1/76. mycobacterium marinum infection from a tropical fish tank. Treatment with trimethoprim and sulphamethoxazole.A paronychial granuloma on the left thumb, in a man who kept tanks of tropical fish, was followed by cutaneous nodules on the left upper limb and tender lymph nodes in the left axilla. mycobacterium marinum was isolated from the lesion on the thumb and also from the tank water. Subsidence of the lesions followed administration of trimethoprim and sulphamethoxazole.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
2/76. Idiopathic granulomatous meningoencephalitis presenting as an intracranial tumor.A 2-year-old girl presented with a single episode of generalized seizure. magnetic resonance imaging examination showed an intracranial mass with a diameter of 2.5 cm in the right parieto-occipital region of the cerebrum. These clinicoradiological findings were suggestive of intracranial tumor. Histologically, fibroblastic proliferation of storiform pattern was noted, associated with epithelioid granulomas. The etiological pathogens for the granulomas could not be detected even though investigation of special histochemical staining, immunohistochemical study and dna analysis of mycobacterium tuberculosis by polymerase chain reaction technique was performed. On electron microscopic examination, the area appearing as a storiform pattern consisted of fibroblasts showing much dilated rough endoplasmic reticulum and slender tappering cytoplasmic processes without cellular junctional complex. No organisms were identified in the granulomatous area of the lesion. From those findings the diagnosis as idiopathic granulomatous meningoencephalitis was made.- - - - - - - - - - ranking = 0.2keywords = bacterium (Clic here for more details about this article) |
3/76. hepatitis in disseminated bacillus Calmette-Guerin infection.Local immunotherapy with an attenuated live strain of mycobacterium bovis, bacillus Calmette-Guerin (BCG), is an effective and frequently used treatment for in situ transitional cell carcinoma (TCC) of the bladder. Success rates are high, and serious side effects are infrequent but can affect every organ system. A 79-year-old patient with recently diagnosed TCC who was treated with intravesical BCG for a recurrence after initial surgical treatment is reported. After unsuccessful attempts at bladder catheterization with the creation of a false passage for his third treatment, BCG was instilled via a suprapubic catheter the same day and again a week later. Two weeks after the third BCG instillation, the patient presented with profound lethargy and weakness to the point of not being able to get up out of a chair. He was febrile, anorexic, icteric and had hepatosplenomegaly. Disseminated BCG infection was suspected on the basis of history, clinical examination and a liver biopsy that showed noncaseating granulomatous hepatitis. Empirical treatment was started with antituberculous combination therapy. A short course of an oral corticosteroid was given. Clinical improvement was marked and sustained so that the patient could be discharged home for the full six-month course of his treatment. Disseminated BCG infection with granulomatous hepatitis can be severe and life-threatening in cases where a large intravascular inoculum of BCG may have been given inadvertently.- - - - - - - - - - ranking = 0.2keywords = bacterium (Clic here for more details about this article) |
4/76. Granulomatous tubulointerstitial nephritis in the renal allograft.Granulomatous tubulointerstitial nephritis has rarely been described in renal allografts. Of 1,574 renal allograft tissue specimens obtained from 514 patients in the period 1993 to 1998, we report three cases (0.6%) with interstitial nephritis containing multiple noncaseating granulomas. biopsy specimen 1 was obtained from a 44-year-old woman with a 6-day history of systemic candida albicans infection and showed multiple granulomas containing budding yeasts. biopsy specimen 2 was from a 33-year-old man who presented with miliary spread of mycobacterium tuberculosis 12 days before the allograft biopsy. biopsy specimen 3 was from a 23-year-old woman who presented with escherichia coli urinary infection and bacteremia that was treated with antibiotics for 10 days before the biopsy. Granulomatous inflammation in reponse to infectious agents or drugs in immunosuppressed kidney transplant recipients can rarely give rise to allograft interstitial nephritis that is distinct from acute rejection. To our knowledge, there are no prior reports of granulomatous tubulointerstitial nephritis associated with C albicans and E coli infection or antibiotic therapy in human renal allografts.- - - - - - - - - - ranking = 0.2keywords = bacterium (Clic here for more details about this article) |
5/76. Mycobacterium intracellulare as a cause of a recurrent granulomatous tenosynovitis of the hand.We report a case of recurrent granulomatous tenosynovitis with M. intracellulare in a 55-year-old hiv negative diabetic woman. Identification of the causative agent further than belonging to the M. avium-intracellulare complex is provided by specific PCR-amplification of genomic dna and sequencing of an hypervariable region within its 16S rna gene. Sixteen months antibiotic regimen of rifabutin and clarithromycin led to a complete resolution of the tenosynovitis.- - - - - - - - - - ranking = 0.8keywords = bacterium (Clic here for more details about this article) |
