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Wang Y, Ren X, Shen D, Mao C, Wang H, Peng B, Gao J, Cui L. Spinal Intrathecal Actinomycosis Causes Multisegmental Root Failure: A Case Report. Front Neurol 2020; 11:621. [PMID: 32714273 PMCID: PMC7344188 DOI: 10.3389/fneur.2020.00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
Abstract
Actinomycosis is a slowly progressing infection caused by Actinomyces species, which consists of filamentous gram-positive bacteria. Intraspinal actinomycosis is very rare and most of the previous cases presented with epidural lesions. Only two cases of intrathecal actinomycosis have been described. We reported a case of intrathecal actinomycosis in a 46-year-old woman. Our patient presented with multisegmental root failure, which was different from previous intrathecal cases mainly involving the spinal cord. The manifestations, cervical MR imaging results, biopsy and histopathological features, and treatment history of the patient were reviewed. Clinical features of this disease resemble intraspinal neoplasms, other infectious processes, and granulomatous diseases, thus being difficult to diagnose preoperatively. Histopathological evidence from the biopsy is important for timely diagnosis. Early diagnosis and treatment may greatly improve the prognosis.
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Affiliation(s)
- Yanying Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xinyu Ren
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chenhui Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Han Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
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2
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Balkhair A, Al Wahaibi A, Al-Qadhi H, Al-Harthy A, Lakhtakia R, Rasool W, Ibrahim S. Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report. IDCases 2019; 18:e00614. [PMID: 31485412 PMCID: PMC6715833 DOI: 10.1016/j.idcr.2019.e00614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022] Open
Abstract
Basidiobolomycosis is rare infection caused by the saprophytic fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis is an infrequent, albeit, increasingly reported, emerging form of the disease and typically affects immunocompetent individuals with potentially grave sequelae if unrecognized. Acquaintance with this exceptionally rare fungus and its potential for presenting as gastrointestinal mass masquerading as colonic malignancy is critical for timely diagnosis, appropriate treatment and successful clinical outcome. We report a case of gastrointestinal basidiobolomycosis masquerading as colonic malignancy in a 29-year-old Omani patient successfully treated with combination of surgery and prolonged azole antifungal therapy.
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Affiliation(s)
- A. Balkhair
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - A. Al Wahaibi
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - H. Al-Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Oman
| | - A. Al-Harthy
- Department of Surgery, Sultan Qaboos University Hospital, Oman
| | - R. Lakhtakia
- Department of Pathology, Sultan Qaboos University Hospital, Oman
| | - W. Rasool
- Department of Medicine, Gastroenterology Unit, Sultan Qaboos University Hospital, Oman
| | - S. Ibrahim
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
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3
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Colonic basidiobolomycosis presenting with intestinal obstruction and a normal eosinophil count. IDCases 2019; 17:e00565. [PMID: 31194167 PMCID: PMC6555899 DOI: 10.1016/j.idcr.2019.e00565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/23/2022] Open
Abstract
Gastrointestinal basidiobolomycosis (GIB), caused by Basidiobolus ranrum, is a rare fungal infection with a limited geographic distribution. The majority of the cases are reported from the warm areas of Arizona in USA, Saudi Arabia and Iran. We report a middle aged patient who was admitted to hospital with suspected metastatic colonic carcinoma. He presented with constipation, anorexia and weight loss. Computed tomography scan disclosed a mass involving the mid and distal sigmoid colon and hypodense lesion in hepatic segment IV. Excised tissue during a Hartmann's surgery showed an extensive eosinophil-rich transmural inflammation with mural necrotizing granulomas and several broad septated fungal hyphae. He was commenced on voriconazole following surgery. The diagnosis of basidiobolomycosis was established by histopathological examination. Since the diagnosis was not suspected preoperatively tissue culture for fungi was not collected. However molecular testing confirmed the diagnosis of GIB. Therapy involved a combination of surgical resection of the mass and prolonged voriconazole treatment. Increased awareness among physicians is needed for early diagnosis and treatment of GIB.
