SUSPECTED HYPOVITAMINOSIS A-ASSOCIATED SALT GLAND ADENITIS IN NORTHERN ROCKHOPPER PENGUINS ( EUDYPTES MOSELEYI).

Supraorbital salt-excreting glands are present in at least 10 avian orders and are largest in marine species, including penguins. Diseases of the avian salt gland have been described infrequently. From September 2015, five captive northern rockhopper penguins ( Eudyptes moseleyi) were presented over a 6-wk period for unilateral or bilateral supraorbital swellings. In September 2016, two cases recurred and two additional cases were identified. Histopathology demonstrated salt gland adenitis with extensive squamous metaplasia. Blood plasma testing demonstrated marked vitamin A and E deficiencies within the colony. Prolonged frozen storage of feed-fish was implicated as a cause of vitamin depletion; reducing storage times and addition of dietary supplementation prevented recurrence.

Linfadenitis por Mycobacterium bovis, una entidad a tener en cuenta / Mycobacterium bovis lymphadenitis, an entity to consider

Las medidas de control del ganado y la pasteurización de los productos lácteos han hecho que la enfermedad tuberculosa por Mycobacterium bovis sea infrecuente en nuestro medio. El diagnóstico de esta entidad requiere un alto índice de sospecha, fundado en una historia clínica detallada y pruebas complementarias oportunas. La presentación más frecuente es extrapulmonar, principalmente como linfadenitis, por lo que ante una adenopatía de mala evolución se recomienda remitir al paciente para estudio y valorar la realización de punción aspiración con aguja fina para examen citológico y cultivo. Presentamos un caso de linfadenitis por M. bovis en una niña de siete años que respondió adecuadamente al tratamiento médico (AU9

Cattle control measures and milk products pasteurization have made Mycobacterium bovis disease uncommon in our environment. The diagnosis of this disease requires a high index of suspicion based on a detailed medical history and appropriate laboratory tests. Extrapulmonary cases are the main presentation, especially lymphadenitis, for this reason, is recommended to refer to study all the adenopathies with poor evolution, for evaluating de need of a fine-needle aspiration for citologý examination and culture. We report the case of M. bovis lymphadenitis in a 7-year-old girl with adequate response to medical treatment (AU)

Rapid community identification, pain and distress associated with lymphoedema and adenolymphangitis due to lymphatic filariasis in resource-limited communities of North-eastern Nigeria.

Identification of communities with people that could benefit from adenolymphangitis (ADL) and lymphoedema morbidity management within Lymphatic Filariasis Elimination Programmes (NLFEP) in many African countries is a major challenge to programme managers. Another challenge is advocating for proportionate allocation of funds to alleviating the suffering that afflicted people bear. In this study we developed a rapid qualitative technique of identifying communities where morbidity management programme could be situated and documenting the pain and distress that afflicted persons endure. Estimates given by health personnel and by community resource persons were compared with systematic household surveys for the number of persons with lymphoedema of the lower limb. Communities in Northeastern Nigeria, with the largest number of lymphoedema cases were selected and a study of local knowledge, physical, psychosocial burden and intervention-seeking activities associated with the disease documented using an array of techniques (including household surveys, key informant interviews, group discussions and informal conversations). Health personnel gave a more accurate estimate of the number of lymphoedema patients in their communities than either the community leader or the community directed ivermectin distributor (CDD). Community members with lymphoedema preferred to confide in health personnel from other communities. The people had a well developed local vocabulary for lymphoedema and are well aware of the indigenous transmission theories. Although the people associated the episodic ADL attacks with the rains which were more frequent at that period they did not associate the episodes with gross lymphoedema. There were diverse theories about lymphoedema causation with heredity, accidental stepping on charmed objects and organisms, breaking taboos. The most popular belief about causation, however, is witchcraft (60.9%). The episodic attacks are dreaded by the afflicted, since they are accompanied by severe pain (18%). The emotional trauma included rejection (27.5%) by family, friends and other community members to the extent that divorce and isolation are common. Holistic approach to lymphoedema morbidity management should necessarily be an integral component of the ongoing transmission elimination programme. Any transmission prevention effort that ignores the physical and psychological pain and distress that those already afflicted suffer is unethical and should not be promoted.

Sebaceous adenitis in Havanese dogs: a retrospective study of the clinical presentation and incidence.

