Paragonimus westermani infection manifesting as a pulmonary cavity and adrenal gland mass: A case report.

We report a case of Paragonimus westermani infection simultaneously affecting two separate organs that presented as both a pulmonary cavity and adrenal mass in an immunocompromised host. A 65-year-old male with a previous kidney transplant visited our clinic because of hemoptysis. Chest computed tomography (CT) showed a pulmonary cavity and right adrenal gland mass. The Aspergillus antigen titer in bronchial lavage fluid was elevated and showed positive conversion. It was necessary to differentiate lung cancer with adrenal gland metastasis from a fungal infection with an adrenal gland adenoma. Positron emission tomography CT suggested benign disease, and it was misdiagnosed as pulmonary aspergillosis based on the elevated Aspergillus antigen titer in the bronchial lavage fluid. Owing to the adverse effects of anti-fungal treatment, the patient underwent wedge resection of the lung and P. westermani was confirmed. A careful history revealed that the patient had eaten raw freshwater crabs 3 years earlier, and a test for serum antibodies to P. westermani was positive. Despite treatment with praziquantel, the adrenal mass persisted on 3-month follow-up CT. A right adrenalectomy was performed and a P. westermani infection was confirmed.

Pathological Findings in Leatherback Sea Turtles (Dermochelys coriacea) During an Unusual Mortality Event in São Paulo, Brazil, in 2016.

The leatherback sea turtle (LST; Dermochelys coriacea) is highly migratory and is primarily distributed throughout tropical and subtropical regions. The LST populations found in Brazil are critically endangered. An unusual mortality event occurred between August and November 2016 with 23 LSTs stranded along a 100 km coastal segment in Iguape, Ilha Comprida and Ilha do Cardoso in southern São Paulo state. This study investigated the pathological findings and most likely causes of death of 10 LSTs. Male (n = 9) and adult (n = 9) animals predominated. All but one animal was in good body condition and all were found dead. The most prevalent gross findings were suggestive of bycatch, namely cutaneous erosions, abrasions and/or lacerations around the neck and flippers (n = 9), generalized congestion (n = 8) and pulmonary oedema (n = 6). Other prevalent gross findings were: cutaneous epibiosis by Stomatolepas elegans (n = 7); ileocecal diverticulitis (n = 7); distal oesophagitis (n = 5); and fibrinous coelomitis (n = 5). Microscopically, the most prevalent findings were: hepatic melanomacrophage centre hypertrophy or hyperplasia (n = 9); interstitial pneumonia (n = 8); multisystemic congestion (n = 6); pulmonary oedema with or without aspirated material (n = 5); adrenal coccidiosis (n = 5) with variable multiorgan involvement; and multiorgan bacterial disease (n = 5). Five animals had food ingesta (cnidarians, crustaceans) in the oesophagus or stomach; only one had evident plastic foreign bodies. Asphyxia due to entanglement in nets was the most frequently identified cause of death (n = 8); a cause of death was not identified in two animals. Our findings provide evidence of the severe negative impact of entanglement in fishing nets in LSTs, raising concerns for conservation. These findings also contribute to knowledge of the pathology of LSTs in South American populations.

Second case of histoplasmosis in a captive mara (Dolichotis patagonum): pathological findings.

A second case of histoplasmosis in a captive mara (Dolichotis patagonum) from a colony at the wildlife park Africam Safari, Puebla, Mexico, is described, and the mara died with disseminated clinical form of the disease, affecting mostly the large intestine and adrenal. The pathological findings of this case 2 revealed severe granulomatous typhlocolitis and moderate granulomatous gastrohepatic lymphadenitis with numerous yeast-like cells, 2-4 mum in diameter, with a clear halo surrounding them inside the cytoplasm of macrophages, suggesting the parasitic form of Histoplasma capsulatum. Adrenocortical cells had abundant similar microorganisms in their cytoplasm without any associated lesion. Gomori's methenamine silver and periodic acid Schiff stained positively these microorganisms. Immunohistochemistry, using a rabbit anti-H. capsulatum serum, and transmission electron microscopy supported the diagnosis of H. capsulatum infection.

