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At least 721 records · Page 40Linked to original sources
PubMed2004

Contribution of flow cytometry to the diagnosis of malignant and non malignant conditions in lymph node biopsies.

In order to assess the contribution of FC to the diagnosis of lymph node disorders we retrospectively compared the pathological and the FC diagnosis made in 118 consecutive lymph node biopsies. Pathological diagnosis included non malignant conditions (n = 43), B-cell Non Hodgkin lymphoma (NHL) (n = 30), T-cell NHL (1 case), carcinoma (n = 18), Hodgkin lymphoma (HL) (n = 15), melanoma (n = 2), chronic myelocytic leukemia (n = 12), miscellaneous non-lymphoid tissues (n = 6) and undetermined conditions (n = 2). Among the 116 assessable samples, FC was in agreement with histology in 102 cases (87.9%; 95%CI = 81-93) which included 38 benign conditions (90%; 95% CI = 77-97%), 29 NHL (96.7%; 95% CI = 83-100), 18 carcinomas (100%; 95% CI = 81-100), and 12 HL (80.0%; 95% CI = 52-96). Discrepancies (14 cases) included 3 HL undiagnosed by FC and 2 granulomatous adenitis with an erroneous FC diagnosis of HL. Finally, a malignant condition was suspected only by FC in 5 cases (1 carcinoma, 2 B-cell and 2 T-cell NHL) and subsequently demonstrated by additional diagnostic procedures. In conclusion, this study confirms that FC performed on fresh lymph node samples is a powerful diagnostic tool in patients with malignant lymphoma. A few cases left undiagnosed by classical pathological analysis can be recognized by FC. Carcinoma is readily identified by FC analysis, while some benign conditions and Hodgkin lymphoma can be misdiagnosed with the use of FC, although the potential of FC to properly recognize HL is improving compared to previously reported studies. FC is a useful adjunct to pathological analysis of lymph node specimens.

Adenocarcinoma↗
PubMed1956

Failure to transfer tuberculin sensitivity passively with plasma fractions containing alpha globulin.

We are unable to confirm the observations reported by Cole and Favour that passive transfer of plasma fractions containing alpha globulin (IV + V or IV-10) from tuberculin-sensitive guinea pigs confers delayed sensitivity to tuberculoprotein upon normal animals. In guinea pigs with chronic cervical adenitis due to infection with group C hemolytic streptococci, injection of fraction IV + V and repeated skin tests with PPD induced indurated skin reactions of 9 to 10 mm., maximal at 24 hours, and, in one experiment, a positive tissue culture response to tuberculin. It is suggested that this reactivity was actively induced. Normal or infected recipients of fraction I + II + III from the plasma of tuberculin-sensitive donors manifested edematous responses to tuberculopolysaccharide, maximal at 4 to 6 hours, as reported. Skin tests with pneumococcal C polysaccharide revealed no evidence of passive transfer of C-reactive protein in fractions I + II + III or IV + V.

Alpha-Globulins↗
PubMed1997

Four additional cases of Burkholderia gladioli infection with microbiological correlates and review.

Burkholderia gladioli has only recently been reported to be a human pathogen. Four cases of B. gladioli infection (including bacteremia, pneumonia, and cervical adenitis) in two adults and two young children are reported. Three of these four patients were severely immunocompromised. Commercial systems were frequently unable to identify this bacterium correctly. Antimicrobial susceptibility patterns indicated that B. gladioli strains were susceptible to the quinolones, aminoglycosides, and imipenem. In vitro laboratory investigations demonstrated that B. gladioli strains were susceptible to complement-mediated lysis of pooled human serum, thus implying that healthy individuals should be immune to infection. These four cases together with three previously reported cases suggest that B. gladioli primarily causes disease in severely immunocompromised individuals. The lack of mortality associated with infection, coupled with susceptibility to serum and lack of recognizable virulence-associated factors, suggests that this species has a low pathogenic potential.

Adult↗
PubMedDate not supplied

Infections with Pseudomonas paucimobilis: report of four cases and review.

