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Faria DK, Almeida Júnior JND, Faria CS, Durante B, Falasco BF, Terreri Neto E, Antonangelo L. How a discerning cytological examination can aid in the diagnosis of infectious diseases: case reports. ACTA ACUST UNITED AC 2021; 54:e10462. [PMID: 33439934 PMCID: PMC7798183 DOI: 10.1590/1414-431x202010462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022]
Abstract
Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.
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Affiliation(s)
- D K Faria
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J N de Almeida Júnior
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C S Faria
- Laboratório de Investigação Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B Durante
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B F Falasco
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Terreri Neto
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L Antonangelo
- Laboratório de Patologia Clínica, Departamento de Patologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Laboratório de Investigação Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Dientamoeba fragilis, a Commensal in Children in Danish Day Care Centers. J Clin Microbiol 2017; 55:1707-1713. [PMID: 28330885 DOI: 10.1128/jcm.00037-17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
Dientamoeba fragilis is an intestinal protozoan of debated clinical significance. Here, we present cross-sectional and longitudinal observations on D. fragilis in children aged 0 to 6 years from a 1-year multi-day-care-center cohort study set in Copenhagen, Denmark. The inclusion period for the cohort was 2009 through 2012. Stool samples collected from the children were accompanied by questionnaires completed by the parents or guardians of the children. Using real-time PCR, D. fragilis was detected in the first stool sample from 97 of 142 (68.3%) children. We evaluated the associations between seven plausible risk factors (age, sex, having siblings, having domestic animals at home, having had infant colic, recent history of intake of antibiotics, and recent history of travel abroad) as well as six reported symptoms (lack of appetite, nausea, vomiting, abdominal pain, weight loss, and diarrhea) and testing positive for D. fragilis The final multivariable model identified being >3 years old and having a history of recent travel abroad as risk factors for testing positive for D. fragilis Moreover, univariable analyses indicated that having siblings was a risk factor. There was no statistical association between a recent history of gastrointestinal symptoms and testing positive for D. fragilis Among the 108 children who were represented by ≥2 samples and thus included in the longitudinal analysis, 32 tested negative on the first sample and positive later, and the last sample from each of the 108 children was positive. The results are in support of D. fragilis being a common enteric commensal in this population.
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Cacciò SM, Sannella AR, Bruno A, Stensvold CR, David EB, Guimarães S, Manuali E, Magistrali C, Mahdad K, Beaman M, Maserati R, Tosini F, Pozio E. Multilocus sequence typing of Dientamoeba fragilis identified a major clone with widespread geographical distribution. Int J Parasitol 2016; 46:793-798. [DOI: 10.1016/j.ijpara.2016.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
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Abstract
Dientamoeba fragilis is a single-celled protozoan, closely related to the trichomonads. Reported worldwide as causing human gastrointestinal symptoms, D. fragilis is very common and is second only to Blastocystis spp. Dientamoebiasis equals or exceeds the incidence of giardiasis. This minireview includes diagnostic options, clinical relevance, therapy, an animal model, the confirmed cyst stage, and sequencing data. The development of a rodent model, fulfilling Koch's postulates, and the confirmation of a cyst stage have clarified transmission routes, including fecal-oral transmission. The prevalence of D. fragilis varies between 0% to over 82%; results depend on the geographic location, group studied, and diagnostic methods used.
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