Bronchoalveolar lavage cytological alveolar damage in patients with severe pneumonia

INTRODUCTION: Histological examination of lung specimens from patients with pneumonia shows the presence of desquamated pneumocytes and erythrophages. We hypothesized that these modifications should also be present in bronchoalveolar lavage fluid (BAL) from patients with hospital-acquired pneumonia. METHODS: We conducted a prospective study in mechanically ventilated patients with clinical suspicion of pneumonia. Patients were classified as having hospital-acquired pneumonia or not, in accordance with the quantitative microbiological cultures of respiratory tract specimens. A group of severe community-acquired pneumonias requiring mechanical ventilation during the same period was used for comparison. A specimen of BAL (20 ml) was taken for cytological analysis. A semiquantitative analysis of the dominant leukocyte population, the presence of erythrophages/siderophages and desquamated type II pneumocytes was performed. RESULTS: In patients with confirmed hospital-acquired pneumonia, we found that 13 out of 39 patients (33.3%) had erythrophages/siderophages in BAL, 18 (46.2%) had desquamated pneumocytes and 8 (20.5%) fulfilled both criteria. Among the patients with community-acquired pneumonia, 7 out of 15 (46.7%) had erythrophages/siderophages and 6 (40%) had desquamated pneumocytes on BAL cytology. Only four (26.7%) fulfilled both criteria. No patient without hospital-acquired pneumonia had erythrophages/siderophages and only 3 out of 18 (16.7%) had desquamated pneumocytes on BAL cytology. CONCLUSION: Cytological analysis of BAL from patients with pneumonia (either community-acquired or hospital-acquired) shows elements of cytological alveolar damage as hemorrhage and desquamated type II pneumocytes much more frequently than in BAL from patients without pneumonia. These elements had a high specificity for an infectious cause of pulmonary infiltrates but low specificity. These lesions could serve as an adjunct to diagnosis in patients suspected of having ventilator-associated pneumonia

Fatal Disseminated Acanthamoeba lenticulata Acanthamebiasis in a Heart Transplant Patient

We report a fatal case of disseminated acanthamebiasis caused by Acanthamoeba lenticulata (genotype T5) in a 39-year-old heart transplant recipient. The diagnosis was based on skin histopathologic results and confirmed by isolation of the ameba from involved skin and molecular analysis of a partial 18S rRNA gene sequence (DF3)

Semantic Integrative Digital Pathology: Insights on Microsemiological Semantics and Image Analysis Scalability

International audienceBeing able to provide a traceable and dynamic second opinion has become an ethical priority for patients and health care professionals in modern computer-aided medicine. In this perspective, a semantic cognitive virtual microscopy approach has been recently initiated, the MICO project, by focusing on cognitive digital pathology. This approach supports the elaboration of pathology-compliant daily protocols dedicated to breast cancer grading, in particular mitotic counts and nuclear atypia. A proof of concept has thus been elaborated, and an extension of these approaches is now underway in a collaborative digital pathology framework, the FlexMIm project. As important milestones on the way to routine digital pathology, a series of pioneer international benchmarking initiatives have been launched for mitosis detection (MITOS), nuclear atypia grading (MITOS-ATYPIA) and glandular structure detection (GlaS), some of the fundamental grading components in diagnosis and prognosis. These initiatives allow envisaging a consolidated validation referential database for digital pathology in the very near future. This reference database will need coordinated efforts from all major teams working in this area worldwide, and it will certainly represent a critical bottleneck for the acceptance of all future imaging modules in clinical practice. In line with recent advances in molecular imaging and genetics, keeping the microscopic modality at the core of future digital systems in pathology is fundamental to insure the acceptance of these new technologies, as well as for a deeper systemic, structured comprehension of the pathologies. After all, at the scale of routine whole-slide imaging (WSI; ∼0.22 µm/pixel), the microscopic image represents a structured ‘genomic cluster', enabling a naturally structured support for integrative digital pathology approaches. In order to accelerate and structure the integration of this heterogeneous information, a major effort is and will continue to be devoted to morphological microsemiology (microscopic morphology semantics). Besides insuring the traceability of the results (second opinion) and supporting the orchestration of high-content image analysis modules, the role of semantics will be crucial for the correlation between digital pathology and noninvasive medical imaging modalities. In addition, semantics has an important role in modelling the links between traditional microscopy and recent label-free technologies. The massive amount of visual data is challenging and represents a characteristic intrinsic to digital pathology. The design of an operational integrative microscopy framework needs to focus on scalable multiscale imaging formalism. In this sense, we prospectively consider some of the most recent scalable methodologies adapted to digital pathology as marked point processes for nuclear atypia and point-set mathematical morphology for architecture grading. To orchestrate this scalable framework, semantics-based WSI management (analysis, exploration, indexing, retrieval and report generation support) represents an important means towards approaches to integrating big data into biomedicine. This insight reflects our vision through an instantiation of essential bricks of this type of architecture. The generic approach introduced here is applicable to a number of challenges related to molecular imaging, high-content image management and, more generally, bioinformatics