Sebaceous adenitis is a suspected immune-mediated disease that targets and destroys sebaceous glands. This retrospective study evaluated the clinical presentation and incidence of sebaceous adenitis in Havanese dogs. Sebaceous adenitis was diagnosed in 35% (12 of 34) of Havanese dogs presented over a 5-year period. Onset of clinical signs occurred during young adulthood. Follicular casts were present in 92% (11 of 12) of affected dogs. Other common clinical signs included alopecia and hypotrichosis. The trunk, head and ears were commonly affected, with 67% (8 of 12) of cases having pinnal and/or external ear canal involvement. Secondary pyoderma was seen in 42% (5 of 12) of dogs. Histopathology revealed absent sebaceous glands in 83% (10 of 12) and a lymphoplasmacytic periadnexal infiltrate in 92% (11 of 12) of samples. Treatment included multiple modalities. Cyclosporin was prescribed in 83% (10 of 12) of cases. Other systemic therapies included vitamin A and fatty acid supplementation. Topical therapies included antiseborrhoeic shampoos and sprays, and oil soaks. Follow-up ranging from 2 months to 3 years was obtained in 67% (8 of 12) of dogs. Improvement ranged from minimal to marked, with better clinical response associated with longer duration of treatment. Owners with follow-up of more than 1 year commonly reported occasional flares of the clinical signs. This study found that sebaceous adenitis was a common diagnosis in Havanese dogs, that the ears were commonly affected and that a lymphoplasmacytic periadnexal infiltrate associated with absent sebaceous glands was frequently seen on dermatohistopathological examination.

[Cervical lymphoadenopathy due to Pseudomonas aeruginosa following mesotherapy]. / Linfoadenopatia cervicale da Pseudomonas aeruginosa dopo trattamento con mesoterapia.

Mesotherapy is a treatment method devised for controlling several diseases by means of subcutaneous microinjections given at or around the affected areas at short time intervals. It is used to treat a variety of medical conditions, amongst which all orthopaedic diseases and rheumatic pain. Mesotherapy is especially indicated for neck pain. The mechanism of action is twofold: a pharmacological effect due to the drug administered, and a reflexogenic effect, the skin containing many nerve endings that are sensitive to the mechanical action of the needle. Although this therapy is safe, like any other medical intervention it cannot be considered free of complications that may occur, such as allergies, haematomas, bruising, wheals, granulomas and telangiectasias. Infective complications are also possible, due to pathogenic bacteria that are inoculated through contamination of products, of the materials used for the procedure or even from germs on the skin. We present the case of a patient who had cervical lymphadenopathy due to Pseudomonas aeruginosa after mesotherapy treatment for neck pain.

[Lymph node image with ultrasmall superparamagnetic iron oxide and comparison with pathological result].

OBJECTIVE: To assess the characteristics of enhanced magnetic resonance image with ultrasmall superparamagnetic iron oxide (USPIO) in the inflammatory and tumor metastatic rabbit model, and explore its relevance with histologic ultrastructural findings. METHODS: Totally 36 New Zealand white rabbits were randomly divided into lymphadenitis group and metastatic group. Complete Freund's adjuvant was injected into the bilateral dorsal footpads of 18 rabbits to set up ipsilateral lymphadenitis model. The other 18 rabbits received a subcutaneous implantation of VX2 tumor cell suspension (1.5 x 10(7) cells/ml) in both thighs to set up metastatic lymph node model. Magnetic resonance scan were performed 24 hours before and after USPIO (90 micromol Fe/kg) injection. T2 values of each lymph node were measured and lymph node T2 enhancement rate was calculated as well. HE staining, Prussian blue staining, and electronic microscopy were performed to observe the pathological microstructure changes and the distribution of the iron particle in lymph node. Relationship between lymph nodes USPIO enhancement and its microstructures were further analyzed. Results Thirty-six lymph nodes in lymphadenitis group showed different degrees of reactive hyperplasia. Twenty-six lymph nodes in metastatic group were invaded by tumor cell. Non-enhanced scan showed mild difference between T2 signal intensity of the two pathological lymph node types. After USPIO enhancement, inflammatory lymph nodes showed distinct T2 signal reduction at the center, and metastatic lymph nodes showed homogenous and faint T2 signal reduction. Enhancement rate of benign and malignant lymph nodes were 57.39% and 29.45% respectively (P < 0.01). HE staining and Prussian blue staining indicated USPIO particles located mainly in the macrophages at inflammatory lymphatic medulla, while paracortical area and cortical area contained relatively much less USPIO particles due to less macrophages distribution. MRI findings were correlated with the pathological results. Electronic microscopy also verified that the majority of USPIO particles were located in the numerous cytophagic bubbles of macrophages. Lymph nodes metastasis including 4 lymph nodes with completed structure destruction due to entire tumor infiltration, 19 lymph nodes with partially lymph node structure destruction but reduced USPIO-contained macrophage numbers or reduced USPIO particles in macrophages, and 3 lymph nodes with only localized foci tumor metastasis at subcapsular area. Conclusions USPIO enhancement pattern of different lymph nodes is closely related to distribution and functional status of the intra-node macrophages. It may affect the accuracy of the lymph node property diagnosis based on USPIO enhanced image.

