As infecções por Mycobacterium sp. têm grande importância na suinocultura devido às perdas econômicas decorrentes da alteração do destino de carcaças, tais como condenação total, aproveitamento condicional, ou mercado interno. As principais causadoras de linfadenite granulomatosa (LG), encontradas em matadouros frigoríficos, são as micobactérias pertencentes ao complexo Mycobacterium avium-intracellulare. Na inspeção post mortem não há como determinar a espécie de micobactéria envolvida na linfadenite granulomatosa. Por esse motivo, as carcaças e vísceras dos suínos com lesões granulomatosas em linfonodos seguem a destinação prevista para casos de tuberculose. Em 2009, verificou-se aumento nas condenações por LG em um frigorífico de suínos, sob inspeção federal, na região do Vale do Taquari, RS. Na tentativa de identificar as causas e, possivelmente, adequar os critérios para tais condenações, o presente estudo teve como objetivo determinar a prevalência de LG no período de 2008 a 2011, através da inspeção visual e através de exames histopatológicos e microbiológicos em 47 linfonodos das regiões mesentérica, traqueobrônquica e submandibular, amostrados na linha de abate que foram processados pelos métodos de rotina histológica e corados pela técnica de Ziehl-Neelsen. Em vinte e uma amostras, realizou-se, também, a técnica de PCR quantitativo para circovirus suíno tipo 2 (PCV2) e em 26 amostras exame bacteriológico de rotina. Em vinte (42,6%), dos 47 linfonodos analisados, a lesão foi classificada, visualmente, como cisto sendo 90% destes confirmados pela histologia. Entre os 27 linfonodos classificados como LG na inspeção visual, 19 (70,4%) foram confirmados na histologia. As principais diferenciações da lesão cística para LG, ao exame visual, incluíram a fácil remoção do conteúdo sob leve pressão e a ausência de granuloma ao corte. Na análise histopatológica, observaram-se áreas císticas com conteúdo proteináceo, algumas amostras com infiltrado linfocítico. PCV2 não foi detectado nas amostras testadas e identificou-se Corynebacterium (1/26), Staphylococcus coagulase negativa (4/26) e Staphylococcus hyicus (2/26). A adoção de novos critérios na diferenciação entre lesões tuberculoides e císticas, à inspeção post mortem de linfonodos mesentéricos, determinou a redução da prevalência das condenações por LG de 5,81% em 2009 para 1,47%, em 2011. Não foram detectados agentes infecciosos associados à lesão cística de linfonodos mesentéricos. No entanto, a etiologia dessas lesões císticas não foi determinada. / Infection by Mycobacterium sp. has a great economic impact on the swine industry due to the economic looses associated with condemnation or altered destination of the carcass in slaughterhouse. The main causes of granulomatous lymphadenitis (GL) in pigs are bacterium belonging to the Mycobacterium avium-intracellularis group. Since visual differentiation among Mycobacterium species involved in GL is not possible, carcass and viscera from GL-affected pigs follow the same destination from that of tuberculosis. An increased number of condemnations due to GL in a swine slaughterhouse under federal inspection in the region of Taquari Valley were recorded. In an attempting to identify the causes and to adapt the inspection criteria for such condemnations, this study aimed to determine the prevalence of GL from 2008 to 2011 through visual inspection, histopathological and microbiological examinations in lymph nodes. Forty seven lymph nodes were collected and processed by the routine histological methods and stained by Ziehl-Neelsen. In 21 samples, quantitative PCR for PCV2 was performed. The other 26 samples were analyzed by standard bacteriology. From 47 lymph nodes analyzed, 20 (42.6 %) were classified as cysts by visual inspection, 90% of which were confirmed by histology. A total of 19 (70.4%) of the 27 lymph nodes visually classified as GL were confirmed by histology. The main visual differences between cysts and GL were the easy content removal under light pressure and absence of granuloma at the cut surface. At histopathological examination, cysts showed areas with proteinaceous contents, some of them with histiocytic infiltrate. PCV2 was not detected in the tested samples. Bacteriological analysis identified Corynebacterium (1/26), Staphylococcus coagulase negative (4/26) and Staphylococcus hyicus (2/26). Adoption of a new criteria for differentiating cystic from tuberculous lesions, at the post mortem inspection of mesenteric lymph nodes, decreased the prevalence of 5.81% recorded in 2009 to 1.47% in 2011, in the condemnation due to GL. It is suggested that most lesions previously classified as GL were truly cysts. No infectious agents were associated with such lesions. However, the etiology of these lymph nodal cystic lesions could not be determined.

