RESUMEN
The histopathological alterations in various organs and the presence of AIDS-associated lesions were studied in 86 biopsy and 29 necropsy specimens of AIDS patients. The most common cancer seen in this study were malignant lymphomas (4% of cases) with development of extensive extranodal lymphomatous involvement from the outset. Although a preponderance of high grade B-cell pathologic subtypes is found in AIDS-associated lymphoma, we also report the first case of T-lymphoblastic lymphoma with a picture of acute lymphoblastic leukemia (T-ALL). Tuberculosis (34% of cases) was the most common opportunistic infection presented in tissue sections, and the majority of tissue biopsies revealed poorly organized granulomas and extensive necrosis with numerous bacilli. Penicilliosis (20% of cases) appeared to be the most common cutaneous lesion with multiple organ involvement. The involved organs showed a partially anergic tissue reaction characterized by poorly formed granulomas with diffuse infiltrate of fungi-laden macrophages and lymphoid cell depletion. This organism has to be distinguished from Histoplasma capsulatum and other yeast-form fungi. Co-existing cytomegalovirus and P. carinii infections were the predominant findings in lung necropsy specimens from pediatric patients who died from AIDS. A major pathologic feature in this group was diffuse alveolar damage stage II to III with heavy loads of organism and extensive lymphoplasmacytic infiltration.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/etiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Infecciones por Citomegalovirus/etiología , Hospitales , Humanos , Inmunofenotipificación , Lactante , Leucemia-Linfoma de Células T del Adulto/etiología , Pulmón/inmunología , Enfermedades Pulmonares Fúngicas/etiología , Ganglios Linfáticos/inmunología , Subgrupos Linfocitarios/inmunología , Linfoma Relacionado con SIDA/etiología , Penicillium , Infecciones por Pneumocystis/etiología , Tailandia/epidemiología , Tuberculosis Pulmonar/etiologíaRESUMEN
O sistema nervoso é freqüentemente comprometido em pacientes com a síndrome de imunodeficiência adquirida. As lesöes observadas podem decorrer da açäo direta do vírus da imunodeficiência humana (HIV), de agentes oportunistas, do aparecimento de neoplasias e de eventuais fatores inespecíficos como alteraçöes alteraçöes circulatórias, metabólicas ou degenerativas. Dentre as alteraçöes diretamente relacionadas à açäo do HIV estäo a encefalite e a leucoencefalopatia do HIV, apoliodistrofia difusa e a mielopatia vacuolar. A patogenia destas lesöes ainda näo está plenamente elucidada, sendo que os macrófagos säo as principais células infectadas pelo HIV, parecendo que os efeitos citotóxicos sobre as células do sistema nervoso sejam indiretos, talves a partir de substâncias liberadas pelos macrófagos infectados. Dentre as infecçöes oportunistas, a mais freqüente é a toxoplasmose, seguida da criptococose e da infecçäo pelo citomegalovírus, com algumas diferenças nas séries dos vários países. Vários outros agentes já foram observados no sistema nervoso de pacientes com AIDS. Dentre as neoplasias, o linfoma primário de células B é o mais freqüentemente encontrado. É comum o achado de mais de uma infecçäo ou a associaçäo de infecçöes e neoplasia no sistema nervoso de pacientes com AIDS