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PubMedDate not supplied

Fine needle aspiration cytology in systemic lupus erythematosus lymphadenopathy. A case report.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology characterized by inflammation in various organ systems, including lymph nodes, due to the production of antinuclear antibodies. The onset of disease is between ages 13 and 40 years, with a female preponderance. CASE: A 30-year-old female presented with right cervical lymphadenopathy and gave a history of intermittent fever and swollen joints of 2.5 years' duration. The patient was on intermittent corticosteroids. With a suggestion of tuberculous lymphadenitis, the patient underwent fine needle aspiration (FNA). The diagnosis of lupus adenopathy was established by FNA of enlarged right cervical lymph nodes. Smears showed predominantly typical and atypical immunoblasts, plasma cells, occasional Reed-Sternberg-like cells and dispersed hematoxylin bodies. Smears were negative for acid-fast bacilli. CONCLUSION: When SLE patients develop lymphadenopathy, FNA cytology helps differentiate lupus adenopathy from infectious conditions, such as tuberculous adenitis, and from Kikuchi's lymphadenitis.

Adult↗

PubMedDate not supplied

Cytomorphologic patterns in Calmette Guerin bacillus lymphadenitis.

OBJECTIVE: To study the cytomorphologic patterns of Calmette Guerin bacillus (BCG) lymphadenitis and compare it to those of tuberculous lymphadenitis. STUDY DESIGN: A retrospective cytomorphologic study of 136 cases of clinically diagnosed BCG adenitis. All fine needle aspiration smears of lymphadenitis in the age group 2 months to 2 years during a three-and-half-year period were analyzed. RESULTS: Three distinct cytomorphologic patterns were seen in 112 cases. They were acid-fast bacilli in a necrotic background (62), granulomas with necrosis (47) and granulomas in a reactive lymphoid background (3). CONCLUSION: The cytomorphologic patterns in BCG lymphadenitis were similar to those seen in tuberculous lymphadenitis; however, an exudative response and high acid-fast bacillus positivity was seen more frequently in BCG lymphadenitis. Moreover, Ziehl-Neelsen staining helped to distinguish these cases from pyogenic abscesses.

BCG Vaccine↗

PubMedDate not supplied

Toxoplasma lymphadenitis. Analysis of cytologic and histopathologic criteria and correlation with serologic tests.

OBJECTIVE: To identify cases of Toxoplasma lymphadenitis by light microscopic examination of fine needle aspiration cytology (FNAC) smears and paraffin sections and to correlate the result with those of serologic tests. STUDY DESIGN: The study group consisted of 19 cases of Toxoplasma lymphadenitis, 7 of which were diagnosed by FNAC, 9 on excision biopsy and 3 on FNAC followed by biopsy. Nineteen cases of reactive lymphadenitis, tuberculosis and infectious mononucleosus composed the control group. Sera from all 38 patients were screened for antibodies to Toxoplasma. RESULTS: Eleven of 19 cases (58%) of Toxoplasma adenitis had very high titers of antibody (> 300 ELISA units/ml), and 6 cases (31%) had antibody titers in a range suggestive of active infection (210-300 ELISA units/mL) and required demonstration of rising titers. Overall, 89% of patients with Toxoplasma lymphadenitis showed significant levels of antibody. All patients from the control group showed consistently low levels of antibody to Toxoplasma. CONCLUSION: Though serologic tests are mandatory for the diagnosis of Toxoplasma lymphadenitis, a high index of suspicion can be obtained by means of light microscopy alone.

Adolescent↗

PubMed1988

Lymphadenopathy in an inner-city population consisting principally of intravenous drug abusers with suspected acquired immunodeficiency syndrome.

