Pulmonary infections due to brucellosis in childhood.

INTRODUCTION: Brucellosis is widely distributed zoonotic infection. Brucellosis is a multisystemic disease but pulmonary infection due to brucellosis is very rarely reported. MATERIALS AND METHODS: We retrospectively evaluated our pediatric brucellosis cases between February 2014 and December 2015. The brucellosis patients with and without pulmonary infection were compared with each other. RESULT: We detected pulmonary infection in 18 of the 98 brucellosis patients. There was no statistical significant difference between the brucellosis patients with and without a pulmonary infection as regards age, gender, and animal husbandry history. The laboratory findings including the Brucella Coombs agglutination titers were also similar. The most common chest X-ray findings were interstitial infiltration and hilar lymphadenopathy. All of our cases with pulmonary infection recovered with the usual anti-brucella treatment. CONCLUSIONS: Brucellosis may cause a pulmonary infection more often than thought. The prognosis of respiratory brucellosis is good and the classic treatment regimen is appropriate.

Pulmonary histopathology of Cytauxzoon felis infections in the cat.

Cytauxzoonosis, caused by Cytauxzoon felis, is a regionally common, often fatal tick-borne disease primarily affecting the domestic cat. Retrospective analysis of case records from January 1995 to June 2005 identified 148 domestic cats diagnosed with cytauxzoonosis, having suitable archived lung sections. Lung sections were examined and graded on relevant parameters, the chief purpose of which was to characterize the pulmonary lesion of fatal feline cytauxzoonosis. Parameters were scored 0 to 3 for no lesion, mild, moderate, and severe, respectively. Evaluated parameters included the presence of interstitial pneumonia, increases in number of alveolar macrophages, degree of intra-alveolar hemorrhage, neutrophils infiltrating peribronchial and septal interstitium, and degree of vascular occlusion. Overall, interstitial pneumonia was moderate (1.72 +/- 0.65); alveolar macrophage numbers were mild (1.20 +/- 0.60); and intra-alveolar hemorrhage was mild (0.78 +/- 0.75). Neutrophil infiltrates were moderate (1.89 +/- 0.76), and vascular occlusion was moderate to severe (2.26 +/- 0.61). Pulmonary edema was common; its scoring was incorporated into the assessment for interstitial pneumonia. Interestingly, a thrombus was detected in the lung of 1 cat. The current understanding of the pathogenesis of cytauxzoonosis focuses on vascular occlusion by macrophages distended by megaschizont parasite stages within liver, spleen, and lung. These findings corroborate the current understanding yet shed light on the possibility that macrophage activation and inflammatory mediators lead to an interstitial pneumonic process characterized by neutrophilic infiltrates and pulmonary edema. These characterized lesions are likely correlative with the respiratory distress seen in affected cats.

In situ immune responses to interstitial pneumonitis in human visceral leishmaniasis.

Lung disease during active human visceral leishmaniasis is frequently reported. As such, studies have associated pulmonary symptoms to interstitial pneumonitis with a mononuclear infiltrate. However, the immune response in this condition has never been described before. The aim of this study was to determine the immunophenotypic pattern and cytokine profile of lung involvement (IPL) in human visceral leishmaniasis. Quantitative methods of analysis were performed using immunohistochemistry, and were compared with a control group of normal lung. Interstitial macrophages and cd8 cells were increased in IPL, and IL-4 as well as TNF-alpha displayed increased expression when compared to the control group. This inflammatory process with a Th2 pattern, as suggested by increased IL-4 and low IFN-gamma expression, is consistent with the immune response in other organs of visceral leishmaniasis. The microenvironment of the immune response in this condition is associated with lung disease in patients with interstitial pneumonitis related to visceral leishmaniasis, increasing the chance of bacterial infection.

A Toxoplasma gondii strain isolated in Okinawa, Japan shows high virulence in Microminipigs.

