RESUMO
ABSTRACT: Animal hoarding disorder, especially dogs and cats, is a complex issue that occurs in almost all communities, and it is necessary to collect data that contribute to the understanding of leptospirosis within the One Health initiative. In order to determine the seroprevalence of Leptospirasp., 71 dogs and 39 cats from 33 people with animal hoarding profile in the municipality of Patos, state of Paraíba, semi-arid region of Northeastern Brazil were evaluated by using the microscopic serum agglutination test (MAT) as diagnostic test. Thirty-eight animals (34.5%; 95% CI = 25.7 - 43.4%) were seroreactive, with 46.5% in dogs and 12.8% in cats (P < 0.01), with the highest frequency of the Icterohaemorrhagiae serogroup in both species. The high seroprevalence reported suggests the need for public policies for this vulnerable population in order to prevent the transmission of zoonoses.
RESUMO: O transtorno de acumulação de animais, principalmente de cães e gatos, é uma questão complexa que ocorre em quase todas as comunidades, sendo necessário o levantamento de dados que contribuam para a compreensão da leptospirose dentro da iniciativa Saúde Única. Com o objetivo de determinar a soroprevalência deLeptospirasp. em cães e gatos provenientes de acumuladores de animais foram utilizados 71 cães e 39 gatos de 33 acumuladores do município de Patos, estado da Paraíba, semiárido do Nordeste brasileiro, utilizando-se o teste de soroaglutinação microscópica (SAM) como teste de diagnóstico. Trinta e oito animais (34,5%; IC 95% = 25,7 - 43,4%) foram sororreativos, sendo 46,5% em cães e 12,8% em gatos (P < 0,01), com maior frequência do sorogrupo Icterohaemorrhagiae em ambas as espécies. A alta soroprevalência encontrada sugere a necessidade de políticas públicas para esta população vulnerável no sentido de prevenir a transmissão de zoonoses.
RESUMO
Background: Human visceral leishmaniasis (HVL) is a potentially fatal disease with a worldwide distribution, being endemic in 12 countries in the Americas. The main reservoir in the urban environment is the dog, whose cases precede the disease in humans. For the control of HVL, the Ministry of Health of Brazil recommends efficiency in the notification of human cases, control of sandflies, elimination of reservoirs and health education, in addition to the interruption in the transmission of the disease by the intensification of surveillance and control of priority areas based on identification by spatial analysis. The objective of the study was to investigate the spatial distribution of canine visceral leishmaniasis (CVL) in the state of Rio Grande do Norte, Brazil, determining areas of risk by identifying spatial clusters, with a view to monitoring and implementing preventive actions. Materials, Methods & Results: Secondary data from sample and/or routine serological surveys for serological diagnosis of LVC in the period from 2011 to 2018 were used. The inclusion of animals in the routine diagnosis per municipality resulted from demands of veterinarians, veterinary clinics, dog tutors, zoonoses control centers and environmental surveillance. The spatial statistical analysis was performed with SatScan software version 9.6 for the detection of spatial clusters, based on using the statistical scan method. Of the total of 231,123 dogs tested in the period, 24,642 (10.6%) were seroreactive for CVL. During the study, the municipalities with the highest number of cases were Natal and Mossoró, with 9,671 and 4,514 cases, respectively. During the years 2011 to 2018, 38 significant clusters (P < 0.05) were identified that included one or more municipalities. Discussion: The state of Rio Grande do Norte has an urban environment susceptible to the occurrence of CVL, with climate and topography that favor the proliferation of the vector and housing in precarious socio-sanitary conditions. The high number of CVL cases in Natal can be explained by the fact that the city is considered endemic for CVL, characterized as an area of intense transmission of the disease, according to the Ministry of Health. In addition, public infrastructure in some locations is deficient and living conditions are unfavorable, so that there is a need to invest in effective protection measures for vector control, as well as a focus on health education, whose HVL control measures in the municipality need to be readjusted. The high rate of cases and the constant presence of clusters in the municipality of Açu can be explained by the increasing degradation of the Caatinga biome, evidenced by the removal of firewood for use in the ceramist pole, whose activity is concentrated on a large scale in the use of raw material and energy, through the production of charcoal, for agricultural and livestock fronts, putting species of fauna and flora at risk. It is also noteworthy that this fact contributes to the destruction of wild ecotopes, resulting in the search for the vector for other sources of human and animal food, allowing an increase in the number of cases of the disease. It's concluded that canine visceral leishmaniasis is distributed in a large part of the state of Rio Grande do Norte. The underreporting and/or deficiency in the disclosure of data by some municipalities represents a challenge in complying with the actions of the Visceral Leishmaniasis Surveillance and Control Program, and attention should be paid to the monitoring and inspection of the execution actions of municipal managers, as well as how to train professionals who are part of the service.
