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.

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.

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.

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.

Study on prevalence and associated risk factors of epizootic lymphangitis in equine in Nagele Arsi town, southeastern Ethiopia.

Epizootic lymphangitis is a contagious, chronic and overwhelming disease of equids, characterized by chronic discharging skin nodules. This study was aimed to investigate the prevalence and associated risk factors of epizootic lymphangitis in equines at Nagele Arsi town, southeastern Ethiopia. A cross-sectional study using a random sampling technique was employed from December 2021 to June 2022 via clinical and microscopic examinations of the lesions. The overall prevalence of epizootic lymphangitis was 4.37% with a prevalence of 6.69%, 0.72%, and 0% in horses, donkeys, and mules, respectively. The sex, species, harness type, season, and body condition scores of equids have shown statistically significant differences (p < 0.05) with the prevalence of epizootic lymphangitis. Macroscopically, the lesions revealed varying degrees of nodule to ulcer on the sternum, limbs, face, and cervical region of the equine. Upon giemsa stain, fungal hyphae with a halo (unstained capsule-like) structure were observed. Histologically, pyogranulomatous inflammation with fibroplasia was appreciated. In conclusion, epizootic lymphangitis was rampant in the study area. This requires a detailed investigation incorporating a large sample size using fungal culture and other molecular techniques including PCR.

Proteomics of Toxigenic Corynebacteria.

Within the genus Corynebacterium, six species are potential carriers of the tox gene, which encodes the highly potent diphtheria exotoxin: Corynebacterium diphtheriae, Corynebacterium belfantii, Corynebacterium rouxii, Corynebacterium ulcerans, Corynebacterium pseudotuberculosis and Corynebacterium silvaticum. Based on their potential to infect different host species and cause either human infections, zoonotic diseases or infections of economically important animals, these bacteria are of high scientific and economic interest and different research groups have carried out proteome analyses. These showed that especially the combination of MS-based proteomics with bioinformatic tools helped significantly to elucidate the functional aspects of corynebacterial genomes and to handle the genome and proteome complexity. The combination of proteomic and bioinformatic approaches was also used to discover new vaccine and drug targets. In addition, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has been established as a fast and precise tool for the identification of these bacteria.

Non-Venereal Sclerosing Lymphangitis of the Penis in a 35-Year-Old Saudi Male: A Case Report.

Sclerosing lymphangitis is a rare penile lesion characterized by a cord-like, firm swelling at the penile coronal sulcus. It affects males between the ages of 30 and 40 and usually resolves spontaneously. Due to the rarity of this condition, we decided to report this case. Herein, we present a case of a 35-year-old male that was evaluated for a painless, cord-like, penile lesion that enlarges during erection, characteristic of sclerosing lymphangitis.

Multi-Omics of Corynebacterium Pseudotuberculosis 12CS0282 and an In Silico Reverse Vaccinology Approach Reveal Novel Vaccine and Drug Targets.

Corynebacterium pseudotuberculosis is an important animal pathogen, which is also able to infect humans. An optimal treatment of infections with this pathogen is not available today and consequently, more research is necessary to understand the infection process. Here, we present a combined -omics and bioinformatics approach to characterize C. pseudotuberculosis 12CS0282. The genome sequence of strain 12CS0282 was determined, analyzed in comparison with the available 130 C. pseudotuberculosis sequences and used as a basis for proteome analyses. In a reverse vaccinology approach, putative vaccine and drug targets for 12CS0208 were identified. Mass spectrometry analyses revealed the presence of multiple virulence factors even without host contact. In macrophage interaction studies, C. pseudotuberculosis 12CS0282 was highly resistant against human phagocytes and even multiplied within human THP-1 cells. Taken together, the data indicate a high pathogenic potential of the strain.

Upper-limb acute superficial lymphatic thrombosis: A case report.

Upper-limb acute superficial lymphatic is a rare phenomenon that has received little attention in the medical literature to date, yet it mimics superficial venous thrombosis and may also complicate a skin punch biopsy.

Pulmonary Lymphangitis Carcinomatosa Mimicking Immunotherapy-Related Interstitial Pneumonitis: A Case Report.