Effect of Fasciola gigantica infection on adrenal and thyroid glands of riverine buffaloes.

Effect of Fasciola gigantica infection on adrenal and thyroid glands was investigated using eight male, yearling Murrah buffaloes. The animals were randomly assigned to two groups of four buffaloes each (Group-A, infected; Group-B, non-infected control). Animals of Group-A were orally infected with 1000 F. gigantica viable metacercariae, keeping other four animals of Group-B as uninfected control. In the infected buffaloes, the clinical signs began appearing from 7th week postinfection (p.i.) and eggs were detected in the faeces between day 93 and 99 (95.5+/-1.25) postinfection (p.i.). The serum cortisol level, revealed a significant (P<0.05) rise during initial stage of the infection, followed by a continuous fall from 12th week onward. Peak cortisol level on 10th week (13.30+/-2.57ngml(-1)) was associated with eosinophilia (11.0+/-0.95%). However, non-infected controls maintained almost uniform cortisol levels (3.97+/-0.15-5.88+/-0.09ngml(-1)) throughout the period of the study. The pathological changes of adrenal glands were correlated with physiological dysfunction of the glands. The levels of T(3) and T(4) were significantly (P<0.05-0.01) low from 14th week onward and were synchronous with in situ migration, growth and development of F. gigantica. Significant reduction in the thyroid hormones was further supported by histopathological evidence of lymphocytic thyroiditis confirming hypothyroidism. A decrease in Hb, PCV, total erythrocyte counts and appearance of reticulocytes in the blood of the infected buffaloes suggested regenerative anemia, which could partly be due to hypothyroidism.

First detection of Allobilharzia visceralis (Schistosomatidae, Trematoda) from Cygnus cygnus in Japan.

Adult schistosomes were detected in the veins or capillaries of the large intestine, mesentery, liver, and adrenal glands in eight of 13 whooper swans (Cygnus cygnus) examined in Iwate Prefecture, Japan. However, neither eggs nor severe tissue injuries were observed in any of the swans. The schistosomes were definitively identified as Allobilharzia visceralis based on the nucleotide sequences of the ribosomal internal transcribed spacer (ITS) region. Allobilharzia visceralis infections have been reported in whooper swan in Iceland and tundra swan (Cygnus columbianus) in North America. These detections suggest that A. visceralis is distributed extensively along the swan flyways because the swans are migratory birds. To the best of our knowledge, this is the first report of A. visceralis infection in Asia.

Alveolar echinococcosis of the right adrenal gland: a case report and review of the literature.

BACKGROUND: Extrahepatic manifestations of Echinococcus multilocularis are very rare, especially in the adrenal glands. To the best of our knowledge, only seven cases of adrenal alveolar echinococcosis have been reported, all from the Far East. All of these occurred exclusively in the right adrenal gland. CASE PRESENTATION: We report a rare case of an extrahepatic alveolar echinococcosis in an asymptomatic 78-year-old white man with an incidentaloma of his right adrenal gland. After surgical resection and medical treatment with albendazole no recurrence of the disease appeared at 1-year follow-up. CONCLUSIONS: As the occurrence of Echinococcus multilocularis in Europe increases, alveolar echinococcosis should be included in the differential diagnosis of cystic adrenal incidentalomas.

Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome.

A case of disseminated pneumocystosis occurring in a patient with the acquired immunodeficiency syndrome is described. Postmortem examination of this patient, who had three episodes of Pneumocystis carinii pneumonia during his 3-year clinical course, revealed clinically unsuspected infiltration of lymph nodes, spleen, adrenal glands, and bone marrow, in addition to persistent pulmonary infection by the organism.

Correlation between adrenal central vein parasitism and heart fibrosis in chronic chagasic myocarditis.

