Microorganisms

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Microorganisms show-up every once in a while. It is essential to know 'em.

Microorganisms

Fungi

Name (disease) Kingdom Size Shape Stains Other (microscopic) Clinical References Image
Aspergillus (aspergillosis) Fungi ? Hyphae that branching
with 45 degrees angle 		PAS-D Fruiting heads when aerobic ? Immunosuppression [1] Aspergillus (WC), Aspergillus cytology (WC)
Zygomycota (zygomycosis);
more specific
Mucorales (mucormycosis) 		Fungi ? Branching hyphae with variable width ? Granulomata assoc. Diabetes, immunodeficient [1] Mucormycosis (homestead.com), Zygomycosis (WC)
Coccidioides, usually C. immitis
(coccidioidomycosis) 		Fungi Large - 20-60 micrometers,
endospores 1-5 micrometers 		Spherules Stains? Other? Immunodeficient [1] Coccidioidomycosis (med.sc.edu) C. immitis (WC) (webpathology.com)
Histoplasma (histoplasmosis) Fungi 2-5 micrometers Spherical GMS Intracellular (unlike candida), granulomata Source: soil with bird droppings [1] Histoplasmosis (WC)
Blastomyces (blastomycosis) Fungi 5-15 micrometres Spherical (yeast) Stains? Granulomas, broad-based budding yeast Habitat: Northeast America, Africa [1][2] Blastomyces
Paracoccidioides (paracoccidioidomycosis) Fungi 6-60 micrometres Spherical (yeast) Stains? Multiple budding "steering wheel" appearance Clinical??? [1] P. brasiliensis (WC).
Pneumocystis jirovecii (pneumocystis pneumonia; abbrev. PCP) Fungi (previously thought to be a protozoan) 7-8 micrometres "Dented ping-pong ball" GMS Usually in clusters of alveolar casts with a honeycomb appearance HIV/AIDS associated [3] PCP (WC)
Cryptococcus (cryptococcosis) Fungi 5-15 micrometres Yeast GMS Prominent (i.e. thick polysaccharide) capsule HIV/AIDS associated, most common CNS fungus [1] Crytococcosis - methenamine silver (WC), Crytococcosis - mucicarmine (WC).

Notes:

  • Bold text = key features.

Fungi

Main article: Fungi
  • There are lots of 'em. Below are a few of 'em.

Terminology:[4]

  • Hyphae = microscopic filamentous growth (of fungi) -- single cell.
  • Mycelial = filamentous network of hyphae.
  • Septae/septation = hyphae may be subdivided by septae -- if they aren't they are one mass of protoplasm. (?)
  • Dimorphism = exist in two forms; e.g. single cell (yeast) and mycelial growth.
  • Pseudohyphae = looks like hyphae --but branching pattern is created by separate cells.[5]

Tissue invasive fungi

Typically:[6]

  • Mucor.
  • Aspergillus.

List

Worms & stuff

Schistosomiasis

See Urine cytopathology.

General

  • Trematode, i.e. type of worm.

Microscopic

Features of ova (S. haematobium):[7]

  • Elliptical ~140 micrometres max dimension.
  • "Spike" approx. the size of a PMN.

Images:

Toxoplasma

General

  • Common CNS infection.
    • Toxoplasma gondii - pathogenic; causes toxoplasmosis.
  • Protozoa.
  • A TORCH infection.

Microscopic

General:

  • Dependent on location in body.

Lymph node

LN features:[8]

  • Reactive germinal centers (pale areas - larger than usual).
    • Often poorly demarcated - due to loose epithelioid cell clusters at germinal center edge - key feature.
  • Epithelioid cells - perifollicular & intrafollicular.
    • Loose aggregates of histiocytes (do not form round granulomas):
      • Abundant pale cytoplasm.
      • Nucleoli.
  • Monocytoid cells (monocyte-like cells) - in cortex & paracortex.
    • Large cells in islands/sheets key feature with:
      • Abundant pale cytoplasm - important.
      • Well-defined cell border - important.
      • Singular nucleus.
    • Cell clusters usually have interspersed neutrophils.

