Role of FNA and Special Stains in Rapid Cytopathological Diagnosis of Pulmonary Nocardiosis

2018 ◽  
Vol 62 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Ridhi Sood ◽  
Ruchita Tyagi ◽  
Pavneet Kaur Selhi ◽  
Gursheen Kaur ◽  
Harpreet Kaur ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Periodic Acid ◽  
Tertiary Care ◽  
Opportunistic Pathogen ◽  
Clinical Findings ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Periodic Acid Schiff ◽  
Pulmonary Nocardiosis ◽  
Inflammatory Infiltrates

Background: Nocardia, a gram-positive aerobic bacillus of the Actinomycetales family, is a significant opportunistic pathogen in immunocompromised individuals. Clinical and radiological features of pulmonary nocardiosis are nonspecific and can be misdiagnosed as tuberculosis, pneumocystis, staphylococcal or fungal infections, or as malignancy. Aspiration cytology with special stains is a quick and effective approach for accurate diagnosis. Materials and Methods: We present 7 cases of pulmonary nocardiosis, admitted to the pathology department in a tertiary-care hospital in Punjab. Clinical findings, immune status, laboratory tests, chest radiographs, and computed tomography scans were reviewed. Cytologically, special stains like 1% Ziehl-Neelsen (ZN), 20% ZN, periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), and reticulin stains were studied along with May-Grünwald Giemsa, Papanicolaou, and hematoxylin and eosin. Results: All the patients were immunocompromised. The radiological changes were nonspecific. Cytomorphology showed acute and chronic inflammatory infiltrates with necrosis. None of the cases showed well-defined granulomas. GMS, modified 1% ZN and, Gordon and Sweet reticulin stains highlighted the delicate filamentous bacteria in all cases. PAS and 20% ZN stain for tuberculous bacilli were uniformly negative. Conclusion: FNAC can provide a quick and accurate diagnosis of nocardiosis and thereby facilitate timely medical management.

scholarly journals Vascular malformations of central nervous system: A series from tertiary care hospital in South India

2016 ◽  
Vol 07 (02) ◽  
pp. 262-268
Author(s):  
Sudhir Babu Karri ◽  
Megha S. Uppin ◽  
A. Rajesh ◽  
K. Ashish ◽  
Suchanda Bhattacharjee ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Vascular Malformations ◽  
Demographic Data ◽  
Periodic Acid ◽  
Tertiary Care ◽  
Care Hospital ◽  
Periodic Acid Schiff ◽  
Radiological Features ◽  
Risk Of Hemorrhage

ABSTRACT Aims and Objectives: To describe clinicopathological features of surgically resected vascular malformations (VMs) of central nervous system (CNS). Materials and Methods: Histologically diagnosed cases of VMs of CNS during April 2010–April 2014 were included. Demographic data, clinical and radiological features were obtained. Hematoxylin and eosin slides were reviewed along with Verhoeff-Van Gieson (VVG), Masson’s trichrome, periodic acid-Schiff, and Perls’ stains. Morphologically, cavernomas and arteriovenous malformations (AVMs) were distinguished on the basis of vessel wall features on VVG and intervening glial parenchyma. Results: Fifty cases were diagnosed as VMs of CNS with an age range of 14–62 years. These included 36 cavernomas, 12 AVMs, 2 mixed capillary-cavernous angiomas. Most of the cavernoma patients (15/36) presented with seizures, whereas AVM patients (8/12) had a headache as the dominant symptom. Twenty-nine patients were reliably diagnosed on radiological features. Microscopic evidence of hemorrhage was seen in 24/36 cavernomas and 6/12 AVMs, as opposed to radiologic evidence of 10 and 4, respectively. Reactive gliosis was seen in 16 cavernomas. Conclusions: Histological features are important for classifying the VMs of CNS as there are no specific clinical and radiological features. Type of VM has a bearing on management, prognosis, and risk of hemorrhage.

scholarly journals Granulomatous dermatosis: histopathological study in a tertiary care hospital

