RESUMEN
A granulomatose com poliangeíte (GPA) é uma vasculite de pequenos vasos, de acometimento sistêmico variável, sendo o trato respiratório superior, inferior e rins os órgãos mais afetados. O acometimento traqueobrônquico se dá por várias manifestações, sendo a estenose subglótica a manifestação mais comum. A apresentação da estenose pode ser independente das manifestações sistêmicas da GPA e nem sempre segue a mesma evolução e resposta ao tratamento dos demais órgãos acometidos por essa vasculite, podendo ser grave o suficiente para necessitar de traqueostomia. Este estudo tem como objetivo relatar um caso de GPA com evolução para estenose subglótica (ESG) de 60% da luz da traqueia e o comportamento desta complicação frente às opções terapêuticas utilizadas. É um estudo observacional, descritivo, do tipo relato de caso. O caso demonstra a complexidade dessa apresentação clínica frente às opções terapêuticas disponíveis, por vezes, necessitando da combinação de medidas farmacológicas e intervencionistas. O manejo bem-sucedido da ESG é essencial para evitar complicações graves, destacando a importância do diagnóstico precoce e do acompanhamento rigoroso para garantir a qualidade de vida dos pacientes afetados por essa condição desafiadora. Palavra-chave: Estenose subglótica. Granulomatose com poliangeíte. Granulomatose de Wegener.
Asunto(s)
Humanos , Femenino , Adulto , Vasculitis/complicaciones , Granuloma del Sistema Respiratorio , Granulomatosis con Poliangitis/diagnósticoRESUMEN
This study analyzed the type 1 and type 2T helper (Th1/Th2) cytokines (including interleukins), immune cellular, matrix profile, and pathogens in granulomas with unexplained etiology compared to those with infectious and noninfectious etiology. Surgical lung biopsies from 108 patients were retrospectively reviewed. Histochemistry, immunohistochemistry, immunofluorescence, morphometry and polymerase chain reaction were used, respectively, to evaluate total collagen and elastin fibers, collagen I and III, immune cells, cytokines, matrix metalloproteinase-9, myofibroblasts, and multiple usual and unusual pathogens. No relevant polymerase chain reaction expression was found in unexplained granulomas. A significant difference was found between the absolute number of eosinophils, macrophages, and lymphocytes within granulomas compared to uninvolved lung tissue. Granulomas with unexplained etiology (UEG) presented increased number of eosinophils and high expression of interleukins (ILs) IL-4/IL-5 and transforming growth factor-ß. In sarcoidosis, CD4/CD8 cell number was significantly higher within and outside granulomas, respectively; the opposite was detected in hypersensitivity pneumonitis. Again, a significant difference was found between the high number of myofibroblasts and matrix metalloproteinase-9 in UEG, hypersensitivity pneumonitis, and sarcoidosis compared to granulomas of tuberculosis. Granulomas of paracoccidioisis exhibited increased type I collagen and elastic fibers. Th1 immune cellular profile was similar among granulomas with unexplained, infectious, and noninfectious etiology. In contrast, modulation of Th2 and matrix remodeling was associated with more fibroelastogenesis and scarring of lung tissue in UEG compared to infectious and noninfectious. We concluded that IL-4/IL-5 and transforming growth factor-ß might be used as surrogate markers of early fibrosis, reducing the need for genotyping, and promise therapeutic target in unexplained granulomas.
Asunto(s)
Granuloma del Sistema Respiratorio/inmunología , Granuloma del Sistema Respiratorio/patología , Enfermedades Pulmonares/inmunología , Enfermedades Pulmonares/patología , Adulto , Matriz Extracelular/patología , Femenino , Granuloma del Sistema Respiratorio/microbiología , Humanos , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Tuberculosis is a chronic infectious disease caused by the Mycobacterium tuberculosis complex (CMT), members including M. bovis. The sanitary inspection in slaughterhouses has a great importance on public health for the removal of contaminated meat with pathological lesions. Cattle slaughtered in the abattoir of Garanhuns were subjected to macroscopic, histological, bacteriological, and molecular analyses. Lung inspection revealed gross lesions suggestive of tuberculosis. The characterization of tuberculous granulomas was performed by histopathology and hematoxylin and eosin (HE) staining. The identification of acid-fast bacilli (AFB) was performed on smears with fresh material and histological staining using Ziehl-Neelsen stain. Bacteriological diagnosis was carried out using Stonebrink and Lowenstein-Jensen media, and polymerase chain reaction (PCR) was performed from the DNA extracted from colonies for the identification of Mycobacterium spp. We found that 1% (32/3,.180) of the collected lungs showed lesions suggestive of tuberculosis. Histopathological analysis revealed that 65.62% (21/32) samples had granulomatous pneumonia. AFB was detected in 46.88% (15/32) smears and 4.16% (1/24) histological sections, as analyzed by Ziehl-Neelsen staining. Moreover, 68.75% (22/32) samples showed bacterial growth and molecular identification 90% (18/20) of the samples were positive...
