Integrated Course

Microbiology & Pathology

Patologie

HIV & oportunních

infekcí

Jaroslava Dušková

Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

Neuroimmunoendokrinní

regulace

Nadledviny

Imunitní buňky

TNF

IL-6

IL-1

Glukokortikoidy

CRF

ACT

H

IL-1 neuronální

synapse

n.vagus

+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 AIDSOportunní 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

methenamine silver (sputum)

Cryptococcosis

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.

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

Herpesihch

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.