Fine needle aspiration of pulmonary adiaspiromycosis: a case report

BACKGROUND: Pulmonary adiaspiromycosis is a common disease of many species of wild rodents and occasionally of humans, caused by the inhalation of spores of the fungus Chrysosporium parvum var crescens (Emmonsia crescens). CASE: A 74-year-old female with pulmonary adiaspiromycosis was diagnosed by radiologically guided lung fine needle aspiration (FNA). The specimen showed intracellular and extracellular 100-300 microm conidia with a distinct thick, trilaminar wall, which was positive for Gomori-methenamine silver and periodic acid-Schiff stain. The background consisted of a granulomatous process. CONCLUSION: FNA is an effective method of diagnosing pulmonary adiaspiromycosis, and pathologists need to be aware of the characteristic features of this unusual opportunistic fungal infection.     

Adiaspiromycosis of an Apodemus agrarius captured wild rodent in Korea

Adiaspiromycosis is caused by pulmonary infection with Emmonsia. Inhalated spores of Emmonsia cause asymptomatic infection to necrogranulomatous pneumonia, depending on the burden of adiaspore and host immunity. For disease monitoring of wild rodents captured on Jeju Island in Korea, we examined the lung tissue of wild rodents histopathologically. Spores composed of thick three-layered walls were found following histopathological examination and were diagnosed as adiaspiromycosis. Adiaspiromycosis has been found in mammals in many parts of the world. To our knowledge, this is the first report of adiaspiromycosis of an Apodemus agrarius captured in Korea.     

Intraspecific Diversity and Taxonomy of Emmonsia crescens

Mycopathologia - Emmonsia crescens is known as an environmental pathogen causing adiaspiromycosis in small rodents. As the generic name Emmonsia is no longer available for this species, its...     

Adiaspiromycosis of human skin caused by Emmonsia crescens

Two cases of cutaneous adiaspiromycosis by Emmonsia crescens are reported. This is the first human skin infection by this species and is the first report of its kind in man from India. In the first patient, the agent was demonstrated in KOH mounts, histology and culture from irregular, pigmented skin plaques on the right gluteal area. The lesion also contained calcium. In the second patient the fungus was demonstrated histologically in a knee lesion. The agent had elicited a histiocytic and giant cell reaction in the dermis in both cases. The first patient suffered from anaemia and epilepsy and the second suffered from nephropathy with chyluria. The skin lesions were surgically excised with skin grafting in the first patient.     

Experimental adiaspiromycosis of the common vole (Microtus arvalis) and other small wild mammals after intraperitoneal inoculation

After intraperitoneal inoculation ofE. crescens to nine species of wild small mammals, six species of rodents (Apodemus flavicollis, A. sylvaticus, Clethrionomys glareolus, Microtus agrestis, M. arvalis, Mus musculus) developed generalized adiaspiromycosis. The course of experimental infection corresponded to the infections of laboratory animals provoked in the same manner of inoculation. The authors studied the affliction of individual organs, the dynamics of growth of adiaspores in the organs of the abdominal cavity and in the lungs and followed up morphological changes in the adiaspores. In fresh cover glass preparations, the presence of manifestations was demonstrated justifying considerations on the capacity of multiplication of the adiaspiromycosis agent in the host organism.     

Adiaspiromycosis in Tasmanian wombats?

The finding of small spherules in the lungs of two species of wombats from Tasmania is described. An histological examination of lung tissue caused adiaspiromycosis to be suspected and the etiological agent was thougth to be Chrysosporium parvum.     

Adiaspiromycosis in Czechoslovakian mammals

The examination of 46 mammalian species in Czechoslovakia revealed adiaspiromycosis caused by the Emmonsia crescens in 22 species of free living animals; E. parva was the etiological agent in 3 species. The disease was most frequently found in carnivores of the family Mustelidae.     

Disseminated pulmonary adiaspiromycosis in a crested porcupine (Hystrix cristata Linnaeus, 1758)

Adiaspiromycosis is primarily a necrotizing granulomatous pneumonia caused by a dimorphic fungus of the genus Emmonsia. A young crested porcupine (Hystrix cristata) found dead showed multiple fractures, chronic pleuritis, and granulomatous pneumonia. Microscopically, cystic structures were consistent with adiaspiromycosis by Emmonsia crescens. The diagnosis was confirmed using molecular methods.     

Adiaspiromycosis in large free living carnivores

Adiaspiromycosis was identified in 6 animals in the examination of the lungs of 90 large carnivores. Emmonsia crescens (Chrysosporium parvum var. crescens) was demonstrated as the causative agent in 5 cases of disease — in the badger (Meles meles), the otter (Lutra lutra) and the fox (Vulpes vulpes). E. parva was demonstrated in the remaining case of disease in a fox. The badger is a new, up to the present unknown host of E. crescens. The sporadic occurrence of adiaspiromycosis in the fox and the otter classifies this disease among rare diseases of these animals.     

