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A 38-day-old prematurely born infant developed rapidly progressive facial cellulitis in association with ipsilateral submandibular lymphadenopathy and pulmonary consolidation. Group B streptococci (GBS) were isolated from blood, endotracheal, and lesion cultures. Prompt recognition of GBS cellulitis-adenitis and institution of parenteral, synergistic antibiotic therapy are important.
Immunohistochemical detection of lactoferrin (LF), lysozyme (LZ) and carcinoembryonic antigen (CEA) was made in obstructive adenitis of the submandibular glands. Atrophic and altered acinar cells in the early stage of the lesion stained strongly for LF, whereas they were unreactive or stained slightly for LZ. Ductal cells usually stained for LZ. Staining for CEA was strong and irregularly distributed in altered acinar cells. Duct-like structures and dilated ductal segments in the chronic stage were generally negative for LF, LZ and CEA. Secretory components in luminal cavities gave abundant staining for LF, LZ and CEA. Histocytes which infiltrated into the connective tissue in the later stage showed a positive LZ reaction.
Lectin-binding profiles and keratin distribution in obstructive adenitis of human submandibular glands (SMGs) are reported and compared those of normal SMGs. Histologically, obstructive changes in the SMGs included acinar atrophy, duct-like structure formation in the early stage, and disappearance of acinar cells and dilation of ductal segments in the later, chronic stage. The following lectins were used: Con A (Glc, Man), PNA(Gal, GalNAc), RCA-I(Gal), DBA(GalNAc), SBA(Gal, Gal-NAc), UEA-I(alpha-L-Fuc) and WGA(GlcNAC, NeuNAc). Lectin staining in atrophic acinar cells was usually reduced except for SBA binding and was irregularly distributed in altered acinar and ductal epithelia. Binding of DBA and UEA-I lectins were particularly intense along the luminar borders of ductal segments in the lesions. Immunohistochemically detectable keratins were characterized by intense staining in atrophic acinar cells and in all the ductal segments, whereas normal acinar cells, either serous or mucous, were negative.
Staphylococcus epidermidis, a human commensal, is a common cause of bacteremia in immunocompromised patients with indwelling medical devices. We report a case of isolated cervical adenitis caused by S. epidermidis in an immunocompetent patient and comment on the presumed pathogenesis.
The effect of needle aspiration in suppurative post-BCG adenitis was studied. Nodes that had been aspirated (43 patients) regressed in 25 (58%) and 41 (95%) patients two and six months after aspiration. In the control group (34 patients) regression occurred in three (9%) and 22 (65%) patients. Spontaneous drainage with sinus tract formation was also significantly less in the aspirated group at six months (7% v 44%).
One hundred seventy consecutive patients with clinical suggestion of acute appendicitis were studied by ultrasound (US) with the examiner using the graded compression technique. In 14 patients, the only US findings consisted of enlarged mesenteric lymph nodes in combination with mural thickening of the terminal ileum. This was consistent with the findings at surgery in four patients and with the results of barium studies in seven patients. In nine of 14 patients, stool cultures were performed, eight of which were positive for Yersinia enterocolitica. None of these 14 patients finally proved to have appendicitis. In a patient with acute pain in the right lower quadrant whose appendix cannot be visualized sonographically and whose US findings consist of enlarged mesenteric lymph nodes and mural thickening of the terminal ileum, the diagnosis is probably mesenteric adenitis and acute terminal ileitis. Appendectomy should be avoided in this condition.
Four cases of cervical adenitis occurring in infants under four months of age are presented. Coagulase positive staphylococci were recovered in pure culture from the involved lymph node in each instance. Staphylococcal aureus as a cause of lymphadenitis should be suspected in patients who present with acute lymph node swelling and no obvious focus of infection. Antibiotic management of this clinical problem should include therapy specific for the staphylococcus.
We report a 14-year-old girl who presented with signs of appendicitis and had her appendix removed. She subsequently proved to have mesenteric adenitis owing to Salmonella typhi which responded to treatment with ceftriaxone.
Atypical mycobacterium cervical adenitis (AMCA) is a disease primarily of childhood and usually presents as a unilateral mass or draining sinus. The pathogens are mycobacteria which are distinct from Mycobacteria tuberculosis, leprae and bovis (the typical mycobacteria). The atypical mycobacteria are readily recovered from the environment and are generally of low virulence. They are increasingly being recognized as pathogen for man though they are probably not transmissible from human contact. Most commonly these organisms are implicated in either pulmonary disease or lymphadenopathy. Fourteen cases of AMCA occurring in childhood are presented. A review of the bacteriology of the atypical mycobacteria is included. The clinical presentation, differential diagnosis, chemotherapeutic management and role of surgical intervention are discussed.
