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Samudralwar RD, Bailey TC, Vellimana AK, Wright NM, Clifford DB. Mycobacterium haemophilum Related Myelitis in Geographically Linked Cases. Ann Neurol 2024; 95:614-616. [PMID: 37953637 DOI: 10.1002/ana.26828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Rohini D Samudralwar
- Division of Multiple Sclerosis and Related Neuroinflammatory Disorders, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas C Bailey
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ananth K Vellimana
- Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
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De New KM, Coates JR, Wellehan J, Gull T, Childress A, Anderson MN, Royal AB. Mycobacterium haemophilum infection in canine cerebrospinal fluid. Vet Clin Pathol 2023. [PMID: 36931892 DOI: 10.1111/vcp.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/20/2022] [Accepted: 10/13/2022] [Indexed: 03/19/2023]
Abstract
A 4-year-old female spayed Australian cattle dog was presented to the Emergency Service at the University of Missouri Veterinary Health Center Small Animal Hospital for generalized pain and lethargy. At presentation, the dog showed severe cervical spinal pain and thoracic limb deficits consistent with a multifocal neuroanatomic localization. Magnetic resonance imaging of the cervical spine revealed T2 and T1 postcontrast intense signal extending from the level of the medulla through C5 most marked in the caudal brainstem and cranial cervical spinal cord. The suspected diagnosis was severe meningoencephalomyelitis and secondary edema. Analysis of cerebrospinal fluid (CSF) collected from the cerebellomedullary cistern revealed a marked mixed pleocytosis with intralesional structures morphologically consistent with Mycobacterium sp. Standard DNA PCR assay performed on the CSF yielded the presence of Mycobacterium haemophilum. To the authors' knowledge, this is the first reported case of CNS mycobacteriosis diagnosed on CSF analysis in a dog.
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Affiliation(s)
| | | | - Jim Wellehan
- University of Florida, Gainesville, Florida, USA
| | - Tamara Gull
- University of Missouri, Columbia, Missouri, USA
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Fisk EA, Cassirer EF, Huggler KS, Pessier AP, White LA, Ramsay JD, Goldsmith EW, Drankhan HR, Wolking RM, Manlove KR, Nordeen T, Hogg JT, Taylor KR. ABORTION AND NEONATAL MORTALITY DUE TO TOXOPLASMA GONDII IN BIGHORN SHEEP (OVIS CANADENSIS). J Wildl Dis 2023; 59:37-48. [PMID: 36648765 DOI: 10.7589/jwd-d-22-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023]
Abstract
Low lamb recruitment can be an obstacle to bighorn sheep (Ovis canadensis) conservation and restoration. Causes of abortion and neonate loss in bighorn sheep, which may affect recruitment, are poorly understood. Toxoplasma gondii is a major cause of abortion and stillbirth in domestic small ruminants worldwide, but no reports exist documenting abortion or neonatal death in bighorn sheep attributable to toxoplasmosis. Between March 2019 and May 2021, eight fetal and neonatal bighorn lamb cadavers from four western US states (Idaho, Montana, Nebraska, and Washington) were submitted to the Washington Animal Disease Diagnostic Laboratory for postmortem examination, histologic examination, and ancillary testing to determine the cause of abortion or neonatal death. Necrotizing encephalitis characteristic of toxoplasmosis was identified histologically in six of eight cases, and T. gondii infection was confirmed by PCR in five cases with characteristic lesions. Other lesions attributable to toxoplasmosis were pneumonia (3/5 cases) and myocarditis (2/5 cases). Protozoal cysts were identified histologically within brain, lung, heart, skeletal muscle, adipose tissue, or a combination of samples in all five sheep with PCR-confirmed T. gondii infections. Seroprevalence of T. gondii ranged from 40-81% of adult females sampled in the Washington population in October and November 2018-2021, confirming high rates of exposure before detection of Toxoplasma abortions in this study. Of 1,149 bighorn sheep postmortem samples submitted to Washington Animal Disease Diagnostic Laboratory between January 2000 and May 2021, 21 of which were from fetuses or neonates, a single case of chronic toxoplasmosis was diagnosed in one adult ewe. Recent identification of Toxoplasma abortions in bighorn sheep suggests that toxoplasmosis is an underappreciated cause of reproductive loss. Abortions and neonatal mortalities should be investigated through postmortem and histologic examination, particularly in herds that are chronically small, demographically stagnant, or exhibit reproductive rates lower than expected.