Importance of free living mustelid carnivores in circulation of adiaspiromycosis

The study of adiaspiromycosis in 8 species of free living mustelid carnivores (266 specimens) revealed the average intensity of infection to be 41.4%. The highest incidence rate was found in the exoanthropic species Putorius eversmanni (73.1 %) and Martes martes (72.2%) while the lowest was observed in the hemisynanthropic species Putorius putorius (30.6%). The stone marten (Martes foina) is a new, still unknown reservoir host of C. parvum var. crescens, C. parvum for which Putorius eversmanni and Mustela nivalis are new hosts, was also demonstrated in 3 cases. In the present paper, the role of mustelid carnivores in natural foci of adiaspiromycosis is discussed and evaluated. The importance of these predators in the circulation of C. parvum var. crescens is relatively wide. They make possible the liberation of adiaspores from the lungs of their prey — primarily small mammals — into the environment and participate in the spread of infection in both the horizontal and vertical directions. They play a part in the process of distributing of the organism to the vicinity of human dwellings, in the development of new elementary foci, and also act as important reservoir hosts of C. parvum var. crescens.     

Adiaspiromycosis Due to <Emphasis Type="Italic">Emmonsia crescens</Emphasis> is Widespread in Native British Mammals

Adiaspiromycosis caused by Emmonsia crescens is primarily a respiratory disease affecting small mammals, especially members of the Families Rodentia, Carnivora and Mustelidae. Although isolated reports exist of adiaspiromycosis in free-living British wildlife, the extent of infection in wild animals in the UK, and the significance of any associated pathology are unclear. Here, we report the results of histopathological examination of lungs of free-living wild mammals from the south–west UK coupled with digestion of lung material in potassium hydroxide followed by centrifugation and microscopic examination for the presence of adiaspores. The combined results showed that almost one-third (27/94, 28.7%) of animals examined had evidence of infection with E. crescens. Attempts to culture E. crescens from infected lungs were unsuccessful. However, E. crescens could be confirmed as the causative agent by PCR amplification and sequencing of DNA from adiaspores micro-dissected from animal lungs. The prevalence of adiaspiromycosis was largely independent of animal species or precise geography. Adiaspore burdens in most animals were low, consistent with transient exposure to E. crescens. However, burdens in several animals suggested heavy or repeated exposures to E. crescens, and were considered sufficient to have significantly impaired respiratory function. Finally, since E. crescens is apparently widespread in UK mammals and the first UK human case of adiaspiromycosis was reported recently, we present data obtained using a previous isolate of E. crescens demonstrating that both the mycelial and adiaspore phases of the organism are susceptible to amphotericin B, voriconazole, itraconazole and caspofungin.     

Influence of animal hibernation on the development of mycoses

The development of adiaspiromycosis and trichophytosis depending upon the state of activity of redcheeked squirrels is described. The conidia of Chrysosporium (Emmonsia) parvum var. crescens, are not transformed into adiaspores when injected into hibernating animals. During the hibernation period of four months, most of the conidia die. After awakening, the remaining viable conidia are transformed into adiaspores. During hibernation the squirrels, which had been infected with Trichophyton mentagrophytes var. granulosum, developed a symptom-free infection.     

Histoplasma capsulatum in the environment of sporadic histoplasmosis cases

Conclusions 1. Acute pulmonary histoplasmosis in adults is demonstrated to be associated with exogenous sources of infection in one-half of a series of cases. 2. No exogenous sources of infection were found in chronic pulmonary histoplasmosis in adults by methods comparable to those used in acute pulmonary histoplasmosis. 3. The significance of these findings for the pathogenesis of the three clinical forms of histoplasmosis is discussed. 4. In acute pulmonary histoplasmosis in adults, the isolation ofH. capsulatum from the environment at sites of exposure aided in specific diagnosis.Two acute pulmonary histoplasmosis cases were reported previously (2–3).     

Two cases of acute pseudogout attack following parathyroidectomy.

Two cases of acute attack of pseudogout associated with primary hyperparathyroidism are reported. Case 1 suffered from acute pain and swelling of the right ankle and dorsal of the right foot. Case 2 suffered from unknown fever and pain of the bilateral jaw, shoulder, elbow, wrist and knee joints. Postoperative radiological studies revealed the association of chondrocalcinosis in both cases. Synovial fluid in case 2 was aspirated and analyzed for calcium pyrophosphate dihydrate crystal by microscopic examination.     

