Pathological characteristics of Linguatula serrata (aberrant arthropod) infestation in sheep and factors associated with prevalence in Iran.

Linguatula serrata is a cosmopolitan zoonotic parasite in which carnivores and herbivores serve as final and intermediate hosts, respectively. The aim of this study was to compare the L. serrata nymphal infection rate and intensity of infection (mean number of nymphs ±â€¯standard error) to the appearance and pathological changes of mesenteric lymph nodes (MLNs) infected with L. serrata using sheep slaughtered in Tabriz, Iran. In addition, the effect of age, sex, and season on the prevalence of L. serrata infection was evaluated. For this purpose, over a four-year period, 31,078 MLNs from 3199 sheep were examined, with 4972 (15.99%) MLNs infected representing 518 (16.20%) sheep. Collected MLNs were categorized by color as normal, red or black and by consistency as normal, soft or hard. L. serrata were found in 8.88% of normal-colored MLNs, 14.45% of red (hemorrhagic) MLNs and 44.57% of black-colored MLNs, with the difference being significant for infection and infection intensity (P < 0.0001). In regards to MLN consistency, 7.98% of normal, 31.52% of soft and 5.42% of hard lymph nodes were found to be infected with the infection rate and intensity in soft nodes being significantly different (P < 0.0001). Pathological changes in MLNs infected with L. serrata nymph with normal color and consistency had calcification of the L. serrata nymph, granulomatous inflammation around the nymph and some neutrophils. Granulomatous inflammation around the L. serrata nymph, haemosiderophage, macrophage and lymph node depletion from lymphocytes were observed in MLNs infected with L. serrata nymph with soft consistency. In addition, MLNs infected with L. serrata nymph with hard consistency and black color contained neutrophils in the capsule's wall, caseous necrotic mass and L. serrata surrounded by a thick capsule. In regards to prevalence, age, sex and season (autumn) were significant (P < 0.0001, P < 0.01, respectively). These study results suggest that targeted meat inspection and targeted animal interventions could be used to decrease human exposure to L. serrata and animal infection.

Ultrasound-guided core needle biopsy of cervical lymph nodes in the diagnosis of toxoplasmosis.

BACKGROUND: Our study investigates whether the histopathological features of toxoplasmic lymphadenitis (TL), specifically noncaseating microgranuloma and follicular hyperplasia, can be obtained by sonographic-guided core needle biopsy (CNB) of cervical lymph nodes. METHODS: Thirty-two patients seen from June 2014 to March 2015 were positive for toxoplasma immunoglobulin M antibody. Among those patients, 21 underwent CNB of a cervical lymph node and were enrolled in this study. The pathologic findings were reviewed. RESULTS: Twenty-nine lymph nodes in 21 patients were sampled. Eighteen of the 21 (86%) patients had a microgranuloma without caseating necrosis or giant cells, and all 21 (100%) patients had follicular hyperplasia. CONCLUSIONS: The histologic findings of TL were detected by sonographic-guided CNB, which can be used as part of the first line of investigation in patients with unexplained cervical adenopathy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:192-196, 2017.

Role of fine-needle aspiration cytology in the prompt diagnosis of recurrence of visceral leishmaniasis presented as isolated cervical leishmanial lymphadenopathy.

We report a case of isolated cervical leishmanial lymphadenopathy diagnosed by fine-needle aspiration cytology (FNAC) in apparently cured case of visceral leishmaniasis. A 28-year-old female presented with cervical lymphnode enlargement to surgery outpatient department and was subjected for FNAC. Smear showed numerous Leishmania donovani bodies in the cytoplasm of macrophages and giant cells, and extracellular spaces. She was treated by Amphotericin B for alternate 14 days and the size of the lymphnode regressed. She was found asymptomatic for 1 year of follow-up.

Isolated leishmanial lymphadenopathy - a rare type of leishmaniasis in India: a case report.

A patient presented with isolated, soft to firm, inguinal swelling since childhood clinically thought to be a benign lipomatous lesion. Fine-needle aspiration of the swelling revealed amastigote form of Leishmania donovani in a background of reactive lymphoid hyperplasia. Excision of the swelling resulted in reversal of positive Aldehyde test. Isolated leishmanial lymphadenopathy in an immunocompetent person, is a rare manifestation of leishmaniasis in India. The possible role of transplacental transmission is discussed.

