Disseminated Scedosporium apiospermum infection in a Maremmano-Abruzzese sheepdog.

BACKGROUND: Few cases of scedosporiosis have been reported in animals, but the true prevalence is probably underestimated due to a lack of awareness. Scedosporiosis in dogs has often been associated with localized infection (i.e., nasal infection, eumycetoma, or keratomycosis) or, in rare cases, disseminated infections. CASE PRESENTATION: This case report describes the clinical and pathological features and the diagnostic process of a rare systemic and fatal fungal infection in a dog caused by Scedosporium apiospermum. A 10-month-old female Maremmano-Abruzzese sheepdog showing weakness, lethargy, lateral decubitus, miosis and muscular rigidity was presented. Rodenticide poisoning was clinically suspected for the differential diagnosis. However, postmortem examinations revealed the presence of a swollen and soft subcutaneous nodule located near the right inguinal breast, which was associated with massive enlargement of the inguinal lymph nodes and small disseminated, cream-colored nodules in the kidneys and mesentery. Multiple fungal pyogranulomas were observed upon histological examination. Fungal isolation from the kidneys, breast and inguinal lymph nodes was performed. The internal transcribed spacer (ITS) sequences from the fungal colony DNA were searched in BLAST in the NCBI GenBank for species identification. The sequences of the fungi isolated from the kidney and breast cultures showed 100% sequence identity with sequences from Scedosporium apiospermum. CONCLUSIONS: This report shows that Scedosporium apiospermum may act as a primary pathogen in young and apparently healthy dogs and represents an important pathogen that should be considered during the diagnostic process, particularly when a fungal infection is suspected.

Pyogenic Granuloma Formation Following Ahmed Valve Glaucoma Implant.

Ocular pyogenic granuloma is a benign tumor seen after ocular insult secondary to ocular surgeries, trauma or infection. Although benign, intervention is sometimes necessary. Previous authors have reported pyogenic granuloma formation following oculoplastic surgeries. We report a pyogenic granuloma after an Ahmed glaucoma valve implantation. A 65-year-old gentleman presented with right eye redness associated with pain and swelling ~2 months after Ahmed glaucoma valve implantation. Examination found a sessile growth on the tube extruding puss with signs of endophthalmitis. The glaucoma drainage device was explanted and culture results grew Staphylococcus aureus. This article discusses the formation of pyogenic granuloma on a glaucoma drainage device and its management.

Multiple Pyogenic Granulomas After Burns: Response to Conservative Treatment in Five Children.

We describe five children with multiple pyogenic granulomas after burns that were healed effectively using conservative treatment consisting of 1% povidone-iodine, silver nanoparticle dressing, and antibiotics. No relapse of the lesions was observed from 6 months to 2 years later.

Methicillin-resistant staphylococci carriage in the oral cavity: a study conducted in Bari (Italy).

OBJECTIVES: The oral cavity may represent a site of colonization by antibiotic-resistant bacteria, such as methicillin-resistant staphylococci (MRS). To define the prevalence of staphylococci and MRS in the oral cavity, an observational study was carried out in the city of Bari (Italy). METHODS: Sixty subjects were asked to provide oral samples and a questionnaire about risk factors of colonization by MRS. An enrichment medium specific for staphylococci was used for the isolation. RESULTS: Swabs and corresponding questionnaires were available from 36 out of 60 patients. Staphylococci were isolated from seven out of 36 samples (prevalence 19.4%). Among the seven staphylococcal isolates, three were Staphylococcus aureus, and one strain, belonging to S. epidermidis species, was found to be MR (1.7%). No methicillin-resistant S. aureus were isolated. Five out of seven staphylococcal isolates exhibited resistance to more than two classes of non-beta-lactams antimicrobials. None of the risk factors analysed correlated with the status of MRS carriers, except the presence of oral disease. CONCLUSIONS: The results underline the potential role of the oral cavity as a reservoir of staphylococci.

The clinical spectrum of Actinomyces-associated lesions of the oral mucosa and jawbones: correlations with histomorphometric analysis.