[Magnetic resonance enhancement features of inflammatory lymph nodes with ultrasmall superparamagnetic iron oxide in rabbit model].

OBJECTIVE: To study magnetic resonance enhancement features of inflammatory lymph nodes using different doses of ultrasmall superparamagnetic iron oxide (USPIO) particles in order to establish a standardized protocol for USPIO enhanced magnetic resonance imaging of lymph nodes. METHODS: A total of 12 healthy New Zealand rabbits were injected complete Freund's adjuvant in foot pad to establish popliteal inflammatory lymph node model. Different doses (45, 90, 135 micromol Fe/kg) of USPIO were injected intravenously. Magnetic resonance scans were performed before and after USPIO injection to observe the enhancement features of different groups. T2 signal intensity, T1 signal intensity, T2 x value, and T2 value were measured and T2 enhancement ratio was calculated at different time points. RESULTS: Twenty-four hours after USPIO injection, there was no statistical difference in T2 signal intensity and T2 enhancement ratio between 90 and 135 micromol Fe/kg dose groups, but both were superior to 45 micromol Fe/kg group (P < 0.05). There were no statistical differences in T2 signal intensity, T1 signal intensity, T2 value, and T2 enhance ratio among different postcontrast time delays from 6 to 24 hours in 90 micromol Fe/kg group (P > 0.05), and signal reduction of lymph nodes peaked 18 hours after USPIO injection. Better images were acquired with a postcontrast delay of 18-24 hours. CONCLUSIONS: Lymph nodes can be enhanced well with a dose of 90 micromol Fe/kg. Postcontrast delay of 18-24 hours is appropriate for acquiring satisfactory enhancement images.

[Diagnostics and comprehensive treatment of patients with odontogenic lymphadenitis complicated by phlegmons].

The duthor detected special changes in oral liquid of macro and trace substances concentrations and their ratio in dynamics of convalescence for 24 patients with odontogenic lymphadenitis complicated by phlegmon. It was established that termination of inflammatory process on earlier terms at addition in complex treatment of this pathology of polyvitaminic complex considerably lowering strontium concentration in oral liquid (Patent RU 2210378 from 20.08.2003).

Adenitis por micobacterias no tuberculosas / Nontuberculous mycobacterial lymphadenitis

Objetivo Estudiar las características epidemiológicas, clínicas y evolutivas de las linfadenitis por micobacterias no tuberculosas. Métodos Estudio retrospectivo de 54 pacientes menores de 14 años diagnosticados de linfadenitis por micobacterias atípicas entre 1987 y 2004. Los criterios de inclusión fueron: a) reacción en cadena de la polimerasa (PCR) o cultivo positivo; b) test de sensitinas positivo con valor superior en 6 mm al Mantoux, y c) hallazgos anatomopatológicos compatibles con infección micobacteriana, junto con Mantoux menor de 15 mm, radiografía de tórax normal, ausencia de contacto tuberculoso, Mantoux negativo en familiares directos, y exclusión de otras causas de adenitis granulomatosa. Resultados Se detectaron 54 casos de adenitis por micobacterias no tuberculosas. Estas infecciones aumentaron desde 1996 coincidiendo con una disminución de adenitis tuberculosas. La edad media de los pacientes fue de 35 meses (rango: 14 meses-6 años). La localización más frecuente fue submaxilar en 22 de 63 adenitis (34,9 %) y laterocervical en 21 adenitis (33,3 %). El Mantoux fue superior a 10 mm en 8/42 (19 %). El cultivo fue positivo en 18/34 de los casos (52,9 %) y la PCR en 8/15 (53,3 %). La micobacteria más aislada fue Mycobacterium avium (61 %). Se produjo fracaso terapéutico en 8 de los 21 pacientes tratados inicialmente con antibióticos (38 %) y en 10 de los 13 tratados con drenaje (77 %). En el 100 % (8/8) de los casos en los que se realizó exéresis quirúrgica se consiguió la curación definitiva. Conclusiones Los casos de adenitis por micobacterias no tuberculosas han aumentado desde 1996 en nuestro hospital. La rentabilidad de los cultivos es baja y el Mantoux presenta falsos positivos con frecuencia, lo cual dificulta el diagnóstico. La exéresis quirúrgica fue el tratamiento más eficaz. Sin embargo, en adenitis que presenten difícil abordaje quirúrgico y en recurrencias postexéresis el tratamiento farmacológico puede ser útil

