Feline sporotrichosis: Characterization of cutaneous and extracutaneous lesions using different diagnostic methods

Sporotrichosis is a mycotic infection of the cutaneous and subcutaneous tissues caused by Sporothrix spp. that can also cause extracutaneous manifestations. This study aimed to characterize cutaneous and extracutaneous sporotrichosis lesions in cats. Over 1 year, 102 cats rescued by the Zoonoses Control Center of Belo Horizonte, Brazil, euthanized with clinical suspicion of feline sporotrichosis were evaluated. After euthanasia, the animals were evaluated by macroscopic, cytological, histopathological, and immunohistochemistry (IHC) examinations; fungal culture; and polymerase chain reaction (PCR). Sporothrix infection was identified by at least one diagnostic technique in all cats (n = 102) evaluated by postmortem examination, including 26/28 cases (93%) evaluated by IHC, 66/90 cases (73%) evaluated by cytology, 70/102 cases (68.6%) evaluated by histopathology, and 62/74 cases (84%) evaluated by fungal culture. Two cats had positive results only by fungal culture. Cytology and histopathology examinations were effective in diagnosing sporotrichosis, although IHC was needed to confirm the diagnosis in cats with low fungal loads. Sporothrix brasiliensis was confirmed by the sequencing of 3 samples. Skin lesions were characterized mainly by pyogranulomatous to granulomatous dermatitis (frequently with subcutaneous inflammation) with different intensities of Sporothrix spp. yeast. Extracutaneous findings associated with sporotrichosis included rhinitis or rhinosinusitis, lymphadenitis, pneumonia, meningitis, periorchitis, conjunctivitis, and glossitis. Extracutaneous infections were observed in 74/102 cases, and a possible association between the chronicity of the disease and the higher pathogenicity of this fungal species in cats requires further investigation.

B12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I

BACKGROUND

The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency-related glossitis (B12-def glossitis) and gastric serum biomarkers [gastrin-17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti-Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12-def glossitis.

METHODS

A cross-sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests.

RESULTS

Of 243 patients, 133 with B12-def glossitis were in the case group, and 110 with other oral mucosal diseases (non-glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow ). Univariate logistic regression showed that G17hi PGIlow was a high-risk factor for B12-def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti-H. pylori antibodies compared to the non-G17hi PGIlow group.

CONCLUSION

Gastric serum biomarkers in patients with B12-def glossitis generally showed G17hi PGIlow , suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non-G17hi PGIlow groups may represent different etiologies of B12 deficiency.

Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System

Tongue examination is an important diagnostic method for judging pathological conditions in Kampo (traditional Japanese medicine), but it is not easy for beginners to learn the diagnostic technique. One reason is that there are few objective diagnostic criteria for tongue examination findings, and the educational method for tongue examination is not standardized in Japan, warranting the need for a tongue image database for e-learning systems that could dramatically improve the efficiency of education. Therefore, we constructed a database comprising tongue images whose findings were determined on the basis of votes given by five Kampo medicine specialists (KMSs) and confirmed the educational usefulness of the database for tongue diagnosis e-learning systems. The study was conducted in the following five steps: development of a tongue imaging collection system, collection of tongue images, evaluation and annotation of tongue images, development of a tongue diagnosis e-learning system, and verification of the educational usefulness of this system. Five KMSs evaluated the tongue images obtained from 125 participants in the following eight aspects: (i) tongue body size, (ii) tongue body color, (iii) tongue body dryness and wetness, (iv) tooth marks on the edge of the tongue, (v) cracks on the surface of the tongue, (vi) thickness of tongue coating, (vii) color of tongue coating, and (viii) dryness and wetness of tongue coating. Medical students (MSs) were given a tongue diagnosis test using an e-learning system after a lecture on tongue diagnosis. The cumulative and individual match rates (%) (individual match rates of 100% (5/5), 80% (4/5), and 60% (3/5) are shown in parentheses, respectively) were as follows: (i) tongue body size: 92.8 (26.4/26.4/40.0); (ii) tongue body color: 83.2 (10.4/20.8/52.0); (iii) tongue body dryness and wetness: 88.8 (13.6/34.4/40.8); (iv) tooth marks on the edge of the tongue: 88.8 (6.4/35.2/47.2); (v) cracks on the surface of the tongue: 96.8 (24.0/35.2/37.6); (vi) thickness of tongue coating: 84.8 (7.2/21.6/56.0); (vii) color of tongue coating: 88.0 (15.2/37.6/35.2); and (viii) dryness and wetness of tongue coating: 74.4 (4.8/19.2/50.4). The test showed that the tongue diagnosis ability of MSs who attended a lecture on tongue diagnosis was almost the same as that of KMSs. We successfully constructed a tongue image database standardized for training specialists on tongue diagnosis and confirmed the educational usefulness of the e-learning system using a database. This database will contribute to the standardization and popularization of Kampo education.