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Abstract
The pathogenic entomophthoralean fungi cause infection in insects and mammalian hosts. Basidiobolus and Conidiobolus species can be found in soil and insect, reptile, and amphibian droppings in tropical and subtropical areas. The life cycles of these fungi occur in these environments where infecting sticky conidia are developed. The infection is acquired by insect bite or contact with contaminated environments through open skin. Conidiobolus coronatus typically causes chronic rhinofacial disease in immunocompetent hosts, whereas some Conidiobolus species can be found in immunocompromised patients. Basidiobolus ranarum infection is restricted to subcutaneous tissues but may be involved in intestinal and disseminated infections. Its early diagnosis remains challenging due to clinical similarities to other intestinal diseases. Infected tissues characteristically display eosinophilic granulomas with the Splendore-Höeppli phenomenon. However, in immunocompromised patients, the above-mentioned inflammatory reaction is absent. Laboratory diagnosis includes wet mount, culture serological assays, and molecular methodologies. The management of entomophthoralean fungi relies on traditional antifungal therapies, such as potassium iodide (KI), amphotericin B, itraconazole, and ketoconazole, and surgery. These species are intrinsically resistant to some antifungals, prompting physicians to experiment with combinations of therapies. Research is needed to investigate the immunology of entomophthoralean fungi in infected hosts. The absence of an animal model and lack of funding severely limit research on these fungi.
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Affiliation(s)
- Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan, USA
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, USA
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5
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Chatterjee A, Chatterjee S. Deep Invasive Fungal Infection of the Hand in a Child Mimicking a Local Gigantism. J Hand Microsurg 2018; 10:41-45. [PMID: 29706736 DOI: 10.1055/s-0037-1606627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022] Open
Abstract
Subcutaneous and deep fungal infections in the hand are rare among children. These are usually found in immunocompromised adults or in persons engaged in soil handling activities, due to direct exposure, especially in the tropics. Delay in diagnosis is usual because pyogenic and other granulomatous infections are considered first. The authors present the case of a healthy, immunocompetent 2½-year-old child who presented with progressive swelling of the right hand mimicking a localized gigantism of the entire hand. Multiple operative drainage procedures done previously had failed to resolve the condition. A biopsy established the presence of fungal hyphae, thus confirming the diagnosis of deep fungal infection of the hand and guided proper therapeutic intervention. A strong index of suspicion needs to be maintained in cases not responding to conventional antibacterial therapy, and both microbiologic and histopathologic samples need to be obtained to establish the diagnosis.
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Affiliation(s)
- Anirban Chatterjee
- Department of Orthopedics, Medica Superspecialty Hospital, Kolkata, West Bengal, India
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6
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McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The cytopathology of Actinomyces, Nocardia, and their mimickers. Diagn Cytopathol 2017; 45:1105-1115. [PMID: 28888064 DOI: 10.1002/dc.23816] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022]
Abstract
Nocardia species and Actinomyces species are 2 of the most commonly diagnosed filamentous bacteria in routine cytopathology practice. These genera share many overlapping cytomorphologic features, including their thin, beaded, branching, Gram-positive, GMS-positive filamentous structures that fragment at their peripheries into bacillary- and coccoid-appearing forms. Features that help distinguish between these 2 microorganisms include the width of their filamentous structures, the angles at which they branch, and their ability or lack thereof to retain a modified acid-fast stain. In addition to cytomorphologic overlap, overlap in clinical presentation is frequent with pulmonary and mucocutaneous presentations seen in both. Differentiating between Nocardia and Actinomyces is essential because patients with these infections require different approaches to medical management. Both antibiotic susceptibilities and the need for early surgical intervention as part of the treatment plan vary greatly among these 2 groups. This review focuses on the clinical presentation, cytomorphology and staining characteristics that can be useful in identifying and distinguishing between Nocardia and Actinomyces infections, as well as their mimickers.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Charles D Sturgis
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, 10900 Euclid Ave, Cleveland, Ohio, 44106.,Department of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio, 44106
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7
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Eyelid Mycetoma Masquerading as Sebaceous Carcinoma. Ophthalmic Plast Reconstr Surg 2016; 33:S101-S104. [PMID: 26882058 DOI: 10.1097/iop.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 56-year-old Asian woman presented with an upper eyelid mass. The lesion was exposed after eversion of the eyelid revealing a thickened tarsus with yellowish areas. Working diagnosis was sebaceous carcinoma. Biopsy was performed. Histopathological studies showed a mycotic eumycetoma with Splendore-Hoeppli phenomena and - microbiologic cultures grew Scedosporium apiospermum. The patient was started on voriconazole 200 mg po bid with adequate serum levels. A complete response was observed after 18 weeks of voriconazole therapy. To the best of our knowledge, this is the first published case of S. apiospermum eumycotic mycetoma of the eyelid. It is important to consider mycotic infection in the differential diagnosis of eyelid tumors even in healthy patients.
