Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Skin Infections

Cutaneous infections are very common and can be caused by a wide variety of different organisms. In addition, it is not uncommon to find involvement of more than one infectious agent affecting the skin, particularly in immunocompromised individuals. Following the onset of both the widespread practice of allogeneic bone marrow and solid organ transplantation, as well as the human immunodeficiency virus (HIV) epidemic, more and more…

Infections of the Nervous System

Introduction The central nervous system (CNS) is well protected and separated from the rest of the body by a thick physical barrier, the skull and the spine, and by a finer blood–brain barrier. Therefore infections of the CNS occur by trauma, by hematogenous spread with disruption of the blood–brain barrier, or by direct spread in more vulnerable areas such as the olfactory nerve. If an infection…

Perinatal Infections

The placenta is a fetally derived organ present in the maternal uterus; it has many different functions, including serving as a barrier to infection. Maternal infectious diseases and vaginal colonization can lead to congenital infections if the placental barrier is breached. The fetus develops in a fluid-filled space surrounded by membranes composed of two epithelial-mesodermal layers, the amnion and chorion ( Fig. 18.1 ). These membranes…

Gynecologic Infections

Because the female genital tract comprises both cutaneous and mucosal surfaces in contact with the external environment, exposure to a significant number of infectious agents, either commensal or pathogenic, is the norm. And because the lower genital tract is in communication with the normally sterile peritoneal cavity, ascending infections can be treacherous. In addition, close physical contact with sexual partners can lead to infectious sexually transmitted…

Genitourinary Infectious Disease Pathology

Infections of the genitourinary tract can be caused by a number of viral, bacterial, fungal, and parasitic organisms ( Table 16.1 ). Although many of these organisms are also seen in other locations, some of them have a predilection for the genitourinary area. Their clinical manifestations, in conjunction with their gross and microscopic appearances, are useful in characterizing these infections, and ancillary tests are often useful…

Infections of Joints, Synovium-Lined Structures, and Soft Tissue

Pathogenic involvement of joints and other synovium-lined structures, including tendon sheaths and bursae, is a relatively uncommon but important form of infection. Its significance is related to the severe destruction of musculoskeletal structures it can cause, which often results in permanent disability and, in some instances, even death. Synovial tissue is vital to the normal functioning of the musculoskeletal system. It helps maintain joints, tendons, bursae,…

Infection of Bone

Osteomyelitis is defined literally as inflammation of bone and marrow, albeit, the common use of the term virtually always implies infection. Infection of the skeleton, the largest organ system of the body, is important because it is a major site of microbial infestation that is often morbid and sometimes fatal. All types of organisms, including bacteria, mycobacteria, fungi, viruses, and parasites, can cause osteomyelitis, but infections…

Infectious Diseases of the Bone Marrow and Spleen

The bone marrow and spleen may be affected by a wide variety of infectious agents. Pathologists must be aware of the clinical concern for infection to initiate appropriate studies to detect microorganisms and be prepared to recognize features of infection even when it is not clinically suspected. Bone marrow sampling may be performed to evaluate fever of unknown origin (most commonly in immunosuppressed patients but sometimes…

Infectious Lymphadenitis

Lymph nodes play an important role in reaction to infectious processes. In many cases the histologic changes are nonspecific and a particular etiology cannot be assigned; in other cases the findings are characteristic of specific entities. This chapter focuses on histologically distinctive types of infectious lymphadenitides and on their differential diagnosis. Lymphadenitis of Viral or Possible Viral Etiology Epstein-Barr Virus/Infectious Mononucleosis Infectious mononucleosis is a symptomatic…

Liver and Bile Duct Infections

The liver is the target of many infectious agents, most notably hepatotropic viruses such as hepatitis B virus (HBV) and hepatitis C virus (HCV). In addition, many infectious organisms can involve the liver in the setting of disseminated infection, in immunosuppressed patients, or as a medical curiosity. The major challenge facing the pathologist in diagnosing these conditions is that many of these diseases have overlapping histopathologic…

