Cytopathology of Infectious Diseases (eBook)

Liron Pantanowitz, MD is Associate Professor of Pathology, University of Pittsburg Medical Center, UPMC Shadyside, Pittsburg, PA Walid E. Khalbuss, MD, PhD is Associate Professor of Pathology, University of Pittsburg Medical Center, UPMC Shadyside, Pittsburg, PA Pam Michelow, MD is Division Head, Cytology Unit, Department of Anatomical Pathology University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa

Cytopathology of Infectious Diseases 3
Foreword 7
Series Preface 9
Contents 11
Contributors 13
1: Introduction 17
Suggested Reading 19
2: Specimen Collection and Handling 20
Specimen Type 23
Specimen Sites 25
Suggested Reading 27
3: Host Reactions to Infection 28
Acute (Purulent) Inflammatory Response 28
Cytomorphologic Features 28
Differential Diagnosis 30
Ancillary Studies 30
Eosinophilia and Allergic Mucin 30
Cytomorphologic Features 30
Differential Diagnosis 30
Ancillary Studies 31
Granulomatous Inflammation 31
Cytomorphologic Features 32
Differential Diagnosis 32
Ancillary Studies 33
Necrosis 36
Cytomorphologic Features 36
Differential Diagnosis 37
Ancillary Studies 37
Viral Cytopathic Effect 37
Cytomorphologic Features 37
Differential Diagnosis 38
Ancillary Studies 38
Reactive Epithelial and Mesenchymal Repair 38
Cytomorphologic Features 38
Differential Diagnosis 39
Ancillary Studies 39
Reactions with Impaired Cell-Mediated Immunity 40
Cytomorphologic Features 40
Differential Diagnosis 40
Ancillary Studies 40
Immune Reconstitution Inflammatory Syndrome 40
Cytomorphologic Features 41
Differential Diagnosis 41
Ancillary Studies 41
Hemophagocytosis and Emperipolesis 41
Cytomorphologic Features 42
Differential Diagnosis 42
Ancillary Studies 43
Ciliocytophthoria 43
Cytomorphologic Features 43
Differential Diagnosis 44
Ancillary Studies 44
Xanthogranulomatous Inflammation 44
Cytomorphologic Features 44
Differential Diagnosis 44
Ancillary Studies 44
Malakoplakia 45
Cytomorphologic Features 46
Differential Diagnosis 47
Ancillary Studies 47
Inflammatory Pseudotumor Reaction 47
Cytomorphologic Features 47
Differential Diagnosis 48
Ancillary Studies 48
Crystal Formation 48
Cytomorphologic Features 48
Differential Diagnosis 49
Ancillary Studies 49
Splendore-Hoeppli Phenomenon 49
Cytomorphologic Features 50
Differential Diagnosis 51
Ancillary Studies 51
Suggested Reading 51
4: Microbiology 52
Viruses 52
Papillomaviruses 53
Herpesviruses 55
Respiratory Viruses 59
Polyomaviruses 59
Poxviruses 60
Retroviruses 60
Miscellaneous Viruses 61
Bacteria 61
Gram-Positive and Gram-Negative Bacteria 62
Mycobacteria 63
Filamentous Bacteria 66
Chlamydia 66
Fungi 69
Candida 70
Cryptococcus 71
Aspergillus 73
Zygomycetes 74
Dimorphic Fungi 76
Pneumocystis 83
Dematiaceous Fungi 84
Dermatophytes 85
Hyalohyphomycoses 85
Parasites 85
Protozoa 85
Apicomplexans 89
Helminths 91
Algae 97
Suggested Reading 98
5: Gynecological Infections 100
Inflammatory Changes 102
Normal Flora 102
Microbiology 102
Clinical Features 104
Cytomorphologic Features 104
Diagnostic Note 105
Leptothrix vaginalis 105
Microbiology 105
Clinical Features 105
Cytomorphologic Features 105
Diagnostic Note 105
Viral Infections 106
Human Papillomavirus (HPV) 106
Microbiology 106
Clinical Features 107
Cytomorphologic Features 107
Diagnostic Note 109
Ancillary Tests 110
Herpes Simplex Virus (HSV) 110
Microbiology 110
Clinical Features 111
Cytomorphologic Features 112