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8
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Levels of infection, pathology and nodule size of Onchocerca flexuosa (Nematoda: Onchocercidae) in red deer (Cervus elaphus) from northern Spain. J Helminthol 2014; 89:326-34. [PMID: 24622346 DOI: 10.1017/s0022149x1400011x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Between 2005 and 2007, the presence of Onchocerca flexuosa (Wedl, 1856) was discovered and investigated in 110 red deer (Cervus elaphus) shot in the Riaño Regional Hunting Reserve, in the province of León (north-western Spain). Nodules containing O. flexuosa were located in the dorsal region and flanks of the deer. These were collected and measured, and some adult parasites were extracted from the nodules and identified by morphology and by obtaining mitochondrial 12S rDNA sequences, which were identical to those of previously published sequences for O. flexuosa. Some nodules were prepared for histology, embedded in paraffin, sectioned and stained with haematoxylin-eosin. Histologically, the worms were found in several compartments separated by an infiltrated fibrous tissue. These compartments were inhabited by several females and males, surrounded by a fibrous capsule. A total of 85.45% (95% confidence interval (CI): 78.86-92.04%) of red deer were parasitized, with a mean intensity of 9.53 ± 12.27 nodules/host, ranging between 1 and 74 nodules/deer. Significant differences in prevalence and intensity of infection were found between young and adult red deer, and also between seasons. However, no significant differences between males and females were observed. Five hundred and ninety-seven nodules were measured (15.81 ± 3.94 mm) and classified by sizes into small ( < 10 mm), medium (10-20 mm) and large (>20 mm). No relation was found between the size of the nodules and the time of infection. The high values found in the studied parameters show that northern Spain is an area of high-intensity infection for deer.
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9
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A case of pulmonary aspergilloma without actinomycosis. J Med Microbiol 2013; 62:1258. [DOI: 10.1099/jmm.0.058370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Unis G, Oliveira FDM, Severo LC. A case of pulmonary aspergilloma without actinomycosis. J Med Microbiol 2013; 62:1097. [DOI: 10.1099/jmm.0.060392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gisela Unis
- Hospital Santório Parteno, RS, Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | - Flávio de Mattos Oliveira
- Laboratório de Micologia, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Doutor em Ciências Pneumológicas (UFRGS), Brazil
| | - Luiz Carlos Severo
- Professor Associado (Nível 4), Departamento de Medicina Interna, Faculdade de Medicina UFRGS, Pesquisador 1B CNPq, Brazil
- Laboratório de Micologia, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Doutor em Ciências Pneumológicas (UFRGS), Brazil
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11
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Batta B, Robin A, George JL, Angioi K. ["Teddy bear granuloma", a rare condition: a case report of a 3-year-old child]. J Fr Ophtalmol 2012; 35:117-20. [PMID: 22261387 DOI: 10.1016/j.jfo.2011.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/28/2011] [Accepted: 07/19/2011] [Indexed: 11/30/2022]
Abstract
Conjunctival synthetic fiber granulomas, or "Teddy bear granulomas", are rare granulomatous responses to synthetic fabric fibers. We report the case of a 3-year-old boy with no prior infectious or traumatic history, brought in by his parents for an incidentally discovered conjunctival growth in his right eye. Slit lamp examination revealed a 10-mm growth in the inferior fornix surrounding a small greyish foreign body. Surgical excision and histopathology revealed granulomatous inflammatory cell response with foreign body giant cells surrounding exogenous material. This foreign material was birefringent in polarized light, very suggestive of synthetic fabric fibers, which permitted the diagnosis of Teddy bear granuloma. Synthetic fiber granulomas present in children as unilateral, more or less inflammatory growths in the inferior conjunctival fornix. Surgical excision with histopathology makes the diagnosis and effects the cure.