Pseudomonas paucimobilis (formerly CDC group IIK, biotype 1) is a strictly aerobic, nonfermenting, oxidase- and catalase-positive, gram-negative bacillus that is widely distributed in water and soil. Its name derives from the difficulty encountered in demonstrating its motility, even in liquid media. This microorganism is responsible for two types of infection in humans: sporadic or community-acquired infections, probably of endogenous or environmental origin (bacteremia, meningitis, urinary tract infection, and wound infection); and outbreaks of nosocomial infection associated with the contamination of sterile fluids employed in hospitals. We present four cases of infection caused by P. paucimobilis (two of bacteremia, one of leg ulcer infection, and one of cervical adenitis). The majority of infections produced by P. paucimobilis have a good prognosis; no deaths related to this entity have been reported in the literature. The published results of susceptibility tests suggest that the aminoglycosides (either alone or in combination with a beta-lactam antibiotic) or the quinolone may be the agents of choice in the treatment of these infections.

Adult↗
PubMedDate not supplied

Clinical efficacy of sulbactam/ampicillin in pediatric infections caused by ampicillin-resistant or penicillin-resistant organisms.

Twenty-three children two months to 11 years old were treated with sulbactam/ampicillin or sulbactam/penicillin. Eleven had urinary tract infections (UTI), eight had pus-forming cervical adenitis, and four had lobar pneumonia. Pathogens were isolated from 18 patients: Escherichia coli from 10, Staphylococcus aureus from seven, and Klebsiella pneumoniae from one. All isolates were resistant to ampicillin or penicillin alone. Sulbactam (50 mg/kg per day) plus ampicillin (1:2 or 1:3 ratio) or penicillin (1:1.2 or 1:1.8 ratio) was given by intravenous bolus injection at 6-hr intervals for four to 11 days (mean duration, nine days). All pathogens were eradicated during treatment. Two patients with UTI relapsed after completion of treatment; the isolates were resistant to the combination. Clinical response was rapid and consistent with bacteriologic findings. Twenty-two of 23 children had a favorable clinical response. No systemic or local adverse effects were recorded. One child had eosinophilia and another had neutropenia at the end of treatment. Four children had slight and transient increases in hepatic transaminases. These results indicate that sulbactam/ampicillin may prove safe and effective for the treatment of non-life-threatening pediatric infections.

Ampicillin↗
PubMed2001

The role of Yersinia enterocolitica and Yersinia pseudotuberculosis in granulomatous appendicitis: a histologic and molecular study.

Granulomatous appendicitis is an enigmatic entity. Purported causes include Crohn's disease, foreign body reactions, sarcoidosis, and infectious agents; however, most cases remain idiopathic. Yersinia enterocolitica (YE) and Y. pseudotuberculosis (YP) have been implicated as causes of appendicitis, ileocolitis, and mesenteric adenitis. The authors examined the potential role of YE and YP in granulomatous appendicitis using histologic and molecular methods. Forty cases of granulomatous appendicitis were evaluated for histologic features including transmural inflammation, number and character of granulomas, and mucosal changes. Twort Gram, Grocott methenamine-silver (GMS), and Ziehl-Neelsen stains were evaluated, and polymerase chain reaction (PCR) analysis was performed to identify pathogenic YP and YE. Twenty-five percent (10 of 40) of the cases were positive for pathogenic Yersinia by PCR (four YE, four YP, and two with both species). Prominent histologic features included epithelioid granulomas with lymphoid cuffing, transmural inflammation with lymphoid aggregates, mucosal ulceration, and cryptitis. One Yersinia-positive case contained mural Gram-negative bacilli; fungal and acid-fast bacilli stains were all negative. Except for one culture-negative case, serologies and cultures were not done or results were unavailable. Two Yersinia-positive patients were diagnosed subsequently with Crohn's disease, suggesting a possible relationship between the two entities. No other patients developed significant sequelae. YE and YP are important causes of granulomatous appendicitis, and Yersinia infection may mimic Crohn's disease. No histologic features distinguish reliably between Yersinia species, or between Yersinia-positive and Yersinia-negative cases. Because special stains and cultures are often not diagnostic, PCR analysis is an excellent technique for the diagnosis of Yersinia.