The correlation between Trypanosoma cruzi parasitism of the adrenal central vein (ACV) wall and fibrous connective tissue neoformation in the left ventricular myocardium (LVM) of patients with chronic Chagas' disease who were autopsied was evaluated using the following procedures: 1) a comparison of the incidence of fibrosis in the LVM among 18 chagasic patients with ACV parasitism and 18 individuals without phleboparasitism; 2) a determination of fibrosis intensity in the LVM in 12 cases with ACV parasites and in 12 cases without phleboparasitism, matched with respect to age, sex, race, and anatomoclinical form of the disease (indeterminant, cardiac, and digestive forms); and 3) in the cases with ACV parasitism, a calculation of Pearson's correlation coefficient between T. cruzi nests in the vessel and the intensity of fibrous connective tissue neoformation in the LVM. Among chagasic individuals with adrenal phleboparasitism, there was an increased incidence and intensity of fibrous connective tissue neoformation in the LVM, both highly significant, compared with patients without adrenal phleboparasitism. Furthermore, there was a positive, though nonsignificant, correlation (r = +0.19) between the density of nests in the ACV and the intensity of myocardial fibrosis. These results are consistent with previous data showing a higher intensity of the leukocyte exudate in the LVM and increased heart weight in individuals with T. cruzi nests in the ACV, suggesting a role of parasitism at that site in terms of the development of chronic chagasic cardiopathy.

Possible role of an adrenal parasite reservoir in the pathogenesis of chronic Trypanosoma cruzi myocarditis.

The possible contribution of parasitism of the central vein of the adrenal gland (CVAG) to chronic Trypanosoma cruzi myocarditis was assayed by comparing the occurrence of nests of amastigotes in the left ventricular myocardium (LVM) and determining the number and extent of areas of focal leucocyte exudate (FLE) in Chagas disease patients with and without CVAG parasitism. The frequency of occurrence of T. cruzi nests in the LVM, as well as the FLE number and area, were greater among patients with CVAG parasitism. We therefore suggest that CVAG parasitism plays a role in the onset and intensity of chronic T. cruzi myocarditis.

Subclinical cyathostomiasis and unidentified helminthiasis in a juvenile emu (Dromaius novaehollandiae).

The nematode Cyathostoma variegatum (a lungworm) was present in the distal trachea and proximal bronchi of an 8-mo-old emu that was euthanatized after fracturing the left tibiotarsus. Clinical signs of infection were not present prior to euthanasia and abnormalities were not noted on gross or histologic examination of the respiratory tract. The absence of respiratory signs in this and other emus underscores the need for routine fecal examinations to interrupt the inadvertent spread of this potentially life-threatening parasite. In addition to the lungworms, large helminth eggs were present in renal and reproductive tissue. Egg morphology was suggestive of species of Deletrocephalus or Paradeletrocephalus. The mechanism by which these eggs became lodged in this ectopic site is unknown.

Serodiagnosis of toxoplasmosis in a common wombat.

An 8-yr-old captive, female common wombat (Vombatus ursinus) from Victoria, Australia was euthanased after an illness of 36 days manifested by lethargy, inappetance and terminal coma with respiratory failure. Toxoplasmosis was diagnosed during life by the Toxoplasma direct agglutination test (DAT) which showed a positive initial titre of 1:1,024 at 22 days after onset of illness and a four fold rise in titre to 1:4,098 2 wk later, just prior to death. The Toxoplasma modified agglutination test (MAT) remained negative over this time period. The serological diagnosis was confirmed by histological diagnosis of granulomatous encephalitis, focal myocarditis, interstitial pneumonia and severe adrenal cortical necrosis and the presence of tachyzoites of Toxoplasma gondii in large numbers within the focal necrotic lesions in the brain, myocardium and adrenal cortices. The serological response in the wombat differed from that of the typical eutherian which exhibits a reaction in both the DAT and MAT within 2 wk of infection with T. gondii. An incidental finding was calcification in the media of the ascending aorta and proximal parts of the major arteries.

[Comparison of parasitology of the central vein of the adrenal gland and the other tissues in chronic chagas disease]. / Comparação do parasitismo da veia central da supra-renal com o de outros tecidos em chagásicos crônicos.

