Exploring Histoplasma species seroprevalence and risk factors for seropositivity in The Gambia's working equid population: Baseline analysis of the Tackling Histoplasmosis project dataset.

Introduction: Exposure rates to Histoplasma species, the causative agent of equine epizootic lymphangitis (EL), are unknown amongst working equids in The Gambia. The primary aims of this study were to estimate anti-Histoplasma antibody seroprevalence in the equid population in rural The Gambia and to explore risk factors for seropositivity. Methods: A nationwide cross-sectional study was conducted (February-July 2022), representing baseline measurements of a longitudinal cohort study. Horses (n = 463) and donkeys (n = 92) without EL signs were recruited in 18 study sites. Following informed owner consent, equid clinical and management data were recorded. Blood samples were collected by jugular venepuncture, and sera were subject to the IMMY Latex Agglutination Histoplasma test (LAT). Seropositivity risk factors were explored by multi-level, multivariable logistic regression analysis. Study site and household variance were described using a latent-variable approach. Whole blood DNA extractions were subject to nested ITS-PCR to detect Histoplasma capsulatum var. farciminosum (HCF), and agreement with LAT results was measured using Cohen's kappa statistic. Results: Anti-Histoplasma antibody seroprevalence in horses and donkeys was 79.9% [95% confidence interval (CI) 76.0-83.5%] and 46.7% (95% CI 36.3-57.4%), respectively. In horses, two multivariable models explained the maximum amount of data variability. Model 1 demonstrated increased odds of seropositivity in mares [odds ratio (OR) = 2.90 95% CI 1.70-4.95, p < 0.001] and decreased odds in horses <2.5 years (OR = 0.46 95% CI 0.22-0.95, p = 0.04; reference: ≥4.5 years). Model 2 demonstrated increased odds in horses recruited during the rainy season (OR = 2.03 95% CI 1.08-3.84, p = 0.03) and those owned by farmers reporting previous EL in their equids (OR = 1.87 95% CI 1.04-3.37, p = 0.04). Decreased odds were measured in horses <2.5 years (OR = 0.37 95% CI 0.18-0.78, p = 0.01) and horses reported to transport firewood (OR = 0.45 95% CI 0.28-0.74, p = 0.001). On multivariable analysis of donkeys, decreased odds of seropositivity were demonstrated amongst donkeys owned by households which also owned horses (OR = 0.23 95% CI 0.06-0.85, p = 0.03). HCF infection prevalence in horses and donkeys was 22.0% (n = 102/463, 95% CI 18.3-26.1%) and 5.4% (n = 5/92, 95% CI 1.8-12.2%), respectively. No significant agreement was measured between LAT and nested ITS-PCR results (κ < 0.00). Conclusion: High Histoplasma spp. exposure was demonstrated amongst equids in The Gambia. Investigation of risk factors, including equid husbandry and management strategies, as well as geoclimatic variations, is warranted. Outcomes may inform sustainable and equitable EL control strategies in The Gambia and comparable settings worldwide.

Crescentic Glomerulonephritis in Association With Renal Cell Carcinoma: A Case Report.

Clear renal cell carcinoma (RCC) is the most common primary renal tumor originating within the renal cortex. It is responsible for 75% to 85% of all primary renal neoplasms. Multiple risk factors are associated with the development of RCC, the most common being smoking. On some occasions, RCC has been linked to some autoimmune conditions, but data is limited. Especially, its association with glomerulonephritis (GN) is rare in literature and not fully understood. In this case report, we discuss a presentation of RCC associated with crescentic GN.

Collision tumor of pulmonary adenocarcinoma and small lymphocytic lymphoma: A rare case of concurrent malignancies in the same lymph node.

