Immunity to Invasive Fungal Diseases

Invasive fungal diseases are rare in individuals with intact immunity. This, together with the fact that there are only a few species that account for most mycotic diseases, implies a remarkable natural resistance to pathogenic fungi. Mammalian immunity to fungi rests on two pillars, powerful immune mechanisms and elevated temperatures that create a thermal restriction zone for most fungal species. Conditions associated with increased susceptibility generally reflect major disturbances of immune function involving both the cellular and humoral innate and adaptive arms, which implies considerable redundancy in host defense mechanisms against fungi. In general, tissue fungal invasion is controlled through either neutrophil or granulomatous inflammation, depending on the fungal species. Neutrophils are critical against Candida spp. and Aspergillus spp. while macrophages are essential for controlling mycoses due to Cryptococcus spp., Histoplasma spp., and other fungi. The increasing number of immunocompromised patients together with climate change could significantly increase the prevalence of fungal diseases. Expected final online publication date for the Annual Review of Immunology, Volume 40 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Using Ultrasound Guided Needle Biopsy in Combination With GeneXpert MTB/RIF to Diagnose Epididymal Tuberculosis: a Study of 12 Cases

Objective: This study aims to investigate the diagnostic utility of percutaneous ultrasound-guided needle biopsy in combination with GeneXpert MTB/RIF for epididymal tuberculosis.Methods: Between March 2019 to March 2021, specimens obtained from 12 patients with confirmed epididymal tuberculosis by ultrasound guided needle biopsy were sent for pathology and laboratory examination at the Shandong Public Health Clinical Center. The laboratory examination included acid-fast staining, Mycobacterium tuberculosis culture by BACTEC MGIT 960, and the GeneXpert MTB/RIF test. The diagnosis and complications were comprehensively analyzed.Results: Among the 12 cases, seven cases had granulomatous inflammation and necrotic tissue, four cases had chronic inflammatory cells and necrotic tissue, and one case had chronic inflammatory cell infiltration. Furthermore, among the 12 patients, five patients were positive for Mycobacterium tuberculosis culture, two patients were positive for the acid-fast staining, and twelve patients were positive for the GeneXpert MTB/RIF assay. The sensitivity and specificity of the acid-fast staining, Mycobacterium tuberculosis culture and GeneXpert MTB/RIF in the diagnosis of epididymis tuberculosis were 16.67% and 100.00%, 41.67% and 100.00%, and 100.00% and 50.00%, respectively. The diagnostic value analysis of the three detection techniques indicated that the GeneXpert MTB/RIF technique (Kappa=0.63, AUC=0.75) is superior to the Mycobacterium tuberculosis culture (Kappa=0.17, AUC =0.71) and acid-fast staining (Kappa=0.05, AUC=0.58). Conclusion: Ultrasound guided percutaneous biopsy combined with GeneXpert MTB/RIF assay is extremely useful for diagnosing epididymitis tuberculosis and determining rifampin resistance, with superior sensitivity, specificity and AUC value.

Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis

Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy is invasive and has limited sensitivity for identifying granulomas, it is the only modality that yields a definitive diagnosis of cardiac sarcoidosis. It is imperative to develop novel pathological approaches for the precise diagnosis of cardiac sarcoidosis. Here, we aimed to discuss commonly used diagnostic criteria for cardiac sarcoidosis and to summarize useful and novel histopathologic criteria of cardiac sarcoidosis. While classical histologic observations including noncaseating granulomas and multinucleated giant cells (typically Langhans type) are the most important findings, others such as microgranulomas, CD68+ CD163− pro-inflammatory (M1) macrophage accumulation, CD4/CD8 T-cell ratio, Cutibacterium acnes components, lymphangiogenesis, confluent fibrosis, and fatty infiltration may help to improve the sensitivity of endomyocardial biopsy for detecting cardiac sarcoidosis. These novel histologic findings are based on the pathology of cardiac sarcoidosis. We also discussed the principal histologic differential diagnoses of cardiac sarcoidosis, such as tuberculosis myocarditis, fungal myocarditis, giant cell myocarditis, and dilated cardiomyopathy.