Toxoplasma gondii strains have been isolated all over the world and their virulence has been examined mainly using laboratory mice. However, T. gondii differs in virulence depending on the host animal species. Therefore, to evaluate the virulence of each strain in domestic animals, it is necessary to examine using not only mice but also the concerned animals. We have shown that TgCatJpOk4, a T. gondii strain recently isolated in Okinawa, Japan, has a high virulence against laboratory mice, comparable to highest virulent RH strain in mice; however, the virulence to domestic animals remains unknown. In this study, we examined the virulence using the Microminipig. After infection, four out of five infected pigs showed severe clinical symptoms: inappetence, hypoactivity and tachypnea. Eventually, three out of the five infected pigs succumbed before the end of the observation. Among the three dead pigs, histological analysis revealed that interstitial pneumonia and spotty necrosis in the liver indicating that the TgCatJpOk4 strain has a high virulence not only in laboratory mice, but in pigs as well.

First report of a fatal autochthonous canine Angiostrongylus vasorum infection in Belgium.

Canine angiostrongylosis is considered as an emergent disease in Europe and Canada. A fatal case of Angiostrongylus vasorum infection is described in a four and a half month old puppy born in Belgium. The dog was presented with marked neurological disorders, body weight loss, a profound weakness and mild respiratory signs. The dog was given antibiotics and mucolytic compounds with very little improvement and consequently was referred to a specialist for additional examinations. As the general condition of the dog was rapidly declining, the animal was euthanized shortly after on its owners' request and a necropsy was carried out. Extensive gross pulmonary lesions were observed and histopathological examination revealed the presence of numerous larvae with morphology compatible with A. vasorum. Larvae were also found in the product of a bronchoalveolar lavage but fecal material was not examined. The presence of A. vasorum circulating serum antigen was demonstrated through ELISA; additionally an A. vasorum specific PCR was performed on brain material and yielded a positive result. This case confirms that the clinical diagnosis of canine angiostrongylosis can be very challenging especially when respiratory signs are absent or very mild such in the present case. This is the first reported case of canine angiostrongylosis in Belgium.

Angiostrongylus vasorum infection in red foxes (Vulpes vulpes) in southern Italy.

Angiostrongylus vasorum (Nematoda: Angiostrongylidae) infection was detected at post-mortem examination in the pulmonary arteries and hearts of 34/102 (33,3%) of red foxes (Vulpes vulpes) from the Campania Region in southern Italy. Pathological changes consisted of granulomatous interstitial pneumonia caused by larvae and intravascular pulmonary adult nematodes. These changes confirm that angiostrongylosis infection in red foxes has a mainly chronic course, in which the infected host may disperse parasite larvae in the environment over its lifetime. Results suggest that the life cycle of A. vasorum is well established in the red fox in the Campania Region representing a potential infection risk for dogs.

Chronic interstitial pneumonitis in dogs naturally infected with Leishmania (Leishmania) chagasi: a histopathological and morphometric study.

Eighteen mongrel dogs of unknown age and naturally infected with Leishmania (Leishmania) chagasi, were obtained from the City Hall of Belo Horizonte, Brazil. Four dogs were used as control. Lung samples were obtained and immediately fixed in formalin. The histopathological picture of all lung tissue sections was a chronic and diffuse interstitial pneumonitis. The thickened inter-alveolar septa were characterized by the cellular exudate (mostly macrophages, lymphocytes and plasmocytes) associated with collagen deposition. Morphometric analysis showed greater septal thickness in the infected animals than in controls. In fact, the morphometric study of collagen stained with ammoniac silver confirmed a larger deposition of collagen in the infected animals. The parasitologic method was carried out during the study of the lesions on the slides. However, we did not observe any correlation between the histopathologic and morphometric data and the clinical status of the animals. We conclude that the pulmonary lesions observed in all naturally infected dogs were correlated with the disease and that the morphometric method used was satisfactory for the analysis of septal thickness and of increased collagen deposition, confirming the presence of fibrosis.

Systemic toxoplasmosis and concurrent porcine circovirus-2 infection in a pig.

Systemic toxoplasmosis and concurrent infection with porcine circovirus-2 (PCV-2) was diagnosed in a fattening pig. Clinical examination of the herd showed that up to 30% of the pigs of this weight group suffered from severe respiratory signs including sneezing and coughing, with a mortality rate of up to 5%. Gross necropsy examination revealed severe interstitial pneumonia and generalized lymphadenopathy. On microscopical examination there was necrotizing inflammation of the lung, adrenal glands and lymph nodes, associated with lymphoid depletion, cytoplasmic basophilic botryoid inclusion bodies and protozoal microorganisms. Infection with Toxoplasma gondii was confirmed by immunohistochemistry (IHC). Polymerase chain reaction analysis, in-situ hybridization and IHC confirmed systemic PCV-2 infection. These findings, associated with the respiratory signs and lesions in lymphoid tissues, are characteristic for post-weaning multisystemic wasting syndrome (PMWS). In this case, immunosuppression by PCV-2 may have triggered systemic toxoplasmosis, or immune stimulation caused by coinfection with T. gondii may have caused extensive replication of PCV-2.