BACKGROUND: Collision tumors, a rare and challenging diagnostic entity, are characterized by the simultaneous presence of two distinct histological neoplasms within the same anatomical site. The underlying mechanisms of collision tumors are not well understood, though various theories attempt to explain this phenomenon. CASE PRESENTATION: A 77-year-old Palestinian man, a heavy smoker with multiple comorbidities, presented with a productive cough and significant weight loss. Computed tomography (CT) scan with IV contrast revealed extensive pulmonary involvement, mediastinal lymphadenopathy, and adrenal gland nodules. An excisional biopsy of a lymph node confirmed the presence of both metastatic pulmonary adenocarcinoma and small Lymphocytic Lymphoma (SLL) through histopathological and immunohistochemical analyses. DISCUSSION: Collision tumors have been documented in various anatomical sites, such as the lung, gastrointestinal tract, skin, and genitourinary system. However, their occurrence in lymph nodes is exceptionally rare. Additionally, to our knowledge, a collision tumor involving both pulmonary adenocarcinoma and small lymphocytic lymphoma within the same lymph node has not been previously reported. CONCLUSION: Collision tumors are uncommon and should be considered in the differential diagnosis of complex oncological cases. Accurate diagnosis requires comprehensive investigations, including imaging studies and detailed pathological examinations.

An overview of various stages and morphology of Histoplasma capsulatum var. farciminosum in the horse.

This article describes the development of the pathogenic dimorphic fungus Histoplasma capsulatum var. farciminosum (HCF), which is the causative agent of Equine epizootic lymphangitis (EEL), from the mycelial form in the soil to the yeast form in the horse. In this study, the stages and morphology of HCF were identified through histopathological analysis and culture with various samples collected in Ethiopia from 15 horses showing clinical signs of EEL. In equids, especially cart horses in Ethiopia, poor-quality harnesses cause cutaneous wounds, which often attract flies facilitating the transmission of the fungus. Also, HCF infection occurs through open wounds or ocular mucous membranes when horses roll on contaminated damp soil. Respiratory histoplasmosis can occur through inhaling fungal spores, which is rare. HCF microconidia enter the lungs and skin wounds and are phagocytized by tissue-resident macrophages. The spores undergo intracellular replication within the macrophages transitioning into yeasts. The infected macrophages undergo lysis releasing pathogenic yeast cells into the surrounding tissue. Consequently, yeast-rich purulent exudate is produced, contaminating the soil in stables where yeast cells germinate into the mycelial form, and the entire process starts from the beginning.

Molecular characterisation of Histoplasma capsulatum sensu lato from Ethiopian horses reveals two distinct phylogenetic clades.

Epizootic lymphangitis (EL) is a highly prevalent and contagious infectious disease affecting horses in many parts of Ethiopia caused by Histoplasma capsulatum sensu lato ('var. farciminosum'). In this study, 12 suspected isolates of H. capsulatum sensu lato or yeasts unidentified by conventional biochemical tests isolated from Ethiopian horses with EL were characterised by internal transcribed spacer sequencing. Six of the 12 isolates were identified to be members of H. capsulatum sensu lato and the other six were Pichia kudriavzevii (synonym: Candida krusei) (n = 3), Trichosporon asahii (n = 1), Geotrichum silvicola (n = 1) and Moesziomyces aphidis (n = 1), respectively. The six H. capsulatum sensu lato isolates were further characterised by multilocus sequence analysis. Four distinct gene loci (arf [462 bases], H-anti [410 bases], ole1 [338 bases] and tub1 [272 bases]) of these six isolates as well as those of two H. capsulatum sensu lato ('var. farciminosum') reference strains (ATCC 58332 and ATCC 28798) were polymerase chain reaction (PCR)-amplified and sequenced. Phylogenetic analyses of their concatenated nucleotide sequences showed that three of the isolates and the reference strain ATCC 58332 were identical and belonged to the Eurasia clade within Latin American (LAm) A (H. suramericanum), and those of the other three isolates and the reference strain ATCC 28798 were identical and belonged to the Africa clade. At least two distinct phylogenetic clades of H. capsulatum sensu lato were circulating in Ethiopian horses with EL. Advanced molecular technologies and bioinformatics tools are crucial for the accurate identification and typing of pathogens as well as the discovery of novel microorganisms in veterinary microbiology.

