-infectious syndromes such as arthritis and erythema nodosum. The present case report discusses bilateral vestibular loss possibly caused by an infection with Y. enterocolitica. PATIENTS: A 27-year-old caucasian woman initially presented with the otologic symptom of spinning vertigo accompanied by nausea and vomiting. RESULTS: Physical exam revealed spontaneous nystagmus to the left. Bithermal caloric responses were absent. Pure tone audiometry showed a bilateral symmetric high-frequency sensorineural hearing loss. Neurologic exams did not reveal involvement of the central vestibular system. Perilymphatic fistula on the left side was excluded by tympanoscopy. Serology for rheumatoid factors and HLA B27 was negative. Lead or mercury intoxication was also excluded. In her medical history the patient reported intermittent watery diarrhea and stress dependent arthralgia that had commenced during a stay in Argentina three years ago. Serology was positive, revealing elevated titers for Y. enterocolitica type 3 (1:200) and type 9 (1:400). DISCUSSION: Bilateral vestibular loss is rare. The main cause is aminoglycoside ototoxicity or meningitis. Yersina infections have not yet been described as inducing disease of the labyrinth. Present pathophysiologic knowledge of yersinia infections is described as follows: After peroral infection, gastrointestinal permeability is increased. Low-molecular-weight substances may enter the bloodstream and stimulate the formation of circulating immune complexes. These are held responsible for extraintestinal manifestations of yersinosis. Whether these circulating immune complexes and antibodies against Y. enterocolitica have an effect on the inner ear remains unclear. CONCLUSION: Because the coincidence of yersiniosis and a bilateral vestibular loss with no other identified cause, a postinfectious immune response is suggested as possible pathogenic mechanism.
In order to test the Fuller and Hodgson hypothesis that modification of the anticodon-adjacent base in certain tRNA's not only prevents mRNA base-pairing at that site but also increases the stabilization of a stacked conformation in the anticodon loop, we have examined the interaction between adenosine and its N(6)-isopentenyl derivative by means of model compounds. The synthetic 9-[3-(aden-9-yl)propyl]-6-(3-methyl-2-butenylamino)purine, Ad-C(3)-iPAd (IV), in which the adenine and N(6)-substituted adenine moieties are joined at the 9 and 9' positions by a trimethylene chain, served as a useful spectroscopic model for assessing the base-base interaction free from the complicating features of the carbohydrate and phosphodiester groupings. The hypochromism for the model, which was determined in dilute aqueous solution and represents the decrease in integrated ultraviolet absorption intensity of Ad-C(3)-iPAd (IV) compared with equimolar 9-propyladenine (Ad-C(3)) and 6-(3-methyl-2-butenyl-amino)-9-propylpurine (V, iPAd-C(3)), was 17.9 per cent in neutral solution, 8.4 per cent in 0.1 N HCl, and 18.5 per cent in 0.1 N NaOH. Comparison with the per cent hypochromism calculated for the simple model Ad-C(3)-Ad (e.g., 16.5% in neutral solution) confirms the strong interaction in IV observed between uncharged plane-parallel adenine and N(6)-substituted adenine rings. The cause for changes in the absorption spectrum of Ad-C(3)-iPAd are discussed. The fluorescence and phosphorescence emission spectra of Ad-C(3)-iPAd in ethylene glycol-water glass at 80 degrees K add considerable weight to the conclusion that there is a strong tendency for adenine and N(6)-(Delta(2)-isopentenyl)adenosine (I) to stack if this is permitted by steric considerations.
We have examined the stacking interactions of N(2)-dimethyl-guanosine with the nucleosides, e.g., adenosine and cytidine, found adjacent to it in certain tRNA's, by the use of model compounds in which the trimethylene bridge was substituted for the ribose-phosphate-ribose linkage. From the hypochromism exhibited by synthetic 9-[3-(aden-9-yl)propyl]-2-dimethylaminopurine-6-one (IV) and by 9-[3-(cytos-1-yl)propyl]2-dimethylaminopurin-6-one in aqueous solution (VI) it is appearent that the interaction is at least as great between the N(2)-dimethylguanine moiety and adenine or cytosine as between guanine and these two bases. The fluorescence and phosphorescence emission spectra were obtained in ethylene glycol-water glass at 80 degrees K. The exciplex fluorescence observed for both bi-molecules (IV and VI) containing the N(2)-dimethylguanine unit provides further evidence for stacked chromophores.
