Reactivity of fungal organisms in tissue sections using anti-mycobacteria antibodies

Immunohistochemistry in the diagnosis of cutaneous bacterial infections

The identification of pathogens is of vital importance for the adequate treatment of infections. During the past 2 decades, the approach to histopathologic diagnosis has been dramatically transformed by immunohistochemistry (IHC) specifically in the diagnosis and classification of tumors and more recently in the diagnosis of infectious diseases in tissue samples. The main goals of this article were to: (1) identify by IHC the cutaneous structures where bacterial pathogens are expressed in the course of infection, (2) identify the specific cells in which bacterial pathogens are expressed in positive cases, and (3) describe the pattern of distribution of the bacterial antigens within these cells (nuclear, cytoplasmatic, or membranous). This article is an up-to-date overview of the potential uses and limitations of IHC in the histopathologic diagnosis of cutaneous bacterial infections. In conclusion, IHC is especially useful in the identification of microorganisms that are present in low numbers, stain poorly, are fastidious to grow, culture is not possible, or exhibit an atypical morphology.

Improved detection of mycobacteria species in formalin-fixed tissue sections

AIMS

To develop an antibody broadly reactive against mycobacterial species, which will improve detection of mycobacteria in tissue sections by immunohistochemistry (IHC).

METHODS

A sheep antisera was developed by immunization with multiple mycobacteria, and was tested by IHC against a range of mycobacteria in tissues from many species, as well as negative tissue controls and other bacteria.

RESULTS

The sheep antiserum, MAS-01, reacted with all 18 mycobacterial species tested, but did not react with uninfected inflammatory tissues. Although MAS-01 cross-reacted with two microbial genera which are related to mycobacteria (Corynebacteria and Proprionibacteria), it did not with Nocardia or Actinomyces. The antibody was more sensitive than the Ziehl-Neelsen stain for detection of tissue mycobacteria, and shortened the time required to identify these infections.

CONCLUSION

The MAS-01 antiserum will facilitate rapid identification of tissue mycobacterial infection by histopathologists.

Application of anti-BCG antibody for rapid immunohistochemical detection of bacteria, fungi and protozoa in formalin-fixed paraffin-embedded tissue samples

The applicability of an anti-Mycobacterium bovis (BCG) antibody-based immunohistochemistry (IHC) procedure was investigated using everyday veterinary pathological samples collected from 13 different animal species. Fifty-one formalin-fixed and paraffin-embedded tissue samples were selected for this study. Forty, 4 and 7 tissue samples contained different species of bacteria, fungi and protozoa, respectively. Three serial sections were prepared in each case. Two sections were pre-treated with enzyme and heat, respectively, while the last section was not pre-treated. In seven cases the sensitivity of histochemical staining (HSM), IHC and bacteriological culture were compared. Heating of the sections in a microwave oven was the most effective method in the case of almost all pathogens used. Strong or moderate positive reactions were observed for 26 bacterial species, all fungal and 2 protozoal species, while weak reactions occurred for 2 bacterial and 1 protozoal species. Only 4 protozoal and 12 bacterial species, including Leptospira and all the five Mycoplasma species examined, showed no reaction in this test. IHC had almost the same sensitivity as bacteriological culture and was more sensitive than HSM. The IHC method presented here should be preferred to HSM as a general screening tool in cases where pathological lesions suspicious for infections are evident and no microorganism can be cultured in vitro or only formalin-fixed tissue samples are available for the laboratory examination.

Modified immunohistological staining allows detection of Ziehl-Neelsen-negative Mycobacterium tuberculosis organisms and their precise localization in human tissue

The diagnosis of mycobacterial infection depends on the Ziehl-Neelsen (ZN) stain, which detects mycobacteria because of their characteristic acid-fast cell wall composition and structure. The histological diagnosis of tuberculosis (TB) comprises various aspects: (1) sensitive detection of mycobacteria; (2) precise localization of mycobacteria in the context of granulomatous lesions; (3) 'staging' of disease according to mycobacterial spread and granulomatous tissue integrity. Thus, detection of minute numbers of acid-fast bacteria in tissue specimens is critical. The conventional ZN stain fails to identify mycobacteria in numbers less than 10(4) per ml. Hence many infections evade diagnosis. PCR is highly sensitive, but allows neither localization within tissues nor staging of mycobacterial disease, and positive findings frequently do not correlate with disease. In this study, an anti-Mycobacterium bovis bacille Calmette-Guérin polyclonal antiserum (pAbBCG) was used to improve immunostaining, which was compared to the ZN stain in histological samples. Screening of tissue samples including lungs, pleural lesions, lymph nodes, bone marrow, and skin for mycobacterial infection revealed that pAbBCG staining detects infected macrophages harbouring intracellular mycobacteria or mycobacterial material as well as free mycobacteria that are present at low abundance and not detected by the ZN stain. The positive pAbBCG staining results were confirmed either by PCR analysis of microdissected stained tissue or by culture from tissue. This immunostaining approach allows precise localization of the pathogen in infected tissue.

Deep infection by Trichophyton rubrum in an immunocompromised patient

Dermatophytes are common pathogens of skin but rarely cause invasive disease. We present a case of deep infection by Trichophyton rubrum in an immunocompromised patient. T. rubrum was identified by morphological characteristics and confirmed by PCR. Invasiveness was apparent by histopathology and immunohistochemistry. The patient was treated successfully with itraconazole.