Using multilocus sequence analysis with four concatenated housekeeping gene loci, at least two distinct phylogenetic clades, namely Eurasia clade and Africa clade, of Histoplasma capsulatum sensu lato were confirmed to be circulating in Ethiopian horses with epizootic lymphangitis.

Thoracic lymphangitis as an immune-related adverse event: a case report.

The efficacy of immune checkpoint inhibitors (ICIs) has been widely recognized in several cancers and is now being used in the perioperative setting for lung cancer.We recently encountered an immune-related adverse event that has not been previously reported: thoracic lymphangitis, which occurred after postoperative ICI treatment for lung cancer. The patient complained of breathlessness and her condition rapidly progressed to hypoxia grade 3. Chest computed tomography revealed significant lymphostasis. With high-dose steroid treatment, the patient showed improvement.Therefore, as the frequency of neoadjuvant, adjuvant, and perioperative ICI use is expected to increase, it is crucial to understand and monitor this adverse event.

Interstitial lung disease was suspected, but biopsy revealed pulmonary lymphangitis carcinomatosa.

Introduction: Pulmonary lymphangitis carcinomatosa is a rare and severe manifestation of metastatic disease that causes pulmonary symptoms and radiologic patterns similar to interstitial lung diseases. Case presentation: We report a case of a 78-year-old woman who presented to our department with insidiously developed symptoms of fatigue, dry cough, and severe dyspnea for 3 months. Chest radiography showed bilateral interstitial changes. On suspicion of interstitial lung disease, bronchoscopy and transbronchial cryobiopsy were carried out. Surprisingly, histopathological investigation revealed pulmonary lymphangitis carcinomatosa originating from primary breast adenocarcinoma. Conclusion: To achieve an accurate diagnosis and prevent delay of initiation of proper treatment a thorough diagnostic approach is necessary. In case of doubt, biopsy should be performed to secure clarification. In this case report we discuss the diagnostic value of transbroncial cryobiopsy for this purpose.

Sporotrichosis transmitted by domestic cats: A case report. / Esporotricosis transmitida por gato doméstico: a propósito de un caso.

Sporotrichosis is a subacute to chronic subcutaneous mycosis caused by dimorphic fungi of the Sporothrix spp. complex. It is considered the most frequent subcutaneous mycosis in Latin America and predominates in tropical areas. In Argentina, its prevalence is estimated at 0.01-0.02%. In half of the patients, it manifests as lymphocutaneous sporotrichosis. Infection results from the agent's inoculation on the skin or mucous membrane by trauma with contaminated plants. There are also cases of zoonotic transmission by contact with animals, such as armadillos, birds, rats, horses, fish, mosquitoes, and cats. Here we describe the case of a 14-year-old female patient who consulted due to nodular lymphangitic syndrome for two months and, given the lack of response to multiple antibiotic regimens, a biopsy was performed and a culture of the lesion was done, which confirmed the diagnosis of lymphocutaneous sporotrichosis.

La esporotricosis es una micosis subcutánea de evolución subaguda-crónica causada por hongos dimórficos del complejo Sporothrix spp. Es considerada la micosis subcutánea más frecuente en Latinoamérica y predomina en zonas tropicales. La prevalencia en Argentina se estima entre el 0,01 % y el 0,02 %. En la mitad de los pacientes, se manifiesta como una esporotricosis linfocutánea. La infección es consecuencia de la inoculación del agente en la piel o mucosas a partir un trauma con plantas contaminadas. Existen también casos de transmisión zoonótica por contacto con animales como armadillos, aves, ratas, caballos, peces, mosquitos y felinos. Presentamos el caso de una paciente de 14 años, que consultó por síndrome linfangítico nodular de dos meses de evolución y, ante la falta de respuesta a múltiples esquemas antimicrobianos, se decidió realizar biopsia y cultivo de la lesión, que confirmó el diagnóstico de esporotricosis linfocutánea.

Clinicopathological studies on ulcerative lymphangitis in cattle: Alterations in serum inflammatory cytokines, anti-microbial, organs functions, and oxidative stress-related biomarkers.

