Adult pulmonary cytomegalic inclusion disease: report of a case

Pneumocyte injury and ubiquitin-positive pneumocytes in interstitial lung diseases

Pneumocyte injury is a characteristic of pulmonary interstitial pneumonias (IPs). Histological markers of pneumocyte injury and inflammation include pneumocyte necrosis, erosion, hyaline membrane and fibrin exudation with subsequent intraluminal granulation tissue formation. We found that intracytoplasmic inclusions in pneumocytes are ubiquitin-positive (Ub⁺) and that the number of Ub⁺ pneumocytes shows positive correlation with the extent of diffuse alveolar damage (DAD). To determine the role of Ub⁺ pneumocytes and inclusions in IPs, we studied their relationship with pathological and clinical features of DAD, usual interstitial pneumonia (UIP) and organizing pneumonia (OP), including airspace enlargement with fibrosis (AEF). We analysed Ub⁺ pneumocytes, inclusions, erosions and intraluminal granulation tissue in relation to pneumocyte injury. The numbers of immunohistochemically identified Ub⁺ inclusions in each IP were higher than the number of inclusions detected by light microscopy. The inclusions detected by Ub⁺ immunostaining were identical to the inclusions observed by light microscopy. UIP and DAD had many Ub⁺ inclusions, while OP and AEF had fewer Ub⁺ inclusions. These results suggest that the extent of Ub⁺ inclusions reflects the severity of pneumocyte injury among IPs. Thus, Ub⁺ inclusions are a histological marker of pneumocyte injury that may be helpful in determining the severity and prognosis of IPs.

Comparison of Cape Town and Skirrow's Campylobacter isolation protocols in humans and broilers in Morogoro, Tanzania

Comparison of Cape Town and Skirrow's protocols used in isolation of Campylobacter in humans and broilers was carried out in a cross-sectional study in Morogoro, Tanzania. A total of 176 and 158 human stool and broiler intestinal samples were collected, respectively. While human stool samples were collected from selected health centers, broiler intestinal samples were obtained from selected farms and chicken markets. Samples were inoculated and cultured in duplicate using two protocols and prevalence of Campylobacter were established. In humans, the prevalence of Campylobacter isolates was significantly higher (P < 0.001) (21.6%) with Cape Town protocol than Skirrow's method (9.1%). Similarly, a higher prevalence (P < 0.05) in broilers was recorded in Cape Town protocol (77.8%) than Skirrow's method (66.5%). There was a moderate (0.53) Kappa test of agreement between Skirrow's and Cape Town protocols for human samples and substantial agreement (0.72) for broiler samples. This demonstrates that Cape Town protocol is superior over the Skirrow's protocol in Campylobacter isolation. Campylobacter jejuni, Campylobacter coli and Campylobacter lari were the Campylobacter spp. isolated. In humans, C. jejuni accounted for 92.1% and 87.5% of all positive samples with Cape Town and Skirrow's protocols, respectively. In broilers, C. jejuni was isolated at 91.1% and 92.5% of all species obtained with Cape Town and Skirrow's protocols, respectively. This shows that C. jejuni is the common species that may be circulating from either broilers to humans or other animals and vice versa. The present study has introduced Cape Town protocol in Tanzania for Campylobacter isolation from human and animal samples, which is expected to improve the isolation of Campylobacter species. Cape Town protocol may also be a good alternative for use in routine isolation of Campylobacter.

Ultrastructural study of intranuclear inclusion bodies of pulmonary adenocarcinoma

Intranuclear inclusion bodies are sometimes observed in pulmonary adenocarcinoma by light microscopy. Electron microscopic characteristics of lung cancer cells with intranuclear inclusion bodies were studied. In addition, polymerase chain reaction (PCR) was performed using primers coding for human papillomavirus (HPV) types 16, 18, and 33. Eosinophilic intranuclear inclusion bodies were observed in 22 out of 285 cases by light microscopy. Immunohistochemically, cancer cell nuclei stained with PE-10. Three types of intranuclear inclusion bodies were classified electron microscopically. Type A showed aggregation of electron dense particles (30-40 nm) with an electron-dense core and was most frequently observed. Type B consisted of a mass of branching and whirling tubular structures. Type B intranuclear inclusions had a relationship with inner nuclear membrane. In type C, several spherical inclusions were observed in one nucleus. HPV DNA was detected using PCR and type-specific probes in a case with type A inclusion bodies. This study suggests that intranuclear inclusion bodies in pulmonary adenocarcinoma are formed by several different mechanisms.

An immunofluorescent study of generalized infection of human cytomegalovirus in a patient with systemic lupus erythematosus

An autopsy case of generalized infection of cytomegalovirus (CMV) in an adult with systemic lupus erythematosus is reported. CMV infection was histologically diagnosed postmortem by the presence of the characteristic cytomegalic cells with inclusion body. In the lungs, viral antigen was seen not only in the cytomegalic cells with inclusion body but also in the cells without intranuclear inclusion body in both of the frozen and the formalin-fixed paraffin sections. Viral antigen was also detected in frozen sections of the liver. CMV was isolated from the lung and liver.

Histologically specific skin lesions in disseminated cytomegalovirus infection

A diabetic renal transplant recipient developed fever, generalized rash, and genital ulcers which showed typical histologic changes of cytomegalovirus (CMV) infection in the dermal vascular endothelium. This infection was confirmed by rising serologic titer of specific antibody, positive viral cultures, and typical nuclear inclusion bodies in pulmonary and hepatic tissue at autopsy. Biopsy of the patient's skin lesions provided the opportunity for early diagnosis of this fatal systemic CMV infection. Two clinical patterns of specific cutaneous involvement in disseminated CMV infection are discussed.