Diagnostic cytology and morphometry of Penicillium marneffei in the sputum of a hypogammaglobulinemia with hyper-IgM patient.

Penicillosis caused by Penicillium marneffei is endemic in Asia and is a highly fatal disease in HIV-AIDS patients. Reports, however; in other immunocompromized diseases are scanty. This report describes the cytological diagnosis of P. marneffei infection from the sputum of a pediatric patient with hypogammaglobulinemia with hyper IgM and severe pneumonia. In this case, rapid, differential identification of the characteristic septated structure of P. marneffei in the macrophages, bronchial epithelium and also extracellularly allowed prompt and proper treatment. In addition, morphometry of P. marneffei obtained from the clinical specimen was reported. This report demonstrated the fungus was not only in the phagocytes, a phenomenon that is well recognized, but also in epithelial cells. Moreover, it also highlights the need for awareness of penicillosis in non-AIDS immunocompromized patients living in, or persons traveling to, P. marneffei-endemic areas.

Evaluation of a manual CD4+ count kit for determination of absolute CD4+ T-lymphocyte counts.

OBJECTIVE: The aim of the present study was to evaluate a manual CD4+ count kit assay (CD4+: cytospheres) for CD4+ T-lymphocyte count compared with flow cytometric method in HIV infected patients. MATERIAL AND METHOD: One hundred thirty three HIV infected patients were recruited from the out patient department of Khon Kaen Hospital. Blood samples were done by a manual CD4+ count kit assay (CD4+: cytospheres) and flow cytometry for CD4+ T-lymphocyte count. The data were analyzed for diagnostic test and correlation coefficient. RESULTS: The data of cytospheres assay and flow cytomeric method showed good correlation (r = 0.88) for the total group. At the absolute CD4+ T-lymphocyte 200 cells/cu.mm, the cytospheres assay demonstrated sensitivity 83.10% (76.73-89.47%), specificity 93.55% (89.37-97.72%), PPV 93.65% (89.51-97.79%), NPV 82.86% (76.45-89.26%). In the case of CD4+ T-lymphocyte count were lower than 200 cells/cu.mm, the cytospheres assay displayed progressive decrease in sensitivity successive increase in specificity. CONCLUSION: The cytospheres technique is an alternative noncytofluorometric assay for CD4+ T-lymphocyte count. This test may be useful for screening in HIV infected adult patients in community hospitals where flow cytometry technique is not available. But the assay is limited in determination only absolute CD4+ T-lymphocyte count with higher than 30 cells/cu.mm. This technique is not benefit in pediatric HIV/AIDS patient due to percentage CD4+ value did not obtained. The quality control should be concern technical skill and proficiency testing for laboratory setting.

Pulmonary tuberculosis in a child presenting with acute hemoptysis.

We report on a tuberculous child whose only presenting symptom was acute hemoptysis. His chest radiograph revealed a mass-like lesion occupying the posterior basal segment of the right lower lung field. Multidetector computerized tomography (MDCT) of the chest showed a hypodense mass supplied by the bronchial artery and drained by the pulmonary vein. Surgical specimens revealed caseating granulomatous inflammation, positive for acid-fast bacilli. The child was successfully treated with a short-course (6-month) regimen of antituberculous drugs.

Overexpression of matrix metalloproteinase 11 in Thai prostatic adenocarcinoma is associated with poor survival.

BACKGROUND: The incidence of prostate cancer, one of the most common cancers in elderly men, is increasing annually in Thailand. Matrix metalloproteinase 11 (MMP-11) is a member of the extracellular matrix metalloproteases which has been associated with human tumor progression and clinical outcome. AIM: To quantify MMP-11 expression in prostatic adenocarcinoma tissues and to determine whether its overexpression correlates with survival outcome, and to assess its potential as a new prognostic marker. MATERIALS AND METHODS: Expression of MMP-11 was analyzed using immunohistochemistry in 103 Thai patients with prostatic adenocarcinoma. Overall survival was analyzed using Kaplan-Meier methods and Cox regression models. RESULTS: Immunoreactivity of MMP-11 was seen in the stroma of prostatic adenocarcinoma tissue samples, high expression being significantly correlated with poor differentiation in Gleason grading, pathologic tumor stage 4 (pT4), and positive-bone metastasis (p<0.05), but not age and prostatic-specific antigen (PSA) level. Patients with high levels of MMP-11 expression demonstrated significantly shorter survival (p<0.001) when compared to those with low levels. Multivariate analysis showed that MMP-11 expression and pT stage were related with survival in prostatic adenocarcinoma [hazard ratio (HR)=0.448, 95% confidence interval (95%CI)=0.212-0.946, HR=0.333, 95%CI=0.15-0.74, respectively]. CONCLUSIONS: Expression of MMP-11 is significantly associated with survival in prostatic adenocarcinoma. High levels may potentially be used for prediction of a poor prognosis.