Metastatic cholangiocarcinoma mimicking tuberculosis in a cow

2021 ◽  
pp. 104063872110299
Author(s):  
Jessica A. Elbert ◽  
Susan Sanchez ◽  
Daniel R. Rissi
Keyword(s):  
Cholangiocellular Carcinoma ◽  
Pcr Assay ◽  
Hepatic Parenchyma ◽  
Histologic Diagnosis ◽  
Fresh Sample ◽  
Animal Diseases ◽  
Hepatic Nodule ◽  
Progressive Weight Loss ◽  
Rule Out ◽  
Mycobacterium Spp

Here we describe a metastatic hepatic cholangiocarcinoma (cholangiocellular carcinoma) in a 14-y-old Beefmaster cow that was euthanized because of depression and progressive weight loss. Gross changes included coalescing, white-to-yellow, firm-to-hard nodules with central areas of necrosis and mineralization that effaced much of the hepatic parenchyma, omentum, mesentery, ruminal serosa, and diaphragm. A fresh sample of a hepatic nodule was submitted for a modified acid-fast (MAF) stain during autopsy to rule out tuberculosis. The MAF stain was inconclusive, and the sample was subsequently submitted for a PCR assay for Mycobacterium spp. Histologically, all nodules consisted of a neoplastic proliferation of epithelial cells surrounded by extensive areas of desmoplasia, consistent with a metastatic cholangiocarcinoma. PCR for Mycobacterium spp. was negative. Although the histologic diagnosis in our case was metastatic hepatic cholangiocarcinoma, gross changes were strikingly similar to those described in cases of tuberculosis, highlighting the need to remain vigilant in the identification of zoonotic and suspected foreign animal diseases during autopsy to protect human health.

Association between a rapid diagnostic test to detect methicillin-resistant Staphylococcus Aureus pneumonia and decreased vancomycin use in a medical intensive care unit over a 30-month period

2021 ◽  
pp. 1-3
Author(s):  
Chiagozie I. Pickens ◽  
Chao Qi ◽  
Michael Postelnick ◽  
Joseph Paonessa ◽  
Helen K. Donnelly ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Intensive Care Unit ◽  
Pcr Assay ◽  
Days Of Therapy ◽  
Medical Intensive Care ◽  
Staphylococcus Aureus Pneumonia ◽  
Few Data ◽  
Rule Out

Abstract Vancomycin overuse is common, yet few data are available regarding how to improve stewardship of this antibiotic. We identify an association between use of a PCR assay to rule out MRSA pneumonia and a significant, sustained decrease in average vancomycin days of therapy over a 30-month period.

scholarly journals A case of kidney infection by Corynebacterium pseudotuberculosis in sheep

2017 ◽  
Vol 61 (1) ◽  
pp. 29
Author(s):  
N. PAPAIOANNOU (Ν. ΠΑΠΑΪΩΑΝΝΟΥ) ◽  
M. ZAVLARIS (Μ. ΖΑΒΛΑΡΗΣ) ◽  
N. D. GIADINIS (Ν.Δ. ΓΙΑΔΙΝΗΣ) ◽  
E. J. PETRIDOU (Ε.Ι. ΠΕΤΡΙΔΟΥ) ◽  
V. PSYCHAS (Β. ΨΥΧΑΣ)
Keyword(s):  
Weight Loss ◽  
Veterinary Medicine ◽  
Case Report ◽  
Clinical Case ◽  
Farm Animals ◽  
Corynebacterium Pseudotuberculosis ◽  
Tissue Samples ◽  
Progressive Weight Loss ◽  
Female Sheep ◽  
Rule Out

A three year-old female sheep was presented to the Clinic of Farm Animals, School of Veterinary Medicine, Aristotle University of Thessaloniki, with mild nasal seromucous discharge and progressive weight loss, while rectal temperature was normal. Hematological examination revealed mild leukocytosis, while traces of hemoglobin and protein were found in urinalysis. The animal was euthanized and forwarded for necropsy. An extremely enlarged, nodular right kidney, whose renal parenchyma was completely replaced by multiple abscesses, was the remarkable finding of the necropsy. Microbiological and molecular examinations were performed to establish the diagnosis and rule out Maedi/Visna infection. Tissue samples from the kidney and other organs were, also, examined histologically. Corynebacterium pseudotuberculosis was isolated in microbiological tests. A kidney infection by C. pseudotuberculosis, presented as a clinical case with scant symptoms, is discussed in this case report.