6/76. A case report of mycobacterium marinum infection of the hand.We report a case of mycobacterium marinum infection of the hand presenting initially as triggering of the digits.We like to highlight the unusual source of the infection and difficulty of diagnosis in this case as well as the various treatment modalities.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
7/76. Obstructive granulomatous bronchiolitis due to mycobacterium avium complex in an immunocompetent man.While the development of pulmonary disease due to mycobacterium avium complex (MAC) infection is most commonly associated with underlying predisposing factors, this organism occasionally causes symptomatic disease in otherwise normal individuals. patients with MAC pulmonary disease most often present with cavitating granulomas, but a spectrum of pathologic changes has been described. The authors present a case of MAC pulmonary disease in an immunocompetent, middle-aged man with no identified predisposing factors. The diagnostic biopsy disclosed the unusual finding of noncaseating granulomas with predominant involvement of bronchioles, corresponding to the patient's obstructive and restrictive pulmonary dysfunction.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
8/76. Clinical and pathologic features of mycobacterium fortuitum infections. An emerging pathogen in patients with AIDS.The clinical and pathologic features of mycobacterium fortuitum infection in 11 patients with AIDS were characterized. Nine patients had cervical lymphadenitis; 2 had disseminated infection. The infection occurred late in the course of AIDS, and the only laboratory abnormality seen in more than half of patients (7/11) was relative monocytosis. Absolute monocytosis also was seen in 4 of 11 patients. In both cytologic and histologic preparations, the inflammatory pattern was suppurative with necrosis or a mixed suppurative-granulomatous reaction. M fortuitum, a thin, branching bacillus, stained inconsistently in direct smear and histologic preparations. Staining was variable with Gram, auramine, Brown-Hopps, Gram-Weigert, Kinyoun, Ziehl-Neelsen, modified Kinyoun, and Fite stains. Organisms, when present, were always seen in areas of suppurative inflammation. Incorrect presumptive diagnosis, based on misinterpretation of clinical signs and symptoms or on erroneous identification of M fortuitum bacilli as nocardia species, led to a delay in proper therapy for 7 of 11 patients. Definitive therapy after culture identification resulted in complete resolution of infection in all patients except 1.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
9/76. Pulmonary granuloma caused by pseudomonas andersonii sp nov.Pulmonary granuloma is a common lesion for which gram-negative bacteria are rarely implicated as a cause. Hence, most physicians are unaware of this etiology. We isolated a gram-negative bacterium from a surgically resected pulmonary granuloma in a 42-year-old, nonimmunocompromised woman. Within the necrotizing granuloma, numerous organisms also were demonstrated by Gram stain, suggesting a cause-disease relationship. Characterization of the bacterium by sequence analysis of the 16S ribosomal gene, cellular fatty acid profiling, and microbiologic studies revealed a novel bacterium with a close relationship to pseudomonas. We propose a new species for the bacterium, pseudomonas andersonii. These results suggest that the differential diagnosis of a lung granuloma also should include this gram-negative bacterium as a potential causative agent, in addition to the more common infections caused by acid-fast bacilli and fungi. This bacterium was shown to be susceptible to most antibiotics that are active against gram-negative bacteria.- - - - - - - - - - ranking = 1.2keywords = bacterium (Clic here for more details about this article) |
10/76. Orbital lipogranulomatous inflammation harboring Mycobacterium abscessus.PURPOSE: A case of iatrogenic Mycobacterium abscessus orbital infection is presented to call attention to its distinct histopathologic appearance, mechanism of organism, virulence, and clinical management. methods: Clinicopathologic analysis of an orbital infection caused by M. abscessus is described. Detailed histologic analysis is performed to provide insight into the mechanism of infection and correlate the features of the orbital infection with that of atypical mycobacteriosis at other body sites. RESULTS: A 71-year-old woman had an orbital mass in the supranasal orbit after a blepharoplasty. The mass consisted of a dimorphic inflammatory reaction with a superficial purulent reaction and a deeper granulomatous process consisting of epithelioid tubercles, each centered about a lipid vacuole. Acid-fast bacilli were found in the lipid vacuoles but not elsewhere in the specimen. Each tubercle was surrounded by a zone of lymphocytes and a desmoplastic reaction. Microbiologic culture studies identified M. abscessus. A combination of surgical intervention and antibiotic therapy for 4 weeks eliminated the infection. CONCLUSIONS: Acid-fast stains should be performed on any orbital lesion showing an apparent lipogranulomatous reaction. Although clinical management of orbital atypical microbacteriosis is difficult, the combination of surgical and specific antimicrobial intervention is effective. Our study contributes to an evolving understanding of the mechanism of human infectivity of these low-virulence organisms by suggesting that the orbital fat is a source of lipid material that can harbor the organisms, allowing them to escape host immunosurveillance.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
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