RESUMEN
Cryptococcosis is a life-threatening fungal infection that affects immunocompromised patients, causing predominantly meningoencephalitis and pneumonia. Lymph node involvement is rare and its identification may not be obvious. We report the case of a patient recently diagnosed with AIDS and previously treated for cryptococcal meningitis who developed multifocal cryptococcal disease despite antifungal treatment, expressed as cervical and mediastinal lymphadenitis and constitutional symptoms. The difficulty of the diagnosis was based on the fact that cryptococcal meningitis was resolved after treatment, and the new manifestations were more typical of other conditions such as tuberculosis and malignancy. Final diagnosis was established after fine-needle aspiration cytology of a lymph node with Cryptococcus identification. Such cases may be difficult to manage, and the possibility of clinical relapse versus cryptococcal immune reconstitution inflammatory syndrome is discussed. Induction therapy was restarted and maintained for a longer period, and the total duration was based on clinical response.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Criptococosis/microbiología , Huésped Inmunocomprometido , Linfadenitis Mesentérica/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Biopsia con Aguja Fina , Criptococosis/tratamiento farmacológico , Cryptococcus neoformans/efectos de los fármacos , Diagnóstico Diferencial , Humanos , Masculino , Linfadenitis Mesentérica/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
We report herein Rhodococcus equi infection in an 11-y-old, male llama with a history of diarrhea and endoparasitism. Postmortem examination revealed granulomatous and ulcerative enteritis, pyogranulomatous mesenteric lymphadenitis, fibrinosuppurative peritonitis, and granulomatous hepatitis. Intralesional macrophages were laden with gram-positive cocci. Bacteriology identified R. equi, and cultures tested positive for R. equi choE and vapA genes by PCR. This case expands the reported spectrum of lesions associated with R. equi infections in llamas from pyogranulomatous bronchopneumonia and peripheral lymphadenitis to pyogranulomatous mesenteric lymphadenitis and enteritis. We also link a R. equi that is carrying the virulent-associated protein gene VapA to clinical disease in New World camelids.
Asunto(s)
Infecciones por Actinomycetales/veterinaria , Camélidos del Nuevo Mundo , Enteritis/veterinaria , Linfadenitis Mesentérica/veterinaria , Rhodococcus equi/aislamiento & purificación , Infecciones por Actinomycetales/microbiología , Animales , Animales Domésticos , Proteínas Bacterianas/análisis , Enteritis/microbiología , Masculino , Linfadenitis Mesentérica/microbiología , Oregon , Rhodococcus equi/genética , Rhodococcus equi/patogenicidad , Factores de VirulenciaRESUMEN
BACKGROUND: Listeriosis is a rare disease in cats with naturally occurring cases usually being identified in individual animals. Listerial mesenteric lymphadenitis has not been described previously in cats. OBJECTIVES: To describe the clinical and histological features of listerial mesenteric lymphadenitis in cats as well as treatment outcome. ANIMALS: Listerial mesenteric lymphadenitis was confirmed in 3 cats by histology, immunohistochemistry, and bacterial culture. RESULTS: The affected cats were young to middle aged and were examined for various clinical signs. On both palpation and abdominal ultrasound examination, all cats had marked mesenteric lymphadenomegaly. Survival was prolonged in all 3 cases. Two of the 3 cats were fed a raw meat-based diet before they developed clinical illness. CONCLUSIONS AND CLINICAL IMPORTANCE: Lymphadenitis caused by listeriosis has a protracted time course and should be a differential diagnosis for abdominal lymphadenopathy in young to middle-aged cats. Feeding of a raw meat-based diet may be a contributing factor for development of listeriosis in cats.