Oral manifestations among COVID-19: An observational study of 713 patients

BACKGROUND

COVID-19 outbreak in 2019 took the entire world by a storm with the medical fraternity struggling to understand and comprehend its complex nature. A number of patients who are COVID positive have reported oral lesions. However, there is still a lingering question, whether these lesions are because of coronavirus infection or they are secondary to the patient's systemic condition. This article aims to report the oral findings of an observational study of 713 patients diagnosed with COVID-19.

MATERIALS AND METHODS

A singlssswe-institution, short-term observational study was conducted on patients admitted to Symbiosis University Hospital and Research Centre, Lavale, Pune who were positive to coronavirus, who presented varied oral findings such as herpes simplex, candidiasis, geographic tongue, and aphthous ulcer.

RESULTS

A total of 713 patients, 416 males and 297 females, who were positive to coronavirus, were screened from April 2020 to June 30, 2020, for oral ulcers. In this group, nine patients reported oral discomfort due to varied forms of oral lesions ranging from herpes simplex ulcers to angular cheilitis (1.26%).

CONCLUSION

This study supports the hypothesis that oral manifestations in patients diagnosed with COVID-19 could be secondary lesions resulting from local irritants or from the deterioration of systemic health or could be just coexisting conditions. No specific pattern or characteristic oral lesions were noted in a study of 713 COVID-positive patients in our study to qualify these lesions as oral manifestations of SARS-CoV-2 infection.

Early radiation-induced oral pain signaling responses are reduced with pentoxifylline treatment

Radiation-induced acute oral mucositis is associated with inflammation and pain. In other realms of pain research, nociceptors are known to be activated by inflammatory cytokines; for example, tumor necrosis factor alpha (TNF-α) can activate transient receptor potential ion channels on sensory neurons. But there is an unclear relationship between inflammatory cytokines and molecular mediators of pain in radiation-induced mucositis (RIM) and radiation-associated pain (RAP). In this prospective, analytical, experimental pilot study, a common drug (pentoxifylline [PTX]) was used with the goal of inhibiting TNF-α signaling in mice that underwent lingual irradiation to induce severe acute oral RIM/RAP. Body weight and glossitis scores were recorded daily. Eye wiping behaviors were assayed as a surrogate measure of oral discomfort (which is possible due to cross-sensitization of the mandibular and ophthalmic branches of the trigeminal nerve). Quantitative real-time reverse transcription polymerase chain reaction was performed on irradiated tongue tissue to measure changes in expression of TNF-α, its receptor, nuclear factor kappa-light-chain-enhancer of activated B cells, transient receptor potential vanilloid type 1 (TRPV1), and transient receptor potential vanilloid type 4 (TRPV4). Responsiveness of afferent sensory trigeminal neurons to TNF-α, a TRPV1 agonist (capsaicin), and a partial TRPV4 agonist (histamine) was measured via calcium imaging. Although PTX treatment did not reduce glossitis severity or mitigate weight loss in mice with RIM/RAP, it did inhibit the upregulation of TNF-α's receptor that normally accompanies RIM, and it also reduced neuronal responsiveness to each of the aforementioned chemical stimuli. These results provide provisional evidence that inhibition of TNF-α signaling with PTX treatment may serve as a useful tool for reducing pain in head and neck cancer patients.