A tuberculose é uma doença infecciosa crônica causada por membros do complexo Mycobacterium tuberculosis (CMT), incluindo M. bovis. A inspeção sanitária em matadouros frigoríficos possui grande importância para a saúde pública pela remoção de carne contaminada com lesões patológicas. Os bovinos abatidos no matadouro de Garanhuns-PE foram submetidos a análises macroscópicas, histológicas, bacteriológicas e moleculares. A inspeção pulmonar revelou lesões sugestivas de tuberculose.A caracterização de granulomas tuberculoides foi realizada através da histopatologia e coloração de hematoxilina e eosina (HE). A identificação de bacilo álcool - ácido resistente (BAAR) foi realizado em esfregaços com material fresco e em cortes histológicos sob a coloração de Zihel-Neelsen. O diagnóstico bacteriológico foi realizado em meio de cultivo Stonebrink e Lowenstein-Jensen e a reação em cadeia da polimerase (PCR) sucedeu a partir de DNA extraído de colônias para identificação do Mycobacterium sp... Verificou-se que1% (32/3.180) dos pulmões coletados apresentaram lesões sugestivas de tuberculose. Na análise histopatológica 65.62% (21/32) amostras tinham pneumonia granulomatosa. BAAR foram detectados em 46,88% (15/32) esfregaços e 4,16% (1/24) em corte histológico conforme analisado pela coloração de Ziehl-Neelsen. Além disso, em 68,75% (22/32) das amostras houve crescimento bacteriano e na...
Asunto(s)
Animales , Bovinos , Granuloma del Sistema Respiratorio/veterinaria , Mataderos , Mycobacterium bovis , Tuberculosis Bovina , Sacrificio de Animales , Brasil , Inspección Sanitaria , Salud PúblicaRESUMEN
Tuberculosis is a chronic infectious disease caused by the Mycobacterium tuberculosis complex (CMT), members including M. bovis. The sanitary inspection in slaughterhouses has a great importance on public health for the removal of contaminated meat with pathological lesions. Cattle slaughtered in the abattoir of Garanhuns were subjected to macroscopic, histological, bacteriological, and molecular analyses. Lung inspection revealed gross lesions suggestive of tuberculosis. The characterization of tuberculous granulomas was performed by histopathology and hematoxylin and eosin (HE) staining. The identification of acid-fast bacilli (AFB) was performed on smears with fresh material and histological staining using Ziehl-Neelsen stain. Bacteriological diagnosis was carried out using Stonebrink and Lowenstein-Jensen media, and polymerase chain reaction (PCR) was performed from the DNA extracted from colonies for the identification of Mycobacterium spp. We found that 1% (32/3,.180) of the collected lungs showed lesions suggestive of tuberculosis. Histopathological analysis revealed that 65.62% (21/32) samples had granulomatous pneumonia. AFB was detected in 46.88% (15/32) smears and 4.16% (1/24) histological sections, as analyzed by Ziehl-Neelsen staining. Moreover, 68.75% (22/32) samples showed bacterial growth and molecular identification 90% (18/20) of the samples were positive...(AU)
A tuberculose é uma doença infecciosa crônica causada por membros do complexo Mycobacterium tuberculosis (CMT), incluindo M. bovis. A inspeção sanitária em matadouros frigoríficos possui grande importância para a saúde pública pela remoção de carne contaminada com lesões patológicas. Os bovinos abatidos no matadouro de Garanhuns-PE foram submetidos a análises macroscópicas, histológicas, bacteriológicas e moleculares. A inspeção pulmonar revelou lesões sugestivas de tuberculose.A caracterização de granulomas tuberculoides foi realizada através da histopatologia e coloração de hematoxilina e eosina (HE). A identificação de bacilo álcool - ácido resistente (BAAR) foi realizado em esfregaços com material fresco e em cortes histológicos sob a coloração de Zihel-Neelsen. O diagnóstico bacteriológico foi realizado em meio de cultivo Stonebrink e Lowenstein-Jensen e a reação em cadeia da polimerase (PCR) sucedeu a partir de DNA extraído de colônias para identificação do Mycobacterium sp... Verificou-se que1% (32/3.180) dos pulmões coletados apresentaram lesões sugestivas de tuberculose. Na análise histopatológica 65.62% (21/32) amostras tinham pneumonia granulomatosa. BAAR foram detectados em 46,88% (15/32) esfregaços e 4,16% (1/24) em corte histológico conforme analisado pela coloração de Ziehl-Neelsen. Além disso, em 68,75% (22/32) das amostras houve crescimento bacteriano e na...(AU)
Asunto(s)
Animales , Bovinos , Tuberculosis Bovina , Mycobacterium bovis , Granuloma del Sistema Respiratorio/veterinaria , Mataderos , Sacrificio de Animales , Salud Pública , Brasil , Inspección SanitariaRESUMEN
Paracoccidioidomycosis (PCM), caused by the dimorphic fungus Paracoccidioides brasiliensis (Pb), is the most prevalent systemic mycosis in Latin America. There are few reports in the literature about the disease damages during pregnancy and the consequences to the fetuses and breeding. This study evaluated the implications of PCM during pregnancy on offspring and mothers in Wistar rats. Groups of rats were submitted to systemic Pb infection, by intraperitoneal infusion, and mated 30 days after the infection date. Immediately after birth, rats and neonates were sacrificed to obtain organs for standard histological examination, morphometric analysis, fungi recovery by plating (CFU) and dosing of anti-Pb antibodies by ELISA. There were no stillbirths or miscarriages, however, the fetuses from infected pregnant rats had lower body and organ weight but the fertility rate was 100%. The largest number of CFU was recovered from the organ of pregnant rats, the pathological examination revealed more severe infection in the same group, further on the largest number of granulomas and fungal field. It can be concluded that the PCM was more severe in the group of pregnant rats, with implications to the weight of offspring.