Assuntos
Animais , Cães , Avaliação de Risco e Mitigação , Leishmaniose Visceral/veterinária , Leishmaniose Visceral/epidemiologia , Brasil , Testes Sorológicos/veterinária , Estudos RetrospectivosRESUMO
The main clinical, anatomopathological, and molecular aspects of the infection by Leishmania infantum are described in two cats with multicentric cutaneous, nodular, and ulcerated lesions. The animals were submitted to a clinical examination, followed by serological, molecular and parasitological exams, with culture and isolation of the parasite, and subsequent isoenzymatic characterization. The animals were euthanized and necropsied. Case 1 was an adult, female, mixed-bred stray cat. Case 2 was an adult, male, mixed-bred and domiciled cat. Both were positive for the presence of anti-L. infantum antibodies. In the cytology of the cutaneous nodules and lymph nodes, amastigote forms of Leishmania spp. could be visualized, free and in the interior of the macrophages. In the histopathology, the lesions were characterized by nodular granulomatous and/or ulcerative dermatitis, associated to amastigote forms of Leishmania spp. By means of the polymerase chain reaction, the sequence of the L. infantum kDNA minicircle was amplified. It is concluded that the infection by L. infantum occurs in cats in the State of Paraíba, Northeast region of Brazil and the need to understand the immunological profile of the visceral leishmaniasis in the feline population is highlighted with aimed at the control measures in public health.
Assuntos
Doenças do Gato , Leishmania infantum , Leishmaniose Visceral , Animais , Anticorpos Antiprotozoários/sangue , Brasil , Doenças do Gato/diagnóstico , Gatos , DNA de Cinetoplasto/genética , Eutanásia Animal , Feminino , Leishmania infantum/genética , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/transmissão , Leishmaniose Visceral/veterinária , Macrófagos/parasitologia , Masculino , Reação em Cadeia da Polimerase/veterináriaRESUMO
The main clinical, anatomopathological, and molecular aspects of the infection by Leishmania infantum are described in two cats with multicentric cutaneous, nodular, and ulcerated lesions. The animals were submitted to a clinical examination, followed by serological, molecular and parasitological exams, with culture and isolation of the parasite, and subsequent isoenzymatic characterization. The animals were euthanized and necropsied. Case 1 was an adult, female, mixed-bred stray cat. Case 2 was an adult, male, mixed-bred and domiciled cat. Both were positive for the presence of anti-L. infantum antibodies. In the cytology of the cutaneous nodules and lymph nodes, amastigote forms of Leishmania spp. could be visualized, free and in the interior of the macrophages. In the histopathology, the lesions were characterized by nodular granulomatous and/or ulcerative dermatitis, associated to amastigote forms of Leishmania spp. By means of the polymerase chain reaction, the sequence of the L. infantum kDNA minicircle was amplified. It is concluded that the infection by L. infantum occurs in cats in the State of Paraíba, Northeast region of Brazil and the need to understand the immunological profile of the visceral leishmaniasis in the feline population is highlighted with aimed at the control measures in public health.(AU)