2017 ◽  
Vol 5 (9) ◽  
pp. 3869
Author(s):  
Teerthanath Srinivas ◽  
Hariprasad S.
Keyword(s):  
Clinical Data ◽  
Histopathological Examination ◽  
Periodic Acid ◽  
Tertiary Care ◽  
Histological Finding ◽  
Histopathological Study ◽  
Care Hospital ◽  
Diagnostic Challenge ◽  
Morphological Pattern ◽  
Periodic Acid Schiff

Background: Granulomatous dermatosis shares the histological finding of granuloma formation; it is usually formed because of the persistence of a non-degradable product of active hypersensitivity. The identical histological picture may be produced by several causes, which pose a diagnostic challenge to dermatopathologist, Present study aims at classifying cutaneous granulomatous dermatosis based on the morphology and aetiology of granulomas, and to highlight its significance for specific clinical diagnosis.Methods: A retrospective analysis of skin biopsy was done and cases of cutaneous granulomatous lesions diagnosed on histopathological examination were retrieved for a period of 8 years. Clinical data and diagnosis were retrieved from hospital records. Hematoxylin and eosin stained paraffin sections were reviewed. The morphological pattern of granuloma was classified into sarcoidal, necrotizing, necrobiotic and suppurative granulomas and further aetiological evaluation for the granulomatous dermatosis were done using various special stains like Periodic Acid Schiff stain, Fite-Farraco stain, Gomori methenamine silver stain and acid-fast bacilli stain.Results: A total of 228 cases of cutaneous granulomatous lesion were retrieved; out of these 93cases (40.79%) were sarcoidal granuloma type, 83cases (36.40%) were of suppurative granulomas, 29 cases (12.72%) were of necrobiotic granulomas, 20 cases (8.77%) were necrotizing granuloma and 3 cases (1.32%) had granulomatous dermatitis with vasculitis. Infective aetiology was the commonest cause for granulomatous dermatosis (57.89%), mainly by leprosy, tuberculosis and various fungal infection.Conclusions: Granulomatous dermatosis has significant overlap in histopathological picture of various granulomatous reactions. Morphology alone is seldom specific and cannot be used as diagnostic tool. It is better understood based adequate clinical data, morphology of granuloma, special stains and laboratory workup in arriving at a etiology specific diagnosis for definitive clinical management.

scholarly journals Clinico-morphological Profile of Cutaneous Fungal Infections: An Experience from a Tertiary Care Government Hospital in North India

2021 ◽  
Vol 8 (2) ◽  
pp. A56-62
Author(s):  
Ekta Jain ◽  
Rajpal Singh Punia ◽  
Jagdish Chander ◽  
Mala Bhalla
Keyword(s):  
Fungal Infections ◽  
Periodic Acid ◽  
Critical Role ◽  
Tertiary Care ◽  
Rapid Identification ◽  
Histochemical Staining ◽  
North India ◽  
Fungal Culture ◽  
Periodic Acid Schiff ◽  
Fixed Tissue

Background: Cutaneous fungal infections are predominantly seen in hot tropical countries like India. In the past decade, there has been an escalation in recurrent and chronic fungal infections. Skin biopsy may play a critical role in rapid identification of these infections. Methods: Fifteen cases of cutaneous fungal infections over a period of 6 years were included. Formalin-fixed tissue was subjected to hematoxylin and eosin and histochemical staining including Gomori Methanamine Silver and Periodic Acid Schiff . Results of KOH smear test and fungal culture were included wherever available. The clinico-morphological patterns in various cutaneous fungal infections was evaluated. Results: Most patients were between 25 to 40 years of age and commonly presented as skin ulceration, followed by nodular swelling and multiple discharging sinuses. Candidiasis and Mycetoma infections were the commonest infections. Others included: Cryptococcosis, Dermatophytosis, Chromoblastomycosis and Mucormycosis. The predominant histopathologic patterns were perivascular and interstitial inflammation. Eleven cases were confirmed by KOH examination and culture. Conclusion: The morphologic spectrum of cutaneous fungal infections is varied. Initial presentations of these fungal infections may be indicative of the onset of a life-threatening systemic mycoses. Thus, the histopathologic evaluation of skin tissue specimens is critical for their rapid and accurate diagnosis.

