Ohtomo K, Wang S, Masunaga A, Sugawara I
Department of Molecular Pathology, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose.
Tohoku J Exp Med. 2000 Oct;192(2):99-109. doi: 10.1620/tjem.192.99.
In order to study the frequency of secondary infections of AIDS autopsy cases in Japan, especially the frequency of Mycobacterium aviumintracellulare complex (MAC) infection, retrospective autopsy study was conducted between 1986 and 1997 at the affiliated hospital of Institute of Medical Sciences, University of Tokyo. Secondary infections of various organs from 43 AIDS autopsy cases were examined using histopathology, genetic diagnosis of tuberculosis, Ziehl-Neelsen stain for acid-fast bacilli and immunohistochemistry. Nontuberculous mycobacterial infection (Mycobacterium avium) was observed in 17 cases (40%) out of 43 using polymerase chain reaction (PCR), but M. tuberculosis infection was not observed. Ziehl-Neelsen staining showed a positive reaction in lung and spleen tissues of 7 AIDS autopsy cases. Immunohistochemistry using anti-BCG antibody revealed positivity in 7 AIDS autopsy cases. CD4 counts of 17 AIDS patients with mycobacterial infection were less than 18.7/microl. Other opportunistic infections were also examined by histopathology. Secondary infections were present in every case, and these included cytomegalovirus infection (32 cases), Pneumocystis carinii (15 cases), Candida (16 cases), Aspergillus (12 cases), Cryptococcus (6 cases), Toxoplasma (6 cases), methicillin-resistant Staphylococcus aureus (3 cases), herpes virus (1 case) and Entamoeba histolytica (1 case). Malignant lymphoma was recognized in 14 cases and Kaposi's sarcoma in 6. This is the systemic report on secondary infections of AIDS autopsy cases in Japan. In diagnosis of mycobacterial infections, PCR was more useful than staining for acid-fast bacilli and immunohistochemistry. Secondary infections (especially mycobacterial infection) were closely associated with the low CD4 count.
为研究日本艾滋病尸检病例继发感染的频率，尤其是鸟分枝杆菌胞内复合群（MAC）感染的频率，1986年至1997年在东京大学医学科学研究所附属医院进行了回顾性尸检研究。对43例艾滋病尸检病例的各个器官的继发感染进行了组织病理学检查、结核的基因诊断、抗酸杆菌的萋-尼染色及免疫组织化学检查。在43例中，通过聚合酶链反应（PCR）在17例（40%）中观察到非结核分枝杆菌感染（鸟分枝杆菌），但未观察到结核分枝杆菌感染。萋-尼染色显示7例艾滋病尸检病例的肺和脾组织呈阳性反应。使用抗卡介苗抗体的免疫组织化学显示7例艾滋病尸检病例呈阳性。17例有分枝杆菌感染的艾滋病患者的CD4计数低于18.7/微升。还通过组织病理学检查了其他机会性感染。每例均存在继发感染，包括巨细胞病毒感染（32例）、卡氏肺孢子虫（15例）、念珠菌（16例）、曲霉菌（12例）、隐球菌（6例）、弓形虫（6例）、耐甲氧西林金黄色葡萄球菌（3例）、疱疹病毒（1例）和溶组织内阿米巴（1例）。14例确诊为恶性淋巴瘤，6例为卡波西肉瘤。这是关于日本艾滋病尸检病例继发感染的系统性报告。在分枝杆菌感染的诊断中，PCR比抗酸杆菌染色和免疫组织化学更有用。继发感染（尤其是分枝杆菌感染）与低CD4计数密切相关。