scholarly journals 2157. Evaluation of the Utility of the MRSA Nasal PCR Assay in a Community Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S732-S732
Author(s):  
Athena L V Hobbs ◽  
Stephen Turner ◽  
Bhavyata Parag ◽  
Katherine M Shea ◽  
Nathan Seligson
Keyword(s):  
Healthcare System ◽  
Predictive Value ◽  
Community Hospital ◽  
Hospital Setting ◽  
Pcr Assay ◽  
Hospital System ◽  
Noninvasive Test ◽  
Community Healthcare ◽  
Pcr Assays ◽  
Rule Out

Abstract Background The MRSA nasal PCR assay is a rapid, noninvasive test that has demonstrated a strong negative predictive value (NPV), as high as 99%, for ruling out MRSA pneumonia. These findings are based primarily on literature from large academic centers, which have evaluated both the positive predictive value (PPV) and NPV of MRSA nasal PCR assays. Investigators sought to assess the NPV of the MRSA nasal PCR assay to rule out MRSA pneumonia within a community healthcare system. To the best of our knowledge, this is the largest study from a community hospital and the only study from a community healthcare system for the utilization of a nasal PCR assay to rule out MRSA pneumonia. Methods This is a multicenter, retrospective study of adult patients with both an MRSA nasal PCR assay and positive respiratory culture (sputum, bronchoalveolar lavage, or endotracheal aspirate). Data were collected from September 2014 through August 2015 at three community hospitals (bed size ranging from 328 to 706) across two states within a healthcare system. The study was approved by the Baptist Memorial Hospital Institutional Review Board. PPV and NPV 95% confidence intervals (95% CI) were calculated as previously described in the literature. Results A total of 808 patients were included in the analysis across the three hospitals. The total incidence of MRSA in positive sputum samples was 14.9% across the three facilities. Our study demonstrated an overall NPV of 95.1% (93.2, 96.6%) and a PPV of 65.9% (95% CI 57.2, 73.9%). The high NPV was retained despite unit type, resulting in 94.9% (95% CI 92.7, 96.6%), 96.3% (95% CI 90.8, 99.0%), and 94.7% (95% CI 74.0, 99.9%) for the intensive care units (ICU), medical-surgical units, and the emergency department, respectively (Table 1). Conclusion We concluded that the high NPV of a negative MRSA nasal PCR assay to rule out MRSA pneumonia persisted within a community hospital system. With the results of our study, we plan to utilize institution-specific data along with previously published literature to encourage earlier discontinuation of anti-MRSA antibiotics in patients being treated for pneumonia with negative MRSA nasal PCR assays. Our study demonstrates the validity of the assay in the large community hospital setting with similar findings to studies at large academic institutions. Disclosures All authors: No reported disclosures.

scholarly journals Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia

1994 ◽  
Vol 1 (2) ◽  
pp. 107-112
Author(s):  
Jerome H. Siegel ◽  
Annamali Veerappan ◽  
Romulo Prudente ◽  
Franklin E. Kasmin ◽  
Seth A. Cohen
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Biliary Tree ◽  
Positive Cytology ◽  
Histologic Diagnosis ◽  
Alternative Method ◽  
Diagnosis Of Cancer ◽  
Diagnostic Modalities ◽  
Rule Out

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative.

scholarly journals Assessment of a New Lower-Cost Real-Time PCR Assay for Detection of High-Risk Human Papillomavirus: Useful for Cervical Screening in Limited-Resource Settings?

2017 ◽  
Vol 55 (8) ◽  
pp. 2348-2355 ◽  
Author(s):  
Joel Fokom Domgue ◽  
Mark Schiffman ◽  
Nicolas H. Wentzensen ◽  
Julia C. Gage ◽  
Philip E. Castle ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Real Time Pcr ◽  
Lower Cost ◽  
Limited Resource ◽  
Intraepithelial Neoplasia ◽  
Pcr Assay ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Histologic Diagnosis ◽  
Convenience Sample ◽  
Hpv Types

ABSTRACT Inexpensive and easy-to-perform human papillomavirus (HPV) tests are needed for primary cervical cancer screening in lower-resource regions. In a convenience sample of 516 residual exfoliative cervical specimens from the Kaiser Permanente Northern California and U.S. National Cancer Institute Persistence and Progression Study, we assessed the agreement and clinical performance of a simple, inexpensive real-time PCR assay for the detection of 13 carcinogenic HPV types (the H13 assay; Hybribio, Hong Kong) that is marketed in limited-resource settings compared to previous testing by the Hybrid Capture 2 assay (HC2; Qiagen, Germantown, MD) and the Onclarity assay (BD Diagnostics, Sparks, MD). The test set was chosen to include many HPV-positive specimens. The reference standard was a combination of HC2 and Onclarity results for HPV detection and histologic diagnosis of controls (less than cervical intraepithelial neoplasia grade 2 [<CIN2]) or cases (cervical intraepithelial neoplasia grade 2 or higher [CIN2+]) for disease status. In this enriched convenience sample, H13 tested positive for 94.4% of the 108 HC2- and Onclarity-positive CIN2+ specimens and negative for 88.2% of the 51 HC2- and Onclarity-negative <CIN2 specimens. H13 positivity was significantly lower than that of HC2 among women with CIN2+ (89.9% versus 98.7%, respectively) ( P < 0.001) and <CIN2 (53.5% versus 72.4%, respectively) ( P < 0.001). In conclusion, H13 corresponds well to the combination of HC2 and Onclarity and has good clinical accuracy compared to histologic diagnosis, with less cross-reactivity with untargeted HPV types than HC2. H13 is a lower-cost HPV DNA test that might be useful for primary screening in limited-resource settings.