Asunto(s)
Enfermedades de los Gatos/patología , Listeriosis/veterinaria , Linfadenitis Mesentérica/veterinaria , Animales , Enfermedades de los Gatos/diagnóstico por imagen , Enfermedades de los Gatos/microbiología , Enfermedades de los Gatos/terapia , Gatos , Dieta/veterinaria , Listeria/aislamiento & purificación , Listeriosis/microbiología , Masculino , Carne , Linfadenitis Mesentérica/diagnóstico por imagen , Linfadenitis Mesentérica/microbiología , Linfadenitis Mesentérica/terapia , Alimentos Crudos , Ultrasonografía/veterinariaRESUMEN
Some cases of suppurative mesenteric adenitis have already been described in the literature but not associated with intussusception. We describe the case of a 3-year-old boy presenting to the department of surgery at the University Hospital of Lubumbashi with bowel obstruction. He was visited elsewhere, in the previous 12 days, for diarrhea, vomiting, fever, coma and treated for cerebral malaria and blackwater fever. Surgery revealed an ileal intussusception and a suppurative mesenteric adenitis whose pyoculture revealed the presence of Enterobacter cloacae, sensitive to norfloxacin. We performed desinvagination, sucked the pus out into a syringe and excized completely the site of suppurative adenitis. The evolution of patient was good. The clinician must know that the association between suppurative mesenteric adenitis and intussusceptions exists. The diagnosis is not easy and there is the risk of developing acute peritonitis due to its fistulation in the abdominal cavity.
Asunto(s)
Enfermedades del Íleon/diagnóstico , Obstrucción Intestinal/etiología , Intususcepción/diagnóstico , Linfadenitis Mesentérica/diagnóstico , Preescolar , Enterobacter cloacae/aislamiento & purificación , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/patología , Humanos , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/microbiología , Obstrucción Intestinal/cirugía , Intususcepción/complicaciones , Intususcepción/microbiología , Masculino , Linfadenitis Mesentérica/complicaciones , Linfadenitis Mesentérica/microbiología , Supuración/diagnósticoRESUMEN
Bacteriological analysis was conducted in 136 patients with an acute purulent cholangitis (APCH). The APCH causes were: choledocholithiasis--in 40 (29.9%) patients, coexistence of a common biliary duct stricture and choledocholithiasis--in 39 (28.7%), compression of external biliary ducts by the oedematous pancreatic head in secondary pancreatitis--in 15 (11%), pericholedocheal lymphadenitis--in 3 (2.2%).
Asunto(s)
Bilis/microbiología , Colangitis/microbiología , Coledocolitiasis/microbiología , Conducto Colédoco/microbiología , Constricción Patológica/microbiología , Pancreatitis/microbiología , Enfermedad Aguda , Colangitis/patología , Colangitis/cirugía , Coledocolitiasis/patología , Coledocolitiasis/cirugía , Conducto Colédoco/patología , Conducto Colédoco/cirugía , Constricción Patológica/patología , Constricción Patológica/cirugía , Enterobacter aerogenes/crecimiento & desarrollo , Enterobacter aerogenes/aislamiento & purificación , Enterococcus faecalis/crecimiento & desarrollo , Enterococcus faecalis/aislamiento & purificación , Escherichia coli/crecimiento & desarrollo , Escherichia coli/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/patología , Infecciones por Bacterias Gramnegativas/cirugía , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Klebsiella/crecimiento & desarrollo , Klebsiella/aislamiento & purificación , Linfadenitis Mesentérica/microbiología , Linfadenitis Mesentérica/patología , Linfadenitis Mesentérica/cirugía , Páncreas/microbiología , Páncreas/patología , Páncreas/cirugía , Pancreatitis/patología , Pancreatitis/cirugía , Proteus/crecimiento & desarrollo , Proteus/aislamiento & purificación , Pseudomonas aeruginosa/crecimiento & desarrollo , Pseudomonas aeruginosa/aislamiento & purificación , Estudios RetrospectivosAsunto(s)
Dolor Abdominal/etiología , Linfadenitis Mesentérica/microbiología , Infecciones por Yersinia pseudotuberculosis/complicaciones , Yersinia pseudotuberculosis/aislamiento & purificación , Dolor Abdominal/diagnóstico , Adolescente , Niño , Diagnóstico Diferencial , Humanos , Masculino , Linfadenitis Mesentérica/diagnóstico , Infecciones por Yersinia pseudotuberculosis/diagnósticoRESUMEN
Neonatal animals are generally very susceptible to infection with bacterial pathogens. However, we recently reported that neonatal mice are highly resistant to orogastric infection with Yersinia enterocolitica. Here, we show that proinflammatory responses greatly exceeding those in adults arise very rapidly in the mesenteric lymph nodes (MLN) of neonates. High-level induction of proinflammatory gene expression occurred in the neonatal MLN as early as 18 h postinfection. Marked innate phagocyte recruitment was subsequently detected at 24 h postinfection. Enzyme-linked immunosorbent spot assay (ELISPOT) analyses indicated that enhanced inflammation in neonatal MLN is contributed to, in part, by an increased frequency of proinflammatory cytokine-secreting cells. Moreover, both CD11b(+) and CD11b(-) cell populations appeared to play a role in proinflammatory gene expression. The level of inflammation in neonatal MLN was also dependent on key bacterial components. Y. enterocolitica lacking the virulence plasmid failed to induce innate phagocyte recruitment. In contrast, tumor necrosis factor alpha (TNF-α) protein expression and neutrophil recruitment were strikingly higher in neonatal MLN after infection with a yopP-deficient strain than with wild-type Y. enterocolitica, whereas only modest increases occurred in adults. This hyperinflammatory response was associated with greater colonization of the spleen and higher mortality in neonates, while there was no difference in mortality among adults. This model highlights the dynamic levels of inflammation in the intestinal lymphoid tissues and reveals the protective (wild-type strain) versus harmful (yopP-deficient strain) consequences of inflammation in neonates. Moreover, these results reveal that the neonatal intestinal lymphoid tissues have great potential to rapidly mobilize innate components in response to infection with bacterial enteropathogens.
