Pub Date : 2024-03-01eCollection Date: 2024-01-01DOI: 10.53854/liim-3201-10
Consuelo Venturi, Antonio Guadagno, Serena Varesano, Valentina Ricucci, Nicola Nigro, Antonio Di Biagio, Matteo Bassetti, Paolo Nozza, Francesco Drago, Aurora Parodi, Giulia Ciccarese
Background: a few pathologic and ultrastructural findings of monkeypox skin lesions are available in the literature. To integrate such evidence, we aimed to describe the pathologic features of monkeypox skin lesions and to show monkeypox virions by transmission electron microscopy (TEM).
Methods: we studied the cutaneous biopsies of three patients affected by monkeypox during the 2022 monkeypox outbreak. Skin biopsies have been collected only from body sites with a recent laboratory-confirmed mpox virus infection, defined by a polymerase chain reaction (PCR) positive result in specimens taken through skin swabs.
Results: in all the samples the epidermis showed keratinocytes ballooning degeneration; perivascular/periadnexal infiltrates composed of neutrophils and lymphocytes were observed in the deep dermis. Immunohistochemistry showed that the infiltrate was mostly composed of CD3+ T-cells. TEM revealed monkeypox virus-like particles in various stages of morphogenesis in the dermis and epidermis; virions were interspersed among keratinocytes and within their cytoplasm. At the intracellular level, virions showed a biconcaveshaped central core, surrounded by lateral bodies and an external membrane; they also appeared as rectangular, brick-shaped, or oval particles with eccentric nucleoids. The histologic features of our skin samples confirmed the few other studies on this topic, except for the eosinophilic inclusions of the cytoplasm of keratinocytes (Guarnieri's bodies).
Conclusion: the role of molecular biology is crucial for monkeypox diagnosis but when it is not disposable and/or in doubtful cases, skin biopsy and TEM may be helpful to establish the diagnosis.
背景：关于猴痘皮损的病理学和超微结构研究成果在文献中寥寥无几。方法：我们研究了2022年猴痘爆发期间3名猴痘患者的皮肤活检组织。结果：在所有样本中，表皮显示角质细胞气球变性；在真皮深层观察到由中性粒细胞和淋巴细胞组成的血管周围/附件周围浸润。免疫组化显示，浸润主要由 CD3+ T 细胞组成。TEM显示，真皮和表皮中的猴痘病毒样颗粒处于不同的形态发生阶段；病毒穿插在角质形成细胞之间及其细胞质内。在细胞内，病毒呈双凹形中心核，周围有侧体和外膜；病毒也呈长方形、砖形或椭圆形颗粒，核仁偏心。除了角质形成细胞的细胞质中有嗜酸性包涵体（Guarnieri's bodies）外，我们的皮肤样本的组织学特征证实了其他一些相关研究的结论。
{"title":"Histopathologic and transmission electron microscopic findings in monkeypox cutaneous lesions.","authors":"Consuelo Venturi, Antonio Guadagno, Serena Varesano, Valentina Ricucci, Nicola Nigro, Antonio Di Biagio, Matteo Bassetti, Paolo Nozza, Francesco Drago, Aurora Parodi, Giulia Ciccarese","doi":"10.53854/liim-3201-10","DOIUrl":"10.53854/liim-3201-10","url":null,"abstract":"<p><strong>Background: </strong>a few pathologic and ultrastructural findings of monkeypox skin lesions are available in the literature. To integrate such evidence, we aimed to describe the pathologic features of monkeypox skin lesions and to show monkeypox virions by transmission electron microscopy (TEM).</p><p><strong>Methods: </strong>we studied the cutaneous biopsies of three patients affected by monkeypox during the 2022 monkeypox outbreak. Skin biopsies have been collected only from body sites with a recent laboratory-confirmed mpox virus infection, defined by a polymerase chain reaction (PCR) positive result in specimens taken through skin swabs.</p><p><strong>Results: </strong>in all the samples the epidermis showed keratinocytes ballooning degeneration; perivascular/periadnexal infiltrates composed of neutrophils and lymphocytes were observed in the deep dermis. Immunohistochemistry showed that the infiltrate was mostly composed of CD3+ T-cells. TEM revealed monkeypox virus-like particles in various stages of morphogenesis in the dermis and epidermis; virions were interspersed among keratinocytes and within their cytoplasm. At the intracellular level, virions showed a biconcaveshaped central core, surrounded by lateral bodies and an external membrane<i>;</i> they also appeared as rectangular, brick-shaped, or oval particles with eccentric nucleoids. The histologic features of our skin samples confirmed the few other studies on this topic, except for the eosinophilic inclusions of the cytoplasm of keratinocytes (Guarnieri's bodies).