As infecções por Mycobacterium sp. têm grande importância na suinocultura devido às perdas econômicas decorrentes da alteração do destino de carcaças, tais como condenação total, aproveitamento condicional, ou mercado interno. As principais causadoras de linfadenite granulomatosa (LG), encontradas em matadouros frigoríficos, são as micobactérias pertencentes ao complexo Mycobacterium avium-intracellulare. Na inspeção post mortem não há como determinar a espécie de micobactéria envolvida na linfadenite granulomatosa. Por esse motivo, as carcaças e vísceras dos suínos com lesões granulomatosas em linfonodos seguem a destinação prevista para casos de tuberculose. Em 2009, verificou-se aumento nas condenações por LG em um frigorífico de suínos, sob inspeção federal, na região do Vale do Taquari, RS. Na tentativa de identificar as causas e, possivelmente, adequar os critérios para tais condenações, o presente estudo teve como objetivo determinar a prevalência de LG no período de 2008 a 2011, através da inspeção visual e através de exames histopatológicos e microbiológicos em 47 linfonodos das regiões mesentérica, traqueobrônquica e submandibular, amostrados na linha de abate que foram processados pelos métodos de rotina histológica e corados pela técnica de Ziehl-Neelsen. Em vinte e uma amostras, realizou-se, também, a técnica de PCR quantitativo para circovirus suíno tipo 2 (PCV2) e em 26 amostras exame bacteriológico de rotina. Em vinte (42,6%), dos 47 linfonodos analisados, a lesão foi classificada, visualmente, como cisto sendo 90% destes confirmados pela histologia. Entre os 27 linfonodos classificados como LG na inspeção visual, 19 (70,4%) foram confirmados na histologia. As principais diferenciações da lesão cística para LG, ao exame visual, incluíram a fácil remoção do conteúdo sob leve pressão e a ausência de granuloma ao corte. Na análise histopatológica, observaram-se áreas císticas com conteúdo proteináceo, algumas amostras com infiltrado linfocítico. PCV2 não foi detectado nas amostras testadas e identificou-se Corynebacterium (1/26), Staphylococcus coagulase negativa (4/26) e Staphylococcus hyicus (2/26). A adoção de novos critérios na diferenciação entre lesões tuberculoides e císticas, à inspeção post mortem de linfonodos mesentéricos, determinou a redução da prevalência das condenações por LG de 5,81% em 2009 para 1,47%, em 2011. Não foram detectados agentes infecciosos associados à lesão cística de linfonodos mesentéricos. No entanto, a etiologia dessas lesões císticas não foi determinada. / Infection by Mycobacterium sp. has a great economic impact on the swine industry due to the economic looses associated with condemnation or altered destination of the carcass in slaughterhouse. The main causes of granulomatous lymphadenitis (GL) in pigs are bacterium belonging to the Mycobacterium avium-intracellularis group. Since visual differentiation among Mycobacterium species involved in GL is not possible, carcass and viscera from GL-affected pigs follow the same destination from that of tuberculosis. An increased number of condemnations due to GL in a swine slaughterhouse under federal inspection in the region of Taquari Valley were recorded. In an attempting to identify the causes and to adapt the inspection criteria for such condemnations, this study aimed to determine the prevalence of GL from 2008 to 2011 through visual inspection, histopathological and microbiological examinations in lymph nodes. Forty seven lymph nodes were collected and processed by the routine histological methods and stained by Ziehl-Neelsen. In 21 samples, quantitative PCR for PCV2 was performed. The other 26 samples were analyzed by standard bacteriology. From 47 lymph nodes analyzed, 20 (42.6 %) were classified as cysts by visual inspection, 90% of which were confirmed by histology. A total of 19 (70.4%) of the 27 lymph nodes visually classified as GL were confirmed by histology. The main visual differences between cysts and GL were the easy content removal under light pressure and absence of granuloma at the cut surface. At histopathological examination, cysts showed areas with proteinaceous contents, some of them with histiocytic infiltrate. PCV2 was not detected in the tested samples. Bacteriological analysis identified Corynebacterium (1/26), Staphylococcus coagulase negative (4/26) and Staphylococcus hyicus (2/26). Adoption of a new criteria for differentiating cystic from tuberculous lesions, at the post mortem inspection of mesenteric lymph nodes, decreased the prevalence of 5.81% recorded in 2009 to 1.47% in 2011, in the condemnation due to GL. It is suggested that most lesions previously classified as GL were truly cysts. No infectious agents were associated with such lesions. However, the etiology of these lymph nodal cystic lesions could not be determined.