Diagnostic Note 113
Ancillary Tests 114
Cytomegalovirus (CMV) 114
Microbiology 114
Clinical Features 114
Cytomorphologic Features 115
Diagnostic Note 115
Bacterial Infections 116
Bacterial Vaginosis 116
Microbiology 116
Clinical Features 117
Cytomorphologic Features 117
Diagnostic Note 117
Ancillary Tests 117
Neisseria gonorrheae 118
Microbiology 118
Clinical Features 118
Cytomorphologic Features 118
Diagnostic Note 118
Ancillary Tests 119
Actinomyces 119
Microbiology 119
Clinical Features 119
Cytomorphologic Features 120
Diagnostic Note 120
Ancillary Tests 121
Granuloma Venereum 121
Tuberculosis 121
Microbiology 121
Clinical Features 121
Cytomorphologic Features 122
Diagnostic Note 123
Ancillary Tests 123
Chlamydia trachomatis 123
Microbiology 123
Clinical Features 124
Cytomorphologic Features 124
Diagnostic Note 124
Ancillary Tests 124
Fungal Infections 125
Candida 125
Microbiology 125
Clinical Features 125
Cytolomorphogic Features 125
Diagnostic Note 126
Ancillary Tests 127
Parasitic Infections 127
Trichomonas vaginalis 127
Microbiology 127
Clinical Features 128
Cytomorphologic Features 128
Diagnostic Note 129
Ancillary Tests 129
Schistosomiasis 130
Microbiology 130
Clinical Features 130
Cytomorphologic Features 131
Diagnostic Note 131
Ancillary Tests 132
Enterobius vermicularis 132
Microbiology 132
Clinical Features 132
Cytomorphologic Features 132
Diagnostic Note 132
Ancillary Tests 133
Insects 134
Phthirus pubis 134
Suggested Reading 135
6: Pulmonary Infections 136
Viral Infections 137
Herpes Simplex Virus (HSV) 137
Microbiology 137
Clinical Features 138
Cytomorphologic Features 138
Differential Diagnosis 139
Ancillary Studies 139
Cytomegalovirus (CMV) 140
Microbiology 140
Clinical Features 141
Cytomorphologic Features 141
Differential Diagnosis 141
Ancillary Studies 141
Adenovirus 141
Microbiology 141
Clinical Features 142
Cytomorphologic Features 142
Differential Diagnosis 143
Ancillary Studies 143
Respiratory Syncytial Virus (RSV) 143
Microbiology 143
Clinical Features 143
Cytomorphologic Features 144
Differential Diagnosis 144
Ancillary Studies 144
Parainfluenza 144
Microbiology 144
Clinical Features 144
Cytomorphologic Features 144
Differential Diagnosis 145
Ancillary Studies 145
Measles 145
Microbiology 145
Clinical Features 145
Cytomorphologic Features 145
Differential Diagnosis 145
Ancillary Studies 146
Bacterial Infections 146
Actinomyces 147
Microbiology 147
Clinical Features 147
Cytomorphologic Features 147
Differential Diagnosis 148
Ancillary Studies 148
Nocardia 148
Microbiology 148
Clinical Features 148
Cytomorphologic Features 149
Differential Diagnosis 149
Ancillary Studies 149
Tuberculosis 150
Microbiology 150
Clinical Features 150
Cytomorphologic Features 150
Differential Diagnosis 152
Ancillary Studies 152
Legionella 152
Fungal Infections 153
Candidiasis 153
Microbiology 153
Clinical Features 154
Cytomorphologic Features 154
Differential Diagnosis 155
Ancillary Studies 155
Histoplasmosis 155
Microbiology 155
Clinical Features 155
Cytomorphologic Features 155
Differential Diagnosis 155
Ancillary Studies 156
Blastomycosis 157
Microbiology 157
Clinical Features 157
Cytomorphologic Features 157
Differential Diagnosis 157
Ancillary Studies 157
Cryptococcosis 157
Microbiology 157
Clinical Features 158
Cytomorphologic Features 158
Differential Diagnosis 158
Ancillary Studies 158
Coccidioidomycosis 158
Microbiology 158
Clinical Features 159