Asunto(s)
Ganglios Linfáticos/inmunología , Ganglios Linfáticos/microbiología , Linfadenitis Mesentérica/inmunología , Linfadenitis Mesentérica/microbiología , Yersiniosis/inmunología , Yersiniosis/patología , Yersinia enterocolitica/inmunología , Animales , Animales Recién Nacidos , Perfilación de la Expresión Génica , Inflamación , Ganglios Linfáticos/patología , Macrófagos/inmunología , Linfadenitis Mesentérica/patología , Ratones , Bazo/microbiología , Análisis de Supervivencia , Yersiniosis/microbiologíaRESUMEN
Actinobacillus suis-like organisms (ASLOs) have been isolated from the genital, respiratory, and digestive tracts of healthy adult horses, horses with respiratory disease, and septic foals. Two foals with congenital hypothyroidism-dysmaturity syndrome from separate farms developed ASLO infection. At necropsy, both had contracted carpal flexor tendons, thyroid hyperplasia, and thrombotic and necrotizing mesenteric lymphangitis and lymphadenitis; one foal also had mandibular prognathism. Numerous ASLOs were isolated from tissues from both foals, including intestine. Biochemical testing and mass spectrometric analysis of the two Actinobacillus isolates did not allow unequivocal identification. Comparative genetic analysis was done on these and similar isolates, including phylogeny based on 16S rRNA, rpoB and recN genes, as well as RTX (repeat in toxin) toxin typing of apxIA-apxIVA and aqxA genes. One isolate was identified as Actinobacillus suis sensu stricto, based on the presence of apxIA and apxIIA but not aqxA, whereas the other isolate had aqxA but neither apxIA nor apxIIA, consistent with A equuli ssp haemolyticus. Based on genotypic analysis of the isolates included for comparison, 3 of 3 equine ASLOs and 2 of 5 A equuli isolates were reclassified as A equuli subsp haemolyticus, emphasizing the importance of toxin genotyping in accurate classification of actinobacilli.
Asunto(s)
Infecciones por Actinobacillus/veterinaria , Actinobacillus/clasificación , Actinobacillus/metabolismo , Proteínas Bacterianas/metabolismo , Enfermedades de los Caballos/microbiología , Hipotiroidismo/veterinaria , Actinobacillus/genética , Animales , Cromatografía Líquida de Alta Presión , Electroforesis en Gel de Poliacrilamida , Femenino , Genotipo , Caballos , Hipotiroidismo/complicaciones , Hipotiroidismo/microbiología , Linfangitis/microbiología , Linfangitis/patología , Linfangitis/veterinaria , Masculino , Linfadenitis Mesentérica/microbiología , Linfadenitis Mesentérica/patología , Linfadenitis Mesentérica/veterinaria , Filogenia , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
The problem of diagnostics acute mesenteric a lymphadenitis is actual and till now not solved. Use laparoscopy techniques in differential diagnostics of acute surgical diseases of an abdominal cavity has opened new prospects. Acute mesenteric the lymphadenitis in clinical practice can be surveyed as a polyetiological syndrome of the enlarged mesenteric/lymph nodes. If acute mesenteric the lymphadenitis is implication of infectious diseases medicament therapy is spent. A biopsy of a lymph node with the subsequent histological research at an infectious disease not informative. At verification of tubercular, oncology and autoimmune diseases is the basic method of diagnostics.