Descrevem-se os principais aspectos clínicos, anatomopatológicos e moleculares da infecção por Leishmania infantum em dois gatos, cuja queixa era de lesões cutâneas multicêntricas, nodulares e ulceradas. Os animais foram submetidos à avaliação clínica, seguida de exames sorológicos, molecular e parasitológico, com cultura e isolamento do parasita e posterior caracterização isoenzimática. Os animais foram eutanasiados e encaminhados para a necropsia. O caso 1 era uma gata adulta, sem raça definida e errante. O caso 2 era um gato adulto, sem raça definida e domiciliado. Ambos foram positivos para a presença de anticorpos anti-L. infantum. Na citologia dos nódulos cutâneos e linfonodos, puderam ser visualizadas formas amastigotas de Leishmania spp. livres e no interior de macrófagos. Na histopatologia, as lesões se caracterizavam por dermatite granulomatosa nodular e/ou ulcerativa, associadas a formas amastigotas de Leishmania spp. Por meio da reação em cadeia da polimerase, amplificou-se a sequência do minicírculo do kDNA de L. infantum. Conclui-se que a infecção por L. infantum ocorre em gatos no estado da Paraíba, região Nordeste do Brasil. Deve-se ressaltar a necessidade de compreender o perfil imunológico e epidemiológico da leishmaniose visceral na população felina, com vistas às medidas de controle em saúde pública.(AU)
Assuntos
Animais , Gatos , Gatos/microbiologia , Leishmaniose/microbiologia , Leishmania infantum/patogenicidade , ZoonosesRESUMO
Abstract The main clinical, anatomopathological, and molecular aspects of the infection by Leishmania infantum are described in two cats with multicentric cutaneous, nodular, and ulcerated lesions. The animals were submitted to a clinical examination, followed by serological, molecular and parasitological exams, with culture and isolation of the parasite, and subsequent isoenzymatic characterization. The animals were euthanized and necropsied. Case 1 was an adult, female, mixed-bred stray cat. Case 2 was an adult, male, mixed-bred and domiciled cat. Both were positive for the presence of anti-L. infantum antibodies. In the cytology of the cutaneous nodules and lymph nodes, amastigote forms of Leishmania spp. could be visualized, free and in the interior of the macrophages. In the histopathology, the lesions were characterized by nodular granulomatous and/or ulcerative dermatitis, associated to amastigote forms of Leishmania spp. By means of the polymerase chain reaction, the sequence of the L. infantum kDNA minicircle was amplified. It is concluded that the infection by L. infantum occurs in cats in the State of Paraíba, Northeast region of Brazil and the need to understand the immunological profile of the visceral leishmaniasis in the feline population is highlighted with aimed at the control measures in public health.
Resumo Descrevem-se os principais aspectos clínicos, anatomopatológicos e moleculares da infecção por Leishmania infantum em dois gatos, cuja queixa era de lesões cutâneas multicêntricas, nodulares e ulceradas. Os animais foram submetidos à avaliação clínica, seguida de exames sorológicos, molecular e parasitológico, com cultura e isolamento do parasita e posterior caracterização isoenzimática. Os animais foram eutanasiados e encaminhados para a necropsia. O caso 1 era uma gata adulta, sem raça definida e errante. O caso 2 era um gato adulto, sem raça definida e domiciliado. Ambos foram positivos para a presença de anticorpos anti-L. infantum. Na citologia dos nódulos cutâneos e linfonodos, puderam ser visualizadas formas amastigotas de Leishmania spp. livres e no interior de macrófagos. Na histopatologia, as lesões se caracterizavam por dermatite granulomatosa nodular e/ou ulcerativa, associadas a formas amastigotas de Leishmania spp. Por meio da reação em cadeia da polimerase, amplificou-se a sequência do minicírculo do kDNA de L. infantum. Conclui-se que a infecção por L. infantum ocorre em gatos no estado da Paraíba, região Nordeste do Brasil. Deve-se ressaltar a necessidade de compreender o perfil imunológico e epidemiológico da leishmaniose visceral na população felina, com vistas às medidas de controle em saúde pública.