Immune response pattern of the popliteal lymph nodes of dogs with visceral leishmaniasis.

The present study aimed to estimate the cell response and parasite load in the popliteal lymph nodes of dogs with visceral leishmaniasis (VL), comparing these findings with the clinical staging of the disease. From the necropsy, 33 dogs were classified as symptomatic (S), asymptomatic (A), or oligosymptomatic (O). Cytology and histopathology were used to determine any presence of microscopic lesions and immunohistochemistry, for parasite load. Dog hyperimmune serum was used as the primary antibody. The inflammatory infiltrate in lymph nodes consisted of macrophages and plasmocytes. The granulomas invaded the trabecular and sinusoid regions and sometimes compressed the lymphocytes of the cortical region (atrophy) and medullary cord cells. Parasite load intensity was unrelated to the density of the macrophages infiltrating the lymph node. Significant differences in parasite load (P < 0.05) were observed between the three groups of infected dogs. Follicular hyperplasia of the cortical region occurred among A and O, while follicular atrophy predominated among S. The parasite load was the greatest among S, followed by O. It can be concluded that, regardless of clinical condition, the most evident cell response consisted of macrophages and plasmocytes. Lymphoid atrophy was observed among animals with intense granulomatous reaction and high parasite load, such as among the symptomatic dogs (P < 0.05). Likewise, the oligosymptomatic dogs also presented high density of parasites in the lymph nodes. Thus, we can confirm that dogs with clinical manifestations of VL have an immune system that is less effective for controlling infection by Leishmania chagasi, thereby favoring parasite multiplication.

Diagnosis of visceral leishmaniasis by fine needle aspiration cytology of an isolated cervical lymph node: case report.

A 61-year-old woman presented with an isolated, painless, slightly enlarged right laterocervical lymph node without any other signs and symptoms of disease. Laboratory test including hematological and biochemical parameters were normal. A cervical ultrasonography demonstrated one lymph node (10 mm) on the right laterocervical side and one small reactive lymph node on the left laterocervical side. The fine needle aspiration (FNA) smears revealed a polymorphic population of cells composed of lymphocytes, histiocytes, epitheloid cells, plasma cell, tingible body macrophages and macrophages infiltrated with Leishmania amastigotes. Treatment was initiated with Stiboglukonat Na (Pentostam) and led to a full recovery.

Lymphadenopathy and expression of nodal mast cells and eosinophils in the myiasis by human bot fly.

Wistar rats (Rattus norvegicus) infested with Dermatobia hominis (L. Jr., 1781) had their axillary lymph nodes removed and histopathologically processed. Follicular hyperplasia in the germinal center was noted from 2 d postinfestation (dpi), exhibiting a high number of centerblasts, mitotic and apoptotic cells, and a thin parafollicular area. The paracortex showed hyperplasia rich in dendritic cells, immunoblasts, and endothelial venules, with diapedesis seen from 4 dpi onward. Hyperplasia of the medullar sinus also was first observed at this point, as well as dilated lymphatic sinus, lymph, macrophages, neutrophils, mast cells, and eosinophils. Medullar strings were expanded and filled with immunoblasts, mitotic cells, and plasmocytes. Lymphadenitis was not observed. The expression of mast cells was similar for both myiasis-affected and control rats but increased significantly (mastocytosis) at 7 and 15 d postlarval emergence (dple). Eosinophilia was observed at 4, 10, 15, 20, and 28 dpi as well as at 2, 7, and 15 dple, particularly on the last three observations of dpi and the earliest dple. This experimental approach allowed progressive tissue reactions in the lymph nodes to be monitored during myiasis, particularly those involving mast cells and eosinophils. These reactions abated and complete repair was observed at 60 dple.

Microfilaria of Wuchereria bancrofti in cytologic smears: a report of 5 cases with unusual presentations.

