Subcutaneous fat necrosis of the newborn is a rare, transient panniculitis of full-term infants. Diagnosis is usually made clinically; however, a biopsy is sometimes required. Fine-needle aspiration biopsy (FNAB) offers an alternative to biopsy. The cytology shows a spectrum of changes ranging from clumped lobules of fat with opaque cytoplasm to necrotic aspirates with dispersed fat cells with opaque cytoplasm, foamy macrophages, multinucleated giant cells, lymphocytes, and neutrophils. Radially orientated, refractile, needle-shaped crystals are visible in the cytoplasm of the fat cells and loose lying in the necrotic background. FNAB offers an alternative to biopsy with good results.
Fine needle aspiration biopsy (FNAB) offers a simple outpatient technique for specimen collection in child tuberculosis suspects with peripheral lymphadenopathy. To perform FNAB with mycobacterial culture on an outpatient basis requires use of a sterile transport medium to facilitate bedside inoculation, maintain organism viability and reduce contamination risk en route to the laboratory. The mycobacterial yield and time to positive culture following bedside inoculation into standard mycobacterial growth indicator tubes were compared with initial inoculation into an inexpensive "in-house" liquid growth medium. Of 150 FNAB performed, 57 (38%) cultured Mycobacterium tuberculosis complex. There was one case each with non-tuberculous mycobacteria and Mycobacterium bovis BCG; the remaining 55 being M tuberculosis. Results were concordant in 142 (94.7%) bedside and laboratory inoculation pairs. There was no significant difference in time to positive culture between bedside and laboratory inoculation (16.2 days (SD 0.87) vs 17.1 days (SD 0.85)). Provision of inexpensive specimen transport bottles and practical tuition in FNAB should improve cost-effective diagnosis of tuberculosis at the primary healthcare level.
Both macroscopic and microscopic differences relating to the degree of immune suppression were identified, which seemingly contradicts previous reports. Larger studies are warranted to define the function of antiretroviral therapy and VUE in the mechanism of mother-to-fetus transmission of HIV. Furthermore, the potential role of VUE in the pathophysiology of the compromised immune response observed among HIV-exposed but uninfected infants should be investigated.
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