Neuropathology of AIDS: An Autopsy Review of 284 Cases from Brazil Comparing the Findings Pre- and Post-HAART (Highly Active Antiretroviral Therapy) and Pre- and Postmortem Correlation

Silva, Ana Cristina Araújo Lemos; Rodrigues, Blenda Sousa Carli; Micheletti, Adilha Misson Rua; Tostes, Sebastião; Meneses, Antonio Carlos Oliveira; Silva‐Vergara, Mario León; Adad, Sheila Jorge

doi:10.1155/2012/186850

Cited by 28 publications

(33 citation statements)

References 30 publications

(100 reference statements)

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“…The prevalence of this mycosis associated to AIDS in necropsy reports from teaching hospitals around the world during the last years showed rates ranging from 3.8% to 22.8% (Table 3). [13][14][15][16][17][18][19]28,[35][36][37][38][39] In fact, according to recent reports, the progressive decrease in postmortem examination in many teaching hospitals is worrying. 19,40,41 Several factors would account, for example, economic factors, lack of professional training, loss of academic interest, difficulties to obtain familiar consent, new paradigms in medical education, and better legislation about this matter.…”

Section: Discussionmentioning

confidence: 99%

“…6,15 Some reports have shown discrepancies between clinical and postmortem cryptococcosis diagnosis whereas others have pointed out some concerns with the decreasing rate of postmortem examination in teaching hospitals around the world. 13,[16][17][18] The aim of this study is to present clinical and epidemiological data of AIDS patients with cryptococcosis diagnosed and/ or confirmed at necropsy in a teaching hospital in Brazil.…”

Section: Introductionmentioning

confidence: 99%

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Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Torres

Etchebehere

Adad

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Torres

Etchebehere

Adad

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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“…Whether AIDS patients per se are at higher risk of primary acquired ocular toxoplasmosis is not clearly documented. Before the introduction of highly active antiretroviral treatment, and even today without adequate treatment, toxoplasmic encephalitis remains an initial AIDS-defining illness in up to 33% of all patients [53]. It remains an important cause of neurological disorders, leading to severe pathology including lethal consequence [54].…”

Section: Other Factorsmentioning

confidence: 99%

Ocular Toxoplasmosis: Recent Aspects of Pathophysiology and Clinical Implications

Pleyer

Schlüter

Mänz³

2014

Ophthalmic Res

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Toxoplasma gondii is an extremely successful opportunistic parasite which infects approximately one third of the human population worldwide. The impact of this parasite on human health becomes particularly manifest in congenital damage with infection and subsequent inflammation of neuronal tissues including the retina. Although advances in our understanding could be achieved in ocular toxoplasmosis, large gaps still exist on factors influencing the epidemiology and pathophysiology of this potentially blinding disease. We are only at the beginning of understanding the complex biology of this parasite and its mechanisms of invasion, virulence and interaction with the host's immune response. Since it is a preventable cause of blindness, it is necessary to assess factors that have the potential to control this disease in the future. This mini review will focus on recent advances in postnatal acquired ocular infection and the factors that may influence its prevalence and functional outcome.

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“…However, as we have previously reported, the viral population in the CSF in simian immunodeficiency virus (SIV)-infected macaques does not always reflect the viral populations in the brain parenchyma, presumably the site of direct neuropathology (11,12). In addition, analysis of the human brain is restricted to postmortem samples and thus only gives cross-sectional information at the terminal stages of infection, which is not informative in addressing events in the acute or chronic phase of infection (13). Although brain biopsy samples are feasible, they are difficult to justify on asymptomatic infected individuals due to the risk of unintended complications.…”

mentioning

confidence: 98%

Characterization of Simian Immunodeficiency Virus (SIV) That Induces SIV Encephalitis in Rhesus Macaques with High Frequency: Role of TRIM5 and Major Histocompatibility Complex Genotypes and Early Entry to the Brain

Matsuda

Dang

Brown³

et al. 2014

J Virol

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Although nonhuman primate models of neuro-AIDS have made tremendous contributions to our understanding of disease progression in the central nervous system (CNS) of human immunodeficiency virus type 1 (HIV-1)-infected individuals, each model holds advantages and limitations. In this study, in vivo passage of SIVsmE543 was conducted to obtain a viral isolate that can induce neuropathology in rhesus macaques. After a series of four in vivo passages in rhesus macaques, we have successfully isolated SIVsm804E. SIVsm804E shows efficient replication in peripheral blood mononuclear cells (PBMCs) and monocyte-derived macrophages (MDMs) in vitro and induces neuro-AIDS in high frequencies in vivo. Analysis of the acute phase of infection revealed that SIVsm804E establishes infection in the CNS during the early phase of the infection, which was not observed in the animals infected with the parental SIVsmE543-3. Comprehensive analysis of disease progression in the animals used in the study suggested that host major histocompatibility complex class I (MHC-I) and TRIM5␣ genotypes influence the disease progression in the CNS. Taken together, our findings show that we have successfully isolated a new strain of simian immunodeficiency virus (SIV) that is capable of establishing infection in the CNS at early stage of infection and causes neuropathology in infected rhesus macaques at a high frequency (83%) using a single inoculum, when animals with restrictive MHC-I or TRIM5␣ genotypes are excluded. SIVsm804E has the potential to augment some of the limitations of existing nonhuman primate neuro-AIDS models. IMPORTANCE Human immunodeficiency virus (HIV) is associated with a high frequency of neurologic complications due to infection of the central nervous system (CNS). Although the use of antiviral treatment has reduced the incidence of severe complications, milder disease of the CNS continues to be a significant problem. Animal models to study development of neurologic disease are needed. This article describes the development of a novel virus isolate that induces neurologic disease in a high proportion of rhesus macaques infected without the need for prior immunomodulation as is required for some other models.

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Neuropathology of AIDS: An Autopsy Review of 284 Cases from Brazil Comparing the Findings Pre- and Post-HAART (Highly Active Antiretroviral Therapy) and Pre- and Postmortem Correlation

Cited by 28 publications

References 30 publications

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Ocular Toxoplasmosis: Recent Aspects of Pathophysiology and Clinical Implications

Characterization of Simian Immunodeficiency Virus (SIV) That Induces SIV Encephalitis in Rhesus Macaques with High Frequency: Role of TRIM5 and Major Histocompatibility Complex Genotypes and Early Entry to the Brain

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