Assuntos
Animais , Masculino , Feminino , Gatos , Doenças do Gato/diagnóstico , Leishmania infantum/genética , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/transmissão , Leishmaniose Visceral/veterinária , Brasil , Anticorpos Antiprotozoários/sangue , Reação em Cadeia da Polimerase/veterinária , DNA de Cinetoplasto/genética , Eutanásia Animal , Macrófagos/parasitologiaRESUMO
The aim of this work was to isolate and characterize microorganisms in hypertrophied lymph nodes or gross lesions suggestive of tuberculosis collected from 12 goats and 28 sheep slaughtered at the public slaughterhouse of Patos municipality, Paraíba State, in the Northeast region of Brazil. The identification of mycobacteria was performed by the PRA method (PCR-Restriction Enzyme Analysis). Histopathological examination of lesions was also performed. Organs affected were liver, lung, mammary gland, bladder and mediastinal, mesenteric, submandibular, parotid, popliteal, precrural, prescapular and superficial inguinal lymph nodes. Histopathological examination showed the presence of granulomas in 8 (20.00%) animals. Of the 12 goats, 1 (8.33%) was positive in the culture of mycobacteria, and by PRA method the isolate was classified as belonging to the M. tuberculosis complex. Two (7.14%) sheep were positive for the presence of environmental mycobacteria. There was isolation of Corynebacterium pseudotuberculosis in 8 (66.66%) goats and 17 (60.71%) sheep, and simultaneous isolation of mycobacteria and C. pseudotuberculosis in 1 (8.33%) goat and 1 (3.57%) sheep. The isolation of mycobacteria of the M. tuberculosis complex in goats in this study raises concerns of public health, as professionals involved in handling these animals and the meat and milk consumers are exposed to the risk [...](AU)
O objetivo do presente trabalho foi isolar e tipificar micro-organismos presentes em linfonodos hipertrofiados ou lesões macroscópicas sugestivas de tuberculose colhidos de 12 caprinos e 28 ovinos abatidos no matadouro público do município de Patos, Paraíba. A identificação de micobactérias foi feita com o método PRA (PCR-Restriction Enzyme Analysis). Também foi realizado o exame histopatológico das lesões. Os órgãos afetados foram fígado, pulmão, glândula mamária, bexiga e linfonodos mediastínicos, mesentéricos, submandibulares, parotídeos, poplíteos, pré-crural, pré-escapular e inguinal superficial. O exame histopatológico apontou a presença de granulomas em 8 (20,00%) animais. Dos 12 caprinos, 1 (8,33%) foi positivo no cultivo de micobactérias, e pelo método PRA o isolado foi classificado como pertencente ao complexo M. tuberculosis. Dois (7,14%) ovinos foram positivos para a presença de micobactérias ambientais. Houve isolamento de Corynebacterium pseudotuberculosis em 8 (66,66%) caprinos e em 17 (60,71%) ovinos, e isolamento simultâneo de micobactérias e C. pseudotuberculosis em 1 (8,33%) caprino e 1 (3,57%) ovino. O isolamento de micobactéria do complexo M. tuberculosis em caprinos no presente trabalho levanta preocupações do ponto de vista de saúde pública, uma vez que profissionais envolvidos na manipulação destes animais, bem como a população consumidora de carne [...](AU)
Assuntos
Animais , Mycobacterium tuberculosis , Ovinos , Ruminantes , Inocuidade dos Alimentos , Saneamento de Mercados , LinfonodosRESUMO
The aim of this work was to isolate and characterize microorganisms in hypertrophied lymph nodes or gross lesions suggestive of tuberculosis collected from 12 goats and 28 sheep slaughtered at the public slaughterhouse of Patos municipality, Paraíba State, in the Northeast region of Brazil. The identification of mycobacteria was performed by the PRA method (PCR-Restriction Enzyme Analysis). Histopathological examination of lesions was also performed. Organs affected were liver, lung, mammary gland, bladder and mediastinal, mesenteric, submandibular, parotid, popliteal, precrural, prescapular and superficial inguinal lymph nodes. Histopathological examination showed the presence of granulomas in 8 (20.00%) animals. Of the 12 goats, 1 (8.33%) was positive in the culture of mycobacteria, and by PRA method the isolate was classified as belonging to the M. tuberculosis complex. Two (7.14%) sheep were positive for the presence of environmental mycobacteria. There was isolation of Corynebacterium pseudotuberculosis in 8 (66.66%) goats and 17 (60.71%) sheep, and simultaneous isolation of mycobacteria and C. pseudotuberculosis in 1 (8.33%) goat and 1 (3.57%) sheep. The isolation of mycobacteria of the M. tuberculosis complex in goats in this study raises concerns of public health, as professionals involved in handling these animals and the meat and milk consumers are exposed to the risk [...]
