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| {{CMG}}; {{AE}} {{Preeti}} | | {{CMG}}; {{AE}} {{Preeti}} |
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| {| class="wikitable"
| |
| ! colspan="3" rowspan="2" |
| |
| ! rowspan="2" |Pathophysiology
| |
| ! rowspan="2" |Symptoms
| |
| ! colspan="3" |Laboratory Findings
| |
| |-
| |
| !Immunochemistry
| |
| !Blood work
| |
| !Biospy/CT/CXR
| |
| |-
| |
| | rowspan="9" |'''Infections'''
| |
| | rowspan="3" |'''Bacterial'''
| |
| | rowspan="2" |'''Syphilis'''
| |
| | rowspan="2" |
| |
| * Syphilis is caused by a [[spirochete]], [[Treponema pallidum|''Treponema pallidum'']].
| |
|
| |
| * It has an average incubation period of 3 - 12 weeks.
| |
| * Spirochete penetrates intact mucous membrane or microscopic dermal abrasions and rapidly enters systemic circulation with the [[central nervous system]] being invaded during the early phase of infection.
| |
| * The histopathological hallmark findings are endarteritis and plasma cell-rich infiltrates reflecting a delayed-type of hypersensitivity reaction to the spirochete.
| |
| | rowspan="2" |
| |
| '''Primary syphilis'''
| |
| * Mononuclear leukocytic infiltration, [[macrophages]], and [[lymphocytes]]
| |
| * Swelling and proliferation of small blood vessels
| |
| '''Secondary syphilis'''
| |
| * Swelling and dilatation of blood vessels in the [[dermis]]
| |
| * Epidermal [[hyperplasia]] and neutrophilic infiltration
| |
| * Inflammatory cell infiltrate, predominantly [[plasma cell]]
| |
| '''Tertiary syphilis'''
| |
| * Small vessel inflammation ([[endarteritis obliterans]])
| |
| * Granulomatous lesions ([[gumma]]) containing central necrosis, inflammatory cells, such as [[lymphocytes]], [[macrophages]], [[plasma cells]] and [[Fibroblast|fibroblasts]].
| |
| | rowspan="2" |
| |
| *
| |
|
| |
| * A presumptive diagnosis of syphilis is possible with the use of two types of serologic tests.
| |
| :* Nontreponemal tests (e.g., [[VDRL|venereal disease research laboratory (VDRL)]] and [[RPR|rapid plasma reagent test]]) and
| |
| :* Treponemal tests (e.g., [[FTA-ABS|fluorescent treponemal antibody absorbed (FTA-ABS) tests]], the ''T. pallidum'' passive particle agglutination (TP-PA) assay, various [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]]).
| |
| |
| |
| | rowspan="2" |Darkfield examinations and tests to detect ''[[T. pallidum]].''
| |
| |-
| |
| |
| |
| |-
| |
| |'''Brucellosis'''
| |
| |[[humans]] could be infected by eating undercook meat or raw [[Dairy product|dairy]] products, inhalation of the [[bacteria]] and direct contact of bacteria with [[skin]] [[wounds]] or [[Mucous membranes|mucous membranes.]] Following transmission, [[white blood cells]] phagocyte the pathogen and transports it via hematologic or [[Lymphatic system|lymphatic route]] to different organs specially to those of the [[reticuloendothelial system]].
| |
| |
| |
| * Fever
| |
| * Rash
| |
| * Abdominal pain
| |
| * weightloss
| |
| * Painful lymphadenopathy
| |
| * hepatosplenomegaly
| |
| * arthritis
| |
| |
| |
| * [[Lymphocytosis|Relative lymphocytosis]]
| |
| * positive titer of anti-[[Brucella|b''rucella'']] [[antibodies]] on serological testing
| |
| * There are two types of serological tests, based on:
| |
| ** Antibody production against [[lipopolysaccharide]]
| |
| ** Antibody production against other [[bacterial]] [[antigens]]
| |
| |
| |
| |
| |
| * [[Brucella|''Brucella'']] is most commonly isolated from blood cultures (blood cultures are positive between the 7th and 21st day)
| |
| |-
| |
| | rowspan="4" |'''Viral'''
| |
| |'''infectious mononucleosis'''
| |
| |
| |
| * Epstein-Barr virus, frequently referred to as [[EBV]],
| |
| * the [[EBV|virus]] infects [[B cells]] located in the oropharyngeal epithelium and subsequently spreads to involve the [[lymph nodes]], [[liver]] and [[spleen]].