OBJECTIVES: To characterize the clinical manifestations of Actinomyces-associated lesions of the oral mucosa and jawbones, and to correlate the clinical course and treatment requirements with the findings of histomorphometric analysis. STUDY DESIGN: The study was a 10-year retrospective analysis of archived cases with microscopic identification of Actinomyces infection. Actinomyces colonies were identified, using hematoxylin-eosin, Gram, and periodic acid-Schiff stains, exhibiting filamentous morphology with color variation between center and periphery. Only colonies with adjacent tissue reaction (inflammation, fibrosis) were analyzed. Actinomyces density (AD) was calculated by dividing total number of colonies by tissue surface, Actinomyces relative surface (ARS) was calculated by dividing total bacterial surface by tissue surface. RESULTS: The study included 106 cases (48 male, 58 female; aged 13-84 years, mean 50.5 years). Cases presented a wide clinical spectrum, involving jawbone and/or oral soft tissues. Cases included osteomyelitis associated with bisphosphonates, osteoradionecrosis, osteomyelitis unrelated to radiation or bisphosphonates, periapical lesions, odontogenic cysts, periimplantitis, and lesion mimicking periodontal disease. The AD correlated with median length of antibiotic treatment (R = 0.284; P = .028). CONCLUSIONS: Because we were able to identify 106 such cases, the results indicate that Actinomyces-associated lesions may not be as rare as would be expected from the relatively low number of cases in the literature. Actinomyces-associated lesions presented in a wide spectrum of clinical settings and a variety of contributing factors. Quantitative analysis of the number of bacterial colonies (representing bacterial load) could help in evaluating the aggressive potential of the lesion and help in treatment planning.

Pyogenic granuloma associated with chronic Actinomyces canaliculitis.

A case of chronic Actinomyces canaliculitis with associated pyogenic granuloma formation and bloody tears is described. Although Actinomyces is a well-known cause of canaliculitis, the authors are not aware that it has been reported in association with pyogenic granulomas.

Is pyogenic granuloma associated with Bartonella infection?

Lobular capillary hemangioma and bacillary angiomatosis due to Bartonella infection share several clinical and histopathologic characteristics. We sought to determine whether lobular capillary hemangioma is caused by the same agent as bacillary angiomatosis. Forty-five pathology specimens with a histologic diagnosis of lobular capillary hemangioma obtained from patients with the same clinical diagnosis were tested by immunohistochemistry and polymerase chain reaction for the presence of DNA elements of Bartonella spp. None of the 45 lobular capillary hemangioma specimens tested positive for Bartonella spp. We conclude that lobular capillary hemangioma is not associated with Bartonella spp infection. Further research is required to determine the etiologic agent.

Chronic Staphylococcus aureus infection leading to pyogenic granuloma and preventing socket re-epithelialization after orbital exenteration.

A 71-year-old woman underwent extenteration for conjunctival melanoma with orbital invasion. Her socket failed to epithelialize and contained a diffuse pyogenic granuloma that was caused by chronic Staphylococcus aureus infection. Extensive debridement and long-term intravenous antibiotics resulted in normal healing.

Clinicopathologic analysis of 15 explanted hydroxyapatite implants.

PURPOSE: To report the clinical findings, treatment, outcomes, and histopathologic findings in patients with suspected orbital implant infection requiring implant removal. METHODS: Retrospective, observational case series of 14 patients (15 hydroxyapatite orbital implants) undergoing implant removal from September 1994 through December 2002. Patient age, type of surgery, implant type, symptoms, treatment, histopathology of implant, and follow-up course were analyzed. RESULTS: Of the 14 patients, 7 were female and 7 were male. The mean age at explantation was 42 years. The most common symptoms were discharge and socket tenderness. The most common signs were conjunctival inflammation (edema, hyperemia), discharge, and recurrent pyogenic granuloma. Clinical evidence of infection was documented in 13 patients. Histopathologic assessment of the 15 explanted implants showed acute inflammation and necrosis (abscess) with identification of microorganisms (5 patients), acute inflammation and necrosis without identification of microorganisms (4 patients), chronic inflammation with identification of microorganisms (1 patient), chronic inflammation without identification of microorganisms (3 patients), and a predominant foreign body granulomatous response without identification of microorganisms (2 patients). Osseous metaplasia was seen in 10 implants. Prompt resolution of symptoms and signs occurred in all but one case. CONCLUSIONS: The clinical course of porous orbital implant infection may be prolonged, and the early symptom of recurrent discharge, a common problem for implant recipients, may delay diagnosis. Implant infection should be suspected when there is persistent conjunctival inflammation and discharge after implant placement despite antibiotic therapy, discomfort on implant palpation, and recurrent pyogenic granuloma (indicative of implant exposure). Implant removal is usually required in these cases. If orbital pain (not necessarily related to implant palpation) is the main complaint, without signs of conjunctival inflammation and with or without discharge, one should consider other reasons for the symptoms.