Pleuroscopy in exudative pleural effusion: A North Malaysia experience

Background: Pleuroscopy is one of the investigation modalities available for further evaluation of exudative pleural effusion. Aims of this study is to determine the diagnostic yield and common cause for pleural effusion that underwent pleuroscopy in Respiratory department, Hospital Sultanah Bahiyah .Methods: This is a retrospective descriptive analysis study of 106 patient who underwent pleuroscopy in Hospital Sultanah Bahiyah between July 2014 till Dec 2016. Hospital Sultanah Bahiyah is the only centre doing this procedure in North Malaysia.Result: Biopsy were done in 91% of the cases with diagnostic yield of up to 97%. Most common finding were malignancy (55%) with adenocarcinoma being the commonest subtype. Second commonest finding are granulomatous inflammation (19%) which is not surprising given our burden of tuberculosis. Majority of our patient were male (58%) with mean age of 60 years old. With regard to safety only one case develop complication where the patient develops re-expansion pulmonary oedema with no procedure related mortality.Conclusion: Pleuroscopy is a very safe procedure. Despite the high Tuberculosis burden in Malaysia the most common cause for exudative pleural effusion were due to malignancy, hence pleuroscopy should be consider in all cases of exudative pleural effusion.

Video Assisted Thoracoscopic Surgery in Exudative Pleural Effusion and its Complication Management: An Experience in a Community Hospital

Background: Exudative pleural effusions are common presentation of pleural disease. Long standing pleural effusion might complicate with loculations and cortex formation. Video assisted thoracoscopic surgery can be a useful tool for the diagnosis and the management of the complications. The aim of the study is to determine the cause and treat the complications related to the exudative pleural effusions. Materials and Methods: It is a retrospective analysis of prospectively collected data of all patients with exudative pleural effusions subjected to surgical management. Data were collected over a period of four years in a community hospital in Kathmandu. Results: Of 38 patients who underwent Video assisted thoracoscopic surgery only 33 were eligible for analysis. Male to female ratio was 2.3:1 with male (23) dominance. Twenty six (78.8%) had lymphocyte predominance and 23 (69.7%) had Adenosine deaminase level of more than 40 International unit in pleural fluid analysis. In histopathological examination most common finding was granulomatous inflammation 13 (39.4%), 9 (27.3%) were malignancy and 9 (27.3%) were nonspecific chronic inflammation. Of malignancies adenocarcinoma 3 (9.09%) was the most common finding, mesothelioma 2(6.06%) and 4 (12.12%) other. Conclusion: Video assisted thoracoscopic surgery has a role to play in diagnosis of exudative pleural effusions, particularly when there is dilemma in diagnosis. Video assisted thoracoscopic surgery definitely has a role in diagnosis and treatment of the complications related to pleural effusions.

Crohn’s Disease of the Vulva: a Case Report

Crohn’s disease is a multi-systemic chronic inflammatory disease that can affect various organs besides the gastrointestinal tract such as joints, uvea, and the skin. Vulvar Crohn’s disease is a rare entity occurring with vulvar lesions that show typical Crohn’s disease granulomatous inflammation but are not contiguous with the gastrointestinal involvement. Vulvar Crohn’s disease can be easily confused with other granulomatous diseases and awareness that such involvement may precede gastrointestinal symptoms must be raised. Few cases of vulvar Crohn’s disease have been reported in the literature to date. Here, we report a case of a 43-year-old woman with a 6-month history of a vulvar lesion; the patient was diagnosed with Crohn’s disease of the large bowel just over a year ago.

Resources of modern radiation diagnostics of sarcoidosis (review)

Introduction. Sarcoidosis is a significant social and medical problem. Diagnosis is based on consistency of the clinical picture, histological evidence of granulomatous inflammation, exclusion of alternative diseases, and evidence of systemic involvement. There is no “gold” diagnostic standard for sarcoidosis. Aim. Review of the latest world literature data on the possibilities of modern radiation diagnosis of sarcoidosis. Materials and methods. The review summarizes data from literature published mainly over the past five years in PubMed and eLibrary. Earlier publications were also included as necessary. Results. In the literature review, modern medical imaging methods used to diagnose sarcoidosis, which in some cases can avoid biopsy, are considered. First of all, these are X-ray methods. Today, high-resolution multispiral computed tomography with three-dimensional imaging, as the method with the highest sensitivity, plays a decisive role in the diagnosis and monitoring of sarcoidosis. The use of magnetic resonance imaging and low-dose computed tomography is not well understood in patients with sarcoidosis. Quantitative computed tomography and radiomics techniques have only been partially tested in sarcoidosis. Conclusion. The imaging of sarcoidosis is the subject of a large number of publications that provide detailed descriptions of X-ray and computed tomography techniques. Nevertheless, despite the introduction of new computerized tools for the analysis of chest imaging, traditional X-ray techniques still remain an important role in both the diagnostic and prognostic assessment of changes characteristic of sarcoidosis