Cytomorphologic Features 159
Differential Diagnosis 160
Ancillary Studies 161
Aspergillosis 162
Microbiology 162
Clinical Features 162
Cytomorphologic Features 162
Differential Diagnosis 163
Ancillary Studies 163
Mucormycosis (Zygomycosis) 164
Microbiology 164
Clinical Features 165
Cytomorphologic Features 165
Differential Diagnosis 165
Ancillary Studies 165
Pneumocystis 165
Microbiology 165
Clinical Features 166
Cytomorphologic Features 166
Differential Diagnosis 166
Ancillary Studies 167
Parasitic Infections 168
Dirofilariasis 168
Strongyloidiasis 169
Paragonimiasis 169
Toxoplasma gondii 170
Entamoeba 171
Echinococcosis (Hydatid Disease) 172
Pleural Infections and Empyema 174
Suggested Reading 174
7: Gastrointestinal and Hepatobiliary Infections 175
Gastrointestinal Infections 175
Fungal Esophagitis 175
Cytomorphologic Features 176
Differential Diagnosis 176
Ancillary Studies 176
Herpes Simplex Viruses 177
Cytomorphologic Features 178
Differential Diagnosis 179
Ancillary Studies 179
Cytomegalovirus 179
Cytomorphologic Features 179
Differential Diagnosis 180
Ancillary Studies 181
Helicobacter pylori Gastritis 181
Cytomorphologic Features 181
Differential Diagnosis 182
Ancillary Studies 182
Cryptosporidiosis 183
Cytomorphologic Features 183
Differential Diagnosis 184
Ancillary Studies 185
Giardiasis 185
Cytomorphologic Features 185
Differential Diagnosis 185
Ancillary Studies 186
Microsporidiosis 186
Cytomorphologic Features 187
Differential Diagnosis 188
Ancillary Studies 188
Mycobacterium avium Complex 188
Cytomorphologic Features 188
Differential Diagnosis 189
Ancillary Studies 189
Anal Pap Test 190
Intra-Abdominal Infections 190
Liver Abscess 190
Pancreatitis 192
Hydatid Disease 192
Cytomorphologic Features 193
Differential Diagnosis 194
Ancillary Studies 195
Peritoneal Effusion with Infection 195
Suggested Reading 196
8: Urinary Tract Infections 197
Kidney Infections 197
Acute Pyelonephritis 197
Cytomorphologic Features 198
Differential Diagnosis 198
Ancillary Studies 198
Chronic Pyelonephritis 198
Cytomorphologic Features 199
Differential Diagnosis and Ancillary Studies 199
Xanthogranulomatous Pyelonephritis (XPN) 199
Cytomorphologic Features 199
Differential Diagnosis 200
Ancillary Studies 201
Renal Tuberculosis 201
Cytomorphologic Features 201
Differential Diagnosis 201
Ancillary Studies 202
Fungal Kidney Infections 202
Cytomorphologic Features 202
Differential Diagnosis 202
Ancillary Studies 203
Urinary Bladder Infections 203
Bacterial Cystitis 203
Cytomorphologic Features 203
Differential Diagnosis 204
Ancillary Studies 204
Malakoplakia 204
Viral Infections 205
BK Polyomavirus 207
Microbiology 207
Clinical Features 208
Cytomorphologic Features 209
Differential Diagnosis 211
Ancillary Studies 211
Fungal Infections 211
Microbiology 211
Clinical Features 212
Cytomorphologic Features 212
Differential Diagnosis 212
Ancillary Studies 212
Parasites 213
Schistosomiasis 213
Microbiology 213
Clinical Features 214
Cytomorphologic Features 214
Differential Diagnosis 215
Ancillary Studies 215
Trichomoniasis 215
Male Genital Tract Infections 216
Urethritis 217
Suggested Reading 217
9: Central Nervous System Infections 218
Acute Bacterial Meningitis 222
Microbiology 222
Clinical Features 223
Cytomorphologic Features 223
Differential Diagnosis 224
Ancillary Studies 225
Viral Meningitis 225
Microbiology 225
Clinical Features 225
Cytomorphologic Features 225