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Affiliation(s)
- B Batta
- Service d'ophtalmologie, CHU de Nancy-Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
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12
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Kang JW, Ku JS, Kim CH, Yoon JH. Intranasal mycetoma-induced Splendore-Hoeppli phenomenon. Otolaryngol Head Neck Surg 2009; 142:456-7. [PMID: 20172402 DOI: 10.1016/j.otohns.2009.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/16/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Ju Wan Kang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
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13
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Cheng AG, Kim HK, Burts ML, Krausz T, Schneewind O, Missiakas DM. Genetic requirements for Staphylococcus aureus abscess formation and persistence in host tissues. FASEB J 2009; 23:3393-404. [PMID: 19525403 PMCID: PMC2747682 DOI: 10.1096/fj.09-135467] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/15/2009] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus infections are associated with abscess formation and bacterial persistence; however, the genes that enable this lifestyle are not known. We show here that following intravenous infection of mice, S. aureus disseminates rapidly into organ tissues and elicits abscess lesions that develop over weeks but cannot be cleared by the host. Staphylococci grow as communities at the center of abscess lesions and are enclosed by pseudocapsules, separating the pathogen from immune cells. By testing insertional variants in genes for cell wall-anchored surface proteins, we are able to infer the stage at which these molecules function. Fibrinogen-binding proteins ClfA and ClfB are required during the early phase of staphylococcal dissemination. The heme scavenging factors IsdA and IsdB, as well as SdrD and protein A, are necessary for abscess formation. Envelope-associated proteins, Emp and Eap, are either required for abscess formation or contribute to persistence. Fluorescence microscopy revealed Eap deposition within the pseudocapsule, whereas Emp was localized within staphylococcal abscess communities. Antibodies directed against envelope-associated proteins generated vaccine protection against staphylococcal abscess formation. Thus, staphylococci employ envelope proteins at discrete stages of a developmental program that enables abscess formation and bacterial persistence in host tissues.
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Affiliation(s)
- Alice G Cheng
- Department of Microbiology, University of Chicago, 920 East 58th St., Chicago, IL 60637, USA
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14
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Abstract
Splendore-Hoeppli phenomenon (asteroid bodies) is the in vivo formation of intensely eosinophilic material (radiate, star-like, asteroid or club-shaped configurations) around microorganisms (fungi, bacteria and parasites) or biologically inert substances. This study presents a literature review concerning Splendore-Hoeppli reaction in the mucocutaneous diseases. It examines the histopathological features, nature and differential diagnosis of this reaction. It also discusses the mucocutaneous infections and the non-infective diseases associated with it. Available studies indicate that several mucocutaneous infections can generate Splendore-Hoeppli reaction. The fungal infections include sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis. The bacterial infections include botryomycosis, nocardiosis and actinomycosis. The parasitic conditions include orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans. In addition, Splendore-Hoeppli reaction may be seen with non-infective pathology such as hypereosinophilic syndrome and allergic conjunctival granulomas. The Splendore-Hoeppli reaction material comprises antigen-antibody complex, tissue debris and fibrin. Although the exact nature of this reaction is unknown, it is thought to be a localized immunological response to an antigen-antibody precipitate related to fungi, parasites, bacteria or inert materials. The characteristic formation of the peribacterial or perifungal Splendore-Hoeppli reaction probably prevents phagocytosis and intracellular killing of the insulting agent leading to chronicity of infection. To conclude, Splendore-Hoeppli reaction is a tell tale of a spectrum of infections and reactive conditions. The molecular pathways involved in the development of this reaction are open for future investigations.
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Affiliation(s)
- Mahmoud R Hussein
- Department of Pathology, Assir Central Hospital, King Khalid University, Abha, Kingdom of Saudi Arabia.