Generalized lymphadenopathy in intravenous drug abusers (IVDAs) at risk for AIDS has not been well studied. We have retrospectively analyzed the results of lymph node biopsies obtained from 27 patients referred to the Infectious Diseases Service for evaluation of generalized lymphadenopathy and suspected AIDS during a recent 18-month period. Fourteen of the patients were heterosexual IVDAs, 7 were male homosexual IVDAs, and 6 were male homosexual non-IVDAs. All of the patients were residents of the Bronx, New York. Mycobacterium tuberculosis (TB) was the most frequent diagnosis established on lymph node biopsies from IVDAs, in 12 out of 21 (57%). Tuberculous adenitis was not diagnosed in the 6 non-IVDAs. All TB patients were febrile, 11 (91%) had lost weight, and 10 (84%) had an abnormal chest roentgenogram. The 5TU PPD skin test, however, was reactive in only 2 (16%) of 12 patients. Tuberculosis is important to consider in patient populations with exposure histories to both AIDS and TB. The alarmingly high prevalence of TB in this drug addict population emphasizes the importance of lymph node biopsies with acid-fast smears and mycobacterial cultures in symptomatic IVDAs. Preventive antituberculosis therapy for HIV-positive persons, especially IVDAs, with a history of positive tuberculin reactions or of recent household contact should be seriously considered.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Update on treatment of Marshall's syndrome (PFAPA syndrome): report of five cases with review of the literature.

Marshall's syndrome or PFAPA (periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis) syndrome is a recently described pediatric periodic disease characterized by recurrent febrile episodes associated with head and neck symptoms. The origin of this syndrome is unknown, and it can last for several years. During healthy periods, patients grow normally. The differential diagnosis includes other diseases characterized by periodic fevers, such as familial Mediterranean fever, familial Hibernian fever, hyperglobulinemia D syndrome, Behçet's disease, cyclic neutropenia, juvenile rheumatoid arthritis, and several infectious diseases. Many treatments have been used, with various results, including antibiotics, nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, colchicine, antiviral medicines, steroids, cimetidine, and tonsillectomy. We describe 5 new patients affected by PFAPA syndrome who were observed at the Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy, from November 2000 to August 2001. All children underwent physical examination, bacterial, fungal, and viral cultures, chest radiography, and several laboratory studies. The patients were treated by successful tonsillectomy, and after a mean follow-up of 10 months, no recurrence was observed. An analysis of the literature is also presented with particular emphasis on the differential diagnosis of this rare illness and the results of the different therapeutic options.

Adenoidectomy↗

PubMed1992

Diagnosis and management of anaerobic infections of the head and neck.

Anaerobic bacteria are important pathogens in head and neck infections such as chronic otitis media, chronic sinusitis, chronic mastoiditis, head and neck abscesses, cervical adenitis, parotitis, and postoperative infection. Bacteroides sp (Bacteroides melaninogenicus group, Bacteroides oralis, and Bacteroides fragilis group), Peptostreptococcus sp, and Fusobacterium sp predominate. The observed recent increase in the number of beta-lactamase-producing strains of Bacteroides sp isolated in head and neck infections has been associated with increased failure rates of the penicillins in the management of these infections. The pathogenicity of these organisms is expressed through their ability not only to survive penicillin therapy but also to shield penicillin-susceptible pathogens from the drug. Because of these direct and indirect virulent characteristics of anaerobic bacteria, appropriate antimicrobial therapy must be directed against all pathogens in mixed infections.

Bacteria, Anaerobic↗

PubMed1979

Tick-borne tularemia presenting as ulcerative lymphadenitis.

In a patient with suppurative lymphadenitis who fails to respond to antibiotics routinely used for pyogenic adenitis, the diagnosis of tularemia should be considered if there is good evidence for recent tick or other insect exposure. A trial of streptomycin therapy may be indicated, pending culture and serology results, in any patient whose signs and symptoms strongly suggest this diagnosis.

Arachnid Vectors↗

PubMed1983

Prevalence of lymphadenopathy of the head and neck in infants and children.

This study demonstrates the widespread prevalence of "normal" adenopathy in children; i.e., not associated with infectious adenitis or serious system illness. The knowledge of this distribution is helpful in determining when adenopathy may be pathologic. Occipital and postauricular adenopathy is a common nonspecific finding in infancy; but, over the age of 2 years, it is sufficiently rare that it can be a useful diagnostic finding. Cervical and submandibular nodes are rare in infants under 12 months but are common in older children. Supraclavicular nodes are probably pathologic at any age.

Aging↗

PubMed1994

Infection caused by Propionibacterium in children.