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Affiliation(s)
- Elis A Fisk
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - E Frances Cassirer
- Idaho Department of Fish and Game, 3316 16th St., Lewiston, Idaho 83501, USA
| | - Katey S Huggler
- Department of Fish and Wildlife Sciences, University of Idaho, 875 Perimeter Dr., Moscow, Idaho 83844, USA
| | - Allan P Pessier
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Laura A White
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Joshua D Ramsay
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Elizabeth W Goldsmith
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Holly R Drankhan
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Rebecca M Wolking
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
| | - Kezia R Manlove
- Department of Wildland Resources and Ecology Center, Utah State University, 5230 Old Main Hill, NR 206, Logan, Utah 84322, USA
| | - Todd Nordeen
- Nebraska Game and Parks Commission, 2200 N 33rd St., PO Box 30370, Lincoln, Nebraska 68503, USA
| | - John T Hogg
- Montana Conservation Science Institute Ltd., 5200 Miller Creek Rd., Missoula, Montana 59803, USA
| | - Kyle R Taylor
- Washington Animal Disease Diagnostic Laboratory, 1940 SE Olympia Ave., Pullman, Washington 99164-7034, USA
- Department of Veterinary Microbiology and Pathology, Washington State University College of Veterinary Medicine, PO Box 647040, Pullman, Washington 99164-7040, USA
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Rayment KM, Garner MM, Drees R, Francis MM, Rose JB, Sim RR. Atypical Candidiasis of the Gnathotheca in a Lesser Flamingo (Phoeniconaias minor). J Avian Med Surg 2022; 35:457-463. [DOI: 10.1647/20-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kelsey M. Rayment
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
| | - Michael M. Garner
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
| | - Randi Drees
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
| | - Marla M. Francis
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
| | - Josephine B. Rose
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
| | - Richard R. Sim
- From the School of Veterinary Medicine, University of Wisconsin–Madison, 2015 Linden Dr, Madison, WI 53706, USA (Rayment); Northwest ZooPath, 654 West Main St, Monroe, WA 98272, USA (Garner); Royal Veterinary College, Hawks-head Lane, North Mymms, Ha
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Lamb SK, Reavill D, Wolking R, Dahlhausen B. Retrospective Review of Mycobacterial Conjunctivitis in Cockatiels ( Nymphicus hollandicus). J Avian Med Surg 2021; 34:250-259. [PMID: 33099978 DOI: 10.1647/1082-6742-34.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The etiologic disease organism responsible for causing mycobacteriosis in avian species is an acid-fast gram-positive bacterium. This bacterium causes granulomatous disease in various internal organs, but in cockatiels (Nymphicus hollandicus) it has been commonly identified within the conjunctival tissues. Twenty-six cases of mycobacterial conjunctivitis in cockatiels were diagnosed through histopathologic assessment of diseased tissue samples, Fite acid-fast staining, and polymerase chain reaction in this retrospective study. Clinicians who saw these cases were contacted, and information was obtained regarding recommended treatment protocols prescribed for the patients, the Mycobacterium species identified, and case outcomes. All patients in this retrospective study had a biopsy performed on the affected conjunctival tissue, and because of the small size of the patients, this excisional biopsy removed the affected tissue in its entirety or significantly debulked the lesion. Of the 26 cases, 10 were lost to follow-up, 4 were euthanatized, 7 died, and 5 were alive at the time this information was submitted for publication.