scholarly journals Viral origin of wheeze in the under-five population in Pakistan

2021 ◽  
Vol 15 (7) ◽  
pp. 1491-1493
Author(s):  
Muhammad Arshad ◽  
Usman Saeed ◽  
M. Imran Ashraf ◽  
Shoaib Ahmed ◽  
Roman Abbas ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Pcr Assay ◽  
Viral Origin ◽  
Case Research ◽  
Long Duration ◽  
Polymerase Chain ◽  
Syncytial Virus ◽  
Keywords Asthma ◽  
Rule Out

Background: One of the most common issues arising these days is wheezing that is observed in kids below five year of age accompanied with acute respiratory infections (ARIs). The main etiological causes of ARIs are viruses. Aim: To investigate the viral cause of wheezing in kids below five years of age who were hospitalized in hospital located in Pakistan. Methods: Forty candidates under 5 years of age were admitted complaining wheezing, in this case research. Nasal and throat swaps were taken. For screening purpose, real-time, polymerase chain reaction (PCR) assay was employed in order to rule out rhinovirus, influenza 1 and 2, respiratory para influenza virus (PIV) 1, 2, 3 and 4, syncytial virus (RSV), human meta-pneumovirus, bocavirus (HBoV), Enterovirus Coronavirus, Parechovirus and adenovirus. Results: 30% was regarded as total viral detection rate. Candidates detected with pheumonina viral RNA markers were found from their samples (6 cases), episodic wheeze (1 cases) bronchiolitis (7 cases) and multitrigger wheeze (8 cases). It was discovered that RSV was the most common virus found (30%) which is then followed by PIV1, 2 and 3(18%), HBoV (8%) and rhinovirus (4%). Whereas mixed infection was found in case of in 32 per cent. Conclusions: According to the case research, respiratory viral agents was found to be the culprit in 30 per cent of kids suffering from wheezing; the most common RSV and PIV were responsible for 50 per cent of the total number of cases involved. In case of 30% of cases mixed infections were reported. There was also noteworthy Seasonal variation was noted. Moreover, Further research required to accomplished with a large samples and long duration follow up span in order to clarify results of research. Keywords: Asthma - bronchiolitis - child - incidence - PCR

Evaluation of the timing of MRSA PCR nasal screening: How long can a negative assay be used to rule out MRSA-positive respiratory cultures?

2021 ◽  
Author(s):  
Stephen C. Turner ◽  
Nathan D Seligson ◽  
Bhavyata Parag ◽  
Katherine M Shea ◽  
Athena L V Hobbs
Keyword(s):  
Culture Collection ◽  
Optimal Timing ◽  
Sample Collection ◽  
Pcr Assay ◽  
Full Cohort ◽  
Hospital System ◽  
Respiratory Sample ◽  
Surgical Units ◽  
Significant Difference ◽  
Rule Out

Abstract Purpose Previous studies indicate that the polymerase chain reaction (PCR) nasal assay for methicillin-resistant Staphylococcus aureus (MRSA) has a consistently high (&gt;95%) negative predictive value (NPV) in ruling out MRSA pneumonia; however, optimal timing of PCR assay specimen and respiratory culture collection is unclear. Methods A study including 736 patients from a community hospital system was conducted. Patients were included if they had undergone MRSA nasal screening with a PCR assay and had documented positive respiratory culture results. Results In the full cohort, the MRSA PCR nasal screen assay was demonstrated to have an NPV of 94.9% (95% confidence interval [CI], 92.8%-96.5%) in ruling out MRSA-positive respiratory cultures. When evaluating the NPV by level of care (ie, where the MRSA PCR nasal assay sample was collected), no significant difference between values for samples collected in an intensive care unit vs medical/surgical units was identified (NPV [95%CI], 94.9% [92.7%-96.6%] vs 95.3% [88.4%-98.7%]).Additionally, NPV remained high with use of both invasive (NPV [95%CI], 96.8% [92.7%-99.0%]) and noninvasive (NPV [95%CI], 94.5% [91.7%-96.2%]) respiratory sampling methods. Finally, when evaluating the effect of time between MRSA PCR nasal screening and respiratory sample collection, we found high NPVs for all evaluated timeframes: within 24 hours, 93.8% (90.1%-96.4%); within 25 to 48 hours, 98.6% (92.7%-100.0%); within 49 hours to 7 days, 95.7% (91.4%-98.3%); within 8 to 14 days, 92.9% (85.1%-97.3%); and after more than 14 days, 95.5% (84.5%-99.4%). Conclusion We report high NPVs for up to 2 weeks between specimen collections, which allows clinicians to use a negative MRSA PCR nasal screen assay to rule out MRSA pneumonia, potentially leading to decreased exposure to MRSA-active antibiotics.

