RESUMEN
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
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
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)