Asunto(s)
Linfadenitis Mesentérica/diagnóstico , Linfadenitis Mesentérica/terapia , Enfermedad Aguda , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Biopsia , Diagnóstico Diferencial , Humanos , Laparoscopía , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/virología , Linfadenitis Mesentérica/microbiología , Linfadenitis Mesentérica/virologíaRESUMEN
RATIONALE: Endotoxemia has long been documented in obstructive jaundice, and altered intestinal barrier function is considered to be one of the important mechanisms for this phenomenon. The aim of this study was to investigate the role of different microalgae (Chlorella sp. and Spirulina sp.) extracts in intestinal barrier function and oxidative stress in experimentally jaundiced rats. METHODS: A total of 60 male wistar rats were randomly divided into four groups of 15 each: I, sham operated; II, bile duct ligation (BDL); III, BDL+Chlorella sp.; IV, BDL+Spirulina sp. Rats were fed rat chow or microalgae extracts supplemented enteral diet ten days after sham operation or BDL. Main outcome measures were endotoxin concentrations in plasma, evidence of bacterial translocation (BT) in mesenteric lymph nodes (MLNs) and liver, oxidative stress, and histology. RESULTS: Compared to the group I, a significant increase in contamined MLNs, liver, and spleen samples and increased endotoxemia were noted in group II (P<0.01) but were significant reduced in group III (P<0.05). There was no significant difference in BT rate between the group II and group IV (P>0.05). Moreover, Chlorella sp. administration protected in jaundiced rats against oxidative stress, as demonstrated by reduction of intestinal lipid peroxidation, increase of the antioxidant reduced glutathione (GSH), and decrease of the oxidized glutathione (GSSG). The intestinal mucosa in control rats was atrophic with significantly decreased villous density and total mucosal thickness. Chlorella sp. caused a significant reduction in villous atrophy compared with controls. CONCLUSIONS: Chlorella sp. microalgae supplemented enteral diet has significant protective effects on intestinal mucosa barrier in obstructive jaundice, and reduces intestinal translocation of bacteria and endotoxin.
Asunto(s)
Traslocación Bacteriana , Chlorella/química , Colestasis/complicaciones , Endotoxemia/terapia , Mucosa Intestinal/metabolismo , Estrés Oxidativo , Animales , Colestasis/microbiología , Mezclas Complejas/uso terapéutico , Suplementos Dietéticos , Nutrición Enteral , Mucosa Intestinal/microbiología , Mucosa Intestinal/patología , Hígado/metabolismo , Hígado/microbiología , Hígado/patología , Masculino , Linfadenitis Mesentérica/microbiología , Sustancias Protectoras/uso terapéutico , Distribución Aleatoria , Ratas , Ratas Wistar , Spirulina/química , Bazo/microbiologíaAsunto(s)
Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/patología , Listeriosis/veterinaria , Linfadenitis Mesentérica/veterinaria , Animales , Bovinos , Resultado Fatal , Listeria monocytogenes/aislamiento & purificación , Listeriosis/microbiología , Listeriosis/patología , Linfadenitis Mesentérica/microbiología , Linfadenitis Mesentérica/patologíaRESUMEN
Nalidixic acid-resistant Salmonella typhi NARST infections increase minimal inhibitory concentrations of fluoroquinolones, due to chromosomal mutations in the gene encoding DNA gyrase, and can lead to a delayed treatment response. This in turn alters the course of the disease allowing for a protracted period of illness and the occurrence of complications. In this case report, we present a patient from the Indian sub-continent, who was diagnosed with NARST complicated by sub-intestinal obstruction, her diagnosis, treatment, and subsequent recovery.
Asunto(s)
Antiinfecciosos/uso terapéutico , Ciprofloxacina/uso terapéutico , Obstrucción Intestinal/microbiología , Linfadenitis Mesentérica/microbiología , Fiebre Tifoidea/tratamiento farmacológico , Adulto , Diagnóstico Diferencial , Farmacorresistencia Bacteriana , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Linfadenitis Mesentérica/diagnóstico , Ácido Nalidíxico/uso terapéutico , Salmonella typhi/efectos de los fármacos , Fiebre Tifoidea/diagnósticoRESUMEN
Although the association between inflammatory bowel disease and gastrointestinal infections has been suggested, the mechanisms involved in the pathogenesis of Crohn's disease (CD) are still undetermined. We report the case of a man, who presented with mesenteric adenitis initially due to a Yersinia pseudotubercolosis infection, who was later diagnosed with Crohn's disease. This case is in keeping with recent evidence in the literature which suggests that CD is a disease linked to abnormal immune responses to enteric bacteria in genetically susceptible individuals.
