Achados neuropatológicos na síndrome da imunodeficiência adquirida (sida): revisão de 138 casos

Wainstein, Marco V.; Ferreira, Lisiane; Wolfenbuttel, Luciano; Golhspan, Liane; Sprinz, Eduardo; Kronfeld, Matias; Edelweiss, Maria Isabel

doi:10.1590/S0037-86821992000200002

Resumos

Com o objetivo de determinar a incidência das direrentes afecções que podem atingir o Sistema Nervoso Central (SNC) na Síndrome da Imunodeficiência Adquirida (SIDA) realizou- se um estudo retrospectivo através de necrópsias realizadas no Hospital de Clínicas de Porto Alegre. Para tanto, foram examinadas 138 necrópsias de pacientes portadores de SIDA que haviam morrido entre janeiro de 1985 e dezembo de 1990. Todos os cérebrosforam analisados macroscópica e microscopicamente através da hematoxilina-eosina e, quando necessário, colorações, especiais como Grocott, PAS, Giemsa e Ziehl-Nielsen, foram empregadas. As principais lesões encontradas foram: toxoplasmose cerebral em 29 casos (21 %); criptococose em 17 (12%); tuberculose em dois (1%) e um (0,7%) de candidíase. Além destas lesões inflamatórias foram observados 15 casos (10%) com lesões vasculares; oito (6%) com gliose e sete (5%) com achados sugestivos de encefalopatia pelo HIV. Podemos concluir que o SNC é um dos principais órgãos-alvo da SIDA e que a toxoplasmose cerebral é a principal forma de acometimento do SNC nestes pacientes.

SIDA; Sistema nervoso central; Toxoplasmose cerebral

This is an autopsy s study performed in a retrospective fashion to determine the incidence of diseases that could affect the Central Nervous System in AIDS. For this purpose, 138 autopsies of patients with AIDS performed at the "Hospital de Clinicas de Porto Alegre ", Brazil, between january/85 and december/90 were studied. All the brains were evaluated macroscopically and microscopically mainly through hematoxylin-eosin staining and if necessary special tecniques like PAS,Grocott, Giemsa and Ziehl-Nielsen were done. Results have revealed 29 (21%) cases with cerebral toxoplasmosis; cryptococosis in 17 (12%); tuberculosis in two (1%) and one case (0,7%) of candidiasis. Besides these inflammatory lesions, 15 (10%)presented vascular lesion; 8(6%) had gliosis and 7(5%) cases had suggestive findings ofHTV-encephalopath. We can conclude that the CNS is a important target affected by AIDS and that cerebral toxopalsmosis is the principal disease in the CNS in AIDS patientes.

AIDS; Central nervous system; Cerebral toxoplasmosis

ARTIGOS

Achados neuropatológicos na síndrome da imunodeficiência adquirida (sida): revisão de 138 casos

Marco V. Wainstein; Lisiane Ferreira; Luciano Wolfenbuttel; Liane Golhspan; Eduardo Sprinz; Matias Kronfeld; Maria Isabel Edelweiss

^{Endereço para correspondência} Endereço para correspondência: Dra. Maria Isabel Edelweiss. Serviço de Anatomia Patológica/HCPA. R. Ramiro Barcelos 2350 subsolo 90035-003 Porto Alegre, RS, Brasil.

RESUMO

Com o objetivo de determinar a incidência das direrentes afecções que podem atingir o Sistema Nervoso Central (SNC) na Síndrome da Imunodeficiência Adquirida (SIDA) realizou- se um estudo retrospectivo através de necrópsias realizadas no Hospital de Clínicas de Porto Alegre. Para tanto, foram examinadas 138 necrópsias de pacientes portadores de SIDA que haviam morrido entre janeiro de 1985 e dezembo de 1990. Todos os cérebrosforam analisados macroscópica e microscopicamente através da hematoxilina-eosina e, quando necessário, colorações, especiais como Grocott, PAS, Giemsa e Ziehl-Nielsen, foram empregadas. As principais lesões encontradas foram: toxoplasmose cerebral em 29 casos (21 %); criptococose em 17 (12%); tuberculose em dois (1%) e um (0,7%) de candidíase. Além destas lesões inflamatórias foram observados 15 casos (10%) com lesões vasculares; oito (6%) com gliose e sete (5%) com achados sugestivos de encefalopatia pelo HIV. Podemos concluir que o SNC é um dos principais órgãos-alvo da SIDA e que a toxoplasmose cerebral é a principal forma de acometimento do SNC nestes pacientes.

Palavras-chave: SIDA. Sistema nervoso central. Toxoplasmose cerebral.