毒蛇咬伤致急性呼吸衰竭38例救治分析

目的探讨毒蛇咬伤致急性呼吸衰竭的发病机制和治疗措施。方法选择毒蛇咬伤患者38例,应用抗蛇毒血清、机械通气等综合治疗。结果经综合救治措施治疗,38例全部痊愈出院。结论综合救治措施是抢救毒蛇咬伤致急性呼吸衰竭最有效的方法。     

华南常见毒鹅膏菌及其中毒事件分析

根据文献报道和实际调查对华南地区的有毒鹅膏种类进行统计分析,确认了21种常见有毒鹅膏菌,包括急性肝脏损害型的剧毒鹅膏、急性肾脏损害型和神经精神型的毒鹅膏各7种。对2000-2019年20年间发生的有毒鹅膏中毒事件进行统计分析显示,华南地区有毒鹅膏中毒事件共发生45起,163人中毒,60人死亡,病死率为36.8%;毒鹅膏的中毒事件主要发生在3-9月,其中3月份最多。致命鹅膏Amanita exitialis引起的中毒起数、中毒人数和中毒死亡率均占中毒事件总数的70%左右,是华南毒蘑菇中毒的“头号杀手”。本研究对华南地区毒蘑菇中毒的科学精准防控、有效减少中毒事件的发生、以及降低中毒死亡率具有重要意义。     

侵袭性肺曲霉病临床和病理分析——附23例报告

目的 分析侵袭性肺曲霉病(IPA)临床和组织病理特征,为探讨IPA早期诊断和临床病理分型提供依据.方法 非选择性地总结本院34年来512例成人(年龄≥16岁)尸检资料,依据病理切片真菌形态确定IPA患者共23例,并进行临床和病理对照分析.结果 23例中有明确基础疾病者21例,有明确诱因者20例.临床上表现有发热等中毒症状者17例(73.91%),合并呼吸道症状者18例(78.26%),存在肺部和肺外栓塞征象者9例(3.91%).胸部影像表现和病理检查符合急性支气管肺炎型15例次,血管侵袭型12例次,急性气管支气管炎型5例次,粟粒型3例次和胸膜炎型1例次.其中急性支气管炎型和血管侵袭型常合并存在,并成为患者致死的直接原因.结论 IPA临床表现复杂多变,探讨临床尤其是胸部影像学检查和组织病理分型有利于患者的早期诊断和判断预后.     

80例急性心肌梗死患者心电监护及护理

目的总结急性心肌梗死患者心电监护及护理经验。方法对本院性心肌梗死患者及时进行心电监护,对出现的心律失常者进行对症处理。结果本组80例患者中出现心律失常55例,其中室性心律失常48例,临床治愈45例;出现心室颤动7例,4例及时电复律转为窦性心律,3例抢救无效死亡。本组心律失常均发生在心肌梗死后1周内,尤其是发病24小时内,出现最多。结论心律失常是心肌梗死患者常见的并发症,也是患者死亡的主要原因,持续心电监护对患者心律失常的及时发现、明确诊断、指导抢救有重要意义。     

Flow cytometric characterization of phenotype,DNA indices and p53 gene expression in 55 cases of acute leukemia

OBJECTIVE: To characterize the phenotype of acute leukemia cases using flow cytometry, to detect mixed lineage cases and to use DNA index determination, including S-phase fraction (SPF) and p53 detection, to find if there was any correlation of SPF and p53 expression with outcome. STUDY DESIGN: Fifty-five cases of acute leukemia were enrolled in this study. A complete hemogram and routine bone marrow examination, including cytochemistry, was done. Mycloperoxidase-negative cases were evaluated on a flow cytometer using monoclonal antibodies. DNA indices were determined by flow cytometry in all cases, and p53 was detected immunohistochemically using the alkaline phosphatase/antialkaline phosphatase technique. RESULTS: Acute myeloblastic leukemia (AML) was diagnosed in 32 cases; acute lymphoblastic leukemia (ALL) was diagnosed in 18 (14 B lineage and 4 T line age). Four cases showed mixed lineage leukemia, and undifferentiated acute leukemia was diagnosed in one case. The mean/range of SPF for these groups were 3.76/0.33-6.91, 6.25/0.15-21.4, 2.89/0.35-10.64, 2.60/0.72-6.94 and 7.34, respectively. Aneuploidy was detected in two cases of B-lineage ALL and tetraploidy in a case of AML-M7, while all others were diploid p53. Was detected in 6 of 55 cases (10.90%). Follow-up was available for 24 patients. Five patients relapsed, and four had B-cell type ALL and were diploid and expressed no p53 gene. SPF% did not show any correlation with outcome. CONCLUSION: These data suggest that within acute leukemia subtypes, there is a wide variation in SPF. SPF does not seem to correlate with outcome. Immunophenotyping is essential to determine the lineage in myeloperoxidase-negative cases. It is perhaps the only way to diagnose mixed lineage leukemia and aberrant expression of markers presently. The p53 gene was detected less frequently. However, more studies are required from different centers with longer follow-up to evaluate prognostic significance.     

Adiaspiromycosis in a European beaver from Sweden

An infection with the rare mycosis Chrysosporium parvum was diagnosed in a European beaver (Castor fiber) shot in northern Sweden. The animal was in normal body condition and no signs of disease were observed. In the lungs a large number of nodules, up to 5 mm diameter, were observed. A large number of adiaspores were observed in the interstitium of the lungs and in the mediastinal lymph node. A chronic inflammatory reaction dominated by mononuclear leukocytes and giant cells was observed around the spores. This is the first report of adiaspiromycosis (Chrysosporium parvum) in the European beaver.