BACKGROUND: Endemicity of filariasis in tropical countries calls for its high incidence. However, the disease is often overlooked or misdiagnosed because unusual presentations. As a result the patients are often subjected to numerous investigations before a definitive diagnosis is made. CASES: Microflaria ofWucheria bancrofti was observed in fine needle aspiration (FNA) smears of 5 cases including 1 axilla?ry lump, 1 epididymal nodule, 1 spermatic cord nodule and 2 thyroid nodules. All 5 cases presented with clinical details not diagnostic of filariasis. CONCLUSION: The importance of detecting microfilaria in unsuspected cases cannot be undermined and has been highlighted in this report. Careful screening of FNA smears might be helpful in detecting microfilaria even in patients not presenting with features characteristic of the disease. It will prevent delay in institution of specific therapy and subsequent morbidity of the patient.

Chronic clinical manifestations related to Wuchereria bancrofti infection in a highly endemic area in Kenya.

Clinical examinations were conducted in an effort to provide baseline data for a pilot filariasis elimination programme implemented in a Wuchereria bancrofti-endemic focus in Malindi district, Kenya. Of 186 males aged 15 years and above examined, 64 individuals (34.4%) had hydrocele, and the prevalence of the manifestation in those above 40 years old was 55.3%. The prevalence of leg lymphoedema in persons aged 15 years and above was 8.5%, with a higher rate in males (12.6%) than in females (5.7%). The overall prevalence of inguinal adenopathy was 8.6%, and males had a significantly higher (12.9%) prevalence of adenopathy than females (5.1%) (P<0.001). The data in the present study provided support for consideration of filarial infection as a possible cause of inguinal lymphadenopathy in bancroftian filariasis-endemic areas. The results of this study also indicate that lymphatic filariasis is a serious public health problem in the northern coastal areas and morbidity control programmes should be implemented to alleviate the suffering of those affected.

Atypical American visceral leishmaniasis caused by disseminated Leishmania amazonensis infection presenting with hepatitis and adenopathy.

Leishmania amazonensis is widely recognised as a cause of cutaneous leishmaniasis in Latin America, but it can also disseminate to produce atypical visceral leishmaniasis with hepatitis and lymphadenopathy. The patient, an 8-year-old Brazilian boy, presented with a febrile illness and hepatosplenomegaly, elevated liver enzymes and generalised adenopathy. Serological tests using antigens of L. chagasi, the typical cause of visceral leishmaniasis in Latin America, were inconclusive. Leishmania amazonensis was eventually isolated in a culture of a lymph node. The patient recovered fully after treatment with meglumine antimoniate. As this case illustrates, L. amazonensis produces a spectrum of disease that includes atypical American visceral leishmaniasis with evidence of hepatocellular injury and generalised lymphadenopathy.

Lymphatic filariasis in children: adenopathy and its evolution in two young girls.

Lymphatic filariasis is a widespread infectious disease of children in endemic areas, but little is known about the early lymphatic damage in children and its evolution, either with or without treatment. Two girls (ages 6 and 12 years) from a Wuchereria bancrofti endemic region of Brazil presented with chronic inguinal adenopathy. Neither had microfilaremia. By ultrasound both were shown to have living adult worms in their enlarged inguinal nodes and had occult local lymphatic damage (lymphangiectasis). One girl spontaneously developed acute adenitis in the affected node prior to any intervention; this adenitis resolved within 10 days and was associated with the progressive disappearance over 45-90 days of all local abnormalities detectable by ultrasound. In the other child, after treatment with a single dose of diethylcarbamazine (DEC), the same clinical picture of transient adenitis and resolving abnormalities (detectable by ultrasound) occurred. These findings demonstrated filariasis as the cause of adenopathy in children, and also both spontaneous and treatment-induced worm-death, with subsequent reversal of lymphatic abnormalities.

Bronchopulmonary and mediastinal leishmaniasis: an unusual clinical presentation of Leishmania donovani infection.

We describe a case of unusual leishmaniasis in a Sudanese man with a history of progressively enlarging granulomatous mediastinal lymphadenopathy, worsening hemoptysis, and an intense mucosal granulomatous inflammatory response in the large bronchi. Leishmania donovani DNA was detected in bronchial biopsies by polymerase chain reaction. This is a novel description of human leishmanial infection in an immunocompetent patient involving this anatomical site. The patient's condition improved clinically, spirometrically, and radiologically after a course of treatment with amphotericin B. The cell-mediated immune response was analyzed before, during, and after successful antileishmanial chemotherapy.

