Fine needle aspiration of toxoplasmic (Piringer-Kuchinka) lymphadenitis: a cytohistologic correlation study

OBJECTIVE

To define the cytomorphologic features of toxoplasmic lymphadenitis (TL) and to establish the diagnostic sensitivity and specificity of the cytologic diagnosis.

STUDY DESIGN

A cytohistologic correlation study of 11 patients in which a histologic diagnosis of TL was available. These cases were analyzed in a blind study among other cases of nonneoplastic lymphadenopathies. The results of the study are expressed in terms of diagnostic sensitivity and specificity. Although not included in the study, 3 other cases of TL with serologic confirmation were also reviewed.

RESULTS

Microgranulomas were a characteristic finding in TL. They consisted of small clusters of epithelioid histiocytes, each with abundant cytoplasm and an eccentric, oval nucleus. Diff-Quik-stained smears had cytoplasm with particularly pale staining and a homogeneous appearance. Most microgranulomas had a monotonous appearance with a few, small lymphocytes accompanying the epithelioid cells. No necrosis, suppurative changes or giant cells were present. Blind examination by 4 reviewers led to a correct diagnosis of TL in 9 of the 11 cases. Eight of the 9 cases were recognized by each of the 4 reviewers. One false positive diagnosis was made by 1 of the reviewers. The sensitivity of the diagnosis was 72.7-81.8% and the specificity 98.8-100%.

CONCLUSION

This study showed high sensitivity and specificity for the cytologic diagnosis of TL. Given the appropriate clinical context, the presence of characteristic epithelioid microgranulomas permits a diagnosis of TL. The cytologic diagnosis can be easily confirmed with serologic studies, thereby avoiding biopsy.

Mouse model for Chagas disease: immunohistochemical distribution of different stages of Trypanosoma cruzi in tissues throughout infection

Different stages of Trypanosoma cruzi are seen during mammalian infection. Histologic sections of infected hearts have shown amastigotes and, when using immunohistochemistry (IHC), parasite antigens; however, demonstration of trypomastigotes in these tissues has proven elusive. Using a mouse strain that develops chagasic cardiomyopathy (histologically similar to human infection) 70 days after injecting T. cruzi-Brazil strain, we studied the distribution of parasite stages and the extent of inflammation. All organs had varying amounts of mononuclear inflammation by day 10, which peaked between day 20 and day 30, and decreased by day 50. Amastigotes were detected in myocytes, histiocytes, acinar pancreatic cells, astrocytes and ependymal cells by day 10, and the number of amastigotes peaked on day 30. Immunohistochemistry demonstrated trypomastigotes in sinusoids, vessels and interstitial tissues of several organs between day 15 and 50. Abundant parasite antigens (granular staining) were detected in connective tissues throughout the infection. The burden of amastigotes and trypomastigotes during the acute phase seems to correlate with the degree of inflammation and granular staining in the chronic stage.

Disseminated American cutaneous leishmaniasis

BACKGROUND

While studying cutaneous leishmaniasis in the central part of western Venezuela, we found four cases of disseminated American cutaneous leishmaniasis, three from the Lara State and one from Portuguesa State.

METHODS

A clinical history was taken for each of these patients, followed by microscopic examination of the Giemsastained smears from their cutaneous lesions and by a Montenegro skin test. Serum from a skin lesion were grown in Novy-MacNeal-Nicolle medium (NNN). Hamsters were inoculated with suspension of tissues taken from the patient's lesions. Biopsies were taken for histopathologic examination. Isolates from cultures on NNN medium and from hamsters were subcultured in Schneider's medium for parasite identification, using molecular techniques. Treatment with injections of N-methyl glucamine antimonate, 25 mg/kg/day was prescribed for each patient for 20 consecutive days and, after a week of rest, a second course of injections was administered.

RESULTS

Patients had disseminated papular, ulcerous, nodular, and ulceronodular lesions on the skin. Smears of the skin lesions from all of the patients showed abundant amastigotes within histiocytes or free in the tissues. The skin test was negative in two patients. On histopathologic examination of skin lesions, mainly numerous vacuolated histiocytes filled with amastigotes were observed. Isolates from all the patients were identified as Leishmania venezuelensis. One of the patients healed after treatment with N-methyl glucamine antimonate. The others were resistant to this therapy.

CONCLUSIONS

Diffuse cutaneous leishmaniasis can be caused also by Leishmania venezuelensis. Patients with nodular lesions who presented a negative Montenegro skin test were more resistant to treatment with specific pentavalent antimonials.