Background: Affection with Corynebacterium pseudotuberculosis (C. pseudotuberculosis) and development of cellulitis and/or abscess formation with cutaneous lymphangitis in cattle is rare to some extent, so literature about the biochemical changes that would accompany this infection is rare. Aim: In this context, the present study was designed to screen the effect of the infection with C. pseudotuberculosis cutaneous lymphangitis on the release of some immune molecules, organ functions, and redox state in Baladi cows. Methods: Fourteen Baladi cows from a small dairy farm in El-Behira, Egypt, were selected to complete this study. After bacteriological culture confirmation, seven of them were found suffering from cutaneous lesions due to infection with C. pseudotuberculosis (Diseased group), while the others were healthy (Healthy group). Serum samples were obtained to evaluate the presumptive changes in some clinicopathological parameters. Results: Serum analysis revealed a significant decrease in the levels of interferon-gamma and interleukin-17 as well as a significant decrement in the concentration of beta-defensin (ß-defensin) and lipocalin-2. While serum level of interleukin-10 recorded a significant increase in these animals when compared to healthy control animals. Concurrently, the affected animals recorded a significant elevation in serum levels of hepato-cardiac enzymes, urea, and creatinine in addition to disturbance in the serum redox state. Conclusion: In conclusion, infection with C. pseudotuberculosis cattle may disturb the defensive immune state, body organ function, and redox state of the animals.

А Rare Case of an Infected, Ruptured Popliteal Artery Aneurysm Occurring Following Surgical Treatment for Panaritium.

We present a successful case of treating an infected popliteal aneurysm in a 71-year-old man who arrived at the emergency department in a septic state, reporting a three-week history of fever, lethargy, general malaise, and pain and swelling in the right popliteal fossa. Previously diagnosed with a sizable right popliteal aneurysm, the patient had undergone endovascular treatment using a Viabahn (WL Gore & Associates, Flagstaff, USA) endoprosthesis two months earlier. His fever and malaise emerged a week following minor surgery for a toe infection (panaritium) on the right foot, leading to subsequent necrotic lymphangitis on the dorsum of the same foot. A PET/CT scan strongly indicated an infection within the aneurysmal sac, while a CT angiography confirmed the integrity of the stent graft without any leaks but revealed a ruptured aneurysm. Urgent surgical intervention was necessary. An extra-anatomical autovenous bypass was conducted, followed by an aneurysm and endograft removal. Subsequently, a vacuum-assisted closure (VAC) system was employed to manage the infected wound post sac extraction. The surgical procedure went smoothly without complications, and following a course of antibiotics, the patient recovered well, eventually being discharged after 50 days.

Growth inhibitory effect of selected medicinal plants from Southern Ethiopia on the mycelial phase of Histoplasma capsulatum var. farciminosum.

BACKGROUND: Epizootic lymphangitis is an infectious and chronically debilitating disease of the equines. Histoplasma capsulatum var. farciminosum, a thermally dimorphic fungi, is the causative agent for the disease. In Ethiopia, the disease significantly affects carthorses, posing threats to animal welfare, and resulting in substantial economic losses. Limited availability of widely accessible antifungals in addition to the chronic nature of the disease is the major challenge against management of epizootic lymphangitis. This study aimed to assess the in vitro efficacy of specific local medicinal plant extracts against the mycelial phase development of H. capsulatum var. farciminosum in southern Ethiopia. The leaves of Xanthium strumarium, Kanda (Family Rubiaceae), Croton macrostachyus (Bisana in Amharic), and Centella Asiatica (Echere waye as a local name in Zeyissegna) that are traditionally used for the treatment of different skin ailments were collected and extracted for the in vitro trial. RESULTS: The study revealed that methanol extracts of Xanthium strumarium, Kanda, Croton macrostachyus, and Centella Asiatica, at minimum inhibitory concentrations of 1.25 mg/ml, 2.5 mg/ml, 2.5 mg/ml, and 5 mg/ml, respectively, inhibited the growth of H. capsulatum var. farciminosum. CONCLUSION: This in vitro finding could serve as significant preliminary data in the exploration of effective alternative treatment options for epizootic lymphangitis. This study provides a crucial foundation for further research aimed at determining the chemical components and in vivo effectiveness of these plant extracts against both the mycelial and yeast forms of Histoplasma capsulatum var. farciminosum.