| |
| * incubation period ranges from 4 to 6 weeks.
| |
| *
| |
| |Characteristic triad of [[fever]], [[pharyngitis]], and [[lymphadenopathy]] lasting for 1 to 4 weeks.
| |
|
| |
| Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
| |
| |
| |
| * presence of [[Lymphocytes|atypical lymphocytes]] (often recorded by automated blood analyser machines as an increase in the monocycte count) is characteristic of [[EBV|EBV infection]].
| |
| *
| |
| |
| |
| ==== Peripheral Blood Smear ====
| |
| * hallmark of the disease is the presence of [[Reactive lymphocyte|atypical lymphocytes]] (a type of mononuclear cell) .
| |
| * [[Lymphocytosis|Atypical lymphocytosis]] is present in approximately 75% of patients
| |
| * Greater than 10% atypical lymphocytes is diagnostic of mononucleosis.
| |
| |
| |
| |-
| |
| |'''cytomegalovirus'''
| |
| |
| |
| * Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]].
| |
| * In disseminated disease, it involves both [[liver]] and renal organs.
| |
| |Common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]] and [[loss of appetite]].
| |
| * Abdominal examination reveals [[splenomegaly]].
| |
| * [[Maculopapular rash]] may be present.
| |
| |
| |
| * Positive monospot test.
| |
| * Elevated [[liver enzymes]]
| |
| * [[PCR]] of CSF with detectable virus is diagnostic.
| |
| |
| |
| |
| |
| * CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or periventricular areas.
| |
| * Brain biopsy with + staining for [[CMV]] or evidence of owl's eyes is also diagnostic.
| |
| |-
| |
| |'''human immunodeficiency virus'''
| |
| |Acute HIV infection may be asymptomatic or may cause a [[mononucleosis]]-like syndrome
| |
|
| |
| |[[fever]], [[fatigue]], [[sore throat]], [[myalgia]], and [[lymphadenopathy]]
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| |'''cat scratch fever'''
| |
| |The causative organism was first thought to be ''Afipia felis'', but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, ''[[Bartonella henselae]]'' (''B. henselae'') and ''Bartonella clarridgeiae'', which are rod-shaped [[Gram-negative]] bacteria.
| |
| |Symptoms of Cat scratch fever are:
| |
| * Painful [[lymphadenopathy]]
| |
| * [[Fever]]
| |
| * [[Chills]]
| |
| * [[Back pain]]
| |
| * [[Headache]]
| |
| * [[Sore throat]]
| |
| * [[Abdominal pain]]
| |
| * Vision problems
| |
| * [[Malaise]]
| |
| * Alteration of mental status
| |
| * [[Convulsion|Convulsions]]
| |
| |
| |
| * [[Polymerase chain reaction]] ([[PCR]]) is the most sensitive test and is able to differentiate between different Bartonella species.
| |
| * Serological testing (indirect immunofluorescence or enzymatic immunoassay with titration of [[IgG]] or [[IgM]] antibodies) - to detect serum antibody to B henselae.
| |
| |
| |
| * [[Complete blood count]] and differential count - [[lymphocytosis]] is seen in the acute phase.
| |
| * [[Erythrocyte sedimentation rate]] - elevated.
| |
| |
| |
| |-
| |
| |'''Mycobacterial'''
| |
| |'''tuberculosis'''
| |
| |
| |
| * Mostly in endemic areas
| |
| |Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]], [[hemoptysis]]
| |
| |
| |
| * [[Sputum]] smear positive for [[acid-fast bacilli]]<nowiki/>and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
| |
| |Mild normocytic [[anemia]], [[hyponatremia]], and
| |
|
| |
| [[hypercalcemia]]
| |
| |
| |
| * CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
| |
| |-
| |
| |'''Parasitic'''
| |
| |'''toxoplasmosis'''
| |
| |A [[parasitic disease]] caused by ingestion of cat feces, affect all organs and particularly dangerous in [[pregnant]] woman. Toxoplasma infections may also present with a mononucleosis-like syndrome seen in patients with acute HIV syndrome.