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Affiliation(s)
| | - Drury Reavill
- Zoo/Exotic Pathology Service, Carmichael, CA 95608, USA
| | - Rebecca Wolking
- Washington Animal Disease Diagnostic Lab, Pullman, WA 99164, USA
| | - Bob Dahlhausen
- Veterinary Molecular Diagnostics, Milford, OH 45150, USA
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Reed K, Wolf K, Anderson K, Wolking R, Garner MM. Fatal Meningoencephalitis From a Rhizomucor pusillus Infection in a Juvenile Magellanic Penguin ( Spheniscus magellanicus). J Avian Med Surg 2021; 35:86-89. [PMID: 33892594 DOI: 10.1647/1082-6742-35.1.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 7-month-old, male Magellanic penguin (Spheniscus magellanicus), housed in an outdoor exhibit, developed acute neurologic signs that progressed to death over 2 days. On gross examination, the bird had congested, edematous lungs, and cerebellar hemorrhage. Histologic examination identified granulomatous pneumonia and encephalitis, with thrombosis and eosinophilic, branching fungal hyphae that had invaded the meningeal vessel walls. Polymerase chain reaction identified the fungus in the brain as Rhizomucor pusillus, an uncommon cause of mucormycosis. This organism has previously been reported in respiratory, skeletal, and sino-orbital lesions of avian species. This clinical report describes meningoencephalitis associated with Rhizomucor pusillus in a penguin.
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Affiliation(s)
- Kathlyn Reed
- Point Defiance Zoo & Aquarium, Tacoma, WA 98407, USA,
| | - Karen Wolf
- Point Defiance Zoo & Aquarium, Tacoma, WA 98407, USA
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Han S, Armién AG, Hill JE, Fernando C, Bradway DS, Stringer E, Newton AL, Huang Y. Infection With a Novel Rickettsiella Species in Emperor Scorpions ( Pandinus imperator). Vet Pathol 2020; 57:858-870. [PMID: 32844733 DOI: 10.1177/0300985820951495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rickettsiella infection was diagnosed in 4 adult emperor scorpions (Pandinus imperator) from 2 different collections over a 3-year period. One case had a 2-day history of weakness, failure to lift the tail, or respond to stimulation, with rapid progression to death. The other 3 cases were found dead. There were no gross lesions, but histologically the hemolymphatic vasculature and sinuses, presumed hematopoietic organ, heart, midgut and midgut diverticula, nerves, and skeletal muscle were infiltrated with phagocytic and granular hemocytes with necrosis. Phagocytic hemocytes contained abundant intracellular microorganisms that were Fite's acid-fast-positive, Macchiavello-positive, variably gram-positive or gram-negative, and Grocott's methenamine silver-negative. By transmission electron microscopy, hemocytes contained numerous phagocytic vacuoles with small dense bacterial forms (mean 0.603 × 0.163 μm) interspersed with large bacterial forms (mean 1.265 × 0.505 μm) and few intermediary forms with electron-dense nucleoids and membrane-bound crystalline arrays (average 4.72 μm). Transmission electron microscopy findings were consistent with bacteria of the family Coxiellaceae. Based on sequencing the 16S ribosomal RNA gene, the identity was confirmed as Rickettsiella, and phylogenetic analysis of protein-coding genes gidA, rspA, and sucB genes suggested the emperor scorpion pathogen as a new species. This study identifies a novel Rickettsiella causing infection in emperor scorpions and characterizes the unique pathological findings of this disease. We suggest this organism be provisionally named Rickettsiella scorpionisepticum.