Asunto(s)
Enfermedad de Crohn/etiología , Linfadenitis Mesentérica/complicaciones , Linfadenitis Mesentérica/microbiología , Infecciones por Yersinia pseudotuberculosis/complicaciones , Yersinia pseudotuberculosis/patogenicidad , Adulto , Anticuerpos Antibacterianos/inmunología , Enfermedad de Crohn/genética , Enfermedad de Crohn/patología , Predisposición Genética a la Enfermedad , Antígenos de Histocompatibilidad Clase II/inmunología , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/genética , Enfermedades del Íleon/patología , Íleon/patología , Masculino , Linfadenitis Mesentérica/inmunología , Yersinia pseudotuberculosis/inmunología , Infecciones por Yersinia pseudotuberculosis/inmunologíaRESUMEN
We report the first description of portal and mesenteric vein thrombosis associated with suppurative mesenteric adenitis in a 71-year-old woman. The bacterium detected in mesenteric lymph nodes was Fusobacterium nucleatum, an anaerobic Gram-negative bacillus. Our patient had a clinical syndrome of pharyngitis and fever preceding portal vein thrombosis. Abdominal symptoms improved with antibiotics and anticoagulant therapy. This location of F. nucleatum in mesenteric lymph nodes provides an interesting insight into the occurrence of septic thrombosis in the portal vein following pharyngo-tonsillar infection.
Asunto(s)
Infecciones por Fusobacterium/complicaciones , Fusobacterium nucleatum , Linfadenitis Mesentérica/microbiología , Oclusión Vascular Mesentérica/microbiología , Vena Porta , Trombosis/microbiología , Anciano , Femenino , Infecciones por Fusobacterium/diagnóstico por imagen , Fusobacterium nucleatum/aislamiento & purificación , Humanos , Ganglios Linfáticos/microbiología , Linfadenitis Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A38-year-old cadaveric kidney transplant recipient presented with fever, pneumonia, and mesenteric lymphadenopathy 9 months after transplant. Blood culture, bone marrow culture, and fine-needle aspiration cytology of mesenteric lymph nodes confirmed the diagnosis of disseminated Penicillium marneffei infection. He recovered after receiving parenteral amphotericin B followed by oral itraconazole therapy. P. marneffei infection is a dimorphic fungal opportunistic infection endemic in Southeast Asia, southern China, Taiwan, and Hong Kong. It has been well reported in human immunodeficiency virus (HIV)-positive patients in the endemic areas, and also in other immunocompromised patients. This diagnosis must be considered for all febrile transplant recipients who have the relevant clinical features and travel history to Southeast Asia. Prompt treatment with anti-fungal therapy improves the survival and outcome of these patients.
Asunto(s)
Trasplante de Riñón/efectos adversos , Linfadenitis Mesentérica/microbiología , Penicillium/aislamiento & purificación , Neumonía/microbiología , Adulto , Cadáver , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Micosis/microbiologíaRESUMEN
Mesenteric adenitis is a self-limited condition characterized by fever, localized right lower quadrant abdominal pain, and frequent leukocytosis, making it difficult to differentiate from appendicitis. We report a case of mesenteric adenitis in an 8-year-old boy who presented at the emergency department with right lower quadrant abdominal pain, diarrhea, and fever up to 40 degrees C. Acute appendicitis was initially suspected, but further abdominal ultrasound and contrast enhanced computed tomography studies showed a normal appendix with marked mesenteric adenopathy. Symptomatic treatment was given and pain and fever subsided 2 days later. Follow-up sonography showed resolution of adenopathy, confirming the diagnosis of mesenteric adenitis. The admission stool cultures grew Salmonella enterica serovar Enteritidis (S. Enteritidis). Unlike previous reports in western countries where Yersinia species prevails and was thought to be self-limited, S. Enteritidis carries potential risk for serious systemic complications, such as meningitis or septic arthritis. The isolation of this unusual microbiological species thus has both therapeutic and epidemiological implications for mesenteric adenitis in Taiwan.
