Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports.

BackgroundCoccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms.Case presentationThe first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist's interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis.ConclusionsThough history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging

Frecuencia de neoplasias en perros en el área metropolitana de Monterrey, N.L. y coccidioidomicosis en algunos casos con sospecha original de neoplasia.

La coccidioidomicosis es una infección micótica respiratoria con diseminación sistémica ocasional. La coccidioidomicosis diseminada es considerada una enfermedad multifacética. En la medicina, la coccidioidomicosis diseminada se incluye dentro de un grupo de enfermedades infecciosas que se han referido como los grandes imitadores. En muchos casos, las neoplasias malignas se incluyen en el diagnóstico presuntivo. En medicina veterinaria, la coccidioidomicosis diseminada es común en perros. Sin embargo, a pesar de ser un dilema diagnóstico, coccidioidomicosis diseminada es subestimada y con frecuencia no se incluye en los diferenciales, incluso en zonas endémicas. En este trabajo se incluye un total de 688 biopsias remitidas, de las cuales se recopilaron 469 neoplasias y además 4 casos en especial de lesiones que fueron sospechosas de neoplasia, sin embargo, fueron causadas por Coccidioides spp. el cual, produce lesiones granulomatosas que crearon sospechas de neoplasias en cada caso durante el período enero 2010 hasta marzo 2016

A Retrospective Study of the Thoracic and Abdominal Radiographic Abnormalities in Canine Multicentric Lymphoma

This dissertation presents the results of a retrospective study of the radiological findings in 84 cases of canine multicentric lymphoma, referred to the Department of Surgery, Glasgow University Veterinary School. The features analysed in the study include: the abnormalities detected on thoracic and abdominal radiographs, and the frequency of occurrence of individual changes and combinations of changes; the role of radiographic examination in the diagnosis of lymphoma; the difficulties encountered in interpretation of the radiographs; the relationship between the thoracic radiological findings and the occurrence of hypercalcaemia; the prognostic relevance of radiological abnormalities and, in comparison, clinical staging, for the individual patient There is little published work dealing specifically with the radiographic features of multicentric lymphoma in the dog. The results of this study are discussed in the light of the radiological studies undertaken by Ackerman and Madewell (1980) and Kene (1984). The major conclusions are: the majority of cases of lymphoma have multiple radiological abnormalities; multicentric lymphoma is not a radiological diagnosis i.e. it cannot be diagnosed on the basis of radiographic findings alone; many of the features seen in lymphoma are non-specific, and have numerous possible causes; cranial mediastinal disease is neither a prerequisite for, nor a disproportionately common finding in, hypercalcaemia; the absence of radiological abnormalities may be a positive prognostic indicator, but in general radiology has no place as a prognostic indicator for the individual patient

Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports.

BackgroundCoccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms.Case presentationThe first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist's interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis.ConclusionsThough history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging

Implications of human interaction for health of past populations in Asia

Drivers of human mobility such as migration, trade and conflict is today recognised to considerably influence the spread and prevalence of infectious diseases globally. Additionally, these factors are known to impact nutritional levels of migrating populations. However, the impacts of interactions between two or more populations, which occurs following human mobility, has received little attention in the palaeopathological literature. This thesis investigates whether human population interaction significantly influenced the health of prehistoric populations in Asia. Six skeletal assemblages across three case studies (n=450) in Asia’s prehistory were explored to assess the level of nutritional and infectious diseases. These were the Middle to Late and Final Jomon (5000-2300BP), Pre-Neolithic to Neolithic Vietnam (6900-3500BP) and Bronze Age to Xiongnu Period Mongolia (4500 to 1800BP). The questions proposed for this thesis were: 1) Did increasing levels of population interaction over time significantly affect the health of populations in prehistoric Asia? And; 2) How did population interaction interplay with a range of other sociocultural, biological and ecological factors to influence the health of populations in prehistoric Asia? It was hypothesised that human interaction would have a considerable impact on the health of prehistoric populations from Asia, but that other sociocultural, environmental and biological factors would mediate the degree of impact. To assess the implications of human population interaction on prehistoric health, protocols of weighted diagnostic criteria for differential diagnosis of infectious diseases, nutritional diseases and anaemias in dry bone were developed to standardise identification where they do not yet exist in the palaeopathological literature. Additionally, inclusion criteria for an overall infectious disease prevalence, that encompasses specific and non-specific infectious diseases, was developed. A three-stage statistical approach was applied to address the research questions. This involved analysis within assemblages (site level), diachronically across two assemblages in the same region (regional level) and across all assemblages to assess general trends in the influence of human population interaction on disease dynamics (continent level). The results of this study demonstrated that varying levels of human population interaction influenced the prevalences and diversity of infectious diseases in Asia, but only indirectly influenced the prevalences of nutritional diseases. However, residential mobility and population density served to mediate the impact that human population interaction had on infectious disease prevalences and diversity in past populations. Therefore, the hypothesis was supported for infectious diseases but not nutritional diseases. Additionally, the impact of disease on mortality was variable and dependent on the pathogens introduced through human population interaction processes