O objetivo do presente trabalho foi isolar e tipificar micro-organismos presentes em linfonodos hipertrofiados ou lesões macroscópicas sugestivas de tuberculose colhidos de 12 caprinos e 28 ovinos abatidos no matadouro público do município de Patos, Paraíba. A identificação de micobactérias foi feita com o método PRA (PCR-Restriction Enzyme Analysis). Também foi realizado o exame histopatológico das lesões. Os órgãos afetados foram fígado, pulmão, glândula mamária, bexiga e linfonodos mediastínicos, mesentéricos, submandibulares, parotídeos, poplíteos, pré-crural, pré-escapular e inguinal superficial. O exame histopatológico apontou a presença de granulomas em 8 (20,00%) animais. Dos 12 caprinos, 1 (8,33%) foi positivo no cultivo de micobactérias, e pelo método PRA o isolado foi classificado como pertencente ao complexo M. tuberculosis. Dois (7,14%) ovinos foram positivos para a presença de micobactérias ambientais. Houve isolamento de Corynebacterium pseudotuberculosis em 8 (66,66%) caprinos e em 17 (60,71%) ovinos, e isolamento simultâneo de micobactérias e C. pseudotuberculosis em 1 (8,33%) caprino e 1 (3,57%) ovino. O isolamento de micobactéria do complexo M. tuberculosis em caprinos no presente trabalho levanta preocupações do ponto de vista de saúde pública, uma vez que profissionais envolvidos na manipulação destes animais, bem como a população consumidora de carne [...]
Assuntos
Animais , Inocuidade dos Alimentos , Mycobacterium tuberculosis , Ovinos , Ruminantes , Linfonodos , Saneamento de MercadosRESUMO
O objetivo deste estudo foi avaliar os fosfatos de cálcio, pirofosfato de cálcio (CPP) com tratamento térmico a 70 0 e 900°C, fosfato tricálcio associado à hidroxiapatita (TCP/HA) e hidroxiapatita (HA) como substitutos ósseos. Foram utilizados 20 coelhos (Oryctolagus cuniculus), de ambos os sexos, da raça Nova Zelândia, pesando em média 2,5±0,41 kg. Os animais foram distribuídos, ao acaso, em dois grupos de 10 animais de acordo com o período em que foram eutanasiados (30 ou 60 dias). Os implantes foram introduzidos na metáfise proximal e distal de cada fêmur, de modo que os CPP 700 e 900 foram introduzidos no membro esquerdo, enquanto o TCP/HA e HA no membro direito. Foram realizadas avaliações clínico-cirúrgicas e radiográficas imediatamente após a cirurgia e aos 30 e 60 dias dopós-operatório. Os animais apresentaram evolução clínica normal. Na avaliação radiográfica observou-se diferença estatística entre os grupos com maior grau de radiopacidade nos animais do grupo 60 dias que utilizaram os implantes TCP/HA e HA. Na avaliação histológica, por meio de microscopia de luz e análise morfométrica, os materiais TCP/HA e HA proporcionaram maior neoformação óssea ao redor dos implantes do que com os CPP700 e CPP900 aos 30 e 60 dias de avaliação.(AU)
The aim of this study was to evaluate the calcium phosphate, calcium pyrophosphate (CPP) with heat treatment at 700 and 900 ° C, tricalcium phosphate combined with hydroxyapatite (TCP/HA) and hydroxyapatite (HA) as bone substitutes. We used 20 rabbits (Oryctolagus cuniculus) of both sexes, New Zealand breed, with mean weigh of 2.5 ± 0.41 kg. The animals were randomly divided into two groups of 10 animals in the period in which they were euthanized (30 or 60 days). The implants were placed on the proximal and distal metaphysis of each femur so that CPP 700 and 900 were introduced in the left, while TCP/HA and HA in the right. Clinical and radiographic-surgical evaluations were performed immediately after surgery, and 30 and 60 days post-surgery. The animals showed normal clinical evolution. In the radiographic evaluation there was statistical difference between groups with higher degree of radiopacity at group 60 days that used TCP/HA and HA implants. In the histological evaluation by light microscopy and morphometric analysis the materials TCP/HA and HA showed greater bone formation around the implants than CPP700 and CPP900 at 30 and 60-days evaluation.(AU)
Assuntos
Animais , Coelhos/classificação , Osso e Ossos/anatomia & histologia , Regeneração Óssea/fisiologia , Próteses e Implantes/veterinária , Fêmur/anatomia & histologia , Fosfatos de CálcioRESUMO