Asunto(s)
Anticuerpos Antifúngicos/análisis , Hepatopatías/microbiología , Enfermedades Pulmonares Fúngicas/microbiología , Paracoccidioidomicosis , Complicaciones Infecciosas del Embarazo/microbiología , Animales , Animales Recién Nacidos , Recuento de Colonia Microbiana , Modelos Animales de Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Granuloma del Sistema Respiratorio/microbiología , Granuloma del Sistema Respiratorio/patología , Hepatopatías/patología , Enfermedades Pulmonares Fúngicas/patología , Tamaño de los Órganos , Paracoccidioidomicosis/patología , Embarazo , Complicaciones Infecciosas del Embarazo/patología , Ratas WistarRESUMEN
Tripoli is a microcrystalline siliceous rock used to polish metals and precious stones. Its inhalation has been associated with increased prevalence of breathing complaints and pneumoconiosis. However, its acute human exposure has not been so far studied. We aimed at evaluating the putative mechanical, morphological, biochemical and inflammatory lung damage in mice acutely exposed to Tripoli dust. BALB/c mice were randomly assigned to 2 groups: In control group (CTRL, n=6) animals received intratracheally (i.t.) 0.9% NaCl (50µl), while Tripoli group (TRIP, n=15) received 20mg of Tripoli powder diluted in 50µL of saline i.t. The experiments were done 15 days later. TRIP mice showed higher pulmonary mechanical impedance, polymorphonuclear cells, TNF-α, IL1-ß and IL-6 than CTRL. TRIP presented granulomatous nodules containing collagenous fibers that occupied 35% of the lung tissue area. In conclusion, acute exposure to Tripoli dust triggered important lung damage in mice lungs that if found in human workers could trigger severe illness.
Asunto(s)
Polvo , Exposición por Inhalación/efectos adversos , Pulmón/patología , Pulmón/fisiopatología , Enfermedad Aguda , Animales , Polvo/análisis , Femenino , Granuloma del Sistema Respiratorio/etiología , Granuloma del Sistema Respiratorio/patología , Granuloma del Sistema Respiratorio/fisiopatología , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Ratones , Ratones Endogámicos BALB C , Neumonía/etiología , Neumonía/patología , Neumonía/fisiopatología , Distribución Aleatoria , Dióxido de Silicio/toxicidad , Cloruro de Sodio/administración & dosificación , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
We describe an imported case of histoplasmosis, whose serological profile was established by means of a protein-based microarray platform, the recently described mycoarray. Because of its peculiarities, such a novel tool greatly facilitates the rapid and multiparametric assessment of patients' serological status and lends itself to be employed as an aid in the diagnosis of primary mycoses, especially in nonendemic countries.