Design of a Multi-Epitope Vaccine against Histoplasma capsulatum through Immunoinformatics Approaches.

Histoplasmosis is a widespread systemic disease caused by Histoplasma capsulatum, prevalent in the Americas. Despite its significant morbidity and mortality rates, no vaccines are currently available. Previously, five vaccine targets and specific epitopes for H. capsulatum were identified. Immunoinformatics has emerged as a novel approach for determining the main immunogenic components of antigens through in silico methods. Therefore, we predicted the main helper and cytotoxic T lymphocytes and B-cell epitopes for these targets to create a potential multi-epitope vaccine known as HistoVAC-TSFM. A total of 38 epitopes were found: 23 common to CTL and B-cell responses, 11 linked to HTL and B cells, and 4 previously validated epitopes associated with the B subunit of cholera toxin, a potent adjuvant. In silico evaluations confirmed the stability, non-toxicity, non-allergenicity, and non-homology of these vaccines with the host. Notably, the vaccine exhibited the potential to trigger both innate and adaptive immune responses, likely involving the TLR4 pathway, as supported by 3D modeling and molecular docking. The designed HistoVAC-TSFM appears promising against Histoplasma, with the ability to induce important cytokines, such as IFN-γ, TNF-α, IL17, and IL6. Future studies could be carried out to test the vaccine's efficacy in in vivo models.

The socioeconomic impact of equine epizootic lymphangitis in working equids in low and middle-income countries: A scoping review.

Equine epizootic lymphangitis (EEL) is a very infectious and contagious fungal disease that, with its ocular, respiratory and skin forms, causes severe effects on the health and welfare of working equids. Treatment is expensive and rarely available in low and middle-income countries (LMICs). Epidemiological data is lacking in most countries where the disease is known to exist. The purpose of this scoping review is to identify the current knowledge on the socioeconomic impact of EEL in working equids in LMICs, to highlight knowledge gaps and provide recommendations for future research. Seven eligible papers were obtained from the search of four databases and backward citation searching. The review showed that the available research on this subject is very scarce and restricted to Ethiopia. From the results it emerged that EEL causes detrimental socioeconomic effects on working equids' owners, compromising their health and livelihood. Its economic consequences were attributed to the reduced working capacity and loss of sick animals. Among the social impacts, authors highlighted the stigma around sick equids and their owners. Further studies on the socioeconomic impact of EEL conducted in endemic areas are highly required. The integration of epidemiological data with socioeconomic impact studies from LMICs may promote funding allocation for the development of cost-effective treatments and vaccines and for implementing disease prevention and control programmes. Future research would gain from applying the One Health approach to better examine the multiplicity of the disease socioeconomic effects, therefore increasing the potential of research to orientate policy.

Successful Recovery of COVID-19 Associated With Cardiomyopathy in Advanced Breast Cancer Patient With Pulmonary Lymphangitis Carcinomatosis.

SARS-CoV-2 infection induces myocardiopathy in 19% of severe cases, with a mortality rate of up to 51%. The mainstay of treatment is supportive care, steroids, and tocilizumab (anti-IL-6). This is a case of a 43-year-old woman diagnosed with hormone-positive breast cancer with lung metastasis and pulmonary lymphangitis carcinomatosis (PLC). Her baseline cardiac function was within normal limits. She presented to the emergency department with respiratory distress. Chest CT showed multiple bilateral ground-glass opacities consistent with COVID-19 pneumonia and confirmed by COVID-19-PCR nasal swab. Her condition deteriorated, and she was urgently admitted to the intensive care unit with evidence of a cytokine storm. She was started on tocilizumab, dexamethasone, and meropenem. Echocardiogram (echo) showed a severely reduced ejection fraction with severe global hypokinesis. A second dose of tocilizumab was given, and the dexamethasone dose was increased. Fortunately, the patient had significant clinical and biochemical improvement and regained her normal cardiac function. In conclusion, dexamethasone and tocilizumab could be promising aids in treating cardiomyopathy secondary to SARS-CoV-2 infection.