Utility of anti-bacillus Calmette-Guérin antibodies as a screen for organisms in sporotrichoid infections

BACKGROUND

Sporotrichoid infections often present a diagnostic challenge for the dermatopathologist. Therefore an affordable, reliable method of easier recognition of organisms is desired. Recently, immunohistochemical staining with antibodies against Mycobacterium bovis (bacillus Calmette-Guérin, BCG) was found to be useful in identifying various fungi and mycobacteria with minimal background staining.

OBJECTIVE

The purpose of this study was to demonstrate the usefulness of anti-BCG antibodies as a screen for organisms in sporotrichoid infections.

METHODS

Thirteen specimens of suspected sporotrichosis were selected for staining with anti-BCG antibody. Sporotrichoid infection was confirmed by histochemical staining, biopsy, and follow-up results.

RESULTS

Twelve of the 13 specimens stained positively using anti-BCG antibody. Of the 5 cultures done, 2 were positive for M. marinum, and 1 grew Sporothrix schenckii.

CONCLUSION

Immunohistochemical staining with anti-BCG antibody offers another screening method to identify organisms in sporotrichoid infections because of its ease, cost-effectiveness, and simplicity.

Rapid identification of tissue micro-organisms in skin biopsy specimens from domestic animals using polyclonal BCG antibody

Immunostaining with polyclonal anti-Mycobacterium bovis (BCG) was evaluated as a single screening method for the histological identification of micro-organisms in skin biopsy specimens from various veterinary species. Confirmed archival cases infected with Mycobacteria, Nocardia, Actinobacillus, Actinomyces, Streptococcus/Staphylococcus, Dermatophilus, spirochetes, Blastomyces, Coccidioides, Cryptococcus, Histoplasma, dermatophytes, Malassezia, Sporothrix, Leishmania, Pythium, phaeohyphomycetes and Prototheca organisms were selected. A total of 70 skin biopsy specimens from the dog, cat, horse, ox and llama were evaluated. The anti-BCG immunostain labelled bacteria and fungi with high sensitivity and minimal background staining but did not label spirochetes and protozoa (Leishmania). Differences were not noted between veterinary species. The results indicate that immunostaining with polyclonal anti-BCG is a suitable screening technique for the rapid identification of most common bacterial and fungal organisms in paraffin-embedded specimens. Also, mycobacterial and nocardial organisms were identified more readily with the anti-BCG immunostain in comparison to the histochemical stains.

A new application of BCG antibody for rapid screening of various tissue microorganisms

BACKGROUND

In routine dermatopathology there is growing demand for a simple, fast, cost-effective, and highly sensitive screening tool for the detection of microorganisms.

OBJECTIVE

Our purpose was to determine whether immunostaining with polyclonal anti-Mycobacterium bovis (BCG), which is known for its interspecies cross-reactivity, is a suitable screening method for many common microorganisms in dermatopathologic specimens.

METHODS

A total of 254 formalin-fixed, paraffin-embedded skin specimens of viral, protozoal, fungal, and bacterial infections were stained with appropriate histochemical stains and with anti-BCG.

RESULTS

Anti-BCG labeled bacteria and fungi with high sensitivity and minimal background staining, but did not react with spirochetes, viruses, or protozoa (Leishmania). The quality and sensitivity of anti-BCG staining were superior to conventional histochemical stains.

CONCLUSION

Because of its cross-reactivity with many bacteria and fungi as well as its high sensitivity and minimal background staining, the anti-BCG immunostain is a promising screening tool for the detection of the most common bacterial and fungal microorganisms in paraffin-embedded skin specimens.

Fatal mural endocarditis and cutaneous botryomycosis after heart transplantation

Fatal mural endocarditis and botryomycosis occurred concurrently in a 62-year-old women 4 months after orthotopic heart transplantation. Subsequent to mild mitral regurgitation, infection developed on a left atrial thrombus and was complicated by cerebral embolization. Simultaneously, skin nodules manifested on both forearms. Histologic examination revealed typical aspects of early evolving botryomycosis with massive infiltration of the dermis and hypodermis by necrotic granulomas framed by grains of Gram-positive coccoid forms. Bacteria were decorated by a nonspecific polyclonal antibody to Mycobacterium bovis.

Detection of infection or infectious agents by use of cytologic and histologic stains

A wide variety of stains are useful for detection of different organisms or, for viruses, the cytopathologic changes they induce, in smears prepared directly from clinical specimens and in tissue sections. Other types of stains, such as hematoxylin and eosin, are used routinely to stain tissue sections and are most valuable for assessing the immunologic response of the host to the invading pathogen. In many cases, the pattern of inflammation provides important clues to diagnosis and helps to guide the selection of additional "special" stains used predominantly for diagnosis of infectious diseases. A stain may be nonspecific, allowing detection of a spectrum of organisms, as do the Papanicolaou stain and silver impregnation methods, or detection of only a limited group of organisms, as do the different acid-fast techniques. Some nonspecific stains, such as the Gram stain, are differential and provide valuable preliminary information concerning identification. Immunohistochemical stains, on the other hand, are specific for a particular organism, although in some cases cross-reactions with other organisms occur. Despite the wealth of information that can be gleaned from a stained smear or section of tissue, however, the specific etiology of an infection often cannot be determined on the basis of only the morphology of the organisms seen; culture data are essential and must be considered in the final diagnosis.

Fatal hyalohyphomycosis following Fusarium onychomycosis in an immunocompromised patient

A 35-year-old man with B lymphoblastic lymphoma was treated with bone marrow transplant and aggressive chemotherapy. He developed a Fusarium infection of the great toenail. Septicemic dissemination of a Fusarium sp. occurred 9 months later during a lymphoma relapse. The clinical course of the hyalohyphomycosis was then rapidly fatal despite institution of amphotericin B therapy.