scholarly journals Validation of a Multiplex Real-Time PCR Assay for Detection of Mycobacterium spp., Mycobacterium tuberculosis Complex, and Mycobacterium avium Complex Directly from Clinical Samples by Use of the BD Max Open System

2016 ◽  
Vol 54 (6) ◽  
pp. 1644-1647 ◽  
Author(s):  
Talita T. Rocchetti ◽  
Suzane Silbert ◽  
Alicia Gostnell ◽  
Carly Kubasek ◽  
Raymond Widen
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Real Time ◽  
Mycobacterium Avium ◽  
Open System ◽  
Real Time Pcr ◽  
Clinical Samples ◽  
Pcr Assay ◽  
Content Type ◽  
Multiplex Pcr Assay ◽  
Mycobacterium Spp

A multiplex real-time PCR was validated on the BD Max open system to detect differentMycobacterium tuberculosiscomplex,Mycobacterium aviumcomplex, andMycobacteriumspp. directly from clinical samples. The PCR results were compared to those with traditional cultures. The multiplex PCR assay was found to be a specific and sensitive method for the rapid detection of mycobacteria directly from clinical specimens.

Lymphangioma of the Palatine Tonsil

2013 ◽  
Vol 137 (12) ◽  
pp. 1837-1842 ◽  
Author(s):  
Stacey Mardekian ◽  
Julie Katz Karp
Keyword(s):  
Airway Obstruction ◽  
Benign Lesion ◽  
Surgical Excision ◽  
Palatine Tonsil ◽  
Diagnostic Classification ◽  
Histologic Diagnosis ◽  
Fibrous Stroma ◽  
Rule Out ◽  
True Neoplasm

Lymphangioma of the palatine tonsil is a rare, benign lesion that presents as a tonsillar outgrowth and causes symptoms related to irritation and airway obstruction. Histologically, the mass has abundant dilated lymphatic channels amid a fibrous stroma with lymphoid and adipose elements. There are several theories regarding the pathogenesis of these lesions, and the appropriate diagnostic classification is controversial. Because a lymphangioma may resemble a true neoplasm of the palatine tonsil clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy. Lymphangioma of the palatine tonsil is treated with surgical excision and has no recurrence once completely resected.

A rapid method for the direct identification of paramyxovirus in canine CSF by ultracentrifugation and negative staining as a rule out for distemper

1990 ◽  
Vol 48 (3) ◽  
pp. 594-595
Author(s):  
W.L. Steffens ◽  
M.B. Ard ◽  
C.E. Greene ◽  
A. Jaggy
Keyword(s):  
Subacute Sclerosing Panencephalitis ◽  
Clinical Signs ◽  
Viral Disease ◽  
Etiologic Agent ◽  
Mucosal Inflammation ◽  
Worldwide Distribution ◽  
Negative Stain ◽  
Viral Particles ◽  
Systemic Manifestations ◽  
Rule Out

Canine distemper is a multisystemic contagious viral disease having a worldwide distribution, a high mortality rate, and significant central neurologic system (CNS) complications. In its systemic manifestations, it is often presumptively diagnosed on the basis of clinical signs and history. Few definitive antemortem diagnostic tests exist, and most are limited to the detection of viral antigen by immunofluorescence techniques on tissues or cytologic specimens or high immunoglobulin levels in CSF (cerebrospinal fluid). Diagnosis of CNS distemper is often unreliable due to the relatively low cell count in CSF (<50 cells/μl) and the binding of blocking immunoglobulins in CSF to cell surfaces. A more reliable and definitive test might be possible utilizing direct morphologic detection of the etiologic agent. Distemper is the canine equivalent of human measles, in that both involve a closely related member of the Paramyxoviridae, both produce mucosal inflammation, and may produce CNS complications. In humans, diagnosis of measles-induced subacute sclerosing panencephalitis is through negative stain identification of whole or incomplete viral particles in patient CSF.

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