</p><p><strong>Conclusion: </strong>the role of molecular biology is crucial for monkeypox diagnosis but when it is not disposable and/or in doubtful cases, skin biopsy and TEM may be helpful to establish the diagnosis.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"32 1","pages":"76-82"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10917568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Strongyloides stercoralis is an intestinal nematode endemic throughout tropical and subtropical areas, with a life cycle consisting of free-living and parasitic components. Unlike other soil-transmitted nematodes, it is capable of self-infection, which can cause chronic disease that lasts for decades, or cause overwhelming hyperinfection in people taking corticosteroids or other immunosuppressive drugs or who have impaired Th2 cell-mediated immunity, particularly those infected with human T-lymphotropic virus 1. During hyperinfection, a large numbers of larvae have access to the bloodstream, lungs, central nervous system, and other organs. Bacteremia and polymicrobial meningitis can occur due to disruption of the intestinal mucosa and the presence of bacteria on the surface of foreign larvae. Enterococcal meningitis for instance may occur concurrently with strongyloidiasis as a consequence of haematogenous dissemination. We present a clinical case of a 45-year-old, man from Bangladesh, in which co-infection occurred. The patient was not immunocompromized and had no apparent risk factors, which represents the unusual aspect of this case report. A literature review on enterococcal meningitis and Strongyloides coinfection in adult patients was performed encountering 21 cases. Cases have been reviewed and discussed. Clinicians may suspect S. stercoralis co-infection when identifying an enterococcal meningitis in adult patients coming from endemic areas.
{"title":"Enterococcal meningitis associated with <i>Strongyloides</i> infection: a case report and literature review.","authors":"Lavinia Cosimi, Stefano Di Bella, Roberto Luzzati, Catrin Theresia Simeth, Maurizio Pinamonti, Franco Cominotto, Ugo Giulio Sisto","doi":"10.53854/liim-3104-18","DOIUrl":"https://doi.org/10.53854/liim-3104-18","url":null,"abstract":"<p><p><i>Strongyloides stercoralis</i> is an intestinal nematode endemic throughout tropical and subtropical areas, with a life cycle consisting of free-living and parasitic components. Unlike other soil-transmitted nematodes, it is capable of self-infection, which can cause chronic disease that lasts for decades, or cause overwhelming hyperinfection in people taking corticosteroids or other immunosuppressive drugs or who have impaired Th2 cell-mediated immunity, particularly those infected with human T-lymphotropic virus 1. During hyperinfection, a large numbers of larvae have access to the bloodstream, lungs, central nervous system, and other organs. Bacteremia and polymicrobial meningitis can occur due to disruption of the intestinal mucosa and the presence of bacteria on the surface of foreign larvae. Enterococcal meningitis for instance may occur concurrently with strongyloidiasis as a consequence of haematogenous dissemination. We present a clinical case of a 45-year-old, man from Bangladesh, in which co-infection occurred. The patient was not immunocompromized and had no apparent risk factors, which represents the unusual aspect of this case report. A literature review on enterococcal meningitis and <i>Strongyloides</i> coinfection in adult patients was performed encountering 21 cases. Cases have been reviewed and discussed. Clinicians may suspect <i>S. stercoralis</i> co-infection when identifying an enterococcal meningitis in adult patients coming from endemic areas.</p>","PeriodicalId":502111,"journal":{"name":"Le infezioni in medicina","volume":"31 4","pages":"583-590"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138808152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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