Pneumopathies interstitielles diffuses idiopathiques Classification de Consensus International Multidisciplinaire de l'American Thoracic Society et de l'European Respiratory Society, principales entités anatomo-cliniques, et conduite du diagnostic

Voir Éditorial page 245.Avertissement : Cet article a été suscité par la publication citée en référence n° 1 ; il n'en constitue pas une traduction ni un résumé, mais a pour but de favoriser l'accès de son contenu aux pneumologues francophones. Cette publication demeure la référence primaire dans le domaine.National audienceIntroduction The classification of the idiopathic interstitial pneumonias includes seven clinico-pathologic entities. The diagnosis is based on a multidisciplinary approach, integrating the clinical evaluation, the high-resolution computerised tomography, and the pathological pattern. State of the art A definitive diagnosis of idiopathic pulmonary fibrosis relies on the association of a suggestive clinico-radiological profile and a pathological pattern of usual interstitial pneumonia. Nonspecific interstitial pneumonia is a recently described clinico-pathologic entity, with a better prognosis than that of idiopathic pulmonary fibrosis. Cryptogenic organising pneumonia has been included in the group of idiopathic interstitial pneumonias because of its idiopathic and multifocal characteristics, although it does not predominate in the lung interstitium. Desquamative interstitial pneumonia and respiratory bronchiolitis with interstitial lung disease are rare entities with predominance in young smoking adults. Lymphoid interstitial pneumonia, usually encountered in the context of Sjögren's syndrome, is very rare in its idiopathic form. Acute interstitial pneumonia is responsible for idiopathic acute respiratory distress syndrome. Perspectives The current classification of idiopathic interstitial pneumonias better defines the diagnostic criterias of each clinico-pathologic entity, and is expected to facilitate clinical research. Conclusions This classification has clinical implications, with prognostic and therapeutic significance.Introduction La classification des pneumopathies interstitielles diffuses (PID) idiopathiques comporte sept entités anatomocliniques, dont le diagnostic nécessite une approche multidisciplinaire, qui intègre l'évaluation clinique, le scanner thoracique de haute résolution, et l'aspect histopathologique pulmonaire. État des connaissances Un diagnostic formel de fibrose pulmonaire idiopathique repose sur l'association d'un profil radioclinique évocateur et d'une histologie de type pneumopathie interstitielle commune. La pneumopathie interstitielle non spécifique est une entité anatomoclinique récemment individualisée, dont le pronostic est meilleur que celui de la fibrose pulmonaire idiopathique. La pneumopathie organisée cryptogénique est incluse dans le cadre des pneumopathies interstitielles diffuses idiopathiques du fait de sa nature idiopathique et multifocale, bien qu'il ne s'agisse pas à proprement parler d'une pneumopathie interstitielle. La pneumopathie interstitielle desquamative et la bronchiolite respiratoire avec pneumopathie interstitielle sont des formes rares de PID idiopathique, qui atteignent préférentiellement l'adulte jeune fumeur. La pneumopathie interstitielle lymphocytaire, qui se rencontre notamment au cours du syndrome de Gougerot-Sjögren, est très rare dans sa forme idiopathique. La pneumopathie interstitielle aiguë réalise un syndrome de détresse respiratoire aiguë sans cause établie. Perspectives La classification actuelle des PID idiopathiques permet de préciser les critères diagnostiques de chaque entité anatomoclinique, et devrait faciliter la recherche clinique. Conclusions Cette classification revêt un intérêt clinique, notamment sur le plan thérapeutique et pronostique

Detection of an eosinophil derived neurotoxin in the urine of a patient with idiopathic chronic eosinophilic pneumonia

International audienc