Objective To study the clinical features, epidemiology and outcome of nontuberculous mycobacterial lymphadenitis (NTML). Methods A retrospective study was performed on 54 patients under 14 years old diagnosed with atypical mycobacterial lymphadenitis between 1987 and 2004. Inclusion criteria were: (i) positive polymerase chain reaction (PCR) test or culture; (ii) positive sensitin skin test 6 mm above Mantoux; (iii) histopathologic features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli, Mantoux reaction less than 15 mm, a normal chest radiograph, absence of exposure to an adult with tuberculosis, negative Mantoux test reactions in family members, and exclusion of other causes of granulomatous adenitis. Results Fifty-four patients were included in the study. The number of NTML cases increased notably from 1996, coinciding with a decrease in cases of tuberculous adenitis. The mean age was 35 months (range: 14 months-6 years). Submandibular nodes were involved in 22 of 63 cases of adenitis (34.9 %) and cervical nodes were involved in 21 (33.3 %). In 8/42 patients (19 %) the tuberculin skin test was larger than 10 mm. Cultures were positive in 52.9 % of the cases (18/34) and PCR in 53.3 % (8/15). The most frequently isolated mycobacteria was Mycobacterium avium (61 %). Therapy failed in 8/21 patients receiving antibiotics (38 %), in 10/13 patients with drainage alone (77 %) and in none of the patients who underwent surgery (8/8). Conclusions Nontuberculous mycobacterial adenitis has become more frequent in our hospital since 1996. Cultures do not always allow isolation of mycobacteria and the Mantoux test frequently yields false positive results, thus hampering diagnosis. The most effective treatment was surgical excision. Nevertheless, when the surgical approach is difficult or there is postoperative recurrence, pharmacological treatment can be useful

[Low-intensity infrared laser radiation in the diagnosis and combined treatment of acute nonspecific lymphadenitis of the face and neck in children]. / Infrakrasnoe nizkointensivnoe lazernoe izluchenie v diagnostike i kompleksnom lechenii ostrogo nespetsificheskogo limfadenita litsa i shei u detei.

Clinical course of acute nonspecific lymphadenitis of the face and neck is studied in 241 patients aged 1-14 years in order to improve the diagnosis and therapy of this condition. General clinical examinations were supplemented by laser biophotometry and assessment of the activities of some local defense factors (lysozyme, beta-lysine, secretory and serum IgA). Multiple-modality treatment for the first time included magnetic laser therapy (MLT), and its efficacy is assessed. Results of biophotometry helped define objective criteria for the diagnosis and evaluation of treatment efficacy in children with acute lymphadenitis of the face and neck. MLT proved to be a highly effective treatment modality, decreasing the inflammation and correcting local (oral) defense factors. Use of MLT accelerated all phases of the inflammatory process, promoted its regression at the serous stage, and decreased the incidence of suppurative forms of acute lymphadenitis by 40%.

Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association.

UNLABELLED: Diagnostic criteria of nontuberculous mycobacterial lung disease in HIV-seropositive and -seronegative hosts. The following criteria apply to symptomatic patients with infiltrate, nodular or cavitary disease, or a high resolution computed tomography scan that shows multifocal bronchiectasis and/or multiple small nodules. A. If three sputum/bronchial wash results are available from the previous 12 mo: 1. three positive cultures with negative AFB smear results or 2. two positive cultures and one positive AFB smear B. If only one bronchial wash is available: 1. positive culture with a 2+, 3+, or 4+ AFB smear or 2+, 3+, or 4+ growth on solid media C. If sputum/bronchial wash evaluations are nondiagnostic or another disease cannot be excluded: 1. transbronchial or lung biopsy yielding a NTM or 2. biopsy showing mycobacterial histopathologic features (granulomatous inflammation and/or AFB) and one or more sputums or bronchial washings are positive for an NTM even in low numbers. COMMENTS: these criteria fit best with M. avium complex, M. abscessus, and M. kansasii. Too little is known of other NTM to be certain how applicable these criteria will be. At least three respiratory samples should be evaluated from each patient. Other reasonable causes for the disease should be excluded. Expert consultation should be sought when diagnostic difficulties are encountered.