Asunto(s)
Granuloma del Sistema Respiratorio , Histoplasma/aislamiento & purificación , Histoplasmosis , Enfermedades Pulmonares Fúngicas , Viaje , Adulto , Biopsia , Brasil , Lavado Broncoalveolar , Broncoscopía/métodos , Diagnóstico Diferencial , Granuloma del Sistema Respiratorio/diagnóstico , Granuloma del Sistema Respiratorio/microbiología , Histoplasmosis/diagnóstico , Histoplasmosis/fisiopatología , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Enfermedades Pulmonares Fúngicas/fisiopatología , Masculino , Análisis por Micromatrices/métodos , Tomografía de Emisión de Positrones , Pruebas Serológicas/métodosRESUMEN
OBJECTIVE: To investigate the significance of cellular immune markers, as well as that of collagen and elastic components of the extracellular matrix, within granulomatous structures in biopsies of patients with pulmonary or extrapulmonary sarcoidosis. METHODS: We carried out qualitative and quantitative evaluations of inflammatory cells, collagen fibers, and elastic fibers in granulomatous structures in surgical biopsies of 40 patients with pulmonary and extrapulmonary sarcoidosis using histomorphometry, immunohistochemistry, picrosirius red staining, and Weigert's resorcin-fuchsin staining. RESULTS: The extrapulmonary tissue biopsies presented significantly higher densities of lymphocytes, macrophages, and neutrophils than did the lung tissue biopsies. Pulmonary granulomas showed a significantly higher number of collagen fibers and a lower density of elastic fibers than did extrapulmonary granulomas. The amount of macrophages in the lung samples correlated with FVC (p < 0.05), whereas the amount of CD3+, CD4+, and CD8+ lymphocytes correlated with the FEV1/FVC ratio and VC. There were inverse correlations between TLC and the CD1a+ cell count (p < 0.05), as well as between DLCO and collagen/elastic fiber density (r = -0.90; p = 0.04). CONCLUSIONS: Immunophenotyping and remodeling both showed differences between pulmonary and extrapulmonary sarcoidosis in terms of the characteristics of the biopsy samples. These differences correlated with the clinical and spirometric data obtained for the patients, suggesting that two different pathways are involved in the mechanism of antigen clearance, which was more effective in the lungs and lymph nodes.
Asunto(s)
Matriz Extracelular/inmunología , Inmunidad Celular , Inmunofenotipificación/métodos , Sarcoidosis/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Biopsia , Colágeno/inmunología , Tejido Elástico/inmunología , Tejido Elástico/patología , Matriz Extracelular/patología , Femenino , Granuloma del Sistema Respiratorio/inmunología , Granuloma del Sistema Respiratorio/patología , Humanos , Pulmón/inmunología , Pulmón/patología , Ganglios Linfáticos/inmunología , Ganglios Linfáticos/patología , Linfocitos/inmunología , Macrófagos Alveolares/inmunología , Masculino , Persona de Mediana Edad , Sarcoidosis/patología , Sarcoidosis Pulmonar/inmunología , Sarcoidosis Pulmonar/patologíaRESUMEN
OBJETIVO: Investigar o significado de marcadores de imunidade celular e de componentes elásticos/colágeno da matriz extracelular em estruturas granulomatosas em biópsias de pacientes com sarcoidose pulmonar ou extrapulmonar. MÉTODOS: Determinações qualitativas e quantitativas de células inflamatórias, de fibras de colágeno e de fibras elásticas em estruturas granulomatosas em biópsias cirúrgicas de 40 pacientes com sarcoidose pulmonar e extrapulmonar foram realizadas por histomorfometria, imuno-histoquímica, e técnicas de coloração com picrosirius e resorcina-fucsina de Weigert. RESULTADOS: A densidade de linfócitos, macrófagos e neutrófilos nas biópsias extrapulmonares foi significativamente maior do que nas biópsias pulmonares. Os granulomas pulmonares apresentaram uma quantidade significativamente maior de fibras de colágeno e menor densidade de fibras elásticas que os granulomas extrapulmonares. A quantidade de macrófagos nos granulomas pulmonares correlacionou-se com CVF (p < 0,05), ao passo que as quantidades de linfócitos CD3+, CD4+ e CD8+ correlacionaram-se com a relação VEF1/CVF e com CV. Houve correlações negativas entre CPT e contagem de células CD1a+ (p < 0,05) e entre DLCO e densidade de fibras colágenas/elásticas (r = -0,90; p = 0,04). CONCLUSÕES: A imunofenotipagem e o remodelamento apresentaram características diferentes nas biópsias dos pacientes com sarcoidose pulmonar e extrapulmonar. Essas diferenças correlacionaram-se com os dados clínicos e espirométricos dos pacientes, sugerindo que há duas vias envolvidas no mecanismo de depuração de antígenos, que foi mais eficaz nos pulmões e linfonodos.