We retrospectively reviewed clinical, diagnostic, therapeutic and prognostic features of 35 patients (25 female, 10 male, mean age: 33 years, range: 16-70) with tuberculous lymphadenopathy (TB LAP) which had been followed since 1980. The diagnosis was established by tissue sampling in 32 cases (caseating granulomatous adenitis in 89%) or presence of acid-fast bacilli (AFB) in the aspirate in 2 cases and in the drainage in 1 case. Paraffin-embedded granulomatous tissues were stained by Ehrlich-Ziehl-Neelsen (EZN) and also Mycobacterium tuberculosis DNA was studied by polymerase chain reaction (PCR) (n = 21). The patients were admitted with enlarging LAP (34%), draining LAP (9%), and both systemic complaints and enlarging LAP (57%). Cervical lymph nodes were the most frequently involved site (77%). Pathologic findings on chest X-ray were seen in 23%. Erythrocyte sedimentation rate (ESR) was higher than 100 mm/hour in 25% and associated with systemic complaints. Tuberculin skin test was positive in 91%. AFB could not be seen in any granulomatous tissue (n: 21), but PCR study was positive in 33% (7/21). All patients were given anti-TB treatment (INH,RMP,EMB and/or PZA). Surgical excision of draining LAP with surrounding inflammatory tissues in addition to the medical treatment was needed in 2 cases. Clinical improvement was obtained within 3 months of the treatment and ESR returned to normal within 5 months. After completion of the treatment, 22 patients were followed-up; mean duration was 3 years, and none relapsed. In conclusion, a patient with TB LAP generally presents with a few small, painless, cervical lymph nodes, which are slowly enlarging. For exact diagnosis, excisional biopsy for histologic and microbiologic studies is essential. Use of anti-TB drugs is the main therapeutic option.
Arthritis complicating the common viral infections--mumps, coxsackievirus, and adenovirus--can be enigmatic. Mumps arthritis is often difficult to identify, especially when parotitis is mild, because the arthritic syndrome generally follows complete clearing of salivary adenitis by one to two weeks. Migratory polyarthritis is common and may run a protracted course, but only supportive care is generally needed. Arthritis associated with coxsackievirus or adenovirus infection may be particularly perplexing, as the dominant syndrome may be a classic Still's variety of juvenile rheumatoid arthritis. The polyarthritis may be persistent and/or recurrent, despite administration of potent antiinflammatory agents.
A 13-year-old girl presented with fever, night sweat, weight loss, abdominal pain, haematuria and hepatosplenomegaly. Urinalysis revealed many Schistosoma haematobium ova, but rectal snip examination was negative for schistosomal ova. X-ray and CT scan of the chest revealed enlargement of the anterior, superior, mediastinal and left suprahilar lymph node with an adjacent left pulmonary parenchymal opacity and small peripheral lesions on the right side. A bone marrow aspiration and biopsy was normal. The patient was treated with Praziquantel for her urinary schistosomiasis. Because of her clinical and radiological chest findings, the possibilities of lymphoma and tuberculosis were considered. Therefore, she underwent a thoracotomy and biopsy of her thoracic lesions. The histopathology revealed pulmonary granulomas surrounding schistosoma ova with reactive mediastinal lymph adenitis.
A 12.5-year-old Nigerian child presented with progressively worsening hoarseness of 9 months duration, without overt features of chronic ill health. Superficial discrete cervical adenitis, radiological evidence of miliary tuberculosis and hilar adenopathy were identified on admission. The laryngoscopic findings comprised fully mobile but 'beefy' red, oedematous vocal cords and interarytenoid region. The diagnosis of tuberculous laryngitis was made on the basis of the laryngoscopic, radiological and clinical improvement that followed antituberculous therapy. The possible pathogeneses of tuberculous laryngitis are discussed. We emphasize the importance of considering tuberculous laryngitis in a child with persistent hoarseness.