Pyogranulomatous skin disease and cellulitis in a cat caused by Rhodococcus equi.

This report describes a case of Rhodococcus equi infection causing pyogranulomatous skin disease and cellulitis in a two-year-old female domestic shorthaired cat. The case differed from previously reported cases in cats in its clinical presentation and in the locations of the lesions, which were similar to those seen in horses. The presence of an intracellular organism was confirmed by cytology and on histopathology. The aetiological diagnosis was confirmed by routine biochemical tests specific for R. equi on a pure isolate obtained from a biopsy specimen. The report also reviews the literature of the documented feline cases and discusses the common pitfalls in the diagnosis of such infections.

Pyogenic granuloma: pyogenic again? Association between pyogenic granuloma and Bartonella.

BACKGROUND: Pyogenic granulomas (PG) are benign vascular lesions which were thought to have an infectious etiology, yet none has been found. Bacillary angiomatosis (BA), which presents as disseminated vascular lesions in immunosuppressed patients, and verruga peruana (VP), which presents as crops of vascular nodules in immunocompetent persons, are caused by infection with Bartonella. Thus, the question was raised whether Bartonella could be associated with the development of PG, also a vasoproliferative lesion like BA and VP. The objective of this study was to determine through a case-control study whether such an association exists. METHODS: Patients who presented with PG and age and sex-matched controls with capillary hemangiomas and senile (cherry) angiomas were tested for serum IgG antibodies against Bartonella using an immunofluorescence antibody method. The prevalence of positive serology was compared between the groups. RESULTS: Twenty PG patients and 20 control patients with hemangiomas or angiomas were studied. Six out of 20 PG patients tested positive (30%), while none of the 20 control patients tested positive (0%). The difference between the proportions of seropositivity in the two groups reached statistical significance (p = 0.02, df = 1). CONCLUSIONS: Pyogenic granuloma patients were determined to have a statistically higher prevalence of Bartonella seropositivity compared with control patients. Further studies are needed to confirm the association and establish a possible etiological link. Such an association could have potential therapeutic importance. A nonsurgical approach with antibiotics may be possible and may decrease the recurrence rate and occurrence of satellite lesions.

Aspergillus mycetoma in a secondary hydroxyapatite orbital implant: a case report and literature review.

OBJECTIVE: The authors describe the first case report of a fungal abscess within a hydroxyapatite orbital implant in a patient who had undergone straightforward secondary hydroxyapatite implant surgery. DESIGN: Case report and literature review. INTERVENTION: Four months postoperatively after pegging and 17 months after original implant placement, chronic discharge and socket irritation became evident. Recurrent pyogenic granulomas were a problem, but no obvious area of dehiscence was present over the implant. The peg and sleeve were removed 31 months after pegging (44 months after original placement of the implant). The pain and discharge did not resolve, and the entire hydroxyapatite orbital implant was removed 45 months after sleeve placement and 58 months after initial implant placement. The pain and discharge settled rapidly. MAIN OUTCOME MEASURES: Cultures and histopathology. RESULTS: Results of bacterial cultures were negative. Results of histopathologic examination of the implant disclosed intertrabecular spaces with multiple clusters of organisms consistent with Aspergillus. CONCLUSIONS: Persistent orbital discomfort, discharge, and pyogenic granulomas after hydroxyapatite implantation should cause concern regarding potential implant infection. The authors have now shown that this implant infection could be bacterial or fungal in nature. This is essentially a new form of orbital Aspergillus, that of a chronic infection limited to a hydroxyapatite implant.