Three hundred eighty-six isolates of Propionibacterium sp. were recovered from 2,003 specimens studied for the identification of anaerobic bacteria in children during a 15-year period. Three hundred forty-three (89%) of these were Propionibacterium acnes. A total of 50 (13%) Propionibacterium isolates identified from 45 patients were considered to cause infection. Clinically significant infections caused by Propionibacterium sp. were associated with bacteremia in 10 children; ear infection in eight; abscesses in seven; adenitis and central nervous system infection in five each; burns in four; wounds in three; tumors and bone in two each; and cysts, eye, sinus, and mastoid in one each. Predisposing or underlying conditions were present in 33 children (73%). These included the presence of a foreign body (17), immunodeficiency (six), malignancy (five), diabetes (five), previous surgery (four), and steroid therapy (two). Antimicrobial therapy was given to 41 (91%) children. Surgical drainage was concomitantly performed in 22 (49%). Four patients died. This study highlights the importance of Propionibacterium sp. as an unusual, but potentially important, pathogen in children.

Child↗

PubMed1995

Kawasaki syndrome masquerading as bacterial lymphadenitis.

We present two case reports of older children who initially presented with cervical lymphadenitis and who were eventually diagnosed and treated for Kawasaki syndrome (KS). Both children presented with unilateral cervical lymphadenopathy and fever and later developed additional clinical features of KS, including cardiac aneurysms in one of the patients. Of the five KS clinical criteria which accompany fever for 5 days, cervical lymphadenopathy of > or = 1.5 cm is the least commonly found. Both patients were treated as having bacterial adenitis prior to the diagnosis of KS. We hope to illustrate that in the case of atypical cervical lymphadenitis, KS should be carefully considered in the differential diagnosis.

Child↗

PubMed2005

4 years' experience of head and neck tuberculosis in a south London hospital.

In a south London department of otorhinolaryngology and head and neck surgery, 33 cases of tuberculosis were diagnosed in 4 years. The most common presentation was cervical adenitis (58%) and in some cases the initial investigations suggested malignant disease. Most of the patients were of non-British origin but none proved to be HIV seropositive. Fine-needle aspiration was positive for tuberculosis in 7 of 19 patients. 21 patients required a surgical procedure for diagnosis.

Adult↗

PubMed1980

Acute abdominal pain in children.

During a twelve-month period, 416 children with acute abdominal pain required emergency admission to Southampton General Hospital; 46% had operations. Appendicitis was the commonest organic cause of acute abdominal pain identified (31%). Constipation (9%) can present as acute abdominal pain simulating appendicitis. All children should have a urine sample examined microscopically and the finding of significant pyuria is suggestive, but not diagnostic, of a urinary tract infection (7%). Mesenteric adenitis, which can only be diagnosed with certainty at laparotomy, was less common (4%). Despite careful clinical assessment and follow up, 45% of children in this series remained undiagnosed. Sedation but not analgesia may assist in the diagnosis of the acute abdomen in children.

Abdomen, Acute↗

PubMed1993

Ocular changes induced in the beagle dog by intravenous infusion of a novel dopaminergic compound, FPL 65447.

FPL 65447, a selective D1 receptor agonist with a potential for the acute treatment of renal and cardiac failure and of sepsis and septic shock, was administered to beagle dogs by continuous intravenous infusion for a maximum of 14 days. Ophthalmoscopical examination revealed dose-related changes in the eye and associated structures, consisting of foci of retinal discolouration, corneal changes including oedema, keratitis, opacities and neovascularisation, and inflammation of the iris, periorbital tissues, and adnexa. Microscopical examination confirmed the presence of inflammatory lesions in the eye. These were predominantly histiocytic and were mainly focal circumscribed lesions. More diffuse inflammation with a granulocytic and lymphocytic component was also encountered in the limbus and uveal tract. A predominantly interstitial histiocytic adenitis involving various glandular structures associated with the eye and adnexa was also identified. Possible mechanisms to account for the histiocytic changes are discussed.

Animals↗

PubMed1992

Indications for open cervical node biopsy in HIV-positive patients.

Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Complex↗

PubMed1989

Respiratory and pericardial lesions in turkeys infected with avian or mammalian strains of Chlamydia psittaci.