Differential diagnosis of human lymphatic filariasis using PCR-RFLP.

Filariasis is still a public health problem in tropical countries. The most common causative agents of human filariasis are Wuchereria bancrofti and Brugia malayi. Traditional methods used to detect filarial parasites in human, animal and vector populations are tedious, time consuming, and confer little guarantee of sensitivity and species specificity. We have developed a rapid and specific method to detect filarial parasite DNAs in blood and mosquito samples using the polymerase chain reaction (PCR) technique. The primers used are MF/F and MF/R which amplify a 1.5 kb glutathione peroxidase gene of filarial worms. Using the restriction fragment length polymorphism (RFLP) technique, these PCR products will be further digested with restriction enzymes either Hpa I, Pst I, Alu I or Hinf I to differentiate the genus of filaria. This PCR-RFLP technique can be apply to use in diagnosis and to differentiate between species of filaria in humans the reservoir host and the mosquito vector in endemic areas

Retroperitoneoscopic nephrolympholysis and ureterolysis for management of intractable filarial chyluria.

PURPOSE: To evaluate the feasibility of retroperitoneoscopic lymphatic disconnection in patients with intractable filarial chyluria with the aim of reducing the morbidity of the surgery. PATIENTS AND METHODS: Two patients presented to us with intractable chyluria. They did not respond to conservative measures and endoscopic sclerotherapy. In view of the severe lipid and protein loss associated with recurrent bouts of chyluria, they merited surgical correction by lymphatic disconnection. Because this operation requires extensive mobilization within the retroperitoneum over a large area, it necessitates a large flank or midline incision. In order to reduce the incision-related morbidity, it was decided to undertake the procedure laparoscopically. The retroperitoneal route was chosen for its obvious advantages. RESULTS: Surgery was carried out uneventfully in both patients, with a mean operating time of 2 hours. The patients stayed in the hospital for an average of 2.5 days. Chyluria resolved in the immediate postoperative period, and they have been asymptomatic over a follow-up of 30 and 18 months. One patient had drainage of lymph for 5 days, which resolved spontaneously. CONCLUSIONS: The objectives of open surgery can be achieved by the minimally invasive approach of retroperitoneoscopy. The new approach significantly reduces the incision-related morbidity without compromising the principles of open surgery. We propose five important steps necessary to avoid recurrence and reduce postoperative morbidity.

Topical treatment with hexadecylphosphocholine (Miltex) efficiently reduces parasite burden in experimental cutaneous leishmaniasis.

Ether-lipids and alkylphosphocholines have been found to have anti-leishmanial activity. Oral treatment with hexadecylphosphocholine (HePC) efficiently reduces parasite burden in murine visceral leishmaniasis. Drugs for the treatment of cutaneous leishmaniasis are most commonly administered parenterally, whereas efficient drugs for topical treatment are not in current use. Here we investigate the efficacy of topical treatment with HePC in mice infected with Leishmania mexicana or L. major, causative agents of cutaneous leishmaniasis in the New and Old World, respectively. BALB/c, CBA/J and C57BL/6 inbred mice do not control infection with L. mexicana because they do not mount an efficient Th1-type anti-parasitic lymphocyte response. In contrast, C57BL/6 mice are resistant to an infection with L. major, developing only transient lesions that heal spontaneously owing to an efficient Th1 response. BALB/c, CBA/J and C57BL/6 mice were infected subcutaneously with L. mexicana amastigotes, causing nodular lesions after 5 months. Topical treatment with HePC (Miltex) was highly effective in reducing parasite burden and healed established lesions. The treatment did not induce a Th1 response in L. mexicana-infected susceptible mice and most of the mice relapsed. In resistant C57BL/6 mice infected subcutaneously with 2 x 10(6) L. major promastigotes at the tail base, nodular lesions developed after 2 weeks. Topical treatment with Miltex reduced the parasite load and the mice healed their lesions much faster than the untreated infected controls. The clinical application of Miltex for treatment of cutaneous leishmaniasis may be highly efficient because humans, similarly to resistant mice, in general do not relapse after healing. Clinical trials should be straightforward considering that Miltex is an approved drug for the treatment of breast cancer metastases.