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | rowspan="4" |'''Autoimmune'''
| |
| | colspan="2" |'''Systemic lupus erythematosus'''
| |
| |
| |
| |skin [[rash]], [[arthritis]], positive [[autoimmune]] serology, [[weight loss]], [[Fever|fevers]]<nowiki/>and [[chronic pain]],
| |
|
| |
| |
| |
| |[[ESR]] and [[CRP]]<nowiki/>elevated, positive [[ANA]]
| |
| |
| |
| |-
| |
| | colspan="2" |'''Sjögren's syndrome'''
| |
| |
| |
| |skin [[rash]], [[arthritis]], positive [[autoimmune]] serology, [[weight loss]], [[Fever|fevers]]<nowiki/>and [[chronic pain]],
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | colspan="2" |'''Hydantoin derivatives'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | colspan="2" |'''Sarcoidosis'''
| |
| |
| |
| * More common in African-American females
| |
| * [[Granuloma]] formation is a [[hallmark]] of [[sarcoidosis]] disease
| |
| * Th2 cells also contribute to [[granuloma]] formation. These cells secrete [[fibronectin]] and [[CCL18]], which finally lead to macrophage-mediated [[collagen]] formation and [[fibrosis]].
| |
| * histopathology may shows Inclusions within the sarcoid [[granuloma]] like asteroid bodies, [[Schaumann bodies]], birefringent crystals, and Hamazaki-Wesenberg bodies
| |
| |
| |
| * Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]].
| |
| * can involve all organ systems to varying extent and degree.
| |
| |
| |
| * serum [[ACE]] level
| |
|
| |
| * Serum chitotriosidase
| |
| * Soluble interleukin-2 receptor
| |
| * [[Hypercalcemia]]
| |
| * [[Kveim test]]
| |
| |
| |
| |
| |
| * On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
| |
| * CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
| |
| * Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.
| |
| * Biopsy of lung shows non-[[caseating]][[granuloma]]
| |
| |-
| |
| | rowspan="6" |'''Neoplasms'''
| |
| | colspan="2" rowspan="1" |'''Hodgkin's disease'''
| |
| |Reed-Sternberg cell
| |
| * B-cell origin
| |
| * CD30 (Ki-1) and CD15 (Leu-M1) antigens
| |
| |
| |
| * Painless localized peripheral lymphadenopathy
| |
| * B symptoms
| |
| |
| |
| * Lactate dehydrogenase (LDH) may be increased.
| |
| * ESR elevated
| |
| * Serum creatinine elevated in nephrotic syndrome.
| |
| * Alkaline phosphatase (ALP) increased
| |
| * Hypercalcemia, hypernatremia, and hypoglycemia.
| |
| |
| |
| *
| |
| |
| |
| Fine-needle aspiration
| |
| * Mononucleate and binucleate Reed-Sternberg cells in a background of inflammatory cells
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Chronic lymphocytic leukemia'''
| |
| |
| |
| * Clonal B cells arrested in the B-cell differentiation pathway,.
| |
| * [[Genetic mutation|Genetic mutations]] that promote both [[malignant]]<nowiki/>leukemic proliferation and [[apoptotic]] resistance of mature B cells.
| |
| * Structural [[Genetic mutation|genetic mutations]] involved in the pathogenesis of chronic lymphocytic leukemia include [[chromosome]] 13q deletion, chromosome 17p deletion, and chromosome 11q deletion.
| |
| |
| |
| * [[Fever]]
| |
| * Recurrent [[bleeding]]
| |
| * [[Weight loss]]
| |
| * [[Muscle wasting]]
| |
| * Generalized [[weakness]]
| |
| * Anorexia
| |
| * [[Night sweats]]
| |
| * [[Abdominal pain]]
| |
| * Recurrent [[Infection|infections]]
| |
| |
| |
| * Monoclonality of kappa and lambda producing [[B cell|B cells]]
| |
| * Presence of smudge cells
| |
|
| |
| * Express [[CD19]], [[CD20]], [[CD23]], and [[CD5]] on the [[cell]] surface
| |
| |CBC
| |
| * Absolute [[lymphocytosis]] (>5000 cells/μl)
| |
| * Decreased [[hemoglobin]] concentration
| |
| * Decreased [[Platelet|platelets]] count
| |
| |
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Small cell carcinoma of the lung'''
| |
| |
| |
| * aggressive form of [[lung cancer]] and has the highest association with [[smoking]].
| |
| * starts in the [[bronchi]] and expands through the [[bronchial]] [[mucosa]] and [[Metastasize|metastasizes]] rapidly.