Mucosal leishmaniasis caused by Leishmania tropica in Saudi Arabia

Mucocutaneous leishmaniasis (MCL.) which is called Espundia, and Uta is confined to South and Central America. In this form of leishmaniasis, the reticulo-endothelial system of the mucous membrane of the mouth, nose and throat is parasitized. It causes chronic ulceration of the mucous membranes with destruction of the bone and cartilage of the nose and mouth. In this study, two cases of mucosal leishmaniasis were recorded in two boys. In one patient, a primary lesion was identified on the patient's neck. In the second patient, no lesion or scar of old lesion or even history of leishmaniasis was reported. The causative agent was typed biochemically and proved to be Leishmania tropica.

Atypical cutaneous histological features of visceral leishmaniasis in acquired immunodeficiency syndrome

Cutaneous lesions in Mediterranean visceral leishmaniasis (VL) are very unusual, except for the presence of Leishmania organisms in cutaneous Kaposi's sarcoma in patients with acquired immunodeficiency syndrome (AIDS). We have identified two unusual cutaneous histological features of VL in three patients with AIDS not described previously; two had "silent leishmaniasis," and in the third, Leishmania organisms were present in sweat ducts, suggesting transepithelial elimination through eccrine sweat glands and/or eccrine epithelial tropism.

Post-kala-azar dermal leishmaniasis: a light and electron microscopic study of 18 cases

Post-kala-azar dermal leishmaniasis (PKDL) is caused by the protozoan parasite, Leishmania donovani, and is seen in patients with history of having been treated earlier for the visceral disease form, kala-azar, caused by the same organism. The findings from 18 patients with PKDL are described in this study. The skin manifestations ranged from hypopigmented macules to infiltrated plaques and nodules. Histopathologic examination revealed a cellular infiltrate of lymphocytes, plasma cells, and macrophages. The macrophages were scattered amidst the infiltrate without any localization. In hypopigmented lesions, the infiltrate was confined to the perivascular region in the superficial dermis and was composed mainly of lymphocytes and few plasma cells. In the nodular lesions, the infiltrate occupied the entire thickness of the dermis. Leishman-Donovan bodies were scarce and identified in 16 cases after a prolonged search of Weigert's iron hematoxylin-stained sections. In 2 cases, Leishman-Donovan bodies were not demonstrable. Electronmicroscopic study revealed parasitized macrophages which showed no structural evidence of activation despite the active cellular response around them. The fine structure of the parasites in the histiocytes was also well maintained. This unusual tropical dermatosis is a unique example of change in organotropism of a parasite associated with a change in the host response.

Aluminum tattoo: a phenomenon that can resemble parasitized histiocytes

We present a study of aluminum tattoos that resulted from aluminum chloride cauterization of biopsy sites. The stippled macrophages were studied by light and electron microscopy and by means of X-ray energy spectroscopy (XES) analysis. The light microscopic appearance may be striking, and may mimic the appearance of parasitized histiocytes, although the particles are larger and vary in size and shape. The basophilic particles are electron dense by electron microscopy. XES analysis demonstrated distinct emission peaks corresponding to aluminum, calcium, and phosphorus. Only a minor chloride emission peak was identified. The particles may represent an inorganic precipitate or an organic compound in which aluminum, calcium, and phosphate form a complex with protein.

Visceral leishmaniasis with cysticercosis

A chest wall nodule in a boy with relapsed proven kala-azar was found to contain a cysticercus. In the fibrous wall with lymphohistiocytic aggregates were mononuclear phagocytes containing amastigotes of L. donovani.

Histological and ultrastructural studies of the interaction of Toxoplasma gondii Tachyzoites with mouse omentum in experimental infection

Mouse omentum was studied after intraperitoneal challenge with tachyzoites of Toxoplasma gondii. Parasites inhabit omental histiocytes, fibroblasts, mesothelial cells, and free peritoneal macrophages. Recently infected cells showed enhanced metabolic and functional activity. Villous projections of the parasitophorous vacuole wall appeared, usually opposite the anterior pole of the parasite. In mesothelial cells, projections formed terminal swellings not observed in other infected cells. Activation of host cells was followed by reduction of the density of the cytoplasmic matrix, autophagosome formation, and intracellular edema, indicating the damage. The wall of the parasitophorous vacuole loses the supporting host cell endoplasmic reticulum that was attached to the vacuole just after entrance of the parasite into the cell. Then lysis of the parasitophorous vacuole and complete cell destruction occurs. The growth of parasites in undamaged cells does not coincide with the inflammatory response. Inflammation of the peritoneum develops only after the start of mass destruction of infected cells. Thus tachyzoites of Toxoplasma exert significant pathogenic effects by their ability to activate the host cell, causing lysis of the parasitophorous vacuole and subsequent destruction of the entire cell.