As infecções por Mycobacterium sp. têm grande importância na suinocultura devido às perdas econômicas decorrentes da alteração do destino de carcaças, tais como condenação total, aproveitamento condicional, ou mercado interno. As principais causadoras de linfadenite granulomatosa (LG), encontradas em matadouros frigoríficos, são as micobactérias pertencentes ao complexo Mycobacterium avium-intracellulare. Na inspeção post mortem não há como determinar a espécie de micobactéria envolvida na linfadenite granulomatosa. Por esse motivo, as carcaças e vísceras dos suínos com lesões granulomatosas em linfonodos seguem a destinação prevista para casos de tuberculose. Em 2009, verificou-se aumento nas condenações por LG em um frigorífico de suínos, sob inspeção federal, na região do Vale do Taquari, RS. Na tentativa de identificar as causas e, possivelmente, adequar os critérios para tais condenações, o presente estudo teve como objetivo determinar a prevalência de LG no período de 2008 a 2011, através da inspeção visual e através de exames histopatológicos e microbiológicos em 47 linfonodos das regiões mesentérica, traqueobrônquica e submandibular, amostrados na linha de abate que foram processados pelos métodos de rotina histológica e corados pela técnica de Ziehl-Neelsen. Em vinte e uma amostras, realizou-se, também, a técnica de PCR quantitativo para circovirus suíno tipo 2 (PCV2) e em 26 amostras exame bacteriológico de rotina. Em vinte (42,6%), dos 47 linfonodos analisados, a lesão foi classificada, visualmente, como cisto sendo 90% destes confirmados pela histologia. Entre os 27 linfonodos classificados como LG na inspeção visual, 19 (70,4%) foram confirmados na histologia. As principais diferenciações da lesão cística para LG, ao exame visual, incluíram a fácil remoção do conteúdo sob leve pressão e a ausência de granuloma ao corte. Na análise histopatológica, observaram-se áreas císticas com conteúdo proteináceo, algumas amostras com infiltrado linfocítico. PCV2 não foi detectado nas amostras testadas e identificou-se Corynebacterium (1/26), Staphylococcus coagulase negativa (4/26) e Staphylococcus hyicus (2/26). A adoção de novos critérios na diferenciação entre lesões tuberculoides e císticas, à inspeção post mortem de linfonodos mesentéricos, determinou a redução da prevalência das condenações por LG de 5,81% em 2009 para 1,47%, em 2011. Não foram detectados agentes infecciosos associados à lesão cística de linfonodos mesentéricos. No entanto, a etiologia dessas lesões císticas não foi determinada. / Infection by Mycobacterium sp. has a great economic impact on the swine industry due to the economic looses associated with condemnation or altered destination of the carcass in slaughterhouse. The main causes of granulomatous lymphadenitis (GL) in pigs are bacterium belonging to the Mycobacterium avium-intracellularis group. Since visual differentiation among Mycobacterium species involved in GL is not possible, carcass and viscera from GL-affected pigs follow the same destination from that of tuberculosis. An increased number of condemnations due to GL in a swine slaughterhouse under federal inspection in the region of Taquari Valley were recorded. In an attempting to identify the causes and to adapt the inspection criteria for such condemnations, this study aimed to determine the prevalence of GL from 2008 to 2011 through visual inspection, histopathological and microbiological examinations in lymph nodes. Forty seven lymph nodes were collected and processed by the routine histological methods and stained by Ziehl-Neelsen. In 21 samples, quantitative PCR for PCV2 was performed. The other 26 samples were analyzed by standard bacteriology. From 47 lymph nodes analyzed, 20 (42.6 %) were classified as cysts by visual inspection, 90% of which were confirmed by histology. A total of 19 (70.4%) of the 27 lymph nodes visually classified as GL