Mycobacterium avium Infection Detected as a Negative Image in Giemsa-stained Sputum Cytology Preparations
Keywords:
Giemsa stain, Mycobacterium avium, Negative staining, Nontuberculous mycobacterium, Sputum cytologyAbstract
A borderline-diabetic 63-year-old housewife, a human T-cell leukemia virus-1 carrier, complained of fever and coughing. Com-
puted tomography scan identified a 50 mm-sized, cavitated mass in the lower lobe of the right lung. To evaluate the nature
of the lesion, cytological screening was performed. Giemsa-stained sputum cytology was quite effective for identifying myco-
bacteria as negative (unstained) bacillary images in the cytoplasm of many neutrophils and some macrophages. A re-staining
technique clearly demonstrated acid-fastness of the ghosted rods. Microbial culture and real-time polymerase chain reaction
analysis confirmed infection of Mycobacterium avium. It is necessary for us to employ Giemsa stain in sputum cytology, partic-
ularly when lung infection is clinically suspected.
References
Bishop, PJ., Neumann, G. (1970) The history of the Ziehl-Neelsen stain. Tubercle, 51(2): 196–206.
Singhal, R., Myneedu, VP. (2015) Microscopy as a diagnostic tool in pulmonary tuberculosis. Int J Mycobacteriol, 4(1): 1–6.
DiNardo, AR., Lange, C., Mandalakas AM. (2016) Editorial commentary: 1, 2, 3 (years) … and you're out: the end of a 123-year historic era. Clin Infect Dis, 62(9): 1089–1091.
Maygarden, SJ., Flanders, EL. (1989) Mycobacteria can be seen as “negative images” in cytology smears from patients with acquired immunodeficiency syndrome. Mod Pathol, 2(3): 239–243.
Fisher, JF., Ganapathy, M., Edwards, BH., Newman, CL. (1990) Utility of Gram's and Giemsa stains in the diagnosis of pulmonary tuberculosis. Am Rev Resp Dis, 141(2): 511-513.
Torlakovic, E., Clayton, F., Ames, ED. (1992) Refractile mycobacteria in Romanowsky-stained bone marrow smears. A comparison of acid-fast-stained tissue sections and Romanowsky-stained smears. Am J Clin Pathol, 97(3): 318– 321.
Ang, GAT., Janda, WM., Novak, RM., Gerardo, L. (1993) Negative images of mycobacteria in aspiration biopsy smears from the lymph node of a patient with acquired immunodeficiency syndrome (AIDS): Report of a case and a review of the literature. Diagn Cytopathol, 9(3): 325–328.
Iyengar, KR., Basu, D. (2001) Negative images in the fine needle aspiration cytologic diagnosis of mycobacterial infections. Malays J Pathol, 23(2): 89–92.
Basu, D., Nilkund, J. (2003) Detecting mycobacteria in Romanowsky-stained cytologic smears. A case report. Acta Cytol, 47(5): 774–776.
Prasad, CSBR, Narasimha, A., Harendra Kumar, ML. (2011) Negative staining of mycobacteria. A clue to the diagnosis in cytological aspirates: two case reports. Ann Trop Med Public Health, 4(2): 110–112.
Patnayak, R., Chowdhury, I. (2019) Negative images of mycobacteria in cytology. Med J Dr D Y Patil Vidyapeeth, 12(6): 553-554.
Marrakchi, H., Lanéelle, MA., Daffé, M. (2014) Mycolic acids: structures, biosynthesis, and beyond. Chem Biol, 21(1): 67–85.
Hinson, JM., Bradsher, RW., Bodner, SJ. (1981) Gram-stain neutrality of Mycobacterium tuberculosis. Am Rev Respir Dis, 123: 365–366.
Trifiro, SAM., Lebel, BF., Rene, P. (1990) Ghost mycobacteria on Gram stain. J Clin Microbiol, 28: 146–147.
Bartralot, R., Pujol, RM., García-Patos, V., Sitjas, D., Martín-Casabona, N., Coll, P., et al. (2000) Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts. J Cutan Pathol, 27(3): 124–129.
Li, JJ., Beresford, R., Fyfe, J., Henderson, C. (2017) Clinical and histopathological features of cutaneous nontuberculous mycobacterial infection: a review of 13 cases. J Cutan Pathol, 44(5): 433–443.
Tsutsumi, Y. (2021) Cytological diagnosis of infectious diseases: identification of pathogens and recognition of cellular reactions. IntechOpen: Innate Immunity in Health and Disease, Open access peer-reviewed chapter (60 pages). doi: 10.5772/intechopen.95578.