Irradiation against benign cervical adenitis in children was formerly a widely used form of treatment which has caused a great number of late complications, mostly various benign and malignant tumours in the head and neck area, especially in the thyroid gland. In a follow-up study on 63 individuals irradiated at Karlstad Hospital between 1917 and 1929 we found, in addition to these changes, two hitherto not reported complications. Laryngeal stenoses occurred in 27 cases, 17 of which so severe that they eventually required permanent tracheostomies and 11 had fibrous strictures of the upper esophagus, repeated dilatations have been necessary in many of these cases. These complications were mostly seen in those who had been irradiated at an early age, the laryngeal stenoses appear to be caused by a general retardation or inhibition of the normal growth of the laryngeal cartilages resulting in a microlarynx. One possible explanation for these previously not reported sequelae might be the exceptionally high irradiation doses these persons were exposed to up to 60 years ago.
In the present study the submandibular, labial, and lacrimal glands of 102 postmortem subjects were studied as to the presence of inflammatory foci, fibrosis, atrophy and fatty change. Focal lymphocytic infiltration of these glands with focus scores exceeding 1, one of the findings on which the diagnosis of Sjögren's syndrome is based, was found in 19 cases (18.6%). Fibrosis, atrophy, and fatty change occurred most often in the labial salivary glands of patients over 50 years of age with or without high focus scores. Fibrosis, atrophy and fat infiltration hardly ever occurred in the lacrimal glands although this was the type of gland in which high focus scores occurred most often. The findings suggest that a wider than hitherto recognized spectrum of systemic inflammatory diseases may contribute to lymphocytic adenitis and degeneration of the exocrine glands. The diagnosis of Sjögren's syndrome should be confirmed by additional diagnostic tests.
We analysed inflammatory changes at selected time intervals, of salivary and lacrimal glands in the developing immunostimulatory [BN-->(BN x LEW)F1] model of graft-versus-host (GVH) reaction. A focal mononuclear adenitis in lacrimal and salivary glands developed at day 7 and increased clearly in "onset"-rats. Inflammatory responses in submandibular and parotid glands were less consistent and weaker than in lacrimal glands. There was no significant focus score difference between males and females. The lacrimal infiltrates were characterised immunohistochemically with monoclonal antibodies. Our findings indicate that CD4+ cells of donor origin dominated infiltrates, whereas a moderate number of B cells appeared only in large (late) foci. At stages corresponding to the onset of GVH disease (GVHD) in skin/labial mucosa, numerous CD8+ lymphocytes and NK cells were found in lacrimal glands, adjacent to ductal/ vascular plexa, sometimes forming small foci and with evidence of epithelial damage. We conclude that GVHD-associated T cell migration into rat exocrine glands occurs as a result of the semi-alloantigen-activated phenotype properties of the T cells. This activation occurs initially in lymphoid tissue and migration into glands is secondary to this and unrelated to antigen specificity. We also found evidence of amplification and tissue damage, interpreted as due to local reactivation of the T cells.
Although the association between inflammatory bowel disease and gastrointestinal infections has been suggested, the mechanisms involved in the pathogenesis of Crohn's disease (CD) are still undetermined. We report the case of a man, who presented with mesenteric adenitis initially due to a Yersinia pseudotubercolosis infection, who was later diagnosed with Crohn's disease. This case is in keeping with recent evidence in the literature which suggests that CD is a disease linked to abnormal immune responses to enteric bacteria in genetically susceptible individuals.
We report the case of an infant in whom facial cellulitis was the only initial sign of a group B streptococcal bacteriemia. Adenitis-cellulitis syndrome is a rare clinical manifestation of group B streptococcal infection in infants. Local infection together with the onset of fever can be the only signs of bacteriemia in newborns and infants.
A mass BCG-vaccination campaign was undertaken in Aden Colony during February-May 1952 by WHO/UNICEF in co-operation with the Directorate of Medical Services. Over 31,000 persons (about one-fourth of the total population) were given an intradermal 5 TU test, and 22,000 returned for the reaction to be read. Of these, about one-third were classified as negative and all but a very few of them were given an intradermal injection of BCG vaccine. Of those vaccinated, over half were children of school-age. The results obtained in this campaign are described with particular reference to the number and size of tuberculin reactions, and the results of follow-up examinations in nearly 2,000 schoolchildren.
During the first Yemeni Congress of Uro-Nephrology in Aden, an international team performed the first kidney tranplantations in the region. We report the difficulties encountered and discuss the pros and cons for transplantations in developing countries.
First kidney transplantations were performed in Aden, Jemen in 2003. A difficult medical environment and unrehearsed decision-making process in a country of scant resources were the background of this undertaking. A brief report is given on the medical situation, training and preparedness of the Yemeni medical community for transplant procedures. Initial impressions of psychological aspects of first-ever organ transplantation in this Islamic country are presented.
A 7-year-old Arabian gelding was presented with a 9-month history of progressive patches of nonpruritic scaling, crusting, alopecia, and leukoderma of the periocular areas and muzzle, becoming generalized over time. Sebaceous adenitis was diagnosed on histopathologic examination. Lesions resolved without treatment, coinciding with regression of a sarcoid on the neck.