Conjunctival myxoid stromal tumour: a distinctive clinicopathological and immunohistochemical study

2018 ◽  
Vol 103 (9) ◽  
pp. 1259-1265 ◽  
Author(s):  
Xiao-Yi Qin ◽  
Zhe-Hao Jin ◽  
You-Pei Wang ◽  
Zong-Duan Zhang
Keyword(s):  
Smooth Muscle Actin ◽  
Periodic Acid ◽  
Clinical Findings ◽  
Stromal Tumour ◽  
Bulbar Conjunctiva ◽  
Low Grade ◽  
Ki 67 ◽  
Periodic Acid Schiff ◽  
Multiple Spindle ◽  
Immunohistochemical Stains

Background/aimsTo describe the clinicopathological and immunohistochemical characteristics of 10 patients representing a new entity of benign conjunctival myxoid stromal tumours.MethodsRetrospective review of clinical findings, histopathological and immunohistochemical studies identified 10 cases of low-grade conjunctival myxoid stromal tumours. Specimens were routinely processed and stained with H&E. Immunohistochemical stains for CD34, CD68, vimentin, S100, smooth muscle actin (SMA), myosin, desmin, actin, Bcl-2 and Ki-67 were performed. Specific stains for Alcian-blue periodic acid-Schiff (AB-PAS) and aldehyde fuchsin stains were also performed.ResultsTen patients with an average age of 45.6±11.1 years had a tender white or faint yellow to red mass on the bulbar conjunctiva. All the lesions were completely removed, and none of the patients relapsed. Histologically, all neoplasms consisted of spindle-shaped cells that showed signs of pseudonuclear inclusions, multinuclear cells and had no atypia. The stroma consisted of a large amount of mucus and was infiltrated with delicate to ropey collagens, a few mast cells and new vessels. Immunohistochemical stains were positive for CD34, vimentin and Bcl-2; partial positive for CD68; very low for Ki-67; and negative for S100, SMA, myosin, desmin and actin. AB-PAS suggested that the stroma was mucinous.ConclusionsThese rare benign mesenchymal conjunctival tumours are mostly unilateral and occur in the bulbar conjunctiva. Complete resection is the radical treatment. These lesions are characterised by multiple spindle cells, a large amount of mucus, and sharing similar basic histopathological features with conjunctival myxoma and conjunctival stromal tumour. We suggest naming these lesions ‘conjunctival myxoid stromal tumours’.

scholarly journals Epidemiological characterization of dermatophytes at a tertiary care hospital in Eastern Uttar Pradesh, India

2019 ◽  
Author(s):  
Ankur Kumar ◽  
Vandana Upadhyay ◽  
Amresh K. Singh ◽  
Jayesh Pandey
Keyword(s):  
Low Socioeconomic Status ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Common Species ◽  
Personal Hygiene ◽  
Clinical Samples ◽  
Care Hospital ◽  
Direct Microscopic Examination ◽  
Superficial Mycosis

Background and Purpose: Superficial mycosis is more prevalent in tropical and subtropical countries, such as India. Regarding this, the present study was conducted to determine the epidemiology of superficial mycosis and identify the most common dermatophytic species in this region. Materials and Methods: For the purpose of the study, a total of 220 skin scraping, nail, and hair root specimens were collected. Direct microscopic examination was performed using potassium hydroxide mount. Additionally, the samples were inoculated onto Sabouraud dextrose agar (SDA) and dermatophyte test medium (DTM). The fungal colony of each isolates was stained with lactophenol cotton blue mount, and observed under microscope for species identification. Results: Out of 220 isolates, 172 samples, obtained from 108 males 64 females, were positive for skin fungal infections by either KOH mount or culture. Furthermore, 113 isolates were identified as dermatophytes, while 59 samples were found to be non-dermatophytes. Among the dermatophytes isolated from different clinical samples, Trichophyton verrucosum (42/113, 38%) was the most common species, and Tinea corporis was the most common infection (36.2%). Conclusion: As the findings indicated, dermatophytes had an isolation rate of 78%, which is higher than normal. This can be due to the fact that the majority of the patients were from a rural background (71.7%) with a low socioeconomic status and poor personal hygiene who were exposed to climatic changes.