OBJECTIVE: To investigate the significance of cellular immune markers, as well as that of collagen and elastic components of the extracellular matrix, within granulomatous structures in biopsies of patients with pulmonary or extrapulmonary sarcoidosis. METHODS: We carried out qualitative and quantitative evaluations of inflammatory cells, collagen fibers, and elastic fibers in granulomatous structures in surgical biopsies of 40 patients with pulmonary and extrapulmonary sarcoidosis using histomorphometry, immunohistochemistry, picrosirius red staining, and Weigert's resorcin-fuchsin staining. RESULTS: The extrapulmonary tissue biopsies presented significantly higher densities of lymphocytes, macrophages, and neutrophils than did the lung tissue biopsies. Pulmonary granulomas showed a significantly higher number of collagen fibers and a lower density of elastic fibers than did extrapulmonary granulomas. The amount of macrophages in the lung samples correlated with FVC (p < 0.05), whereas the amount of CD3+, CD4+, and CD8+ lymphocytes correlated with the FEV1/FVC ratio and VC. There were inverse correlations between TLC and the CD1a+ cell count (p < 0.05), as well as between DLCO and collagen/elastic fiber density (r = -0.90; p = 0.04). CONCLUSIONS: Immunophenotyping and remodeling both showed differences between pulmonary and extrapulmonary sarcoidosis in terms of the characteristics of the biopsy samples. These differences correlated with the clinical and spirometric data obtained for the patients, suggesting that two different pathways are involved in the mechanism of antigen clearance, which was more effective in the lungs and lymph nodes.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Matriz Extracelular/inmunología , Inmunidad Celular , Inmunofenotipificación/métodos , Sarcoidosis/inmunología , Análisis de Varianza , Biopsia , Colágeno/inmunología , Tejido Elástico/inmunología , Tejido Elástico/patología , Matriz Extracelular/patología , Granuloma del Sistema Respiratorio/inmunología , Granuloma del Sistema Respiratorio/patología , Pulmón/inmunología , Pulmón/patología , Ganglios Linfáticos/inmunología , Ganglios Linfáticos/patología , Linfocitos/inmunología , Macrófagos Alveolares/inmunología , Sarcoidosis Pulmonar/inmunología , Sarcoidosis Pulmonar/patología , Sarcoidosis/patologíaRESUMEN
Our medical staff identified a case of a forty-six years old Armed Force active duty female that presented with multiple systemic and pulmonary signs and symptoms, such as hemoptysis, arthralgias, chest pain and dyspnea after being exposed to a humid and old wooden building one year ago in the state of Georgia. Various imaging studies (cervical & thoracic x-rays and CT Scans), revealed diffuse small nodules at cervical & thoracic areas, osteolytic lesions and lymphadenopathy. Suspecting a malignant process, a PET-CT Scan was performed revealing a right lung lower lobe nodule consistent with a primary malignancy, metastatic disease, active infectious or inflammatory process. She underwent a CT-guided needle biopsy followed by an open thoracotomy. These results were negative for malignancy and positive for chronic granulomatous inflammatory process. Therefore, special immunologic stains were undertaken revealing a granulomatous process with Histoplasmosis capsulatum. This case was diagnosed in the most unusual manner, given the presenting symptoms and pathological findings which suggested a malignant process, later confirmed by multiple specialized imaging studies and tests. This presumptive diagnosis turned out to be an inflammatory/infectious (fungal) process. We must keep in mind that not all mass lesions encountered by special imaging studies should be considered malignant. This case exemplifies the need of clinicians to exercise strong clinical and critical thinking skills to consider the broad diagnostic possibilities of pulmonary nodules presenting as a malignancy.
Asunto(s)
Errores Diagnósticos , Granuloma del Sistema Respiratorio/etiología , Histoplasmosis/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Personal Militar , Enfermedades Profesionales/diagnóstico por imagen , Tomografía de Emisión de Positrones , Nódulo Pulmonar Solitario/etiología , Tomografía Computarizada por Rayos X , Biopsia con Aguja , Exposición a Riesgos Ambientales , Reacciones Falso Positivas , Femenino , Georgia , Granuloma del Sistema Respiratorio/diagnóstico por imagen , Granuloma del Sistema Respiratorio/patología , Histoplasma/aislamiento & purificación , Histoplasmosis/complicaciones , Histoplasmosis/patología , Humanos , Enfermedades Pulmonares Fúngicas/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Enfermedades Profesionales/patología , Osteólisis/etiología , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Espondilitis/etiología , ToracotomíaRESUMEN
Tuberculosis (TB) pleural disease is complicated by extensive tissue destruction. Matrix metalloproteinase (MMP)-1 and -9 are implicated in immunopathology of pulmonary and central nervous system TB. There are few data on MMP activity in TB pleurisy. The present study investigated MMP-1, -2 and -9 and their specific inhibitors (tissue inhibitor of metalloproteinase (TIMP)-1 and -2) in tuberculous effusions, and correlated these with clinical and histopathological features. Clinical data, routine blood tests, and pleural fluid/biopsy material were obtained from 89 patients presenting with pleural effusions in a TB-endemic area. MMP-1, -2 and -9 were measured by zymography or western blot, and TIMP-1 and -2 by ELISA. Pleural biopsies were examined microscopically, cultured for acid-alcohol fast bacilli and immunostained for MMP-9. Tuberculous pleural effusions contained the highest concentrations of MMP-9 compared with malignant effusions or heart failure transudates. MMP-9 concentrations were highest in effusions from patients with granulomatous biopsies: median (interquartile range) 108 (61-218) pg x mL(-1) versus 43 (12-83) pg x mL(-1) in those with nongranulomatous pleural biopsies. MMP-1 and -2 were not upregulated in tuberculous pleural fluid. The ratio of MMP-9:TIMP-1 was significantly higher in TB effusions. Tuberculous pleurisy is characterised by a specific pattern of matrix metalloproteinase-9 upregulation, correlating with the presence of granulomas and suggesting a specific role for matrix metalloproteinase-9 in inflammatory responses in tuberculous pleural disease.
