Oportunní infekce

Integrated Course
Microbiology & Pathology
Patologie
HIV &
oportunních
infekcí
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Neuroimmunoendokrinní
regulace
CRF
TNF
IL-6
IL-1
ACT
H
IL-1 neuronální
synapse
n.vagus
Nadledviny
Glukokortikoidy
Imunitní buňky
+kortikoteerapie !
Patologie AIDS
Přímý efekt HIV
Oportunní infekce
Nádorové procesy
HIV-Related Lymphadenopathy – HIVRL
 persistující



generalizovana lymfadenopatie HIVRL
trvání déle než tři měsíce
absence jiného důvodu pro lymphadenopatii
histologický průkaz folikulární hyperplázie
BIOPSIE
dif. dg.:
 HIV-Related
Lymphadenopathy – HIVRL
 infekce
 lymfom
 Kaposiho
sarkom
ARC
Zvětšené zárodečné centrum
ARC
hypercelulární parafolikulární zóna
sklerotizovanmý & kolabovaný lymfatický folikl
AIDS
Angiofolikulární hyperplázie
AIDS
Neuropathologie AIDS
Přímý vliv HIV





HIV encephalitis
leukoencephalopatie
vakuolární myelopatie
neuropatie
myopatie
vaskulitidy, AIDS-Dementia komplex, s HIV-asociovaná
progresivní encefalopatie v dětství
Brány vstupu do CNS
hematogenní (pyémie, sepse, virémia)
přímo
cestou plexus chorioideus
lokální zdroj
přímo
(trauma)
roztavení kosti
(sinusitis, otitis)
vv. emissariae
podél nervů
(filla olfactoria)
HIV
encephalitis
HIV encephalitis
Pathologie of AIDS
Oportunní infekce
paraziti: toxoplasmosis
mykózy mycobacteria, spirochety:




Aspergillus, Candida, Cryptococcus
Mycobacterium avium intracellulare
Mycobacterium tuberculosis
Treponema pallidum
virové




Cytomegalovirus
Herpes simplex
Herpes zoster
Polyoma PML
Toxoplasmosis – lymphadenitis cervicalis profunda
Candidosis oesophagi
Intertrigo
Toxoplasmosis cerebri
cysta
Toxoplasmosis
Toxoplasmosis
stereotaktická biopsie mozku
Cryptococcosis
methenamine silver (sputum)
polychrom (CSF)
Cryptococcosis
PAS
Candidosis vaginae
Candidosis - sputum
Candidosis – BAL polychrome
//
methenamine silver)
Aspergilosis pulmonum
TBC pulmonum cavernosa
Aspergillosis
sputum
fruiting head
polychrome
Aspergilloma
Aspergillosis
BAL
( methenamine silver)
Mucor
BAL (polychrome)
Chinen K, Tokuda Y, Sakamoto A, Fujioka Y.:
Fungal infections of the heart:
a clinicopathologic study of 50 autopsy cases.
Pathol Res Pract. 2007;203(10):705-15.

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
cardiac fungal infection (CFI) incidence is increasing
a grim prognosis
an early diagnosis and aggressive therapy
among a total of 4396 autopsy cases 50 CFI patients (1.1%)
32 males and 18 females - mean age of 65.5 years
underlying diseases for CFI included solid malignant
neoplasms (n=23), hematologic disorders (n=10), chronic
renal diseases (n=7), liver diseases (n=5), diabetes mellitus
(n=5), and other
none of the patients was diagnosed to have CFI antemortem!
most patients (n=45) demonstrated multi-organ fungal
infections with myocardial involvement
causative pathogens were Candida (n=36), Aspergillus (n=9),
Mucor (n=4), and Cryptococcus (n=1).
Progressive Multifocal
Leucoencephalopathy
PME
luxol blue
Cytomegalovirosis
CMV
Herpes annogenitalis
Herpes
Herpes
ihch
Herpes labialis
Herpes oralis - smear
Trichomoniasis
Mycobacterium avium intracellullare
Z-N
Pneumocystis jiroveci pneumonia
„Snowball“ with
icicle effect
Pneumocystis
jiroveci
Steven I. Hajdu, MD, FIAC
Memorial Sloan-Kettering
Cancer Center, USA
(dressed in three layers of
protective garbs to do an
AIDS autopsy)
Nejběžnější maligní nádory
u pacientů s AIDS

Kaposihp sarkom
HHV 8

Lymfom
HHV 8, EBV
(extranodální DLBCL)

dlaždicový karcinom
HPV
Sarcoma Kaposii
HHV-8
Sarcoma Kaposii
Kaposi sarcoma
Kaposi sarcoma
dr. Moritz Kaposi
• dr. Moritz Kohn narozen
v Kaposvaru Maďarsko1837
• pracoval u prof. Hebry 1865
• chodil s jeho dcerou Marthou
Hebra 1867
• změnil si jména na Kaposi
1871
• změnil si náboženství 1872
• popsal sarcoma idiopathicum
multiplex haemorrhagicum 1872
• oženil se s Marthou Hebra 1872
• died Vienna 1902
Schulz TF.:
The pleiotropic effects
of Kaposi's sarcoma herpesvirus.
J Pathol. 2006 Jan;208(2):187-98.


Kaposi's sarcoma herpesvirus HHV8
an essential factor in the pathogenesis of
– Kaposi's sarcoma (KS)
– multicentric Castleman's disease (MCD)
– primary effusion lymphoma (PEL)
– an occasional involvement in


bone marrow hypoplasia
haemophagocytic syndrome
Other disease associations are unconfirmed or controversial.
HHV8-associated disease is of particular importance
in immunosuppressed individuals, in particular in patients with
HIV infection and transplant recipients.
nH ML
(colon and mesenterium involved)
Neuropathologie AIDS tumory
Primární mozkový lymfom
většinou B typ
často multicentrický
v některých prokázán EB virus
Kaposiho sarkom (HHV8)
výjimečně meta do CNS
Primary cerebral B cell lymphoma
Well Differentiated Squamous Cell Carcinoma In an AIDS Patient
SIL H
Huppmann AR, Orenstein JM.: Opportunistic
disorders of the
gastrointestinal tract in the age of highly active
antiretroviral therapy.
Hum Pathol. 2010 Dec;41(12):1777-87.
Department of Pathology, George Washington University Medical Center, Washington, DC 20037, USA.



Since the 1996 advent of highly active antiretroviral therapy (HAART)
the incidence of most opportunistic disorders in the developed world has
declined but not disappeared.
The number of new yearly HIV infections (about 55,000) and the total
number of US infections (more than 1.1 million) remain very significant.
Opportunistic GI disorders were diagnosed in 442 endoscopies
performed since 1996 as before, but at about one half the rate.
– The esophagus - Candida.
– Helicobacter pylori - the most common gastric infection
– The small bowel still showed cytomegalovirus (CMV), cryptosporidia, and
Mycobacterium avium complex (MAC) infections.
– Large bowel infections were CMV, cryptosporidiosis, MAC, and
spirochetosis
– Cases of adenovirus, bacterial colitis, Kaposi sarcoma, and lymphoma were
still diagnosed.