| |
| * A [[mutation]] in the [[p53]] [[gene]] is reported in 75%-100% of the cases.
| |
| |relatively rapid onset of symptoms and is associated with the occurrence of [[Paraneoplastic syndrome|paraneoplastic syndromes]] such as the [[syndrome of inappropriate antidiuresis]] ([[SIADH]]), hypercalcemia and many more.
| |
| * [[Cough]] (most common symptom)
| |
| * [[Wheezing]]
| |
| * [[Dyspnea]]
| |
| * [[Hemoptysis]]
| |
| * [[Chest pain]]
| |
| |Nearly all SCLC are immunoreactive for
| |
| * [[keratin]],
| |
| * [[thyroid transcription factor 1]],
| |
| * [[Epithelial cells|epithelial]] membrane [[antigen]]
| |
| [[Neuroendocrine]] and [[neural]] [[differentiation]] result in the expression of molecules like
| |
| * [[Dopamine beta-hydroxylase|dopa-decarboxylase]],
| |
| * [[calcitonin]]
| |
| * [[neuron-specific enolase]],
| |
| * [[chromogranin A]],
| |
| * [[CD56]]
| |
| * [[gastrin]]-releasing [[peptide]]
| |
| * [[insulin-like growth factor 1]]
| |
| |
| |
| |The confirmation of the diagnosis of SCLC is by tumor [[biopsy]].
| |
|
| |
| patients with confirmed diagnosis of SCLC should undergo a [[CT scan]] of the [[abdomen]] for staging purposes.
| |
|
| |
| [[Computed tomography|CT scan]] of the [[abdomen]] helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]].
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Malignant histiocytosis'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Melanoma'''
| |
| |
| |
| * melanoma is the result of multiple genetic mutations. The progression to melanoma usually involves the serine-threonine kinases of the [[MAPK/ERK pathway]] (mitogen-activated protein kinase) following mutation of either the ''[[Ras|N-RAS]]'' or ''[[BRAF]]'' oncogene
| |
| * changes include the overexpression of [[Cadherin|N-cadherin]], [[Integrin|αVβ3 integrin]], MMP-2, [[MSH]], [[cAMP]], and [[survivin]], and the loss of [[E-cadherin]] and TRMP1 proteins
| |
| |Symptoms of melanoma include the following:
| |
| * Rapid growth of an existing [[nevus]]
| |
| * [[Nevus|Bleeding nevus]]
| |
| * [[Nodule|Cutaneous nodules]]
| |
| * [[Hyperpigmentation|Hyper]]/[[Hypopigmented area|hypopigmented skin lesion]]
| |
| * [[Lymphadenopathy|Lymphatic masses]]
| |
| * [[Melanonychia]] (brown/blue nail discoloration)
| |
| * [[Skin ulcer|Non-healing skin ulcer]]
| |
| * [[Skin lesion|Painful skin lesion]]
| |
| * [[Pruritus]]
| |
| * [[Bone pain]]
| |
| |
| |
| |
| |
| |An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is diagnostic.
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Germ cell neoplasms'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | rowspan="5" |'''Other conditions'''
| |
| | colspan="2" rowspan="1" |'''Reactive lymphoid hyperplasia'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | colspan="2" rowspan="1" |'''[[Lymphomatoid granulomatosis]]'''
| |
| |
| |
| |Lymphamatoid granulomatosis manifests in a variety of clinical forms.