Adolescent↗
PubMed2000

Differential diagnosis of fever of unknown origin in children.

Fever of unknown origin in children follows two main clinical patterns, namely fever of unknown origin and chronic episodic fever of unknown origin. Fever of unknown origin is characterized by daily fever persisting for more than 3 weeks. The main causes are infectious, rheumatologic disorders, and malignancy. Chronic episodic fever of unknown origin is characterized by fever lasting for a few days to a few weeks, followed by a fever-free interval and a sense of well-being. The main causes are familial Mediterranean fever, the hyper-immunoglobulin D syndrome, familial Hibernian fever, Behcet disease, the syndrome of periodic fever, aphthous stomatitis, pharyngitis and adenitis, and cyclic neutropenia.

Behcet Syndrome↗
PubMed1985

The carbon dioxide laser in the treatment of vulvar disease.

Our review of the current use of the carbon dioxide laser in treating vulvar disease reveals that it holds significant promise in the treatment of vulvar intraepithelial carcinoma, condylomata acuminata, and focal vestibular adenitis. The long-range results of such treatment, however, are not yet known. Until sufficient data are accumulated to demonstrate the efficacy of the laser in treating the vulvar dystrophies and herpes genitalis, it should be used with caution, and the results should be carefully evaluated and reported.

Adult↗
PubMed2001

Surgical management of retropharyngeal space infections in children.

OBJECTIVE: To study the perioperative management strategies in a large group of pediatric patients undergoing surgical therapy for suppurative adenitis of the parapharyngeal and retropharyngeal spaces. STUDY DESIGN: Retrospective analysis of all patients treated surgically from January 1, 1989, to December 31, 1998, in a tertiary care pediatric hospital. METHODS: Charts were reviewed for demographic data, duration and nature of symptoms, radiological workup, surgical approach, complications, duration of medical therapy and antibiotic choice, and bacteriological findings. Computed tomography (CT) results were correlated to surgical findings. RESULTS: A dramatic increase in the incidence of deep neck space infection was seen during the study period; this increase was congruent with the increase in culture-positive group A beta-hemolytic streptococcal abscesses. More than two-thirds of the patients were boys with the peak incidence being in the 3- to 5-year-old group. The duration of symptoms before presentation was less than might be expected, especially in the younger age groups. Seventy of 73 children were treated with a transoral approach. Sixty-eight of 73 were successfully treated with one operative intervention. Irregularity of the abscess wall was found to be a stronger predictor of the presence of pus than the presence of ring enhancement. CONCLUSIONS: The current study represents the largest series of pediatric retropharyngeal abscesses in the modern medical literature. Changes in the disease process and in management from the first half of the century to today are reviewed, and recommendations for optimal management presented. The data in this series support a transoral approach to these abscesses unless there is extension lateral to the great vessels.

Adolescent↗
PubMed1988

Mediastinal fibrosis complicating histoplasmosis.

Mediastinal fibrosis, the most serious late complication of remote infection by Histoplasma capsulatum, is a thick, dense fibrotic capsule which surrounds a small mediastinal focus of old caseous adenitis. The fibrotic process may accrue over prolonged periods and extend within the lumina of critical mediastinal structures to produce complete occlusion. We summarized clinical and radiographic data for 71 patients with mediastinal fibrosis; the criteria for inclusion were the clinical demonstration of occlusion of major central airways (trachea or mainstem bronchus) or major vessels (pulmonary arteries or veins) and the absence of other disease processes which might cause such obstruction. We selected 65 patients who met these criteria from the medical literature of the last 40 years and report 6 new cases from our experience. The majority of patients were diagnosed between ages 20 and 40. The most common symptoms included hemoptysis, dyspnea, and cough. An accentuated pulmonic component of the second heart sound, wheezing, and localized murmur were among the physical findings reported. Radiographic abnormalities consisted of mass lesions and atelectasis or infiltrates, but were often nonspecific. Chest radiography was deceptively normal in some patients, even in the presence of major central airway or vascular occlusion, especially when the focus was subcarinal. Computed tomography has particular promise to depict the mediastinal abnormalities in this process. Surgery had minimal therapeutic benefit. Because of incomplete followup, the mortality of 30% in this series surely does not represent the true overall mortality of mediastinal fibrosis.