Evidence-based management of rapidly progressing systemic sclerosis.

Systemic sclerosis has the highest case-specific mortality of any of the auto-immune rheumatic diseases, as well as causing major morbidity. It is a major clinical challenge and one that has previously provoked substantial nihilism due to the limited therapeutic options available and the perceived lack of evidence for clinical effectiveness of those treatments that are currently in use. However, this situation is changing; there are emerging data supporting efficacy for some treatment approaches for this patient group together with a growing number of exciting potential novel approaches to treatment that are moving into the clinical arena. Some of the recent clinical trials are reviewed and discussed in detail.

Pulmonary changes during acute experimental murine mansoni schistosomiasis.

Dry cough, dyspnea and manifestations of bronchial asthma have recently been observed in patients with acute schistosomiasis. To investigate the type and pathogenesis of these conditions, an experimental mouse model for acute schistosomiasis was used. Forty mice were divided into four groups of ten each: three infected groups and a non-infected control group. The animals were examined 7, 28-35 and 40 days after exposure to cercariae. During the acute phase of the infection (28-35 days), a process of multifocal interstitial pneumonitis involving the peribronchial, peribronchiolar and subpleural tissues was found. This process was not seen during the other phases of the infection. Indirect immunofluorescence failed to demonstrate the presence of schistosomal antigens in the acute-phase lesions. The pneumonitis was attributed to products (inflammatory mediators) from acute-phase periovular necrotic-inflammatory lesions in the liver that were transported to the lungs by the bloodstream.

[Retrospective clinical and laboratory study of the toxocariasis cases hospitalised between 2005 and 2008]. / Studiu clinic si de laborator, retroprospectiv, asupra cazurilor de toxocaroza la copiii spitalizati in perioada 2005-2008.

UNLABELLED: The authors present the results of retroprospective clinical and laboratory diagnosis on toxocariasis cases hospitalized in the Paediatric Diseases Clinic of Iasi, between January 2005-June 2008. MATERIAL AND METHOD: The study included a number of 228 children. RESULTS: The most frequent clinical manifestation was pulmonary symptoms 80.70%: dyspneea, wheesing, asthma, cough, interstitial pneumonitis. The most frequent digestive symptoms were abdominal pain 41.22%, hepatosplenomegaly 29.38%; cutaneous manifestations were pruritus and urticaria. The laboratory diagnosis: hypereosinophilia was present at 94.73% childrens associated with hyperleucocytosis and hyper-gammaglobulinemia. All the patients were serologic confirmed with toxocariasis. The children responded well to treatment with albendazole.

Sparganum mansoni parasitic infection in the lung showing a nodule.

Reported herein is a 57-year-old man infected by Sparganum mansoni, a kind of tapeworm, showing a solitary nodule of the middle lobe of the right lung. Because a transbronchial biopsy could not diagnose the nodule, a right middle lobectomy was performed on suspicion of malignant tumor. The lesion was diagnosed as sparganosis by histological and immuno-serological examinations. Histological examination revealed granulomatous inflammation with neutrophil and eosinophil infiltration around the worm and interstitial pneumonia surrounding the nodule. Moreover, vasculitis with foreign body giant cell was seen around the lesion. To the authors' knowledge this is the second case of sparganosis limited in the lung, and the current report presents the first detailed histological description of a pulmonary sparganosis case.