| |
| * [[Cough]]
| |
| * [[Dyspnea]]
| |
| * [[Chest pain|Chest tightness]]
| |
| * [[Malaise]]
| |
| * [[Weight loss]]
| |
| * [[Fatigue]]
| |
| * [[Fever]]
| |
| * [[Headache|Headaches]]
| |
| * [[Seizure|Seizures]]
| |
| * [[Hemiparesis]]
| |
| * [[Ataxia]]
| |
|
| |
| * [[Rash|Erythematous rash]]
| |
| * [[Macule|Macules]]
| |
| * [[Papule|Papules]]
| |
| * [[Plaque|Plaques]]
| |
| * [[Nodule (medicine)|Subcutaneous nodules]]
| |
| * [[Nodule (medicine)|Larger ulcerated nodules]]
| |
|
| |
| |
| |
| |'''CBC'''
| |
| * [[Leukopenia]]
| |
| * [[Lymphocytopenia|Lymphopenia]]
| |
| * Low [[CD4]] count
| |
| * [[Leukocytosis]] is rare
| |
| * Elevated [[Hematocrit]]
| |
| |The following x-ray findings are suggestive of assisting in diagnosing Lymphmotoid granulomatosis:
| |
| * [[Nodules|Bilateral nodules]] or [[Mass|masses]] in the lower and peripheral lung
| |
| * [[Infiltration (medical)|Pulmonary infiltrates]]
| |
| * [[Pleural effusion]] in some cases
| |
| * [[Cavitation]] of nodules
| |
| * Chest CT scan may be helpful in the diagnosis of Lymphomatoid granulomatosis. Findings on CT scan suggestive of/diagnostic of Lymphomatoid granulomatosis include:
| |
| *** [[Nodule (medicine)|Nodules]]
| |
| *** [[Cavitation|Cavitations]]
| |
| *** [[Mass|Masses]]
| |
| *** [[Halo sign]] is seen due to the angioinvasive nature of the disease
| |
| ***
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Dermatopathic lymphadenopathy'''
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Angioimmunoblastic lymphadenopathy'''
| |
| |
| |
| * Clonal [[T-cell receptor]] and [[immunoglobulin]] gene rearrangements
| |
| * [[Epstein–Barr virus]] (EBV) has been found in both reactive B-cells and the neoplastic T-cells.
| |
| * [[Trisomy]] 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases..
| |
| * Characteristic findings on gross pathology, aborization and proliferation of [[high endothelial venules]]
| |
| * On microscopic histopathological analysis, [[CD4]]+ [[T-cells]], [[CD8]]+ [[T-cells]], and polyclonal [[plasma cells]].
| |
| |Symptoms include:
| |
| * [[Fever]]
| |
| * [[Weight loss]]
| |
| * [[Skin rash]]
| |
| * [[Night sweats]]
| |
| * [[Edema]]
| |
| * Chest pain
| |
| * [[Abdominal pain]]
| |
| * [[Bone pain]]
| |
| * Painless swelling in the neck, axilla, groin, thorax, and abdomen
| |
| * [[Fatigue]]
| |
| * [[Pale skin color]]
| |
| * [[Dark urine]]
| |
| * [[Chronic pain]] and swelling of the joints
| |
| |
| |
| * Immunophenotyping
| |
| :* Positivity for [[CD2]], [[CD3]], [[CD4]], [[CD5]], [[CD10]], [[CD20]], and focal positivity for [[CXCL13]]
| |
| :* Negative for ALK1 and [[CD30]]
| |
| * Fluorescence in situ hybridization ([[FISH]])
| |
| :
| |
| |
| |
| * [[Complete blood count]] (CBC)
| |
| :* [[Anemia]]
| |
| :* [[Eosinophilia]]
| |
| |Lymph node or extranodal tissue biopsy is diagnostic of angioimmunoblastic T-cell lymphoma.
| |
|
| |
| CT scan suggestive of angioimmunoblastic T-cell lymphoma include:
| |
| * [[Lymphadenopathy|Mediastinal lymphadenopathy]]
| |
| * [[Lymphadenopathy|Inguinal lymphadenopathy]]
| |
| * [[Lymphadenopathy|Aortal lymphadenopathy]]
| |
| * Bilaterally enlarged kidneys
| |
| |-
| |
| | colspan="2" rowspan="1" |'''Giant lymph node hyperplasia (Castleman disease)'''
| |
| |Castleman's disease is likely due to hypersecretion of the cytokine [[Interleukin 6|IL-6]]. In KSHV positive tumors, this is most likely due to expression of the a virus-encoded cytokine, vIL-6, while KSHV negative tumors appear to be the result of over secretion of human IL-6.
| |
| |The most common '[[B symptoms]]' of MCD are
| |
| * High [[fevers]]
| |
| * [[Anemia]]
| |
| * [[Weight loss]]
| |
| * [[Loss of appetite]]
| |
| Other symptoms include:
| |
| * [[Cough]]
| |
| * Chest discomfort
| |
| * [[Fatigue]]
| |
| * [[Weakness]]
| |
| |
| |
| |
| |
| * Complete blood count and differential count - [[low white blood cell counts]], which may to be due to the overproduction of [[interleukin 6]].
| |
| * [[Erythrocyte sedimentation rate]] - elevated in 80% cases.
| |
| |
| |
| |}
| |