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Affiliation(s)
- Sushan Han
- 3447Colorado State University, Fort Collins, CO, USA
| | | | - Janet E Hill
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | | | - Alisa L Newton
- 2015Wildlife Conservation Society, New York Aquarium, Bronx, NY, USA
| | - Yanyun Huang
- Prairie Diagnostic Services Inc, Saskatoon, Saskatchewan, Canada
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Mete A, Rogers KH, Wolking R, Bradway DS, Kelly T, Piazza M, Crossley B. Sarcocystis calchasi Outbreak in Feral Rock Pigeons ( Columba livia) in California. Vet Pathol 2018; 56:317-321. [PMID: 30222062 DOI: 10.1177/0300985818794262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-two feral rock pigeons ( Columba livia) from 10 counties in California with ataxia, torticollis, and difficulty standing and flying were admitted to rehabilitation centers in late winter and spring of 2017 and died or were euthanized. Common necropsy findings included thin body condition, generalized deep red discoloration of organs, and hemorrhagic subcutaneous neck tissues. Meningoencephalitis was observed microscopically in 16 pigeons, and 3 also had protozoal schizonts in the brain. The most consistently affected regions of the brain were cerebellum and brainstem. Skeletal muscles, and less frequently the heart, contained large intrasarcoplasmic bradyzoites typically without inflammation. Fifteen of the 22 birds tested positive using pan- Sarcocystis polymerase chain reaction. The sequence of the amplicon was most closely related to S. calchasi, and the 8 subtyped sequences had 100% homology with S. calchasi. This investigation demonstrated the transcontinental and North American spread of S. calchasi causing a disease outbreak in free-ranging rock pigeons, thus warranting increased surveillance in susceptible native columbids.
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Affiliation(s)
- Aslı Mete
- 1 California Animal Health and Food Safety Laboratory, UC Davis, Davis, CA, USA
| | - Krysta H Rogers
- 2 Wildlife Investigations Laboratory, California Department of Fish and Wildlife, Rancho Cordova, CA, USA
| | - Rebecca Wolking
- 3 Washington Animal Disease Diagnostic Laboratory, Pullman, WA, USA
| | - Daniel S Bradway
- 3 Washington Animal Disease Diagnostic Laboratory, Pullman, WA, USA
| | - Terra Kelly
- 4 Karen C. Drayer Wildlife Health Center, UC, Davis, Davis, CA, USA
| | | | - Beate Crossley
- 1 California Animal Health and Food Safety Laboratory, UC Davis, Davis, CA, USA
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9
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Schafbuch R, Tinkler S, Lim CK, Wolking R, Ramos-Vara J. Disseminated mycobacteriosis caused by Mycobacterium kansasii in a pot-bellied pig. J Vet Diagn Invest 2018; 30:646-650. [PMID: 29855226 DOI: 10.1177/1040638718780189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 1.5-y-old spayed female Juliana pot-bellied pig was presented to the Purdue University Veterinary Teaching Hospital with a history of wasting and anorexia. Enlarged and partially mineralized lymph nodes were identified on radiographs and computed tomography scan. Generalized lymphadenomegaly and disseminated nodules in the lungs, liver, spleen, and kidneys were identified on postmortem examination. Histologic examination revealed caseonecrotic granulomas with numerous intracellular, acid-fast bacilli. Mycobacterium kansasii type II was identified as the etiologic agent by PCR amplification using universal Mycobacterium primers, direct sequencing of the PCR amplicon, and comparison to sequences in GenBank. We describe a case in a pot-bellied pig of mycobacteriosis caused by an atypical mycobacterial species and highlight the important role of laboratory testing in suspected cases of tuberculosis.