were confirmed by histology. The main visual differences between cysts and GL were the easy content removal under light pressure and absence of granuloma at the cut surface. At histopathological examination, cysts showed areas with proteinaceous contents, some of them with histiocytic infiltrate. PCV2 was not detected in the tested samples. Bacteriological analysis identified Corynebacterium (1/26), Staphylococcus coagulase negative (4/26) and Staphylococcus hyicus (2/26). Adoption of a new criteria for differentiating cystic from tuberculous lesions, at the post mortem inspection of mesenteric lymph nodes, decreased the prevalence of 5.81% recorded in 2009 to 1.47% in 2011, in the condemnation due to GL. It is suggested that most lesions previously classified as GL were truly cysts. No infectious agents were associated with such lesions. However, the etiology of these lymph nodal cystic lesions could not be determined.

A 3 year old Hispanic male presented with fevers, skin rash, left neck swelling and refusal to walk of several days duration. Physical exam revealed a febrile, fussy toddler with a tender, cystic lesion in the left submandibular region. Both ankles had tender cystic lesions on the lateral malleolar regions. Labs: WBC 33,000 with neutrophilia, bandemia, thrombocytosis, and increased ESR and CRP. MRI of the neck and ankles revealed cystic lymphatic malformations with no communication with the joints.ENT specialist was consulted and neck cystic lesion was aspirated to rule out a septic focus. Bone scan of the lower extremities ruled out infectious or malignant etiology. He was started on multiple antibiotics with a presumed diagnosis of sepsis. An ECHO on the 4th hospital day showed a pericardial effusion which required a pericardial window. He also developed bilateral pleural effusions which resolved with supportive treatment. Aspirates from the cystic lesions, pericardial fluid, blood and urine cultures were sterile. Even in the second week of hospital stay, he continued to spike high fevers (Tmax 107) with high white counts and left shift inspite of treatment with antibiotics. A diagnosis of systemic onset juvenile idiopathic arthritis (SOJIA) was made with input from rheumatologist. Antibiotics were discontinued and steroids were started with good response. Cystic lesions were treated with percutaneous sclerotherapy with doxycycline. He was discharged home on oral steroids, NSAID’s and weekly methotrexate. Etanercept was added to decrease dependence on oral steroids. He remains in good health 2 years since initial presentation. Discussion: A febrile toddler who refuses to walk is a common clinical presentation in pediatrics. Differential diagnosis of such a patient includes osteomyelitis, septic arthritis, acute rheumatic fever, leukemia and non-accidental trauma. The presence of systemic extra-articular symptoms as in our patient must alert the pediatrician to systemic onset juvenile rheumatoid arthritis (SOJIA). It accounts for 10-20% of all juvenile idiopathic arthritis (JIA) patients with an incidence of 0.4-0.8 per 100,000. SOJIA differs from other conditions in its multisystem involvement. Clinical features like pleurisy, pericarditis, spiking fevers, hepatosplenomegaly and lymphadenopathy overshadow the joint symptoms. The joint involvement may be completely absent or may be a late clinical feature. These patients have leukocytosis, thrombocytosis and high inflammatory markers simulating a septic focus. In our patient, the accurate diagnosis was complicated by the confounding presence of multiple cystic lymphatic lesions. Treatment of SOJIA is challenging. Oral steroids, NSAID’s, methotrexate, etanercept and the newer anakinra have been used with varying success. Our case underlines the importance of considering a diagnosis of systemic onset JIA in a febrile toddler even in the absence of overt joint involvement.