Three groups of turkeys were inoculated with strains of C. psittaci (B577, VS1, TT3) from different restriction endonuclease groups. Turkeys were necropsied at 15 times through post-inoculation day 70. Birds infected with the TT3 strain were lethargic and had decreased body weight. After forced exercise, dyspnea was seen in VS1-infected turkeys. Pericarditis was the most severe lesion in TT3-infected birds. Airsacculitis and bronchopneumonia were the most severe lesions in VS1-infected turkeys. Lateral nasal adenitis was in both VS1- and TT3-infected birds. Only mild peribronchial pneumonia was in B577-infected turkeys. Chlamydial antigen, identified by light microscopy using an immunoperoxidase technique, was seen from post-inoculation days 9 through 50 in the lateral nasal gland and at earlier times in other tissue from VS1- and TT3-infected turkeys. No chlamydial antigen was detected in tissue from B577-infected birds. These studies showed that chlamydial strains from different restriction endonuclease groups are associated with distinct disease syndromes in turkeys.

Air Sacs↗

PubMed1995

Naturally occurring Tyzzer's disease in a puppy.

A naturally occurring case of Tyzzer's disease due to infection with Bacillus piliformis in a wolf-dog hybrid resulted in widely disseminated lesions, including severe myocarditis, hepatitis, enterocolitis, intestinal leiomyositis, and adrenal cortical adenitis. Previously reported lesions for canine Tyzzer's disease have been limited to hepatic necrosis and a necrotizing enterocolitis.

Animals↗

PubMed1996

Lesions of neonatally induced toxoplasmosis in cats.

Five pregnant queens were inoculated orally with Toxoplasma gondii tissue cysts. Twenty-two live and three dead kittens were born 16 to 31 days after inoculation. Four kittens were eaten by queens and, thus, were not available for histologic examination. Twenty-one kittens that died or were euthanatized on day 2 (two kittens), 4 (one kitten), 5 (five kittens), 6 (five kittens), 7 (one kitten), 8 (four kittens), 16 (two kittens), and 29 (one kitten) after birth were studied histologically. T gondii was detected by bioassay and was seen in histologic sections of tissues from all 21 kittens. The histologic lesions associated with neonatal toxoplasmosis were widely disseminated infiltrates of macrophages and neutrophils often accompanied by necrosis; lymphocytes and plasma cells were occasionally present. The most consistent lesions were proliferative interstitial pneumonia (21/21); necrotizing hepatitis (20/21); myocarditis (21/21); skeletal myositis (21/21); glossal myositis (19/19); nonsuppurative encephalitis affecting the cerebrum (18/18), brain stem (15/15), and spinal cord (9/9); uveitis (19/19); necrotizing adrenal adenitis (18/18); and interstitial nephritis (16/21). Placental lesions (2/2) consisted of grossly visible areas of necrosis and mineralization.

Animals↗

PubMedDate not supplied

Sulbactam/ampicillin, a new beta-lactamase inhibitor/beta-lactam antibiotic combination.

Sulbactam/ampicillin is a combination of a beta-lactamase inhibitor with minimal intrinsic antibacterial activity (sulbactam sodium), and an aminopenicillin (ampicillin sodium). The addition of sulbactam to ampicillin has no effect on the chemical stability of ampicillin in aqueous solution, and the administration guidelines of the combination are the same as for ampicillin alone. Sulbactam acts primarily by irreversible inactivation of beta-lactamases from most beta-lactamase-producing organisms. The pharmacokinetics of sulbactam are similar to those of ampicillin with an elimination half-life of about one hour in most patients. One difference is that serum and tissue concentrations of sulbactam are usually twice those of ampicillin, at equivalent doses. The sulbactam/ampicillin combination has been approved for the treatment of adults with intraabdominal, skin and skin structure, and gynecological infections due to beta-lactamase-producing bacteria such as Staphylococcus aureus, Escherichia coli, and species of Klebsiella and Bacteroides. Clinical studies to date have also shown the combination to be effective for the treatment of meningitis, pneumonia, gonorrhea, epiglottis, urinary tract infections, cervical adenitis, and as prophylaxis for abdominal and gynecological surgeries. Many of these studies, however, have included small numbers of patients and/or had design flaws. Adverse effects have been minor with most being attributed to the ampicillin component. Sulbactam/ampicillin compares favorably with other antibiotic regimens in terms of acquisition costs and ease of administration.

Ampicillin↗