Adolescent↗
PubMed1994

Rhodococcus equi infections of humans. 12 cases and a review of the literature.

Increased recognition of Rhodococcus equi as a human pathogen has occurred since 1983, when the first review article summarized the world's literature of 12 cases. In this article, we present 12 cases from the University of Oklahoma Health Sciences Center and review 60 from the literature. Most cases occur in immunocompromised hosts and present as chronic cavitary pneumonias. Associated extrapulmonary disease is seen at diagnosis in 7% of patients with pneumonia, and relapse occurs at extrapulmonary sites in 13%, often without reappearance of pulmonary disease. Relapse may follow a course of antimicrobial therapy that is too brief, but can also occur during treatment. Infections also occur in the gastrointestinal tract, causing enteritis and regional adenitis with abscesses. Contaminated wounds may become infected. Isolated bacteremias may be a manifestation of latent infection recurring during a period of immune suppression. A common feature of human R. equi infection is delay in diagnosis. The insidious course of disease contributes to delay, as does failure to identify the organism. R. equi is easily cultured on nonselective media but commonly mistaken for a diphtheroid or occasionally for a mycobacterium based on acid-fast appearance. Form and duration of treatment are closely related to host immune status. Immunocompromised patients require prolonged or indefinite therapy with multiple antibiotics. Infections in immunocompetent hosts are easily treated with short courses of single agents. Infections related to contaminated wounds are treated primarily by irrigation and debridement. Infections in immunocompromised hosts are increasing in frequency largely due the AIDS epidemic. Infections in immunocompetent hosts, reported rarely before this series, may be underdiagnosed, perhaps because R. equi resembles common commensals and has limited virulence in this population. This report demonstrates that R. equi infections, including community-acquired pneumonias, occur in immunocompetent hosts.

Actinomycetales Infections↗
PubMed1988

Tuberculosis in children and adolescents in the 1980s.

Tuberculosis (TBC) continues to be a major health problem. Between January 1, 1980, and April 30, 1986, 211 children and adolescents presented with a positive tuberculin reaction or symptoms suggestive of tuberculosis. Active disease occurred in 35 (17%); 29 of these had primary infection, whereas 4 adolescents presented with cavitary pulmonary disease and 1 infant each had Pott's disease and cervical adenitis. The proportion of patients with active disease was greater in infants and toddlers; 2 of whom also had meningitis. Two children with active disease were infected with human immunodeficiency virus, 1 of whom died with cavitary tuberculosis. Only 43% of 211 patients were born in the United States. The ethnic distribution was Hispanic 45%, Oriental 30%, Black 18% and other 7%. Bacillus Calmette-Guérin vaccination was documented in 53 (25%) patients; 5 (9%) of these developed active disease. Despite vaccination and the availability of effective drugs, tuberculosis persists and appears to be increasing. Meeting the challenge of tuberculosis in the future will require more rapid diagnostic methods and recognition of the burden of infection in human immunodeficiency disease-infected children, together with revitalization of screening and follow-up programs, especially for toddlers and adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Acute yersiniosis and its surgical significance.

During early 1982, an outbreak of yersiniosis occurred in northern Mississippi. Abdominal pain suggestive of appendicitis was a common manifestation, but laparotomy revealed mesenteric adenitis. Yersinia enteritis should enter the differential diagnosis of acute appendicitis.

Acute Disease↗
PubMed1993

Pediatric cervicofacial actinomycosis.