Asunto(s)
Granuloma del Sistema Respiratorio/etiología , Metaloproteinasa 9 de la Matriz/metabolismo , Tuberculosis Pleural/enzimología , Tuberculosis Pleural/patología , Adulto , Anciano , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Granuloma del Sistema Respiratorio/enzimología , Granuloma del Sistema Respiratorio/patología , Humanos , Masculino , Metaloproteinasa 1 de la Matriz/metabolismo , Persona de Mediana Edad , Derrame Pleural/enzimología , Derrame Pleural/etiología , Derrame Pleural/patología , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-2/metabolismo , Tuberculosis Pleural/complicacionesRESUMEN
Um eqüino de nove anos de idade apresentou ausência de ar expirado e secreção serossanguinolenta na narina direita, associado a ruído respiratório. Os exames endoscópico e radiológico mostraram uma formação de aproximadamente seis centímetros de diâmetro recoberta por mucosa amarelada, que obstruía a cavidade nasal direita e insinuava-se para a cavidade nasal esquerda. Tal massa foi ressecada por meio de sinusotomia frontal direita. O exame histológico e a cultura revelaram lesão granulomatosa causada por fungos. O tratamento pós-operatório compreendeu associação de antibiótico e antiinflamatório, assim como de lavagens com água destilada e chá de camomila.
A 9-year-old horse presented serosanguineous nasal discharge, absence of breath out through the right nostril, and respiratory noise. Endoscopic and radiographic exams revealed a six centimeter diameter mass, covered by yellowish mucosa, which was obstructing the entire right nasal cavity and part of the left one. The mass was excised through a right frontal sinusotomy. The microscopic exam and the culture revealed a fungic granulomatous rhinitis. Antibiotic and anti-inflammatory drugs were postoperatively administered; moreover, camomile tea and distilled water were flushed in a drain placed above the bone flap.
Asunto(s)
Animales , Antibacterianos , Antiinflamatorios , Aspergilosis , Aspergillus , Criptococosis , Equidae , Granuloma del Sistema RespiratorioRESUMEN
Um eqüino de nove anos de idade apresentou ausência de ar expirado e secreção serossanguinolenta na narina direita, associado a ruído respiratório. Os exames endoscópico e radiológico mostraram uma formação de aproximadamente seis centímetros de diâmetro recoberta por mucosa amarelada, que obstruía a cavidade nasal direita e insinuava-se para a cavidade nasal esquerda. Tal massa foi ressecada por meio de sinusotomia frontal direita. O exame histológico e a cultura revelaram lesão granulomatosa causada por fungos. O tratamento pós-operatório compreendeu associação de antibiótico e antiinflamatório, assim como de lavagens com água destilada e chá de camomila.(AU)
A 9-year-old horse presented serosanguineous nasal discharge, absence of breath out through the right nostril, and respiratory noise. Endoscopic and radiographic exams revealed a six centimeter diameter mass, covered by yellowish mucosa, which was obstructing the entire right nasal cavity and part of the left one. The mass was excised through a right frontal sinusotomy. The microscopic exam and the culture revealed a fungic granulomatous rhinitis. Antibiotic and anti-inflammatory drugs were postoperatively administered; moreover, camomile tea and distilled water were flushed in a drain placed above the bone flap.(AU)
Asunto(s)
Animales , Granuloma del Sistema Respiratorio , Aspergillus , Criptococosis , Equidae , Aspergilosis , Antibacterianos , AntiinflamatoriosRESUMEN
Tuberculosis/HIV-1 co-infection is responsible for thousands of deaths each year, and previous studies have reported that co-infected individuals display major morphological alterations in tissue granulomas. The purpose of this study was to evaluate immunohistopathological characteristics in lung tissues from pulmonary TB/HIV-1-co-infected individuals. Following autopsy, tuberculosis-positive HIV-1-negative cases displayed granulomas with normal architecture, mainly composed of a mononuclear infiltrate with typical epithelioid, as well as giant cells, and exhibiting caseous necrosis. In contrast, lesions from the TB/HIV-1-co-infected group showed extensive necrosis, poorly formed granulomas, and a marked presence of polymorphonuclear cells. More importantly, TNF staining was greatly reduced in the TB/HIV-1-co-infected individuals. Our data suggest that HIV-1 infection alters the organization of pulmonary granulomas by modulating TNF and, possibly, cell trafficking, leading to an impaired anti-tuberculosis response.