Images (lymph node):

CNS

CNS features:[9]

  • Granular appearing ball ~ 2x the size of resting lymphocyte.

Images (CNS):

Heart

Features:

  • Intramuscular organisms.

DDx:

Images (heart):

IHC

  • IHC for toxoplasma.[10]

Strongyloidiasis

General

  • Causes by worm Strongyloides stercoralis.
  • High case mortality rate ~ 70%.[11]
  • May present after years of latency due to immune suppression.[12]

Location:

  • Lung. (???)

Microscopic

Features:

  • Long worms.
  • ~10-15 micrometers wide.

Images:

Echinococcus

Microscopic

Features:

  • Laminated wall +/- calcification.[13]
  • Organisms:
    • Hooklets.
    • Scoleces - knoblike anterior end of a tapeworm.[14]

Enterobius vermicularis

  • AKA pinworm.

General

Microscopic

Features - organism:

  • 0.2-0.5 mm width x 2-13 mm length.
  • Characteristic triangular "spikes" seen on cross section - base x height ~ 30 x 30 μm.
    • Spikes is in quotations, as these are really a longitudinal blade-like ridges, that run the length of the worm.

Features - eggs:[16]

  • Ovoid - double walled shells, one side flat.

Images:

Trichinella

General

  • Causes Trichinosis.
    • Classically associated with uncooked pork.[17]
  • Several types; most due to T. spiralis.[17]

Microscopic

Features:

  • Worm.

Image:

Cysticercosis

General

  • Caused by Taenia solium; pork tapeworm.
  • May cause epilepsy; most common parasitic CNS infection.[19]

Gross

  • Multiple cystic spaces.

Image:

Microscopic

Features:

  • Large ovoid body with complex structures (cross-section of worm) - size: millimetres.
    • +/-External eosinophilic microvilli.
    • +/-Gastrointestinal tract - ovoid structure within the worm.

Notes:

  • Histomorphology is not distinctive for the type... microbiology usually figures it out.

Images:

Rhinosporidiosis

Not to be confused with rhinoscleroma.

General

  • Caused by parasite Rinosporidium seeberi.
    • India, Sri Lanka.
  • Nasal mass.
    • May present with obstruction.[20]

Microscopic

Features:[21][20]

  • Globular cysts ~ 100 micrometers with endospores:
    • Hyperchromatic (blue) spherical 10-100 micrometer.

Images:

Stains

Leishmaniasis

General

  • Caused by protozoa in the group Leishmania group.
  • Transmitted to humans by the sand fly.

May be:

Microscopic

Features:

  • Small ~1-2 micrometers.

Images:

Stains

Microsporidiosis

General

  • Extremely small intracellular microorganisms.
    • Human pathogenic organisms in this group include: Enterocytozoon bieneusi, Encephalitozoon hellem, and Encephalitozoon intestinalis.[25]
  • Important in the context of HIV/AIDS,[26] and solid organ transplant recipients.
  • May be seen in immune competent individuals.[25]

Clinical:[25]

  • Diarrhea.
  • Weight loss.
  • Abdominal pain.

Microscopic

Features:

  • Non-specific changes on light microscopy.
    • Partial villus atrophy (villous blunting) and crypt hyperplasia.[25]

Image:

EM

  • Small intracellular microorganisms ~ 1.0-4.0 μm.[27]

Image:

Viruses

Main article: Viruses

This is a fairly big topic. There are about half a dozen viral inclusions (e.g. CMV, HSV, VZV, adenovirus) a decent pathologist ought to be able to identify. The virus article covers 'em.

Bacteria

Main article: Bacteria

This is a small topic when considered from the perspective of an anatomical pathologist. Most stuff is sorted-out by microbiology.

