Lesões do trato gastrointestinal na síndrome da imunodeficiência adquirida: [title]estudo de 45 necrópsias consecutivas

Gastrointestinal tract lesions in the acquired immunodeficiency syndrome: study of forty five consecutive necropsies

ARTIGOS

Lesões do trato gastrointestinal na síndrome da imunodeficiência adquirida: estudo de 45 necrópsias consecutivas

Gastrointestinal tract lesions in the acquired immunodeficiency syndrome: study of forty five consecutive necropsies

Maria Goretti Freire de Carvalho; Maria Aparecida Marchesan Rodrigues; Mariângela Ester Marques; Marcello Franco; Mário Rubens Montenegro

^{Endereço para correspondência}

RESUMO

Com objetivo de estudar afrequência e etiologia das lesões do tubo digestivo na Síndrome da Imunodeficiência Adquirida (AIDS), foram analisadas retrospectivamente 45 necrópsias consecutivas de pacientes adultos portadores do vírus da AIDS. Lesões macroscópicas e cortes histológicos de amostras da boca à região anal foram estudados, sendo as lâminas coradas por HE, métodos histoquímicos ou imunohistoquímicos. Trinta e sete (82,3 %)pacientes apresentaram lesões no tubo digestivo. O local mais freqüente de lesões foi a boca (73,3%), seguido do cólon (55,5%). Lesões múltiplas foram identificadas em 17 (37,7%) casos. O diagnóstico mais prevalente foi infecção pelo citomegalovírus (35,7%) identificado predominantemente no cólon. Candidíasefoi mais freqüente na boca (26,6%) e infecção herpética no esôfago (8,8%). Verificou-se leucoplasiapilosa oral em 16 (35,5%) eneoplasias emsete (15,5%). Asneoplasias incluíram quatro sarcomas de Kaposi, dois Carcinomas intramucosos anais e um linfoma gástrico. Os dados do presente estudo confirmam a importância do trato gastrointestinal como sede de alterações patológicas relacionadas à AIDS.

Palavras-chave: Síndrome da imunodeficiência adquirida. Infecções oportunistas. Trato gastrointestinal. Necropsia.

ABSTRACT

This study was designed to evaluate restropectivefy the frequency and etiology of the gastrointestinal (GI) lesions in 45 consecutive necropsies of adult patients with Acquired Immunodeficiency Syndrome (AIDS). Gross descriptions and histological sections of the GI tract, from mouth to anus, were reviewed. The slides were H&E stained, and when necessary special stains and immunohistochemicalmethods were also employed. There were lesions in GI tract in 37(82.3%) patients; the mouth was the segment mostfrequently involved (73.3% of the cases), followed by the colon (55.5%). Multiple lesions occurred in 17 (37.7%) cases. Cytomegalovirus caused colonic lesions in 35.7% of the cases. Candidiasis was observed in 26.6% mainly in the mouth and herpes simplex (8.8%) was the important agent of esophageal lesions. Oral hairy leukoplasia associated with HPV was found in 16 (35.5%) cases. Neoplasia was diagnosed in 7 (15.5%) cases: four Kaposi's sarcoma, two anal intramucosal carcinomas and one gastric lymphoma. Our data confirm the high frequency and variety of GI tract alterations in AIDS.

Keywords: Acquired immunodeficiency syndrome. Opportunistic infections. Digestive tract. Necropsy.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 06/01/94.

Departamento de Patologia, Faculdade de Medicina da Universidade Estadual Paulista (UNESP) Botucatu, SP.