Oral adverse effects: drug-induced tongue disorders

Objectives

Due to a worldwide increase in drug consumption, oral healthcare professionals are frequently confronted with patients using one or more drugs. A large number of drugs can be accompanied with adverse drug reactions in the orofacial region, amongst others of the tongue. This paper aims to give an overview of drugs that are known to be accompanied with tongue disorders.

Materials and methods

The national drug information database for Dutch pharmacists, composed of scientific drug information, guidelines and summaries of product characteristics, was analysed for drug‐induced tongue disorders. “MedDRA classification” and “Anatomical Therapeutic Chemical codes” were used to categorize the disorders.

Results

The database comprises of 1645 drugs of which 121 (7.4%) are documented to be accompanied with tongue disorders as an adverse effect. Drug‐induced tongue disorders are predominantly observed in the following drug categories: “nervous systems,” “anti‐infectives for systemic use” and “alimentary tract and metabolism”. The most common drug‐induced tongue disorders are glossitis, tongue oedema, tongue discoloration and burning tongue.

Conclusion

Healthcare professionals are frequently confronted with drugs that can cause tongue disorders. The overview of drugs reported in this article supports clinicians in their awareness, diagnosis and treatment of drug‐induced tongue disorders.

Septicemic Actinobacillus suis infection in a neonatal piglet with multifocal necrotic glossitis

Five-day-old neonatal piglets presented with debilitation and ananastasia. At the necropsy of one piglet, the apex of the tongue was found to be discolored dark red, and disseminated white foci were found on the cut surface. Many white foci were also found in the lungs and on the serosa of the liver and spleen. Histopathological findings revealed multifocal necrotic glossitis and pneumonia with Gram-negative bacilli. The bacilli were identified as Actinobacillus suis through immunohistochemical, biochemical, and genetic tests, including 16S rRNA gene sequencing. Although A. suis usually causes inflammation in thoracic and abdominal organs, lesions were also found in the tongue in the present case. This study is the first report of glossitis caused by A. suis.

Dermatologic findings of vitamin B12 deficiency in infants

BACKGROUND/OBJECTIVES

Vitamin B₁₂ deficiency in infants is uncommonly reported from developed countries and generally lacks dermatologic manifestations. On the contrary, infantile vitamin B₁₂ deficiency is common in India and cutaneous manifestations are a constant feature, although often overshadowed by neurologic and hematological manifestations. The aim of this study was to describe the skin changes of vitamin B₁₂ deficiency in infants.

MATERIALS AND METHODS

A retrospective chart review of vitamin B₁₂ deficient infants for clinical and laboratory parameters was performed and data analyzed.

RESULTS

Forty-three infants, 30 boys and 13 girls, aged 4 to 27 months, with vitamin B₁₂ deficiency were identified. Skin hyperpigmentation was present in 41 infants; it was localized to the dorsa of hands and feet in 26. Fifteen infants had generalized hyperpigmentation; 10 had a reticulate pattern, and 5 had a homogeneous pattern. Brown and sparse scalp hair were present in all. Glossitis was seen in 5 infants and cheilitis in 3. Of the 32 infants who underwent laboratory investigations, 28 had anemia and 21 macrocytosis. Serum vitamin B₁₂ was measured in 30 infants; it was low in 19. Of the 11 with normal serum vitamin B₁₂ , 9 had received vitamin B₁₂ before referral but had macrocytosis and low maternal serum vitamin B₁₂ . The infants were treated with vitamin B₁₂ . Skin pigmentation and mucosal changes resolved completely by 3-4 weeks, but hair changes were slower to reverse.