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15
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Coulibaly B, Géraldine H, Le Hémon A, Gouriet F, Marie-Anne C. Une botryomycose ganglionnaire à Staphylococcus aureus. Arch Pediatr 2008; 15:1440-2. [DOI: 10.1016/j.arcped.2008.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 03/20/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
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Hansen T, Kunkel M, Springer E, Walter C, Weber A, Siegel E, Kirkpatrick CJ. Actinomycosis of the jaws—histopathological study of 45 patients shows significant involvement in bisphosphonate-associated osteonecrosis and infected osteoradionecrosis. Virchows Arch 2007; 451:1009-17. [DOI: 10.1007/s00428-007-0516-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 08/03/2007] [Accepted: 09/17/2007] [Indexed: 12/01/2022]
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Abstract
Botryomycosis is a rare chronic bacterial infection, which can involve the skin as well as internal organs. Clinically and histologically it resembles actinomycosis and deep fungal infections. The most common causative organisms described are Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa, but the pathogenesis of botryomycosis is still poorly understood. A 16-year-old girl presented with multiple erythematous solid and partly purulent nodules which were extremely resistant to therapy. In this case we could diagnose a botryomycosis caused by Staphylococcus aureus.
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Affiliation(s)
- M Meissner
- Zentrum der Dermatologie und Venerologie, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main.
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Orhan D, Kiratli H, Kocabeyoğlu S. Conjunctival Splendore-Hoeppli phenomenon in a 3-year-old child. Pediatr Dev Pathol 2006; 9:388-90. [PMID: 16953679 DOI: 10.2350/06-02-0051.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 03/17/2006] [Indexed: 11/20/2022]
Abstract
A case of benign granulomas of the conjunctiva in a 3-year-old girl is reported. Histologic features of the excised conjunctival lesions were consistent with Splendore-Hoeppli phenomenon. This phenomenon is thought to be a granulomatous reaction to an antigen-antibody precipitate related to parasites or fungi. No causative agent is identified in our patient. Immunohistochemical analysis showed no immunoreactivity for immunoglobulin G (IgG), IgM, IgA, or the C3 component of the complement. We propose that the presence of small amelanotic nodular conjunctival tumors should arouse suspicion related to the Splendore-Hoeppli phenomenon even in early childhood.
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Affiliation(s)
- Diclehan Orhan
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, and Ihsan Doğramaci Children's Hospital, Ankara, Turkey.
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Schmack I, Kang SJ, Grossniklaus HE, Lambert SR. Conjunctival granulomas caused by synthetic fibers: report of two cases and review of literature. J AAPOS 2005; 9:567-71. [PMID: 16414525 DOI: 10.1016/j.jaapos.2005.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 07/19/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE We sought to demonstrate the histopathologic and ultrastructural features of conjunctival foreign body granulomas because of synthetic fibers and to compare them to other cases published in the literature. METHODS A 2- and a 7-year-old girl were referred for the surgical removal of slow-growing unilateral inferior conjunctival masses with a lack of primary trauma or surgery. In this report, we describe the light and electron microscopic findings of the 2 cases and review the literature of similar cases using the Medline database. RESULTS Histopathologic and ultrastructural examination of both specimens revealed a granulomatous inflammatory cell response, including histiocytes and multinucleated foreign body giant cells around acellular, uniform sized, oval to round birefringent fibers with manufacturing artifacts. Thirteen other patients with conjunctival synthetic fiber granulomas were identified from the literature. CONCLUSIONS On the basis of the findings in our cases and the review of literature, it appears that conjunctival synthetic fiber granulomas are not a rare entity but are not recognized frequently by ophthalmologists. The most reliable clinical sign to suggest this diagnosis is the presence of a unilateral inferior conjunctival mass in a child or adolescent. Histopathologic and ultrastructural evaluation appears to be the only way to specifically diagnose this condition with certainty.
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Affiliation(s)
- Ingo Schmack
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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20
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Spittell JA, Beckman JA. Chronic lymphocytic leukemia and its treament has depressed immunocompetence. Vasc Med 2003; 8:53-7. [PMID: 12866612 DOI: 10.1191/1358863x03vm469xx] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
MESH Headings
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/etiology
- Aneurysm, Infected/immunology
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/immunology
- Aortic Rupture/diagnosis
- Aortic Rupture/etiology
- Aortic Rupture/immunology
- Aortitis/diagnosis
- Aortitis/etiology
- Aortitis/immunology
- Clostridioides difficile/pathogenicity
- Female
- Humans
- Immunocompromised Host/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Middle Aged
- Osteomyelitis/diagnosis
- Osteomyelitis/etiology
- Osteomyelitis/immunology
- Salmonella/pathogenicity
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Affiliation(s)
- John A Spittell
- Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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