Differential Diagnosis 226
Ancillary Studies 226
Mollaret Meningitis 227
Microbiology 227
Clinical Features 228
Cytomorphologic Features 228
Differential Diagnosis 229
Ancillary Studies 229
Tuberculous Meningitis 229
Microbiology 229
Clinical Features 229
Cytomorphologic Features 229
Differential Diagnosis 229
Ancillary Studies 230
Cryptococcal Meningitis 230
Microbiology 230
Clinical Features 231
Cytomorphologic Features 231
Differential Diagnosis 232
Ancillary Studies 232
Blastomycosis 232
Microbiology 232
Clinical Features 232
Cytomorphologic Features 233
Differential Diagnosis 233
Ancillary Studies 234
Brain Abscess 234
Microbiology 234
Clinical Features 234
Cytomorphologic Features 234
Differential Diagnosis 235
Ancillary Studies 235
Shunt Infections 235
Microbiology 235
Clinical Features 236
Cytomorphologic Features 236
Differential Diagnosis 236
Ancillary Studies 236
Neurosyphilis 236
Microbiology 236
Clinical Features 236
Cytomorphologic Features 237
Differential Diagnosis 237
Ancillary Studies 238
Toxoplasmosis 238
Microbiology 238
Clinical Features 238
Cytomorphologic Features 238
Differential Diagnosis 239
Ancillary Studies 240
Neurocysticercosis 240
Microbiology 240
Clinical Features 240
Cytomorphologic Features 240
Differential Diagnosis 240
Ancillary Studies 240
Primary Amebic Meningoencephalitis 241
Microbiology 241
Clinical Features 241
Cytomorphologic Features 241
Differential Diagnosis 241
Ancillary Studies 241
Angiostrongyliasis 242
Microbiology 242
Clinical Features 242
Cytomorphologic Features 242
Differential Diagnosis 242
Ancillary Studies 243
Suggested Reading 243
10: Hematologic Infections 244
Lymph Node Infections 244
Acute Suppurative Lymphadenitis 244
Cytomorphologic Features 246
Differential Diagnosis 246
Ancillary Studies 247
Cat Scratch Lymphadenitis 247
Cytomorphologic Features 247
Differential Diagnosis 247
Ancillary Studies 248
Lymphogranuloma Venereum 249
Cytomorphologic Features 249
Differential Diagnosis 249
Ancillary Studies 249
Granulomatous Lymphadenitis 250
Cytomorphologic Features 250
Differential Diagnosis 251
Ancillary Studies 253
Mycobacterial Lymphadenitis 253
Cytomorphologic Features 253
Differential Diagnosis 254
Ancillary Studies 255
Fungal Lymphadenitis 255
Cytomorphologic Features 255
Differential Diagnosis 256
Ancillary Studies 257
Toxoplasma Lymphadenitis 257
Cytomorphologic Features 257
Differential Diagnosis 257
Ancillary Studies 258
Leishmania Lymphadenitis 258
Cytomorphologic Features 258
Differential Diagnosis 259
Ancillary Studies 259
Herpes Simplex Virus Lymphadenitis 260
Cytomorphologic Features 260
Differential Diagnosis 260
Ancillary Studies 260
Infectious Mononucleosis Lymphadenitis (EBV Related Lymphadenopathy) 261
Cytomorphologic Features 261
Differential Diagnosis 262
Ancillary Studies 262
Cytomegaloviral (CMV) Lymphadenitis 262
Cytomorphologic Features 263
Differential Diagnosis 263
Ancillary Studies 263
HIV-Associated Lymphadenopathy 263
Cytomorphologic Features 264
Differential Diagnosis 264
Ancillary Studies 264
Spleen Infections 265
Bacilliary Peliosis 265
Cytomorphologic Features 265
Differential Diagnosis 265
Ancillary Studies 265
Splenitis and Splenic Abscess 266
Cytomorphologic Features 266
Differential Diagnosis 266
Ancillary Studies 266
Mycobacterial Infection 266
Cytomorphologic Features 266
Differential Diagnosis 267
Ancillary Studies 267
Infectious Mononucleosis 267
Cytomorphologic Features 268