Asunto(s)
Granuloma del Sistema Respiratorio/inmunología , Infecciones por VIH/complicaciones , Pulmón/inmunología , Tuberculosis Pulmonar/complicaciones , Factor de Necrosis Tumoral alfa/biosíntesis , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Granuloma del Sistema Respiratorio/microbiología , Granuloma del Sistema Respiratorio/patología , Infecciones por VIH/inmunología , Infecciones por VIH/patología , VIH-1 , Humanos , Pulmón/microbiología , Pulmón/patología , Mycobacterium tuberculosis , Tuberculosis Pulmonar/inmunología , Tuberculosis Pulmonar/patologíaRESUMEN
Necrotizing sarcoid granulomatosis (NSG) is a rare entity mainly characterized by a prominent granulomatous vasculitis affecting middle-aged or old individuals and with a favorable prognosis. Although many believe it is a variant of sarcoidosis, the proper classification is still a matter of debate as some of its features are found in sarcoidosis but also in Churg-Strauss syndrome, Wegener's disease and hypersensitivity pneumonitis. In this paper, we described for the first time a case of NSG in a family with several cases of sarcoidosis, reinforcing the relationship between NSG and sarcoidosis. Additional interesting findings were the young age of the patient (15 years old), the symptoms limited to the respiratory tract (uncommon when NSG affects youngsters) and the increase in serologic markers of autoimmune disease. Though complete criteria for autoimmune disease were not present, systemic lupus erythematosus and Sjogren's syndrome are possible candidates. As sarcoidosis is described to be associated with several autoimmune diseases, this finding is an additional suggestion of the relationship between both entities.
Asunto(s)
Granuloma del Sistema Respiratorio/genética , Pulmón/patología , Sarcoidosis Pulmonar/genética , Adolescente , Corticoesteroides/uso terapéutico , Anciano , Femenino , Granuloma del Sistema Respiratorio/tratamiento farmacológico , Granuloma del Sistema Respiratorio/patología , Humanos , Persona de Mediana Edad , Necrosis , Linaje , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar/patologíaRESUMEN
Objetivos: realizar una recopilación biográfíca de los primeros descriptores de la granulomatosis de Wegener (GW) y establecer de una manera detallada los principales hechos que marcaron la evolución de la GW hasta nuestros días.Material y métodos: revisión sistemática de la literatura desde 1866 a 2007 a través de Pubmed, Embase, Ovid, Sciencedirect, SpringerLink, Blackwell Synergy, Highwire y búsqueda en la biblioteca de la Universidad Nacional de Colombia Resultados: se encontraron 4.588 artículos con relación a la GW, de los cuales seleccionamos en idiomas inglés y alemán, con énfasis en revisiones históricas médicas, ensayos clínicos relevantes, estudios controlados, aleatorizados y revisiones en general, con interés para las principales asociaciones médicas, quedando al final un conglomerado de 89 fuentes bibliográficas. Los datos biográficos de los descriptores iniciales están sujetos principalmente a la literatura alemana, muchos datos se perdieron en los escrutinios alemanes y polacos. Conclusiones: las descripciones de la literatura en cuanto al reconocimiento de la GW se centra en el norte de Europa, su descripción se asoció a la de otras vasculitis y permitió reforzar los conocimientos inmunológicos del presente. Observamos cómo la clínica, el tratamiento y posteriormente los estudios paraclínicos fueron ampliándose cada día, logrando así que muchos conceptos originados hace más de 40 años hagan parte de los regímenes actuales.
Objectives: make a biographical compilation of the first ones who described the WG and establishin a detailed way the main facts that marked the evolution of the WG to the present time. Material and methods: a systematic review of literature from 1866 to 2007 through Pubmed,Embase, Ovid, Sciencedirect, SpringerLink, Blackwell Synergy, Highwire and searches in the libraryof the National University of ColombiaResults: There were 4588 articles found related to WG, from which we selected in English and German language, with emphasis in medical historical revisions, relevant clinical tests, controlledrandomizeds studies and revisions in general, with interest for the main medical associations and also to the consideration of the authors of this review. Being left in the end a conglomerate of 89. The bibliographic data of the first describers are attached mainly to german literature, many of thisinformation was lost in the German and Polish scrutinies. Conclusions: the descriptions of literature as far as the recognition of WG are focused in thenorthern Europe, its description was associated to those of other vaculitis and allowed to reinforceimmunological knowledge which is basic in the present. We observed how the clinic, the treatment and later de paraclinic studies were extended every day, and how many concepts created more than 40 years ago are still part of actual regimes.