CONCLUSION

Cutaneous findings are a common feature of vitamin B₁₂ deficiency in Indian infants and resolve with treatment.

Isolation of Avipoxvirus from Tongue of Canaries ( Serinus canaria) Show Severe Localized Proliferative Glossitis

Poxvirus was the causative agent of two unusual outbreaks of proliferative glossitis in canary ( Serinus canaria forma domestica) breeders in the Northern Italy. A total of 45, 7-9-mo-old canaries were submitted in fair postmortem conditions to the Istituto Zooprofilattico Sperimentale delle Venezie at the beginning of November 2005 for diagnostic investigation. Birds belonged to two unrelated and geographically distant aviaries in northern Italy, herein identified as Aviary A and Aviary B. The two breeder flocks had both attended the same bird exposition held at the beginning of October and started experiencing an onset of high mortality 3 wk after the show. Twelve red factor-melanin canaries from Aviary A (Mantua) and 33 dominant white and recessive white canaries from Aviary B (Vicenza) were submitted for laboratory investigations. Clinical signs were unspecific and consisted of depression, ruffling of the feathers, epistaxis, and anorexia due to decreased feed and water intake. Postmortem findings revealed a severe increase in volume, thickening, and hardening of the tongue, which had turned pinkish to dark brown. No apparent gross lesions were noticed in integumentary, respiratory, and digestive systems or other internal organs. Histopathologic evaluation of the tongue revealed severe proliferation of the stratified squamous epithelium containing numerous large eosinophilic intracytoplasmic inclusion bodies (Bollinger bodies) displacing the nuclei of the cells peripherally. Severe ulceration of the surface epithelium, fibrinoheterophilic plaque formation, and moderate basal lymphoplasmacytic infiltrations were also associated with the proliferative lesion. Poxvirus was successfully isolated from the lesions in tissue cultures but not in specific-pathogen-free chicken embryonated eggs. Typical large, brick-shaped viral particles of 300-450 nm were also observed in affected tongues by transmission electron microscopy. This is the first report of multiple outbreaks of "poxvirus glossitis" in canaries.

Tongue nodules in canine leishmaniosis--a case report

BACKGROUND

Canine leishmaniosis (CanL) caused by Leishmania infantum is an endemic zoonosis in southern European countries. Infected dogs can present rare or atypical forms of the disease and diagnosis can be challenging. The present report describes a case of tongue nodules in a 3-year-old neutered female Labrador Retriever dog with leishmaniosis.

FINDINGS

A fine needle aspiration of the lingual nodules revealed amastigote forms of Leishmania inside macrophages. Differential diagnosis ruled out neoplasia, calcinosis circumscripta, solar glossitis, vasculitis, amyloidosis, eosinophilic granulomas, chemical and electrical burns, uremic glossitis and autoimmune diseases. Combined therapy with antimoniate meglumine and allopurinol for 30 days resulted in the normalization of hematological and biochemical parameters. Two months after diagnosis and the beginning of treatment, a mild inflammatory infiltrate was observed by histopathology, but an anti-Leishmania immunofluorescence antibody test (IFAT) was negative as well as a PCR on both tongue lesions and a bone marrow aspirate. Seven months after diagnosis, the dog's general condition appeared good, there were no tongue lesions and a new IFAT was negative. Fifteen months after diagnosis this clinically favourable outcome continued.

CONCLUSIONS

The dog could have suffered a relapsing episode of CanL, but a new systemic or local infection cannot be excluded. Regular clinical re-evaluation should be maintained, as a future relapse can potentially occur. In conclusion, CanL should be considered in the differential diagnosis of nodular glossitis in dogs.

Ultrastructure of newly recognized caliciviruses of the dog and mink

Two recently recognized viruses obtained from a dog with glossitis and from mink with hemorrhagic pneumonia were characterized by electron microscopy. The results of the negative-stained preparations indicated that the viruses were structurally compatible with the calicivirus group.