Tuberculous (TB) biliary stricture with calcified liver nodules rendering obstructive jaundice is a rare clinical phenomenon. Recently, we encountered a young patient with obstructive jaundice who was investigated in a general hospital. He was sent to our hospital for subsequent management after undergoing a series of investigations and biliary stenting. The radiological imagings performed revealed multiple calcified lesions in the liver with proximal bile duct strictures. Blood investigations, tumor markers and tuberculous work up were not remarkable. Subsequently, he underwent laparotomy and biliary reconstruction. Postoperatively, he was discharged well. Histopathological examination of the hepatoduodenal nodes showed chronic infections and granulomatous lymphadenitis, suspicious of a mycobacterium infection.
The purpose of this article is to demonstrate the appearance of active TB lymphadenitis using multimodality imaging apparatus. Multi-modality diagnostic imaging tools, including chest radiograph, Ultrasound (US), Computed Tomographic Scan (CT), Magnetic Resonance Imaging (MRI), and integrated 18F-FDG Positron Emission Tomography/CT examination, were performed to demonstrate TB lymphadenitis in the neck and superior mediastinum of a 26 year old female patient. There was widening of superior mediastinum on chest radiograph. Meanwhile, the ultrasound carried out detected superficial cystic lesions in the cervical region. The MRI found multiple gadolinium enhanced cervical and mediastinal lymphadenophaties. Contrast enhanced CT found heterogeneous enhancing lymphadenopathies in the same anatomical region. FDG PET/CT demonstrated a high metabolic activity in all lesions, as demonstrated by conventional imaging
modalities. Mycobacterium tuberculosis was isolated from 1ml aspirate using US guidance. Post treatment FDG PET CT scan demonstrated a complete metabolic remission of active lesions FDG PET CT can be used to demonstrate metabolic activity of active TB lesions in addition to guide clinicians in treating TB lesions.
Brugia malayi and Wuchereria bancrofti infections cause lymphatic filariasis in Malaysia. About 2.5 million people live in endemic areas of filariasis, of whom 5% have microfilaraemia and probably twice as many are infected. There is a wide clinical spectrum of response to the infection. While some have asymptomatic microfilaraemia, others have episodic attacks of fever, lymphadenitis, retrograde lymphangitis and lymphoedema. Elephantiasis is a late complication. Tropical pulmonary eosinophilia and other forms of occult filariasis are due to hyper allergic reactions to microfilarial antigens. Parasitological and serological tests aid in confirming the clinical diagnosis. The drug of choice is diethylcarbamazine citrate.
We present a young adult female with symptoms of acute tonsillitis and tender cervical lymphadenopathy. Despite a full course of oral antibiotics, she had persistent left lower cervical lymphadenopathy measuring 2.0 x 1.5 cm at 2 weeks post-treatment. Rigid and flexible scope examinations did not reveal any abnormalities in the nasopharynx, oropharynx or hypopharynx. Tuberculosis tests were negative and blood index results were normal. Fine needle aspiration cytology revealed a non-specific granulomatous inflammatory process. Excisional lymph node biopsy was performed, and the patient was diagnosed as having Kikuchi's Disease (KD). We would like to highlight the diagnostic challenges in detecting this condition and the importance of differentiating KD from tuberculosis and malignant lymphoma, the latter of which requires aggressive treatment.
A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia.
A retrospective review of patients with focal non-typhoidal Salmonella (NTS) infection was performed to determine its features and outcome. All patients with focal NTS infection admitted to the University of Malaya Medical Center, Malaysia, from 1993 to 2002 were studied. More than half (58%) of the 35 cases (54% male, median age 39 years, range 1.5 months to 79 years) were immunocompromized or had chronic medical conditions. One-third of the patients (34%) had superficial infections (lymphadenitis or subcutaneous tissue infection) and all recovered with antimicrobial therapy alone. Deep infections (66%) noted were: meningitis (9%), osteomyelitis or arthritis (26%), abscesses of the gastrointestinal tract or adjacent organs (20%), and others (11%). Deep infections were more likely to occur in the extremes of age (<6 months or >60 years, p< 0.04), associated with adverse outcomes with an overall mortality rate of 9%, or required major surgery (15%).
BACKGROUND: Corynebacterium pseudotuberculosis biotype ovis is a bacterium that causes caseous lymphadenitis (CLA), a chronic disease of sheep and goats characterized by the formation of suppurative abscesses in superficial and visceral lymph nodes and internal organs of small ruminants. This study was designed to evaluate the reproductive hormonal changes (estrogen and progesterone) and histopathology in the reproductive organs and associated lymph nodes of does challenged with C. pseudotuberculosis biotype ovis and its immunogen; corynomycolic acid. A total of 12 healthy non-pregnant female goats were grouped into three: A, B and C consisting of four does each. Group A was intradermally inoculated with 2 mL of sterile phosphate buffered saline (PBS) pH 7 (negative control group); group B was intradermally inoculated with 2 mL of corynomycolic acid extract (CMAs), while group C was intradermally inoculated with 2 mL of 10⁹ colony-forming unit (cfu) of live C. pseudotuberculosis. Blood samples were also collected at predetermined intervals for estrogen and progesterone hormonal assays. The does were euthanized 90 days post challenge and tissue samples of the uterus, ovaries, fallopian tubes, cervix and associated lymph nodes were collected and fixed in 10% neutral buffered formalin for histopathological processing. The result showed various degrees of histopathological changes (hemorrhage, congestion, degeneration, necrosis, edema, leucocytic infiltrations) in the reproductive organs and associated lymph nodes of both inoculation groups. Increases in estrogen hormone concentration were observed in both inoculation groups in comparison to the control group. However, progesterone concentration was only increased in group C. This study highlighted that corynomycolic acid extract from C. pseudotuberculosis biotype ovis resulted in significant histopathology in the reproductive organs and associated lymph nodes of does and increase estrogen concentration.
Haptoglobin (Hp) and Serum Amyloid A (SAA) are a group of blood proteins whose concentrations in animals can be influenced by infection, inflammation, surgical trauma or stress. Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis (CLA), and Mycolic acid is a virulent factor extracted from C. pseudotuberculosis. There is a dearth of sufficient evidence on the clinical implication of MAs on the responses of Hp and SAA in goats. Therefore, this study was conducted to evaluate the potential effects of Mycolic acid (MAs) and C. pseudotuberculosis on the responses of Hp and SAA in female goats. A total of 12 healthy female goats was divided into three groups; A, B and C each comprising of 4 goats and managed for a period of three months. Group (A) was inoculated with 2 mL of sterile phosphate buffered saline (as a negative control group) intradermally, while group (B) and (C) were inoculated intradermally with 2 ml each of mycolic acid and 1 × 109 cfu of active C. pseudotuberculosis respectively. The result of the study showed that the Hp concentration in goats inoculated with C. pseudotuberculosis was significantly increased up to 7-fold (1.17 ± 0.17 ng/L) while MAs showed a 3-fold increased (0.83 ± 0.01 ng/L) compared with the control. Whereas SAA concentration in C. pseudotuberculosis and MAs groups showed a significant 3-fold (17.85 ± 0.91 pg/mL) and 2-fold (10.97 ± 0.71 pg/mL) increased compared with the control. This study concludes that inoculation of C. pseudotuberculosis and MAs have significant effects on Hp and SAA levels, which indicates that MAs could have a role in the pathogenesis of caseous lymphadenitis.