scholarly journals Implementation of Pharmacist-driven Antifungal Stewardship Program in A Tertiary Care Hospital

2021 ◽  
Author(s):  
Emre Kara ◽  
Gokhan Metan ◽  
Aygin Bayraktar-Ekincioglu ◽  
Dolunay Gulmez ◽  
Sevtap Arikan-Akdagli ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Clinical Pharmacist ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Antifungal Stewardship ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antifungal Use

Objectives: Antifungal stewardship (AFS) is recommended to reduce the inappropriate use of antifungal drugs. In this study, the role of AFS in providing appropriate antifungal therapy was evaluated. Methods: This study included three periods as observation, feedback/education, and daily AFS activities. In observation period, the use of systemic antifungals was evaluated for a baseline measurement of appropriateness. In second period, monthly meetings were organized to provide feedback and education to physicians regarding antifungal therapy and the rate of adherence to the clinical guidelines. In final period, a clinical pharmacist participated in daily ward rounds to evaluate appropriateness of the antifungal therapy. A scoring system for appropriateness was used for comparison between the three periods. Results: Four hundred and eighteen episodes of antifungal therapy were evaluated. Baseline demographics of patients were similar in all three periods for age, gender, and the number of comorbidities. The indications for antifungal use were for prophylaxis in 22.7%, Candida infections in 58.6%, and invasive mould infections in 18.7%. During the third period, 157 (78.9%) recommendations were made and 151 (96.2%) were accepted. The overall appropriateness of antifungal use increased significantly for prophylaxis (30.8%, 17.9%, 46.3%, p=0.046) and treatment of fungal diseases (27.8%, 32.4%, 71.9%, p<0.001) between the first, second and third periods, respectively. A 30-day mortality was not significantly changed between the three periods (19%, 15.6% and 27.5%; p=0.050). Conclusions: Appropriateness in antifungal therapy can be augmented by the integration of an AFS program. A team-based evaluation of fungal infections and assessment of patients by a clinical pharmacist with a therapeutic perspective may help to increase the quality of antifungal therapy.

scholarly journals Evaluation of a step-by-step approach to frozen section diagnosis in ovarian masses

2021 ◽  
Vol 12 (12) ◽  
pp. 133-139
Author(s):  
Ashumi Gupta ◽  
Neelam Jain
Keyword(s):  
Sensitivity And Specificity ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Tertiary Care ◽  
False Negative ◽  
Significant Proportion ◽  
False Negative Rate ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Ovarian Masses

Background: Ovarian cancer forms a significant proportion of cancer-related mortality in females. It is often detected late due to non-specific clinical presentation. Radiology and tumor markers may indicate an ovarian mass. However, exact diagnosis requires pathological evaluation, which may not be possible before surgery. Intraoperative frozen section (FS) is, therefore, an important modality for the diagnosis of ovarian masses. Aims and Objectives: This study was conducted to study step-by-step approach along with diagnostic utility and accuracy of intraoperative FS in diagnosis of ovarian masses. Materials and Methods: Retrospective comparative analysis was done to determine the diagnostic accuracy of FS as compared to routine histopathology in the pathology department of a tertiary care hospital. Diagnostic categorization was done into benign, borderline, and malignant. Overall accuracy, sensitivity, and specificity of FS technique were calculated. Results: Out of 51 cases, FS analysis yielded accurate diagnosis in 94.1% of ovarian masses. Intraoperative FS had a sensitivity of 94.7%, specificity of 96.9%, 3.1% false-positive rate, and 5.3% false-negative rate in malignant tumors. In benign lesions, FS had 91.7% sensitivity and 100% specificity. FS had 75% sensitivity and 96.4% specificity in cases of borderline tumors. Conclusion: FS is a fairly accurate technique for intraoperative evaluation of ovarian masses. It can help in deciding the extent of surgery. It distinguishes benign and malignant tumors in most cases with high sensitivity and specificity. A methodical approach is useful in determining accurate diagnosis on FS diagnosis.