• 1. Anderson M. Gastroenterological aspects of AIDS in the Third World. Bailliere's Clinical Gastroenterology 4:375-383, 1990.
• 2. Barone JE, Wolkomir AF, Muakkassa FF, Fares II LG. Abdominal pain and anorectal disease in AIDS. Gastroenterology Clinics of North America 17:631 - 638, 1988.
• 3. Baskerville A, Ramsay A, Cranage MP, Cook N, Cook RW, Dennis MJ, Greenaway PJ, Kitchin PA, Stott EJ. Histopathological changes in simian immunodeficiency virus infection. Journal of Pathology 162:67-75, 1990.
• 4. Brandão-Mello CE, Basílio-de-Oliveira CA, Fialho E, Bonecker CWC, Gonzaga AL, Pontes EL, Salomão AR. Acometimento gastrointestinal pelo citomegalovírus na síndrome de imunodeficiência adquirida. Arquivos Brasileiros de Medicina 63:9- 16, 1989.
• 5. Cello JP. AIDS and the Gastroenterologist. Scandinavian Joumalof Gastroenterology 25(suppl. 175):146-158, 1990.
• 6. Centers for disease control and prevention. Revised classification system forHIY infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Journal American Medical Association 269:729, 1993.
• 7. Cummins AG, La Brooy JT, Stanley DP, Rowland R, Shearman D JC. Quantitative histological study of enteropathy associated with HIV infection. GUT 31:317-321, 1990.
• 8. Dworkin B, Wormser GP, Rosenthal WS, Heier SK, Braunstein M, Weiss L, Jankowski R, Levy D, WeiselbergS. Gastrointestinal manifestations of the acquired immunodeficiency syndrome: A review of 20 cases. The American Journal of Gastroenterology 80:774-778, 1985.
• 9. Elia C, Oliveira AV, Madi K. Biopsia jejunal em SIDA. Arquivos de Gastroenterologia 26:100-104, 1989.
• 10. Fantini J, Yahi N, Baghdiguian S, Chermann JC. Human colon epithelial cells productively infected with human immunodeficiency virus show impaired differentiation and altered secretion. Journal of Virology 66:580-585, 1992.
• 11. Fauci AS, Macher AM, Longo DL, Lane H C, Rook AH, Masur H, Gelmann EP. Acquired immunodeficiency syndrome: epidemiologic, clinical, immunologic, and therapeutic considerations. Annals oflntemalMedicine 100:92- 106, 1984.
• 12. Fialho F, Basüio-de-Oliveira CA. O aparelho digestivo na síndrome de imunodeficiência adquirida. Considerações anatomopatológicas. Anais da Academia Nacional de Medicina 152:136-144,1992.
• 13. Gazzard B. AIDS: an overview. Bailliere's Clinical Gastroenterology 4:259-289, 1990.
• 14. Heisse C, Dandekar S, Kumar P, Duplantier R, Donovan RM, Kalsted CH. Human immunodeficiency virus infection of enterocytes and monocuclear cells in human jejunal mucosa. Gastroenterology 100:1521-1527, 1991.
• 15. HeisseC, VogelP, MillerCJ, HalstedCH, Dandekar S. Simian immunodeficiency virus infection of the gastrointestinal tract of rhesus macaques: functional, pathological and morphological changes. American Journal of Pathology 142:1759-1771, 1983.
• 16. JanoffEN, SmithPD. Perspectivesongastrointestinal infections in AIDS. Gastroenterology Clinics of North America 17:451-463, 1988.
• 17. Jautzke G, Sell M, Thalmann U, Janitschke K, Gottschalk J, Shürmann D, Ruf B. Extracerebral toxoplasmosis in AIDS: histological immunohistological findings based on 80 autopsy cases. Pathology Research and Practice 189:428- 436, 1993.
• 18. Lim SG, Condez A, Poulter LW. Mucosal macrophage subsets of the gut in HIV: decrease in antigen-presenting cell phenotype. Clinical and Experimental Immunology 92:442-447, 1993.
• 19. Macho JR. Gastrointestinal surgery in the AIDS patient. Gastroenterology Clinics of North America 17:563-571, 1988.
• 20. McLoughlin LC, Nord KS, Joshi VV, Oleske JM, Connor EM. Severe gastrointestinal involvement in children with the acquired immunodeficiency syndrome. Journal of Pediatric Gastroenterology and Nutrition 6:517-524, 1987.
• 21. Michiels JF, Hofman P, Saint Paul MC, Loubière R, Bernard E, Lefichoux Y. Pathological features of intestinal microsporidiosis in HIV positive patients: a report of 13 new cases. Pathology Research and Practive 189:377-383, 1993.
• 22. Nelson JA, Reynolds-Kohler C, Margaretten W, Wiley CA, Reese CE, Levy JA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. The Lancet 6:259-262, 1988.
• 23. Pavli P, Doe WF. The alimentary tract in disorders of the immune system. In: Whitehead R (ed). Gastrointestinal and Oesophageal Pathology. Churchill Livingstone, London p. 187-200, 1989.
• 24. René E, Verdon R, Aids Git Group: Upper gastrointestinal tract infections in AIDS. Bailliere's Clinical Gastroenterology 4:339-359, 1990.
• 25. Rodgers VD, Kagnoff MF. Gastrointestinal manifestations of the acquired immunodeficiency syndrome. The Western Journal ofMedicine 146:57- 67, 1987.
• 26. Stamm B, Grant JW. Biopsy pathology of the gastrointestinal tract in human immudeficiency virus- associated disease: a 5 year experience in Zurich. Histopathology 13:531-540, 1988.
• 27. Ullrich R, Zeitz M, Heise W, L'age M, Höffken G, Riecken EO. Small intestinal structure and function in patients infected with human immunodeficiency virus (HIV): evidence for HIV induced enteropathy. Annals of Internal Medicine 111:15-21, 1989.
• 28. Velludo MASL, Brunaldi MO, Romanello LMF. Infecções oportunistas do trato digestivo em pacientes com síndrome da imunodeficiência adquirida. Medicina 25:166-179,1992.

Endereço para correspondência:

Dra. Maria Aparecida M. Rodrigues.

Depto. de Patologia/FM/UNESP

Distrito de Rubião Junior s/n

18618-000

Botucatu, SP.

Datas de Publicação

• Publicação nesta coleção
  12 Abr 2013
• Data do Fascículo
  Set 1994

Histórico

• Aceito
  06 Jan 1994
• Recebido
  06 Jan 1994