O objetivo deste estudo foi avaliar os fosfatos de cálcio, pirofosfato de cálcio (CPP) com tratamento térmico a 70 0 e 900°C, fosfato tricálcio associado à hidroxiapatita (TCP/HA) e hidroxiapatita (HA) como substitutos ósseos. Foram utilizados 20 coelhos (Oryctolagus cuniculus), de ambos os sexos, da raça Nova Zelândia, pesando em média 2,5±0,41 kg. Os animais foram distribuídos, ao acaso, em dois grupos de 10 animais de acordo com o período em que foram eutanasiados (30 ou 60 dias). Os implantes foram introduzidos na metáfise proximal e distal de cada fêmur, de modo que os CPP 700 e 900 foram introduzidos no membro esquerdo, enquanto o TCP/HA e HA no membro direito. Foram realizadas avaliações clínico-cirúrgicas e radiográficas imediatamente após a cirurgia e aos 30 e 60 dias dopós-operatório. Os animais apresentaram evolução clínica normal. Na avaliação radiográfica observou-se diferença estatística entre os grupos com maior grau de radiopacidade nos animais do grupo 60 dias que utilizaram os implantes TCP/HA e HA. Na avaliação histológica, por meio de microscopia de luz e análise morfométrica, os materiais TCP/HA e HA proporcionaram maior neoformação óssea ao redor dos implantes do que com os CPP700 e CPP900 aos 30 e 60 dias de avaliação.
The aim of this study was to evaluate the calcium phosphate, calcium pyrophosphate (CPP) with heat treatment at 700 and 900 ° C, tricalcium phosphate combined with hydroxyapatite (TCP/HA) and hydroxyapatite (HA) as bone substitutes. We used 20 rabbits (Oryctolagus cuniculus) of both sexes, New Zealand breed, with mean weigh of 2.5 ± 0.41 kg. The animals were randomly divided into two groups of 10 animals in the period in which they were euthanized (30 or 60 days). The implants were placed on the proximal and distal metaphysis of each femur so that CPP 700 and 900 were introduced in the left, while TCP/HA and HA in the right. Clinical and radiographic-surgical evaluations were performed immediately after surgery, and 30 and 60 days post-surgery. The animals showed normal clinical evolution. In the radiographic evaluation there was statistical difference between groups with higher degree of radiopacity at group 60 days that used TCP/HA and HA implants. In the histological evaluation by light microscopy and morphometric analysis the materials TCP/HA and HA showed greater bone formation around the implants than CPP700 and CPP900 at 30 and 60-days evaluation.
Assuntos
Animais , Coelhos/classificação , Osso e Ossos/anatomia & histologia , Próteses e Implantes , Regeneração Óssea/fisiologia , Fosfatos de Cálcio , Fêmur/anatomia & histologiaRESUMO
Foram realizados exames de citologia conjuntival em 30 cães de raças e idades variadas os quais foram distribuídos de acordo com a idade em dois grupos: GI (até um ano de idade) e GII (mais de um ano de idade). As coletas foram realizadas com swab estéril, o qual rotacionado sobre a conjuntiva inferior e ralado levemente sobre lâmina de vidro, obtendo uma quantidade de células suficiente para realização da avaliação, posteriormente coradas com Panóptico Rápido. Foi observado em ambos os grupos células epiteliais das camadas superficial e intermediária. Em + 67% dos animais do GII e em 27% do GI observou-se grande quantidade de células inflamatórias. Conclui-se que a coloração pelo método Panóptico é eficaz para a avaliação citológica e que dos animais não apresentarem alterações oculares evidente, a presença de células inflamatórias é marcante
The conjunctival cytology exams were performed in 30 dogs of several breeds and ages which were distributed accordingly to the age in groups: GI (animal until 1 year old) and GII (animals over 1 year old). The samples were collected with the use of a sterile swab; which was rotated on the lower conjunctiva, and rolled slightly in sleet of glass, obtaining enough quantity of cells to perform the evaluation, subsequently stained with quick Panoptic. In all smears it was observed the presence of evaluation, subsequently stained with quick Panoptic. In all smears it was observed the presence of epithelial cells of the superficial and intermediary layers. Around 67% of the animals of the GI and 27% of the GII, it was observed a large quantity of inflammatory cells. Concluding that the technique of the Panoptic proved to be efficient to cytological evaluation and therefore the animals didnt have ophthalmic disease evident, the presence of inflammatory cells is significant