scholarly journals Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ravinder Kaur ◽  
Megh S. Dhakad ◽  
Ritu Goyal ◽  
Preena Bhalla ◽  
Richa Dewan
Keyword(s):  
Fungal Infections ◽  
Tertiary Care ◽  
North India ◽  
Clinical Samples ◽  
Fungal Culture ◽  
Care Hospital ◽  
Aids Patients ◽  
Cell Counts ◽  
Fungal Isolates ◽  
Hiv Aids

HIV related opportunistic fungal infections (OFIs) continue to cause morbidity and mortality in HIV infected patients. The objective for this prospective study is to elucidate the prevalence and spectrum of common OFIs in HIV/AIDS patients in north India. Relevant clinical samples were collected from symptomatic HIV positive patients (n=280) of all age groups and both sexes and subjected to direct microscopy and fungal culture. Identification as well as speciation of the fungal isolates was done as per the standard recommended methods. CD4+T cell counts were determined by flow cytometry using Fluorescent Activated Cell Sorter Count system. 215 fungal isolates were isolated with the isolation rate of 41.1%.Candidaspecies (86.5%) were the commonest followed byAspergillus(6.5%),Cryptococcus(3.3%),Penicillium(1.9%), andAlternariaandRhodotorulaspp. (0.9% each). AmongCandidaspecies,Candida albicans(75.8%) was the most prevalent species followed byC. tropicalis(9.7%),C. krusei(6.4%),C. glabrata(4.3%),C. parapsilosis(2.7%), andC. kefyr(1.1%). Study demonstrates that the oropharyngeal candidiasis is the commonest among different OFIs and would help to increase the awareness of clinicians in diagnosis and early treatment of these infections helping in the proper management of the patients especially in resource limited countries like ours.

scholarly journals FUNGAL PROFILE OF INFECTIOUS KERATITIS IN A TERTIARY CARE HOSPITAL - OUR EXPERIENCE

2012 ◽  
Vol 02 (02) ◽  
pp. 10-14
Author(s):  
Sanjeev H. ◽  
Karnaker Vimal K. ◽  
Pai Vijay ◽  
Pai Asha K. B. ◽  
Rai Rekha ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Positive Culture ◽  
Clinical Findings ◽  
Care Hospital ◽  
Infectious Keratitis ◽  
Mycotic Keratitis ◽  
Direct Microscopy ◽  
Ocular Morbidity ◽  
Positive Direct ◽  
High Degree

AbstractInfectious keratitis world wide are a leading cause of ocular morbidity and blindness. A large number of filamentous fungi, Yeasts and Zygomycetes have been incriminated as the causative agent of mycotic keratitis. Early diagnosis and treatment is important in preventing complications like corneal perforation, scleral spread and endopthalmitis. The present study was conducted to elucidate the epidemiological features of mycotic keratitis and study the fungal profile of mycotic keratitis of patients attending our hospital, which is situated on the coastal area of Karnataka.A total of 127 patients with infectious keratitis were investigated between January 2009 to June 2010. Corneal scraping was obtained from 127 patients under aseptic precaution. The scraping was subjected to 10% KOH wet mount, Gram's staining and culture. Of the total 127 patients suspected of having infectious keratitis, 44 (34.65%) were found to be positive for fungal aetiology. Of these, 40(90.90%) cases were positive on direct microscopy for fungal elements and 26(59.09%) cases showed growth on culture after incubation for 2-8 days. In 14 (31.81%) cases, the culture was found to be sterile despite positive direct microscopic findings, but the results were consistent with clinical findings. Positive culture was obtained in 4(09.09%) cases where direct microscopy was found to be negative. The commonest fungi isolated were Aspergillus species (61.5%)Mycotic keratitis continues to be an important cause of ocular morbidity, predominantly among rural population. Prompt diagnosis and early institution of antifungal therapy may limit the ocular morbidity and the sequelae of infectious keratitis. As the manifestation of mycotic keratitis is often confusing, a high degree of suspicion with sound knowledge of predisposing factors and microbiological confirmation is very essential to initiate appropriate therapy.

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