Differential Diagnosis 268
Ancillary Studies 268
Hydatid Cyst 268
Cytomorphologic Features 268
Differential Diagnosis 268
Ancillary Studies 268
Suggested Reading 269
11: Breast, Skin, and Musculoskeletal Infections 270
Breast Infections 270
Acute Mastitis and Abscess 272
Clinical Features 272
Cytomorphologic Features 273
Ancillary Studies 274
Chronic and Granulomatous Mastitis 274
Clinical Features 274
Cytomorphologic Features 274
Ancillary Studies 274
Parasitic Breast Infections 275
Skin and Soft Tissue Infections 275
Leprosy 279
Clinical Features 280
Cytomorphologic Features 282
Differential Diagnosis 282
Ancillary Studies 283
Cutaneous Mycoses 283
Cutaneous Parasites 284
Bone and Joint Infections 286
Bacillary Angiomatosis 287
Cytomorphologic Features 289
Ancillary Studies 289
Suggested Reading 289
12: Head and Neck Infections 291
Salivary Gland Infections 291
Acute Sialadenitis 292
Cytomorphologic Features 292
Ancillary Studies 293
Chronic Sialadenitis 293
Cytomorphologic Features 294
Ancillary Studies 294
Granulomatous Sialadenitis 295
Cytomorphologic Features 295
Ancillary Studies 295
Thyroid Gland Infections 295
Oropharyngeal Infections 297
Herpes Simplex Virus (HSV) 298
Cytomorphologic Features 298
Ancillary Studies 298
Cervicofacial Actinomycosis 299
Cytomorphologic Features 300
Ancillary Studies 300
Oral Candidiasis 301
Cytomorphologic Features 302
Ancillary Studies 303
Sinonasal Infections 303
Rhinoscleroma 304
Rhinosporidiosis 305
Infected Embryologic Cysts 305
Eye Infections 306
Viral Ophthalmic Infections 307
Chlamydial Eye Infection 308
Bacterial Eye Infection 308
Fungal Eye Infection 308
Parasitic Eye Infection 309
Ear Infections 310
Suggested Reading 310
13: Immunosuppressed Host 311
Transplantation 312
Human Immunodeficiency Virus (HIV) Infection 314
Human Papilloma Virus (HPV)-Related Disease 314
Cervicovaginal Disease 315
Anal Disease 316
Lymphadenopathy 316
Oropharyngeal Disease 317
Salivary Gland Lesions 318
Lymphoproliferative Disorders 320
Posttransplant Lymphoproliferative Disorder (PTLD) 320
AIDS-Related Lymphomas (ARL) 321
Plasmablastic Lymphoma 321
Human Herpesvirus-8 (HHV8)-Associated Lymphomas 322
Hodgkin Lymphoma 322
Central Nervous System Disease 322
Pulmonary Disease 326
Renal Disease 328
Spindle Cell Lesions 328
Suggested Reading 330
14: Ancillary Investigations 332
Routine Cytology Stains 333
Papanicolaou (Pap) Stain 333
Romanowsky Stains 333
Hematoxylin and Eosin (H& E) Stain
Toluidine Blue 334
Cell Blocks 334
Special Stains 334
Wet Mount Preparation 335
Bacterial Stains 335
Gram Stain 335
Stains for Helicobacter pylori 336
Warthin-Starry Stain 337
Acid-Fast Stains for Mycobacteria (AFB) 338
Fungal Stains 338
Stains for Rickettsia 342
Stains for Viruses 343
Stains for Parasites 343
Immunocytochemistry 345
In Situ Hybridization 346
Fluorescent Stains 352
Flow Cytometry 354
Serology 355
Signal Amplification Assay 355
Polymerase Chain Reaction (PCR) 355
Electron Microscopy (EM) 358
Culture and Sensitivity 358
Suggested Reading 360
15: Mimics and Contaminants 361
Mimics of Viral Infection 362
Ancillary Studies 364
Mimics of Bacterial Infection 366
Ancillary Studies 367
Mimics of Fungal Infection 367
Ancillary Studies 373
Mimics of Parasitic Infection 374
Ancillary Studies 379
Plant Contaminants and Mimics 379
Ancillary Studies 383
Animal Contaminants and Mimics 383
Ancillary Studies 384
Suggested Reading 386
Index 388