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Affiliation(s)
- Ryan Schafbuch
- Indiana Animal Disease Diagnostic Laboratory and the Departments of Comparative Pathobiology (Schafbuch, Ramos-Vara), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Veterinary Clinical Sciences (Tinkler, Lim), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA (Wolking)
| | - Stacy Tinkler
- Indiana Animal Disease Diagnostic Laboratory and the Departments of Comparative Pathobiology (Schafbuch, Ramos-Vara), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Veterinary Clinical Sciences (Tinkler, Lim), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA (Wolking)
| | - Chee Kin Lim
- Indiana Animal Disease Diagnostic Laboratory and the Departments of Comparative Pathobiology (Schafbuch, Ramos-Vara), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Veterinary Clinical Sciences (Tinkler, Lim), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA (Wolking)
| | - Rebecca Wolking
- Indiana Animal Disease Diagnostic Laboratory and the Departments of Comparative Pathobiology (Schafbuch, Ramos-Vara), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Veterinary Clinical Sciences (Tinkler, Lim), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA (Wolking)
| | - José Ramos-Vara
- Indiana Animal Disease Diagnostic Laboratory and the Departments of Comparative Pathobiology (Schafbuch, Ramos-Vara), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Veterinary Clinical Sciences (Tinkler, Lim), College of Veterinary Medicine, Purdue University, West Lafayette, IN.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, WA (Wolking)
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Disseminated Mycobacterium haemophilum infection in an ASSAM trinket snake (Elaphe frenata). J Zoo Wildl Med 2015; 45:966-9. [PMID: 25632694 DOI: 10.1638/2014-0078.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A sub-adult male Assam trinket snake (Elaphe frenata) that was confiscated from an exotic animal dealer was found dead in its enclosure after a 17-mo quarantine. The snake had grown well during that period and had no physical examination or bloodwork abnormalities during the quarantine. On gross necropsy, masses were found in the epaxial musculature and stomach, the lung was diffusely thickened, the ventricular wall was mottled, and there was intracoelomic and pericardial effusion. Histopathology revealed diffusely disseminated granulomatous infiltrates throughout the lung interstitium and multifocal granulomatous infiltrates in the transmural gastric mass, within the myocardium and pericardial adipose tissue, in the liver and kidney parenchyma, in the cervical region surrounding the trachea and thyroid, and replacing the myofibers of the craniolateral epaxial muscles. Fite-Farracho acid-fast staining revealed numerous intracytoplasmic acid-fast bacilli within macrophages, and polymerase chain reaction testing on frozen tissues followed by nucleic acid sequencing of polymerase chain reaction amplicons identified Mycobacterium haemophilum.
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Mycobacterium haemophilum as the Initial Presentation of a B-Cell Lymphoma in a Liver Transplant Patient. Case Rep Rheumatol 2014; 2014:742978. [PMID: 24523979 PMCID: PMC3913284 DOI: 10.1155/2014/742978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
A 66-year-old woman presented with pustular lesions of her face, trunk, and limbs and an acute arthritis of the knees and elbows.
She had a complex medical background and had been on immunosuppressants for three years after a liver transplant. Tissue samples from her skin lesions and synovial fluid showed acid-fast bacilli. Mycobacterium haemophilum, an atypical mycobacteria, was later grown on culture. During her treatment with combination antibiotic therapy, she developed a pronounced generalised lymphadenopathy. Histology showed features of a diffuse B-cell lymphoma, a posttransplant lymphoproliferative disorder (PTLD).
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Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2012; 24:701-17. [PMID: 21976605 DOI: 10.1128/cmr.00020-11] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental habitats, which can colonize and occasionally infect humans and animals. Several findings suggest that water reservoirs are a likely source of M. haemophilum infections. M. haemophilum causes mainly ulcerating skin infections and arthritis in persons who are severely immunocompromised. Disseminated and pulmonary infections occasionally occur. The second at-risk group is otherwise healthy children, who typically develop cervical and perihilar lymphadenitis. A full diagnostic regimen for the optimal detection of M. haemophilum includes acid-fast staining, culturing at two temperatures with iron-supplemented media, and molecular detection. The most preferable molecular assay is a real-time PCR targeting an M. haemophilum-specific internal transcribed spacer (ITS), but another approach is the application of a generic PCR for a mycobacterium-specific fragment with subsequent sequencing to identify M. haemophilum. No standard treatment guidelines are available, but published literature agrees that immunocompromised patients should be treated with multiple antibiotics, tailored to the disease presentation and underlying degree of immune suppression. The outcome of M. haemophilum cervicofacial lymphadenitis in immunocompetent patients favors surgical intervention rather than antibiotic treatment.
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Kelley CF, Armstrong WS, Eaton ME. Disseminated Mycobacterium haemophilum infection. THE LANCET. INFECTIOUS DISEASES 2011; 11:571-8. [DOI: 10.1016/s1473-3099(11)70029-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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