While immunotherapy with immune checkpoint inhibitors has achieved promising effects in advanced lung cancer treatment, it can induce some unique adverse events, known as immunotherapy-related adverse events (irAEs). Immunotherapy-related interstitial pneumonitis is one of the irAEs, and its incidence is reported as 3.5-8.3% in phase III trials of nivolumab with or without ipilimumab for advanced non-small cell lung cancer patients. However, in the real-world setting, pathology is not routinely used in the diagnostic process of interstitial pneumonitis because diagnosis is usually made using chest computed tomography (CT). Here, we report an educational case of pathologically diagnosed pulmonary lymphangitis carcinomatosa mimicking immunotherapy-related interstitial pneumonitis. The patient was diagnosed with advanced adenocarcinoma of the right lung (stage IVA) and received immunochemotherapy for 6 months. He manifested acute respiratory failure, and a chest CT scan revealed the emergence of diffuse grand-grass opacity predominantly in the left lung. Immunotherapy-induced interstitial pneumonitis was clinically suspected because the primary lesion was stable, and the level of the serum carcinoembryonic antigen decreased. However, the detection of adenocarcinoma cells in the bronchoalveolar lavage sample from the left lung confirmed the diagnosis of pulmonary lymphangitis carcinomatosa. Clinicians' assumptions can sometimes mislead treatment methods; hence, this case draws attention to the perils of misdiagnoses.

Prevalence and risk factors of epizootic lymphangitis in cart pulling horses and mules in Central and South Gondar zones, Amhara region, Ethiopia.

Epizootic lymphangitis (EZL) is a chronic, contagious disease of equids caused by the fungus Histoplasma capsulatum var. farciminosum. The disease is often prevalent in cart pulling equids in developing countries. This study was undertaken in Central and South Gondar zones of Amhara region, Ethiopia with the objectives of estimating the prevalence of EZL in cart pulling horses and mules and identifying the risk factors of the disease. Two towns, one high altitude and one mid altitude, from each of the two zones were included for the study. A total of 528 cart pulling horses and mules from the selected towns were examined clinically, screened by physical examination based on clinical signs of the disease and confirmed by microscopic mycological examination of the causative agent. Potential risk factors data were collected through observation of cart animals and interviewing of cart owners and were statistically evaluated using mixed effect logistic regression. An overall EZL prevalence of 12.5% (95% CI: 9.9-15.6%) was found. The prevalence was 19.9% (95% CI: 15.8-24.8%) in horses and 5.8% (95% CI: 2.4-13.2%) in mules. The disease was prevalent in mid altitude towns but was not detected in high altitude cold towns of the study zones. The risk factor analysis revealed that sharing of harness, mingling of cart animals in cart stations, communal housing and pre-existing trauma wound were risk factors of EZL in cart pulling horses and mules. The study generally indicated that EZL is a prevalent problem in mid altitude towns that endangers the livelihood of the cart owners and wellbeing of cart pulling equids. This warrants the initiation of a control strategy mainly focusing on improving management of cart pulling equids related to the identified risk factors to ameliorate the EZL problem in the study area.

Finger Test for the Diagnosis of a Critically Ill Patient with Necrotizing Fasciitis.

BACKGROUND: Necrotizing fasciitis is a life-threatening soft-tissue infection, often characterized by soft-tissue destruction, systemic toxicity, and high mortality. No single laboratory value can diagnose necrotizing fasciitis; ultimately, necrotizing fasciitis is a clinical diagnosis and therefore presents a diagnostic dilemma for many physicians. The finger probe test is useful in confirming the diagnosis when imaging studies are unobtainable or nondiagnostic. CASE REPORT: We present the case of a 70-year-old woman presenting nonverbal and obtunded with a soft-tissue infection of the right lower extremity. The only pertinent positive vital sign was tachypnea with a respiratory rate of 22 breaths/min. Physical examination revealed nonpitting edema, cold-to-touch lower extremity, and Nikolsky-positive hemorrhagic bullae. Initial laboratory test results showed white blood cell count of 38 x 109/L and lactic acid of 8.2 mg/dL. Advanced imaging was unobtainable, given the patient's worsening clinical status, and the decision was made to perform the finger probe test, which revealed absence of bleeding and presence of friable tissue and "dishwater" discharge. Consequently, the general surgery team took the patient to the operating room and performed an above-the-knee amputation and surgical debridement. Postoperative report noted nonviable tissue consistent with necrotizing fasciitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Necrotizing fasciitis is a life-threatening emergency that can destroy soft-tissue at a rate of 1 inch/h. When imaging is unobtainable or nondiagnostic, the finger probe test can be used in select patients to aid with diagnosis.