Asunto(s)
Biografía , Granuloma del Sistema Respiratorio , Granulomatosis con Poliangitis , Historia de la Medicina , Riñón , VasculitisRESUMEN
A number of clinicopathological manifestations may define the presence of hypersensitivity pneumonitis. Histological study is used to establish the diagnosis and to differentiate the disease from other respiratory disorders. This case report suggests that immunohistological demonstration of the causative antigen in the lung may be a useful diagnostic approach in cases of pigeon hypersensitivity pneumonitis. A 52 year-old woman was studied. She had a prior history of pigeon exposure, and lived in an area with a high prevalence of tuberculosis. Her clinical presentation, respiratory function tests and imaging studies revealed a predominant interstitial lung disease. The results of antiavian antibodies, bronchoalveolar analysis, and other laboratory parameters were non-diagnostic. A lung biopsy showed a prominent granulomatous reaction with a sarcoid-like appearance in some areas, and an interstitial infiltration constituted by lymphocytes, plasma cells and foamy macrophages. Although the disease manifestations were compatible with hypersensitivity pneumonitis, we decided to study the causal antigen by immunohistochemistry. The use of a polyclonal antibody raised against pigeon serum showed a predominant cytoplasmic immunostaining in multinucleated giant cells and histiocytes from lung granulomas. Other respiratory disorders were reasonably excluded. Previous exposure to a known antigen may support the diagnosis of hypersensitivity pneumonitis. Although the inhalation of organic dusts may be clinically evident, the aetiology is commonly evaluated by different challenge tests or immunological methods. We propose that the study of pigeon antigen by immunohistochemistry may be used as part of the diagnostic approach for hypersensitivity pneumonitis.
Asunto(s)
Pulmón de Criadores de Aves/diagnóstico , Columbidae/inmunología , Granuloma del Sistema Respiratorio/inmunología , Pulmón/patología , Animales , Biopsia con Aguja , Pulmón de Criadores de Aves/inmunología , Disnea/etiología , Femenino , Humanos , Inmunohistoquímica , Persona de Mediana EdadRESUMEN
Four patients with clinical diagnosis of interstitial lung disease (ILD) are presented. In these patients, lung biopsies revealed bronchocentric granulomatosis (BG), pulmonary alveolar proteinosis (PAP), diffuse alveolar damage (DAD), and in one biopsy, the clinical manifestations suggested tuberculous primo-infection with systemic dissemination. Three patients died without diagnosis. In all four cases, specific histological stains found Histoplasma capsulatum. Histoplasmosis may mimic other infectious or non-infectious pulmonary diseases, such as interstitial and granulomatous pulmonary disease. Therefore, the absolute need for identification of the organism by culture or special stains cannot be over-emphasized and may lead to a proper mycological diagnosis. This highlights the importance of differential diagnosis with systemic infectious diseases, especially in areas where deep-seated mycosis are endemic.
Asunto(s)
Histoplasma/aislamiento & purificación , Histoplasmosis/patología , Enfermedades Pulmonares Fúngicas/patología , Adulto , Anciano , Biopsia , Diagnóstico Diferencial , Femenino , Granuloma del Sistema Respiratorio/microbiología , Granuloma del Sistema Respiratorio/patología , Histoplasmosis/microbiología , Humanos , Lactante , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Proteinosis Alveolar Pulmonar/microbiología , Proteinosis Alveolar Pulmonar/patología , Tuberculosis/microbiología , Tuberculosis/patologíaRESUMEN
Granulomatose broncocêntrica é um achado histopatológico descritivo, caracterizado pela inflamação granulomatosa necrosante, centrada em brônquios e bronquíolos, e que ocorre associada a doenças infecciosas, imunológicas e neoplásicas, ou de forma idiopática. Este trabalho relata o caso de uma jovem não asmática de 26 anos com dor torácica, febre e tosse produtiva havia um mês, que apresentou consolidação e cavitação em segmento lingular, observadas na radiografia e na tomografia computadorizada de tórax. Punção aspirativa transbrônquica evidenciou lesão inflamatória inespecífica, sem etiologia identificada. O exame histológico de material obtido por biópsia pulmonar a céu aberto foi compatível com granulomatose broncocêntrica idiopática. Após tratamento com prednisona, houve melhora clínica, sem recidivas.
Asunto(s)
Humanos , Femenino , Adulto , Antiinflamatorios , Granuloma del Sistema Respiratorio/diagnóstico , Granuloma del Sistema Respiratorio/tratamiento farmacológico , Prednisona/uso terapéutico , Granuloma del Sistema Respiratorio/patologíaRESUMEN
Informamos el primer caso de granuloma nasal zigomicótico que se diagnostica en nuestro país. El caso se trató de un lactante de 10 meses de edad quien adquirió la enfermedad en el período de convalecencia de una rubéola. En su primera fase la evolución fue tórpida, al extremo de que el proceso llegó a desfigurar la cara del niño, planteándose la posibilidad de que se tratase de un granuloma maligno mediofacial, ante la imposibilidad de aislar el agente etiológico en los cultivos micológicos. Se pudo establecer el diagnóstico mediante coloraciones especiales realizadas a una segunda biopsia, donde se encontraron hifas septadas y el fenómeno de Splendore Hoeppli. El agente etiológico posiblemente se trataba del Basisdoobolus meristosporus. La evolución final fue exitosa con la curación del proceso mediante tratamiento con Anfotericin B(AU)