Microorganisms and cancer

Viruses and cancer

A number of microorganisms are associated with the development of cancer:[28]

Bacteria and cancer

Parasites and cancer

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 682. ISBN 978-1416025887.
  2. ↑ http://pathmicro.med.sc.edu/mycology/mycology-6.htm
  3. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 684. ISBN 978-1416025887.
  4. ↑ http://www.fungionline.org.uk/1intro/3growth_forms.html
  5. ↑ http://pathmicro.med.sc.edu/mycology/mycology-3.htm
  6. ↑ CM 17 Apr 2009.
  7. ↑ URL: http://path.upmc.edu/cases/case622/dx.html. Accessed on: 26 January 2012.
  8. ↑ Ioachim, Harry L; Medeiros, L. Jeffrey (2008). Ioachim's Lymph Node Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 113. ISBN 978-0781775960.
  9. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm. Accessed on: 19 October 2010.
  10. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/N0I001-PQ01-M.htm. Accessed on: 19 October 2010.
  11. ↑ Lim, S.; Katz, K.; Krajden, S.; Fuksa, M.; Keystone, JS.; Kain, KC. (Aug 2004). "Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management.". CMAJ 171 (5): 479-84. doi:10.1503/cmaj.1031698. PMID 15337730.
  12. ↑ Siddiqui, AA.; Berk, SL. (Oct 2001). "Diagnosis of Strongyloides stercoralis infection.". Clin Infect Dis 33 (7): 1040-7. doi:10.1086/322707. PMID 11528578.
  13. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 448. ISBN 978-1416054542.
  14. ↑ http://www.thefreedictionary.com/scoleces. Accessed on: 10 January 2010.
  15. ↑ Dahlstrom, JE.; Macarthur, EB. (Oct 1994). "Enterobius vermicularis: a possible cause of symptoms resembling appendicitis.". Aust N Z J Surg 64 (10): 692-4. PMID 7945067.
  16. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 685. ISBN 978-1416025887.
  17. ↑ 17.0 17.1 Kaewpitoon N, Kaewpitoon SJ, Philasri C, et al. (October 2006). "Trichinosis: epidemiology in Thailand". World J. Gastroenterol. 12 (40): 6440–5. PMID 17072975. http://www.wjgnet.com/1007-9327/12/6440.asp.
  18. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html. Accessed on: 5 December 2010.
  19. ↑ Prasad KN, Prasad A, Verma A, Singh AK (November 2008). "Human cysticercosis and Indian scenario: a review". J. Biosci. 33 (4): 571–82. PMID 19208982.
  20. ↑ 20.0 20.1 20.2 Morelli, L.; Polce, M.; Piscioli, F.; Del Nonno, F.; Covello, R.; Brenna, A.; Cione, A.; Licci, S. (2006). "Human nasal rhinosporidiosis: an Italian case report.". Diagn Pathol 1: 25. doi:10.1186/1746-1596-1-25. PMC 1560165. PMID 16945122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560165/.
  21. ↑ URL: http://www.histopathology-india.net/Rhino.htm. Accessed on: 4 January 2012.
  22. ↑ URL: http://www.arquivosdeorl.org.br/conteudo/acervo_eng.asp?id=428. 4 January 2012.
  23. ↑ 23.0 23.1 Goto, H.; Lindoso, JA. (Apr 2010). "Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis.". Expert Rev Anti Infect Ther 8 (4): 419-33. doi:10.1586/eri.10.19. PMID 20377337.
  24. ↑ den Boer, ML.; Alvar, J.; Davidson, RN.; Ritmeijer, K.; Balasegaram, M. (Sep 2009). "Developments in the treatment of visceral leishmaniasis.". Expert Opin Emerg Drugs 14 (3): 395-410. doi:10.1517/14728210903153862. PMID 19708817.
  25. ↑ 25.0 25.1 25.2 25.3 Didier, ES.; Weiss, LM. (Oct 2011). "Microsporidiosis: not just in AIDS patients.". Curr Opin Infect Dis 24 (5): 490-5. doi:10.1097/QCO.0b013e32834aa152. PMID 21844802.
  26. ↑ Orenstein, JM.. "Diagnostic pathology of microsporidiosis.". Ultrastruct Pathol 27 (3): 141-9. PMID 12775504.
  27. ↑ Didier, ES. (Apr 2005). "Microsporidiosis: an emerging and opportunistic infection in humans and animals.". Acta Trop 94 (1): 61-76. doi:10.1016/j.actatropica.2005.01.010. PMID 15777637.
  28. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 168. ISBN 978-1416054542.
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