By morphological and morphometric analyses of serial sections the occurrence of T. cruzi nests in the central vein and in the parenchyma of adrenal glands, in the left ventricular wall and in the inferior vena cava wall in chronic Chagasic patients was studied. Of 36 cases 50% showed parasites in the adrenal central vein wall (total 29 nests), 3.1% showed parasites in the vena caval wall (only I nest) and 16.8% we found parasites in the myocardiocytes (total 23 nests). The density of parasites measured in the nests for each 100mm2 of the tissue examined, was 0.585 for the adrenal vein, 0.001 for the vena cava and 0.01 for the myocardium. No nest was found in 269103.1mm2 of adrenal parenchyma. Although the central vein area examined was smaller, it showed the largest frequency of T. cruzi nests. Since a basic difference between these tissues is the great quantity of corticoids in the blood of the adrenal central vein, this prevalence may be because of this hormonal ambient, which with its immunosuppressor and anti-inflammatory effects could help T. cruzi survival.

[Acute-phase reaction and parasitism in the central adrenal vein in Chagas' disease patients]. / Reação de fase aguda e parasitismo na veia central da supra-renal de chagásicos crônicos.

The systemic reaction to severe trauma and/or infection, acute phase response (APR), are often associated with immunosuppression and reactivation of chronic latent infection. Our main purpose was to verify, in a group of 71 autopsied chronic chagasic with or without APR, the frequency of T. cruzi nests in the central vein of adrenal gland (CVAG). APR, defined by: 1) death secondary to sepsis and/or trauma plus, 2) bleeding stress gastric ulcerations or 3) spleen reactional state or 4) liver steatosis, was observed in 30 chronic chagasic (APR+). Weight, height and body mass index (BMI) were obtained. APR(+) chronic chagasic had worse nutritional status than APR(-) ones: weight = 49.0 vs 54.5 kg; BMI = 17.5 vs 20.6 kg/m2 (median p < 0.05). CVAG T. cruzi nests frequency were similar (43.3% and 43.9%, respectively) between both Groups. We conclude that APR(+) chronic chagasic had worse nutritional status than APR(-) ones, and that APR development did not change the CVAG T. cruzi nests frequency.

Immunocytochemical study of tissue parasitism of dog adrenal glands in experimental Chagas' disease.

In human beings, the central vein of the adrenal glands has been considered by some authors to be one of the preferential sites of Trypanosoma cruzi settling in the chronic form of Chagas' disease. This appears to be due to the local corticoid-rich environment that may protect the parasite against the immunological defences of the host. An immunocytochemical study of the adrenal glands of 15 dogs was carried out for the detection of tissue parasitism in the acute and chronic phases of experimental T. cruzi infection. No amastigote nests or isolated amastigotes were detected in the adrenal parenchyma or adrenal central vein of the animals studied. Minimal nonspecific inflammatory changes were found in some glands of both infected and noninfected animals. The present results show that the adrenal glands of the dog are not injured and do not constitute a site of escape or reservoir of parasites in experimental Chagas' disease.

[Cardiac weight in patients with chronic Chagas disease with Trypanosoma cruzi nests in the central vein of the adrenal glands]. / Peso cardíaco em chagásicos crônicos com ninhos de Trypanosoma cruzi na veia central da supra-renal.

PURPOSE: Comparative analysis of cardiac weight (CW) in patients with chronic Chagas disease, with or without parasitism by Trypanosoma cruzi in the central vein of the adrenal gland (CVAG). METHODS: The CW has been studied in 96 necropsied individuals with chronic Chagas disease. Among them, 48 of them had Trypanosoma cruzi nests on the wall of the CVAG and the other 48 patients did not have nests in the CVAG. Later, this sample was paired for sex, age and anatomo-clinical form, resulting in 60 patients. Among these patients, 30 of them had Trypanosoma cruzi nests on the walls of the CVAG and the other 30 did not have. RESULTS: The CW of Chagas patients which had nests of T. cruzi in the CVAG, was 484.8 +/- 146.0g, while in the ones that did not have the nests on the walls of the CVAG, the CW weight was 415.8 +/- 125.3g. This difference was statistically significant. In the first group it had a prevail of congestive heart failure. Subsequently to the pairing for sex, age and anatomo-clinical form, the CW was respectively 464.3 +/- 146.2g and 436.0 +/- 108.9g. This difference was not statistically significant. CONCLUSION: These data suggest that the parasitism in the central vein of the adrenal gland, combined with other possible events intrinsic to the chronic Chagas disease patients' hearts, carries a supporting role in the increasing of the cardiac weight and in the congestive cardiac insufficiency.