Exposure of expanded polytetrafluoroethylene-wrapped hydroxyapatite orbital implant: a report of two patients.

PURPOSE: Hydroxyapatite (HA) spheres used to replace volume after an enucleation are often wrapped with autologous tissue before orbital implantation. Man-made materials are less expensive and pose no risk for viral transmission. The use of expanded polytetrafluoroethylene (ePTFE) to wrap HA spheres was evaluated. METHODS: The medical records of 2 consecutive patients who underwent uncomplicated implantation of an HA sphere wrapped in ePTFE were reviewed. RESULTS: An unusual reaction to the ePTFE material that was nonresponsive to topical or systemic antibiotic therapy developed in these 2 patients. Eventual wound erosion and bacterial infection of the implant necessitated its removal. CONCLUSIONS: Although well tolerated in other surgeries, ePTFE, when used to wrap HA spheres and placed into the orbit, may cause persistent conjunctival discharge, pyogenic granuloma formation, and eventual wound erosion. Therefore, the use of this material to wrap HA spheres is not recommended.

Retained Aspergillus-contaminated contact lens inducing conjunctival mass and keratoconjunctivitis in an immunocompetent patient.

PURPOSE: A 66-year-old woman presented with a 1-month history of prominent mucoid discharge and foreign body sensation in her left eye. METHODS: Ocular evaluation revealed a moderately severe superficial punctate keratitis involving the temporal half of the left cornea. The superior tarsal conjunctiva showed marked papillary reaction with an area of indentation temporally. A mass was present in the superior temporal aspect of the fornix, clinically resembling a pyogenic granuloma. At the posterior aspect of this mass and covered by mucoid material, was a soft contact lens. RESULTS: Upon removal of the lens, without any additional therapy, the patient became asymptomatic and totally resolved her keratitis and mass lesion. Cultural identification of the soft contact lens was positive for Aspergillus fumigatus. CONCLUSIONS: We hypothesize that the mucoid discharge and mass lesion represented a mechanism similar to allergic fungal sinusitis.

Abscessed hydroxyapatite orbital implants. A report of two cases.

PURPOSE: The authors describe the rare condition of an abscess within a hydroxyapatite orbital implant in two patients who had undergone seemingly uncomplicated enucleation and orbital implant surgery. METHODS: In the first patient, 14 weeks postoperatively, a chronic discharge developed and the socket became uncomfortable. A pyogenic granuloma was present, occurring over an area of dehiscence. The hydroxyapatite orbital implant was removed 10 months postoperatively. In the second patient, moderate orbital discomfort was noted during the first week postoperatively along with a temporal shift of the implant. The discomfort persisted, and 1 week later a discharge began. The implant was removed 9 weeks after implantation. At the time of surgery, an unsuspected pyogenic granuloma was found in the medial conjunctival formix overlying a small area of implant dehiscence. RESULTS: Conjunctival and implant cultures grew Staphylococcus aureus in our first patient, whereas coagulase-negative staphylococci were cultured from the conjunctiva and implant in our second patient. Results of histopathologic examination of both implants disclosed an abscess cavity containing clusters of gram-positive cocci. CONCLUSION: Persistent orbital discomfort, discharge, and the development of a pyogenic granuloma after hydroxyapatite implant should warn the ophthalmic surgeon of potential implant infection.

Pyogenic versus pseudopyogenic granulomas.

Surgeons are confronted daily with a myriad of skin pathology. Pyogenic and pseudopyogenic granulomas are certainly among the differential diagnoses to many nonhealing dermal lesions. This article revisits two types of vascularized lesions that are perhaps part neoplastic and part inflammatory/reparative. The differences clinically between these two types of lesions are few. The classical form generally is found along mucosal surfaces and upper extremities. The pseudopyogenic granuloma is more often found on the scalp and ears. Confirmation in their diagnoses is based strictly on their histological criteria. The management of these two types of lesions is identical. Excisional biopsies for all nonhealing lesions are warranted to rule out lesions with an ominous progression.