ABSTRACT

This is an autopsy s study performed in a retrospective fashion to determine the incidence of diseases that could affect the Central Nervous System in AIDS. For this purpose, 138 autopsies of patients with AIDS performed at the "Hospital de Clinicas de Porto Alegre ", Brazil, between january/85 and december/90 were studied. All the brains were evaluated macroscopically and microscopically mainly through hematoxylin-eosin staining and if necessary special tecniques like PAS,Grocott, Giemsa and Ziehl-Nielsen were done. Results have revealed 29 (21%) cases with cerebral toxoplasmosis; cryptococosis in 17 (12%); tuberculosis in two (1%) and one case (0,7%) of candidiasis. Besides these inflammatory lesions, 15 (10%)presented vascular lesion; 8(6%) had gliosis and 7(5%) cases had suggestive findings ofHTV-encephalopath. We can conclude that the CNS is a important target affected by AIDS and that cerebral toxopalsmosis is the principal disease in the CNS in AIDS patientes.

Keywords: AIDS. Central nervous system. Cerebral toxoplasmosis.

Texto completo disponível apenas em PDF.

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Recebido para publicação em 17/01/92.

Trabalho realizado na Unidade de Doenças Infecciosas e Serviço de Anatomia Patológica do Hospital de Clínicas de Porto Alegre (HCPA).

Auxílio: FAPERGS e PROPESP

1. Anders KH, Guerra WF, Tomiyasu U, Verity MA, Vinters HV. The neuropathology of AIDS: UCLÁ experience and review. American Journal of Pathology 124:537-558, 1986.
2. Bishburg E, Robert HK, SlimJ, PerezG, Johnson E. Brain lesions in patients with acquired immunodeficiency syndrome. Archives of Internai Medicine 149:941X943, 1989.
3. Budka H, Constanzi G, Cristina S, Lechi A, Parravicini C, Trabattoni R, Vago L. Brain pathology induced by infection with the human immunodeficiency virus (HIV). A histological immunocytochemical, and electron microscopical study of 100 autopsy cases. Acta Neuropathologica 75:185-198, 1987.
4. Gonzales MF, Davis RL. Neuropathology of acquired immunodeficiency syndrome. N europathology and Applied Neurobiology 14:345- 363, 1988.
5. Gray F, Ghererdi R, Scaravilli F. The neuropathology of acquired immunodeficiency syndrome (AIDS): a review. Brain 111:245-266, 1988.
6. Kleihues P, Lang W, Burger PC, Budka H, VogtM, Mourer R, Luthy R, Siegenthaler W. Progressive diffuse leukoencephalopathy in patients with acquired immunodeficiency syndrome (AIDS). Acta Neuropathologica 68:333-339, 1985.
7. Lang W, Miklossy J, Deruaz JP, Pizzolato GP, Probst A, Schaffner T, Gessaga E, Kleihues P. Neuropathologica 77:379-390, 1989.
8. Lantos PL, McLaughlin JE, Scholtz CL, Berry CL, Tighe JR. Neuropathology of the brain in HIV infection. Lancet 11:309-311, 1989.
9. Luft BJ, Brooks RG, Conley FK, McCabe RE, Remington JS. Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome. Journal of the American Medical Association 2532:913- 917, 1984.
10. Michaels J, Sharer LR, Epstein LG. Human immunodefiency virus type 1 (HIV-1) infection of the nervous system: a review. Immunodeficiency Review 1:71-104, 1988.
11. Monte SM, Ho DD, Schooley RT, Hirsh MS, Richardson EP. Subacute Encephalitis of AIDS and its relation to HTLV-III infection. Neurology 37:562- 569, 1987.
12. Navia BA, Cho ES, Petito CK, Price RW, The AIDS dementia complex, II: neuropathology Annals of Neurology 19:525-535, 1986.
13. Navia BA, Petito CK, Gold JWM, Cho ES, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immunodeficiency syndrome: clinical and neuropathological findings of 27patients. Annals of Neurology 19:224-238, 1986.
14. Petito CK, Cho ES, Lehmann W, Navia BA, Price RW. Neuropathology of acquired immunodefiency syndrome (AIDS): an aautopsy review. Journal of Neuropathology and Experimental Neurology 45:635-646, 1986.
15. Rosemberg S, Lopes MBS, Tsanaclis AM. Neuropathology of acquired immunodeficiency syncrome (AIDS). Analysis of 22 Brazilian cases. Journal of the Neurological Sciences 76:187-198, 1986.
16 Sharer LR, Cho ES, Epstein LG. Multinucleated giant cells and HTLV-III in AIDS encephalopathy. Human Pathology 16:760, 1985.
17. Wiley CA, Nelson JA. Role of immunodefiency virus and cytomegalovirus in AIDS encephalitis. American Journal of Pathology 133:73-81, 1988.
18. Wong B, Gold JWM, Brown AE, Lange M, Fried R, Grieco M, Milvan D, Giron J, Tapper ML, Lemer CW, Armstrong D. Central nervous system toxoplasmosis in homosexual men and parenteral drug abusers. Annals of Internal Medicine 100:36- 42, 1984.