Hypertension secondary to adrenal tumors ten years experience.

We have presented our ten years experience in the surgical management of adrenal tumors. Patients presenting with hypertension (9) are normotensive following the removal of the offending adrenal tumor. One patient had an extra-adrenal pheochromocytoma, one had a huge organized adrenal hematoma and one patient has a non-functional tumor. The diagnosis and management of endocrine tumors is a challenge to the clinician.

Primary hydatid cyst in the adrenal gland.

An elderly man presented with a 2-year history of refractory hypertension. His medical history, physical examination and laboratory findings were unremarkable. On subsequent ultrasound study for the evaluation of renal artery stenosis, a large mass obliterating the adrenal gland containing internal cystic structures was identified. A CT study confirmed the diagnosis of primary adrenal gland hydatid cyst. Following surgical resection, the patient's hypertension resolved and medications to control blood pressure were discontinued.

Microfilaria in association with adrenal lymphoma diagnosed on cytology: an extremely rare case report.

Filariasis is a common public health problem in Asian countries. In this report, the authors have described detection of microfilaria in the cytological specimen of adrenal lymphoma. To the best of our knowledge, this is the first reported case in the literature where microfilaria was seen in an adrenal gland involved by lymphoma. The literature is briefly reviewed.

Primary alveolar echinococcosis (Echinococcus multilocularis) of the adrenal gland: report of two cases.

We retrospectively analyzed two rare cases of primary alveolar echinococcosis of the adrenal gland that were misdiagnosed. One male patient was asymptomatic and the lesion was found incidentally, and the other female patient had an obscure abdominal pain. No masses were found in the epigastric region of either patient. Computed tomography (CT) scans revealed oval masses with indistinct margins adjacent to organs. The lesions were slightly enhanced by contrast medium, showing cystic and solid components with a cobbled road appearance. Both cases were diagnosed as adrenal malignant tumors, and adrenalectomies were performed. Postoperative pathology reports confirmed adrenal alveolar echinococcosis. Neither patient had recurrence at 2 years of follow-up. The cobbled road appearance of this disease on CT images may represent the early-stage image of alveolar echinococcosis.

An atypical genotype of Toxoplasma gondii as a cause of mortality in Hector's dolphins (Cephalorhynchus hectori).

Hector's dolphins (Cephalorhynchus hectori) are a small endangered coastal species that are endemic to New Zealand. Anthropogenic factors, particularly accidental capture in fishing nets, are believed to be the biggest threat to survival of this species. The role of infectious disease as a cause of mortality has not previously been well investigated. This study investigates Toxoplasma gondii infection in Hector's dolphins, finding that 7 of 28 (25%) dolphins examined died due to disseminated toxoplasmosis, including 2 of 3 Maui's dolphins, a critically endangered sub-species. A further 10 dolphins had one or more tissues that were positive for the presence of T. gondii DNA using PCR. Genotyping revealed that 7 of 8 successfully amplified isolates were an atypical Type II genotype. Fatal cases had necrotising and haemorrhagic lesions in the lung (n=7), lymph nodes (n=6), liver (n=4) and adrenals (n=3). Tachyzoites and tissue cysts were present in other organs including the brain (n=5), heart (n=1), stomach (n=1) and uterus (n=1) with minimal associated inflammatory response. One dolphin had a marked suppurative metritis in the presence of numerous intra-epithelial tachyzoites. No dolphins had underlying morbillivirus infection. This study provides the first evidence that infectious agents could be important in the population decline of this species, and highlights the need for further research into the route of entry of T. gondii organisms into the marine environment worldwide.