cytopathology conference 12/01/05 - case 1
DESCRIPTION
Cytopathology Conference 12/01/05 - Case 1TRANSCRIPT
Cytopathology Conference
12/01/2005
Case 1
• Pericardial fluid from a 36-year-old female with a history of lupus and a pericardial effusion.
A special stain was performed…
Diagnosis?
Differential Diagnosis
• Idiopathic pericarditis
• Lupus pericarditis
• Pericarditis due to mycobacterium species
• Pericarditis due to gram negative species
Lupus Pericarditis:pericardial fluid positive forMycobacterium mucogenicum
Mycobacterium mucogenicum
• Designated as a new species in 1995– Member of Mycobacterium fortuitum-
chelonae complex.
• Belongs to group IV of the Runyon Classification of nontuberclous mycobacteria (NTM).
Mycobacteria
Mycobacterium tuberculosis
complex
Nontuberculous mycobacteria
Mycobacterium tuberculosis
Mycobacterium bovis
Mycobacterium africanum
Runyon Classification
I) Photochromogens
II) Scotochromogens
III) Nonphotochromogens
IV) Rapid-growers
Mycobacterium mucogenicum
• All Runyon group IV members:
– Acid fast– Don’t produce pigment– Growth: < 7days– Produce arylsufatase after 3 days of growth– Growth at 28 degrees on crystal violet neg.
MacConkey agar
Mycobacterium mucogenicum• Identified as a water contaminant in the
hospital setting.
• Nosocomial infections: post-surgical, catheter related, hemodialysis.
• Commensal organism: found on skin
Mycobacterium mucogenicum• Identification:
– Unique 16s ribosomal unit
– Mycobacterial membrane fatty acid composition:• Resistant to INH and rifampin• Susceptible in vitro to quinolones, amikacin,
imipenim and Bactrim
Microscopic Appearance
• I) M kansasii: long, curved or folded and beaded
• II) M scrofulaceum: very short and delicate
• III) MAC: short, thick and beaded
• IV) M fortuitum: long and filamentous