It is well recognized that cervicofacial actinomycosis is rare in children. We have summarized the cases in the English language literature and reported a recent case from our hospital. In only 10% of clinical situations is actinomycosis the primary diagnosis. Failure to consider actinomycosis in the differential diagnosis of a cervical mass may compromise the ability to make the diagnosis, given the fastidious nature of the most common pathogen, Actinomyces israelii. Indeed, the recovery rate of only 30% in some of the earlier studies of actinomycosis may have been in part due to this oversight. The correct diagnosis, however, is imperative because the treatment of actinomycosis is different from that of routine cervical adenitis in that actinomycosis requires high doses of penicillin over a prolonged time, since it is subject to relapse. Our case serves as a reminder to consider actinomycosis as the possible cause of a cervical mass, not only in adults, but in children as well.

Actinomycosis, Cervicofacial↗
PubMed2004

Resistant Mycobacterium bovis Bacillus Calmette-Guérin disease: implications for management of Bacillus Calmette-Guérin Disease in human immunodeficiency virus-infected children.

Guidelines for the diagnosis and management of Bacillus Calmette-Guérin (BCG) disease in children are lacking, and there are limited data on drug resistance of Mycobacterium bovis BCG. A 6-month-old HIV-infected infant presented with right axillary adenitis ipsilateral to the site of BCG immunization. M. tuberculosis complex was cultured from axillary lymph nodes and gastric aspirates, and M. bovis BCG was isolated. Susceptibility testing before initiation of therapy demonstrated inherent resistance to isoniazid. The organism acquired rifampin resistance during therapy. This was confirmed by the presence of a mutation in codon 531 (Ser531Tyr) of the rpoB gene. Treatment guidelines for BCG disease with consideration of inherent and possible acquired drug resistance should be established in settings with high rates of vertical HIV transmission and routine BCG vaccination.

Animals↗
PubMed2006

Recurrent aseptic encephalitis in periodic fever, aphthous stomatitis, pharyngitis and adenopathy (PFAPA) syndrome.

An 11-year-old boy with episodes of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) is reported. Two PFAPA episodes were associated with aseptic encephalitis and seizures. Recurrent acute aseptic encephalitis or seizures have never been reported during the febrile episodes of PFAPA. This possible association is discussed within the context of the etiology of PFAPA.

Child↗
PubMed2005

Peripheral tuberculous lymphadenitis: epidemiology, diagnosis, treatment, and outcome.

We reviewed 106 patients referred to our institution for treatment of peripheral tuberculous adenitis to establish the epidemiologic, clinical, and pathologic manifestations of this disease. Tuberculous lymphadenitis occurred predominantly in young, foreign-born women a mean of 5 years after arrival in the United States. Tuberculin skin tests were positive in 94% of cases. Lymphadenopathy occurred most frequently in the neck (57%) or supraclavicular area (26%) and involved 1-3 nodes. Forty (38%) patients had an abnormal chest radiograph consistent with granulomatous infection. Culture-positive pulmonary tuberculosis was diagnosed in 41% of those patients with abnormal chest radiographs. Fine needle aspiration was an essential step in the evaluation and diagnosis of tuberculous lymphadenitis. Granulomas were seen in 61% of fine needle aspirates and 88% of surgical biopsies. Positive cultures for Mycobacterium tuberculosis were obtained from 62% of fine needle aspirate samples and 71% of excisional biopsies. The presence of necrosis and/or neutrophilic inflammation in tissue samples correlated with culture positivity. Given the high yield of positive cultures from fine needle aspirates, surgery was rarely indicated as an initial step in immunocompetent adults. In this cohort, 101 patients received a final diagnosis of peripheral tuberculous lymphadenitis. Eighty-two percent received their entire therapy under direct observation, and response to antituberculous therapy was uniformly successful. Paradoxical expansion of adenopathy was seen in 20% of all patients and was more commonly noted in human immunodeficiency virus-seropositive patients. We present a diagnostic algorithm based on our experience.

Adolescent↗