Infections of the Gastrointestinal Tract

The surgical pathologist plays a key role in the diagnosis of gastrointestinal infection. Virtually all types of pathogenic microbes can cause gastrointestinal infection, so the diagnostic pathologist must be cognizant of their varied histologic manifestations and acquainted with the complex morphologic features of viruses, bacteria, fungi, and parasites. Because certain noninfectious inflammatory conditions can mimic infection, recognizing their at times subtle distinctions is a critical aspect…

Cardiac Infections

Introduction Infections can involve all three layers of the heart, and virtually all classes of organisms infect cardiac tissues. Because the entire cardiac output is delivered to the lungs and other vital organs by the cardiac ventricles with each cardiac cycle, the propensity for blood-borne infections to be carried to and from the heart is substantial. This chapter is divided according to the layers involved, in…

Pathology of Pulmonary Infection

Introduction In its role as a portal between the ambient environment and the internal milieu, the lung is also the most frequent site of serious infection. A variety of factors predispose to pulmonary infection, including distortions in lung anatomy, decreased mucociliary clearance, and abnormal cellular and humoral immunity. Iatrogenic immunosuppression and that resulting from human immunodeficiency virus type 1 (HIV-1) infection have led to the emergence…

Ear, Nose, and Throat Infections

The head and neck area is arguably the most complex area of the human body; with its many physical connections to the outside environment, it plays host to myriad infectious processes. The aim of this chapter is to provide the surgical pathologist with important information that will aid in establishing an accurate diagnosis of infection. Because many of the infectious processes affecting the head and neck…

New Technologies for the Diagnosis of Infection

The clinical microbiology laboratory is constantly evolving and progressing. New technologies have revolutionized the characterization and diagnosis of pathogens. The purpose of this chapter is to review the features, benefits, and limitations of some of the key new methodologies in infectious disease diagnostics. The chapter will be organized by technology. New technologies have the most impact in the fields of bacteriology and virology, but there are…

Ultrastructural Diagnosis of Infection

Introduction Electron microscopy (EM) can assist in the identification of infectious organisms in surgical and clinical pathology specimens. However, since the advent of immunohistochemical, molecular (e.g., in situ hybridization, polymerase chain reaction), and serologic techniques, EM has been less often used to identify infectious pathogens. EM can still be useful, particularly in the identification of specific infections and the classification of novel organisms. In addition, EM…

Cytopathology of Infectious and Inflammatory Diseases

Introduction In the previous edition, this chapter stressed the importance of infectious disease cytology to the education of pathology trainees and practitioners. Within the contents of the chapter, are illustrated cases intended to demonstrate the value of the following: 1. A cytopathologist with experience and interest in infectious disease. 2. Rapid onsite evaluation (ROSE) to provide immediate presumptive diagnoses and ensure proper use of cultures and/or…

Biopsy in the Diagnosis of Infection: Clinical Approach

Overview: Biopsy The practice of clinical infectious disease management has undergone a revolution with the advent of newer technologies, such as organism-specific molecular or protein-based diagnostic tools and, more recently, high throughput sequencing technologies on microbial diagnosis and the management of infection. Coupled with a variety of newer antimicrobial therapies, such as those for fungal and viral infections, significant shifts have occurred in clinical care. Despite…

General Principles in the Diagnosis of Infection

The identification of infection in biopsied tissues is the primary responsibility of the surgical pathologist. In an age when both noninvasive and minimally invasive approaches and techniques have increased, it is important to revisit the role of the biopsy in the diagnosis of infection ( Box 2.1 ). Isolating microorganisms in the microbiology laboratory is a sensitive and accurate approach to their identification, but it has…

Molecular Anatomic Pathology: Principles, Techniques, and Application to Immunohistologic Diagnosis

General Principles of Molecular Biology Immunohistochemistry (IHC) is a common technique used for the detection of protein expression in various tissue samples. In modern pathology practice, this methodology is expanded and complemented by molecular techniques that test for changes in nucleic acids—in effect, DNA and RNA—to assist the immunohistologic diagnosis. Many of the chapters in this book refer to theranostic and genomic principles that can be…