Cytopathology Conference 12/01/05 - Case 1

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Cytopathology Conference 12/01/05 - Case 1

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Cytopathology Conference 12/01/05 - Case 1

  1. 1. Cytopathology Conference 12/01/2005
  2. 2. Case 1 <ul><li>Pericardial fluid from a 36-year-old female with a history of lupus and a pericardial effusion. </li></ul>
  3. 5. A special stain was performed…
  4. 9. Diagnosis?
  5. 10. Differential Diagnosis <ul><li>Idiopathic pericarditis </li></ul><ul><li>Lupus pericarditis </li></ul><ul><li>Pericarditis due to mycobacterium species </li></ul><ul><li>Pericarditis due to gram negative species </li></ul>
  6. 11. Lupus Pericarditis: pericardial fluid positive for Mycobacterium mucogenicum
  7. 12. Mycobacterium mucogenicum <ul><li>Designated as a new species in 1995 </li></ul><ul><ul><li>Member of Mycobacterium fortuitum-chelonae complex. </li></ul></ul><ul><li>Belongs to group IV of the Runyon Classification of nontuberclous mycobacteria ( NTM ). </li></ul>
  8. 13. Mycobacteria Mycobacterium tuberculosis complex Nontuberculous mycobacteria Mycobacterium tuberculosis Mycobacterium bovis Mycobacterium africanum Runyon Classification I) Photochromogens II) Scotochromogens III) Nonphotochromogens IV) Rapid-growers
  9. 14. Mycobacterium mucogenicum <ul><li>All Runyon group IV members: </li></ul><ul><ul><li>Acid fast </li></ul></ul><ul><ul><li>Don’t produce pigment </li></ul></ul><ul><ul><li>Growth: < 7days </li></ul></ul><ul><ul><li>Produce arylsufatase after 3 days of growth </li></ul></ul><ul><ul><li>Growth at 28 degrees on crystal violet neg. MacConkey agar </li></ul></ul>
  10. 15. Mycobacterium mucogenicum <ul><li>Identified as a water contaminant in the hospital setting. </li></ul><ul><li>Nosocomial infections: post-surgical, catheter related, hemodialysis. </li></ul><ul><li>Commensal organism: found on skin </li></ul>
  11. 16. Mycobacterium mucogenicum <ul><li>Identification: </li></ul><ul><ul><li>Unique 16s ribosomal unit </li></ul></ul><ul><ul><li>Mycobacterial membrane fatty acid composition: </li></ul></ul><ul><ul><ul><li>Resistant to INH and rifampin </li></ul></ul></ul><ul><ul><ul><li>Susceptible in vitro to quinolones, amikacin, imipenim and Bactrim </li></ul></ul></ul>
  12. 17. Microscopic Appearance <ul><li>I) M kansasii: long, curved or folded and beaded </li></ul><ul><li>II) M scrofulaceum : very short and delicate </li></ul><ul><li>III) MAC: short, thick and beaded </li></ul><ul><li>IV) M fortuitum : long and filamentous </li></ul>

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