Unusual Presentation of Coxsackievirus B and Methicillin-Sensitive Staphylococcus aureus Cellulitis Causing Sepsis.

The clinical association between Coxsackievirus B (CVB) and methicillin-sensitive Staphylococcus aureus (MSSA) has not been well established in the current literature. Here, we report a case of a 29-year-old male who presented with fever and malaise 24 hours after noticing a pruritic lesion on the anterior foreleg that resembled a mosquito bite. After multiple ED visits, laboratory studies, and imaging tests, the patient was admitted for treatment of high fevers and pancytopenia. The final diagnosis was viral sepsis complicated by co-infection with MSSA.

Pulmonary lymphangitis carcinomatosis: A peculiar presentation clustering in MET-amplified gastric cancer.

BACKGROUND: The clinicopathological features of MET-amplified gastric cancer (GC) and real-world data on the efficacy of MET-targeted therapies remain unknown. Pulmonary lymphangitis carcinomatosis (PLC) is a peculiar manifestation of GC, whose management has not been thoroughly described. METHODS: This study analyzed patients diagnosed with MET-amplified GC or GC with PLC at any time point of the disease course from 2011 to 2021 in two centers. Clinicopathological features and survival outcomes of MET-amplified GC were analyzed. The clinical and molecular implications of GC with PLC were discussed. RESULTS: Fifty-eight patients with MET-amplified GC and 20 patients with GC accompanied by PLC were finally enrolled for analysis (including 13 overlapped patients). GC with PLC was more common in female patients (p = 0.010), diagnosed at a younger age (p = 0.002), presented with a higher baseline ECOG PS (p = 0.016), and was more likely to develop lung metastasis (p < 0.001), and serous effusion (p = 0.026) than GC without PLC. Patients with primary MET-amplified GC had a worse prognosis than those with secondary MET-amplified GC (p = 0.005). The application of anti-MET therapy was associated with numerically prolonged survival, but the association was not statistically significant (p = 0.07). MET amplification was concentrated in patients with PLC, in which anti-MET therapies elicited a high response rate. CONCLUSIONS: MET-targeted therapies are efficacious in real-world populations with MET-amplified GC. Patients with PLC have distinct clinical and molecular features and might benefit from MET-targeted therapies.

Delineating the Boundaries of Superficial Lymphangitis: A Retrospective Study of 11 Cases with a Review of Literature.

Background: Lymphangitis is an inflammation of lymphatic channels caused by infectious or non-infectious agents, presenting with characteristic linear erythematous streaks draining toward regional lymph nodes. Objective: To describe the clinical characteristics and etiological factors involved in acute superficial lymphangitis in a retrospective descriptive study. Materials and Methods: Records of patients were analyzed retrospectively who presented with linear erythematous streaks, diagnosed as superficial lymphangitis, in the outpatient department of dermatology during the last 5 years (January 2018-December 2022) in a tertiary care hospital. Patients were evaluated for their demographic profile, detailed history, complete physical examination, and standard blood tests (if necessary). Results: A total of 11 patients were found, out of which 7 (63%) were males and 4 (37%) were females. The mean/median age of these patients was 30 years (range 9-52 years). The minimum duration of development of lymphangitis was within minutes in the case of a mosquito bite reaction and around 72 hours in the case of trauma or infection induced, with a median interval of 48 hours. The site most commonly involved was the upper extremity in 8 (72%) patients, followed by the trunk in 2 (18%) and the lower extremity in 1 (9%). Arthropod bite reactions (63%) were the most common etiological agent. All patients presented with linear erythematous streaks extending towards draining lymph nodes. Conclusion: Lymphangitis is often considered to be a bacterial infection and is mostly treated with antibiotics; however, non-bacterial and non-infectious causes should be kept in mind while treating superficial lymphangitis to make judicious use of systemic antibiotics.