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Tissue and Molecular Diagnosis
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Special stains are also useful for the diagnosis of infection. For example, a Ziehl-Neelsen stain demonstrates acid-fast bacilli, particularly mycobacteria, by staining them bright red in a blue background (Figure16.20). Mycobacteria cannot be seen on H&E slides. Other microorganisms that may be detectable on H&E but are easier to see with a special stain include fungi (PAS or Grocott stain), protozoa (Giemsa stain) and spirochaetes (Warthin-Starry stain).
Infections and infestations affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Whereas Warthin-Starry stain is usually positive,110 culture and serology may remain negative.111 PCR is highly specific but not very sensitive.112 Bacillary angiomatosis is caused by the same B. henselae, but is a disease of immunocompromised subjects.113 Warthin-Starry stain is technically demanding as silver tends to clump out.
Oral and Ocular Manifestations of HIV Infection
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Robert H. Cook-Norris, Antoanella Calame, Clay J. Cockerell
Bacillary epithelioid angiomatosis (BA) is a manifestation of Bartonella henselae or B. quintana infection that presents as violaceous papulonodular lesions most commonly on the skin and occasionally the oral cavity.74 Oral BA is characterized by blue to purple macules or papules most commonly of the palate and gingiva. Overlying exudate and ulceration have been described in a few cases.74 Constitutional symptoms such as fever, chills, headache, and malaise are often present and are clinically helpful in establishing the diagnosis. Distinction from KS can be very difficult and a biopsy is often needed. Histologic examination reveals lobular vascular proliferations and a moderate neutrophilic infiltrate containing argyrophilic micro-organisms that can be visualized with a silver stain such as the Warthin–Starry stain (40–42). Polymerase chain reaction (PCR) can also be performed which allows precise identification of the organism. Erythromycin at a dose of 250–500 mg four times/day is considered first-line treatment although ceftazidime, ciprofloxacin, doxycycline, and azithromycin have also been reported to be effective.74
Diagnostic stewardship based on patient profiles: differential approaches in acute versus chronic infectious syndromes
Published in Expert Review of Anti-infective Therapy, 2021
Giusy Tiseo, Fabio Arena, Silvio Borrè, Floriana Campanile, Marco Falcone, Cristina Mussini, Federico Pea, Gabriele Sganga, Stefania Stefani, Mario Venditti
In the presence of BCNE, proper investigations include cultures of excised valves and/or embolus material [26,27,42,43]. Since valve cultures may yield false positive results, caution is required to correct the interpretation of microbiology results [44]. The isolation of the involved pathogen from the valve also guides the duration of postoperative antibiotic therapy (with a longer recommended duration when the organism is grown from the valve) [45]. Histology examination of the valve and/or embolus material might also have value: specific stains can be used to look for mycobacterium (Ziehl-Neelsen stain), fungi (silver stain, appropriate for both yeast and hyphae) Bartonella species (Warthin-Starry stain) and T. whipplei (periodic acid Schiff positive macrophages) [43].
Fatal abrin poisoning by injection
Published in Clinical Toxicology, 2021
Ginger R. Rinner, Sarah A. Watkins, Farshad Mazda Shirazi, Miguel C. Fernández, Greg Hess, Jason Mihalic, Susan Runcorn, Victor Waddell, Jana Ritter, Sarah Reagan-Steiner, Jerry Thomas, Luke Yip, Frank G. Walter
The medical examiner determined the patient’s death to be due to abrin poisoning by suicide. The autopsy revealed hemorrhage and muscle necrosis at the injection sites, as well as right axillary lymph node hemorrhage with vascular fibrinoid necrosis and thrombi. The brain revealed cerebral edema and intravascular leukocytosis. Intravascular leukocytosis was seen in the heart; however, despite the elevated troponin, there was no myocardial necrosis. The lungs exhibited intravascular leukocytosis and fibrin thrombi, without interstitial or alveolar edema. The liver showed sinusoidal leukocytosis, steatosis, and centrilobular ischemic necrosis. The gastrointestinal tract had submucosal congestion and serosal petechial hemorrhages with no mucosal lesions nor intraluminal hemorrhage. The spleen was congested. The kidneys had glomerular capillary fibrin thrombi and acute tubular epithelial necrosis. Adrenal glands revealed cortical hemorrhage and necrosis. Examination under polarized light did not reveal foreign material at injection sites or in other tissues. Bacterial rods were identified by Warthin Starry stain in the liver and kidney but could not be further characterized despite extensive testing.