This is a retrospective study of the demographic features, treatment and outcome of 28 cases of snake bite admitted to the department of paediatrics of the Royal Victoria Hospital, Banjul, The Gambia over a 3-year period. The age range was 2-14 years and the male:female ratio was 2.1:1. Most bites were on the legs and occurred near home. Most snake bites presented early at hospital and marked swelling of the affected limb was the most common clinical sign. Shock, restlessness and regional adenitis of the affected limb were common in children who died. The case fatality rate was 14.3%. Most children did not receive specific antivenom therapy.
The "nasal glands" occur in many bird species and are powerful sodium ion-excretory organs. In ducks, they are located in supraorbital bony recesses. Granulomatous inflammation of these glands occurs with an incidence of approximately 1% in ducklings (Anas platyrhynchos), and is not associated with specific clinical symptoms. We investigated nine glands of eight animals with granulomas by gross pathology and histopathology, and compared results of bacteriology with 20 non-lesioned nasal glands. Adenitis was characterized by multifocal to coalescent heterophilic granulomas with central necrotic heterophils, and multinucleate giant cells, lymphocytes and plasma cells. Within the centres of the granulomas, there were clusters of Gram-negative bacteria that were identified as halo-tolerant Pseudomonas aeruginosa, Proteus mirabilis and Aeromonas hydrophila. Normal glands contained exclusively various halo-tolerant Gram-positive bacteria, mostly Streptococcus sp. and Enterococcus sp. The distribution of lesions and lack of clinical symptoms were suggestive of a localized ascending infection via the secretory ductules.
Subpopulations of infiltrating lymphocytes, professional antigen-presenting cells (APCs), and Th1/Th2 cytokines that could initiate an autoimmune sialodacryoadenitis were studied in the IQI/Jic mouse model of primary Sjögren's syndrome. Although lymphocytic infiltrations were first seen in submandibular glands (SMGs) of females and in lacrimal glands (LGs) of males at 8 weeks of age, clusters of MHC class II+, CD11c+, B7-2+ dendritic cells (DCs) were already localized in these tissues at 4 weeks. At 8 weeks, the infiltrating lymphocytes consisted of almost equal numbers of B cells and CD4+ T cells. In the inflammatory foci, MHC class II+, CD11c+, B7-2+ DCs formed network-like structures. Duct cells in the lesions showed immunoreactivities for MHC class II and ALCAM (a costimulatory adhesion molecule). IL-12 and IFN-gamma transcripts were detected by RT-PCR in SMGs of females and in LGs of males at 8-12 weeks. These results suggest that the clustered DCs might play an important role in the initiation of the adenitis, and further suggest that the DCs and epithelial cells may participate in the activation of CD4+ T cells. It is also likely that Th1 cytokines mediate the functional interactions between the APCs and CD4+ T cells in the early lesions.
Orf is a zoonosis caused by an epitheliotropic DNA parapox virus. Human orf is a generally benign, self-limiting condition that usually regresses in 6-8 weeks without specific treatment. However, it may be accompanied by local symptoms including pain, pruritus, lymphangitis and axillary adenitis, or less frequently by systemic symptoms such as fever or malaise. Furthermore, it may be complicated by erythema multiforme, Stevens-Johnson syndrome, erysipelas, generalized mucocutaneous eruption, toxic erythema, eyelid oedema and giant, persistent or recurrent lesions in immunocompromised patients. Imiquimod, a potent topical immune response modifier, enhances both the innate and acquired immunity by stimulation of immune system cells resulting in local antiviral, antitumour and immunoregulatory activity. We present, for the first time, four complicated cases of orf successfully treated by topical imiquimod resulting in rapid regression of both orf and associated lesions. Two of the cases were complicated with erythema multiforme, one with recurrent eyelid oedema, and another had giant orf associated with axillary lymphadenitis. We suggest that topical imiquimod may be an effective and safe therapy for complicated orf cases.