Asunto(s)
Linfadenitis Mesentérica/microbiología , Infecciones por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificación , Niño , Diagnóstico Diferencial , Humanos , Masculino , Linfadenitis Mesentérica/diagnóstico , Infecciones por Salmonella/diagnósticoRESUMEN
Infection by Yersinia pseudotuberculosis has become of increasing pathological importance. This report describes the case of a 12-year-old female with mesenteric lymphadenitis due to Yersinia pseudotuberculosis. The patient presented with fever, abdominal pain, and a palpable right abdominal mass. Abdominal ultrasonic imaging and computerized axial tomography (CT) revealed a mass. An exploratory laparotomy was performed, followed by appendectomy and mesenteric lymph node biopsy. The diagnosis of Yersinia infection was confirmed by serology and bacterial culture of the biopsy material. This condition should be considered in patients with a right lower abdominal mass and symptoms similar to those of appendicitis.
Asunto(s)
Neoplasias Abdominales/etiología , Linfadenitis Mesentérica/microbiología , Yersiniosis/diagnóstico , Neoplasias Abdominales/terapia , Antiinfecciosos/uso terapéutico , Apendicectomía , Niño , Femenino , Humanos , Escisión del Ganglio Linfático/métodos , Linfadenitis Mesentérica/terapia , Cavidad Peritoneal , Resultado del Tratamiento , Yersiniosis/terapiaAsunto(s)
Linfadenitis Mesentérica/etiología , Infecciones por Yersinia pseudotuberculosis/complicaciones , Yersinia pseudotuberculosis/patogenicidad , Abdomen Agudo , Neoplasias Abdominales/diagnóstico , Dolor Abdominal/etiología , Adolescente , Apendicitis/diagnóstico , Diagnóstico Diferencial , Humanos , Linfadenitis Mesentérica/diagnóstico , Linfadenitis Mesentérica/microbiología , Yersinia pseudotuberculosis/aislamiento & purificación , Infecciones por Yersinia pseudotuberculosis/diagnósticoRESUMEN
A 69-year-old female was admitted to our hospital because of asthenia, anorexia and 20 kg weight loss. An ultrasound study and computerized tomography (CT) imaging revealed a mesenteric mass and laparotomy was performed. The diagnosis was mesenteric tuberculosis with jejunal involvement. This represents an atypical onset of tuberculosis in a non-immunosuppressed patient.
Asunto(s)
Yeyuno , Linfadenitis Mesentérica/diagnóstico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Gastrointestinal/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Anciano , Femenino , Humanos , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/microbiología , Linfadenitis Mesentérica/microbiología , Tuberculosis Gastrointestinal/microbiología , Tuberculosis Ganglionar/microbiologíaRESUMEN
BACKGROUND: Translocation of intestinal bacteria to mesenteric lymph nodes (MLNs) has been documented in humans under a variety of circumstances, yet its clinical significance remains to be established. The aim of this study was to correlate detectable translocation to MLNs of bacteria and endotoxin with local and systemic signs of inflammation. METHODS: From each of 10 patients with carcinoma of the cecal region two MLNs were harvested prior to resection. The presence of bacteria and endotoxin in the lymphatic tissue and blood was determined by culture methods and DNA preparation (PCR) and by a Limulus assay, respectively. Inflammatory mediators were determined in plasma and in MLN homogenates. RESULTS: Viable bacteria were detected in MLNs of 7 patients and in 9 of 20 lymph nodes. PCR revealed traces of bacteria in 4 patients and in 6 of their MLNs. Combining both modalities, the translocation rate was 80% and 55% for patients and MLNs, respectively. There was no detectable bacteremia. Endotoxin was found in the plasma of 7 patients and in 9 MLNs from 5 patients. There was no correlation between culture findings and endotoxin concentrations. Moreover, bacteriological data did not correspond to local or systemic inflammation. The group of MLN with detectable endotoxin differed significantly from LPS-negative nodes with respect to interleukin-6, interleukin-10, and sCD14. Systemic concentrations of endotoxin and inflammatory parameters did not correspond to levels within MLNs. CONCLUSION: Translocation to MLNs occurs in patients with cecal carcinoma. This, however, seems not to be of major clinical significance if no additional physiologic insults are encountered. Irrespective of the presence of bacteria, there are variations in inflammatory reactions between lymph nodes from one and the same patient, probably reflecting fluctuating response mechanisms to low-grade translocation.