Adenitis infecciosa. Parte 3 / Infectious adenitis. Part 3

Se analizó un grupo de pacientes que concurrieron a los consultorios externos de un hospital de enfermedades infecciosas, presentando como síntoma principal adenopatías regionales o generalizadas. El 78 se hallaban entre los 20 y 40 años de edad, el 56 fue de evolución aguda, predominando netamente la distribución regional, en especial la localización cervical. Se llegó al diagnóstico final en el 80 de los casos. En base a la experiencia realizada, se presenta un algoritmo diagnóstico y se establecen pautas de conducta ante este síndrome (AU)

Adenitis infecciosa. Parte 3 / Infectious adenitis. Part 3

Se analizó un grupo de pacientes que concurrieron a los consultorios externos de un hospital de enfermedades infecciosas, presentando como síntoma principal adenopatías regionales o generalizadas. El 78 se hallaban entre los 20 y 40 años de edad, el 56 fue de evolución aguda, predominando netamente la distribución regional, en especial la localización cervical. Se llegó al diagnóstico final en el 80 de los casos. En base a la experiencia realizada, se presenta un algoritmo diagnóstico y se establecen pautas de conducta ante este síndrome

Characterization of reactive versus tumor-bearing lymph nodes with interstitial magnetic resonance lymphography in an animal model.

RATIONALE AND OBJECTIVES: To determine if magnetic resonance lymphography performed with subcutaneously administered AMI-227, a nanoparticulate iron oxide contrast agent, can distinguish reactive from tumor-bearing lymph nodes. MATERIALS AND METHODS: Mature male Copenhagen rats were inoculated with cell suspensions of R3327-MAT-LyLu rat prostate carcinoma (n = 21) or Freund's complete adjuvant (n = 15) in the left footpad to generate ipsilateral popliteal lymph node metastases or lymphadenitis. At 12 to 14 days after inoculation, T1-and T2-weighted magnetic resonance images of bilateral popliteal areas were obtained before and 24 hours after subcutaneous administration of AMI-227. Contrast-to-noise ratios were calculated in precontrast and postcontrast images. Bilateral popliteal nodes were excised for pathologic assessment. RESULTS: AMI-227 resulted in decreased contrast-to-noise ratios in reactive (T1-W = -7.01 +/- 1.13, T2- W = -31.64 +/- 5.35) and normal (T1 - W = -13.56 +/- 1.97, T2 - W = -21.62 +/- 2.51) nodes. Contrast-to-noise ratios were unchanged (T1 - W = -0.22 +/- 1.71, T2 - W = -2.20 +/- 4.19) in tumor-containing nodes. These differences in contrast-to-noise ratio changes between tumor-bearing versus nontumor-bearing nodes were statistically significant (P < 0.05). Histologic analysis showed similar distribution of AMI-227 within normal and reactive nodes, but not in tumor-bearing nodes. CONCLUSIONS: Differences in AMI-227-uptake between tumor- and nontumor-bearing nodes detected with magnetic resonance imaging are helpful for distinguishing the two entities.

Clinical features of timorian filariasis among immigrants to an endemic area in West Flores, Indonesia.

Fifty-nine persons, who immigrated into a Brugia timori endemic area from non-filarial areas on the island of Flores, Indonesia were examined for filariasis after residing in the village for 2 to 10 years. Six persons had B. timori microfilaremia and 31 had filarial disease. The disease seems to affect immigrants from non-filarial areas severely within a relatively short period. Among those residing in the village, for 2 years, the microfilaria rate was 5% and the elephantiasis rate 21%. Selective treatment using 50 mg diethylcarbamazine per Kg body weight was given to all microfilaria (Mf) positive persons. Approximately one year later the Mf-rate by finger stick and Nuclepore filtration was 9% and 18% respectively. There was indirect indications that the Mf-rate might increase with the passage of time. However, the total filarial disease rate remained constant during the one year period. The relationship between these findings and American servicemen exposed to filariasis during World World II is briefly discussed.

Peritonsillar, peripharyngeal, and deep neck abscesses.

Abscesses of the peritonsillar and peripharyngeal regions typically present as a sore throat and as difficulty in swallowing. One of the most ?striking clinical features is difficulty in controlling saliva. Deep neck abscesses usually are secondary to disease in the pharynx, tonsils, or teeth. Initially, attention should be devoted to finding the primary source of infection. Treatment of these abscesses is incision and drainage.