Endereço para correspondência:

Dra. Maria Isabel Edelweiss.

Serviço de Anatomia Patológica/HCPA.

R. Ramiro Barcelos 2350 subsolo

90035-003

Porto Alegre, RS, Brasil.

Datas de Publicação

Publicação nesta coleção
19 Abr 2013
Data do Fascículo
Jun 1992

Histórico

Recebido
17 Jan 1992
Aceito
17 Jan 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Anders KH, Guerra WF, Tomiyasu U, Verity MA, Vinters HV. The neuropathology of AIDS: UCLÁ experience and review. American Journal of Pathology 124:537-558, 1986.

[2] 2. Bishburg E, Robert HK, SlimJ, PerezG, Johnson E. Brain lesions in patients with acquired immunodeficiency syndrome. Archives of Internai Medicine 149:941X943, 1989.

[3] 3. Budka H, Constanzi G, Cristina S, Lechi A, Parravicini C, Trabattoni R, Vago L. Brain pathology induced by infection with the human immunodeficiency virus (HIV). A histological immunocytochemical, and electron microscopical study of 100 autopsy cases. Acta Neuropathologica 75:185-198, 1987.

[4] 4. Gonzales MF, Davis RL. Neuropathology of acquired immunodeficiency syndrome. N europathology and Applied Neurobiology 14:345- 363, 1988.

[5] 5. Gray F, Ghererdi R, Scaravilli F. The neuropathology of acquired immunodeficiency syndrome (AIDS): a review. Brain 111:245-266, 1988.

[6] 6. Kleihues P, Lang W, Burger PC, Budka H, VogtM, Mourer R, Luthy R, Siegenthaler W. Progressive diffuse leukoencephalopathy in patients with acquired immunodeficiency syndrome (AIDS). Acta Neuropathologica 68:333-339, 1985.

[7] 7. Lang W, Miklossy J, Deruaz JP, Pizzolato GP, Probst A, Schaffner T, Gessaga E, Kleihues P. Neuropathologica 77:379-390, 1989.

[8] 8. Lantos PL, McLaughlin JE, Scholtz CL, Berry CL, Tighe JR. Neuropathology of the brain in HIV infection. Lancet 11:309-311, 1989.

[9] 9. Luft BJ, Brooks RG, Conley FK, McCabe RE, Remington JS. Toxoplasmic encephalitis in patients with acquired immunodeficiency syndrome. Journal of the American Medical Association 2532:913- 917, 1984.

[10] 10. Michaels J, Sharer LR, Epstein LG. Human immunodefiency virus type 1 (HIV-1) infection of the nervous system: a review. Immunodeficiency Review 1:71-104, 1988.

[11] 11. Monte SM, Ho DD, Schooley RT, Hirsh MS, Richardson EP. Subacute Encephalitis of AIDS and its relation to HTLV-III infection. Neurology 37:562- 569, 1987.

[12] 12. Navia BA, Cho ES, Petito CK, Price RW, The AIDS dementia complex, II: neuropathology Annals of Neurology 19:525-535, 1986.

[13] 13. Navia BA, Petito CK, Gold JWM, Cho ES, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immunodeficiency syndrome: clinical and neuropathological findings of 27patients. Annals of Neurology 19:224-238, 1986.

[14] 14. Petito CK, Cho ES, Lehmann W, Navia BA, Price RW. Neuropathology of acquired immunodefiency syndrome (AIDS): an aautopsy review. Journal of Neuropathology and Experimental Neurology 45:635-646, 1986.

[15] 15. Rosemberg S, Lopes MBS, Tsanaclis AM. Neuropathology of acquired immunodeficiency syncrome (AIDS). Analysis of 22 Brazilian cases. Journal of the Neurological Sciences 76:187-198, 1986.

[16] 16 Sharer LR, Cho ES, Epstein LG. Multinucleated giant cells and HTLV-III in AIDS encephalopathy. Human Pathology 16:760, 1985.

[17] 17. Wiley CA, Nelson JA. Role of immunodefiency virus and cytomegalovirus in AIDS encephalitis. American Journal of Pathology 133:73-81, 1988.

[18] 18. Wong B, Gold JWM, Brown AE, Lange M, Fried R, Grieco M, Milvan D, Giron J, Tapper ML, Lemer CW, Armstrong D. Central nervous system toxoplasmosis in homosexual men and parenteral drug abusers. Annals of Internal Medicine 100:36- 42, 1984.