Pulmonary changes during acute experimental murine manson schistosomiasis / Alterações pulmonares na esquistossomose aguda experimental em camundongos

Dry cough, dyspnea and manifestations of bronchial asthma have recently been observed in patients with acute schistosomiasis. To investigate the type and pathogenesis of these conditions, an experimental mouse model for acute schistosomiasis was used. Forty mice were divided into four groups of ten each: three infected groups and a non-infected control group. The animals were examined 7, 28-35 and 40 days after exposure to cercariae. During the acute phase of the infection (28-35 days), a process of multifocal interstitial pneumonitis involving the peribronchial, peribronchiolar and subpleural tissues was found. This process was not seen during the other phases of the infection. Indirect immunofluorescence failed to demonstrate the presence of schistosomal antigens in the acute-phase lesions. The pneumonitis was attributed to products (inflammatory mediators) from acute-phase periovular necrotic-inflammatory lesions in the liver that were transported to the lungs by the bloodstream.

Recentemente tem sido observada a presença de tosse seca, dispnéia, e manifestações de asma brônquica em pacientes com esquistossomose aguda. Para se investigar sobre o tipo e patogenia de tais lesões foi utilizado um modelo experimental de esquistossomose aguda no camundongo. Quarenta animais foram divididos em quatro grupos de 10 animais cada, 3 infectados e um grupo controle não-infectados. Os exames foram feitos após 7, 28-35, e 40 dias após a exposição cercariana. Na fase aguda da infecção (28-35 dias), encontrou-se um processo de pneumonite intersticial multifocal, envolvendo os tecidos peribrônquicos, peribronquiolares e subpleural, processo que esteve ausente nas outras fases examinadas. Não foi possível a demonstração de antígenos do Schistosoma. mansoni nas lesões da fase aguda, através da técnica de imuno-fluorescência indireta. A pneumonite foi atribuída a produtos (mediadores inflamatórios) gerados nas lesões hepáticas necro-inflamatórias periovulares da fase aguda, e transportados para os pulmões pela circulação sanguínea.

Pulmonary besnoitiasis in captive maras (Dolichotis patagonum) associated with interstitial pneumonia.

Six captive maras (Dolichotis patagonum) were found to have cysts consistent with Besnoitia in the lungs by light microscopy and electron microscopy. Three were juveniles that died with no premonitory signs during a 17-month period. The most prominent finding consisted of severe, subacute, diffuse interstitial pneumonia with syncytia and Besnoitia cysts. The severity of pneumonia correlated with the number of cysts and the presence of lytic cysts, often surrounded by chronic granulomatous inflammation. Disseminated infection was observed in one of these maras. The three other maras died of unrelated conditions and had a few Besnoitia cysts in their lungs with mild or no inflammation associated. This is the first report of besnoitiasis in maras and of its association with fatal interstitial pneumonia in any species. Although other agents may have caused the interstitial pneumonia described here, it is possible that zoites released from lytic cysts were involved in the development of this lesion.

Feline immunodeficiency virus predisposes cats to acute generalized toxoplasmosis.

This study was designed to examine the effects of a pre-existing, clinically asymptomatic feline immunodeficiency virus (FIV) infection on a primary challenge with Toxoplasma gondii. Parenteral challenge of FIV-infected cats with tachyzoites of the ME49 strain of T. gondii caused a precipitous drop in all lymphocytes (CD4+, CD8+, and B cells) and generalized severe toxoplasmosis. The predominant postmortem lesions included acute and often fatal interstitial pneumonia, dominated histologically by macrophages, and multifocal to coalescing hepatic necrosis. Immunohistochemistry revealed numerous T. gondii antigen and tachyzoites in macrophages and other cell types in the lung lesions. The proliferative response of peripheral blood mononuclear cells to specific (T. gondii antigen) and nonspecific (Concanavalin A) mitogens was defective in the dually infected cats, suggesting marked immunosuppression. In contrast to the dually infected cats, cats infected only with T. gondii developed a transient, mild clinical disease characterized by anorexia, lethargy, and multifocal chorioretinitis. Lymphocyte changes in T. gondii-infected cats included an early pan-lymphopenia followed by reestablishment of all lymphocyte subset profiles. These cats also showed a reduced proliferative response to Concanavalin A at 1 week after challenge, but a measurable in vivo response to T. gondii antigens, as evidenced by in vitro lymphocyte proliferation in the absence of a mitogenic stimulus. These results show that infection of cats with FIV-NCSU, markedly enhances their susceptibility to a primary T. gondii infection and provides a model to study the mechanisms of the underlying immunological defect(s) occurring early after HIV infection that may predispose individuals to development of acquired immunodeficiency syndrome and associated diseases.