Burns D K, Risser R C, White C L
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235-9072.
Arch Pathol Lab Med. 1991 Nov;115(11):1112-24.
Postmortem neuropathologic changes were evaluated in 141 consecutive patients dying with human immunodeficiency virus infection at publicly supported hospitals affiliated with the University of Texas Southwestern Medical Center in Dallas, between August 1984 and September 1990. Morphologic abnormalities were identified in 112 cases (79%). Cytomegalovirus was the most common opportunistic infection encountered, with characteristic viral inclusions identified in 23 patients, and presumptive evidence of infection in six additional patients. Progressive multifocal leukoencephalopathy was present in four patients. Gram-positive bacterial infections were identified in six patients, and mycobacterial infections in three patients. Opportunistic fungal infections included cryptococcosis (13 cases), histoplasmosis (two cases), and coccidioidomycosis (one case). Toxoplasmosis was uncommon, with active or quiescent lesions identified in five patients. Lymphoma was present in nine patients and was primary in the central nervous system in five patients. Multinucleate giant cell (human immunodeficiency virus) encephalitis was identified in 28 patients. In an additional 26 patients, microglial nodules and/or more generalized white-matter abnormalities were encountered in the absence of multinucleate giant cells, cytomegalovirus inclusions, or systemic cytomegalovirus infection. Vacuolar change was present in 21% of spinal cords, and was highly correlated with cytomegalovirus infection in the nervous system. Mixed infections and/or neoplasms were identified in 24 patients. This survey documents a high frequency of neuropathologic abnormalities in human immunodeficiency virus-infected individuals in a geographical region of the United States not represented in previous series. Variations noted in the frequencies of specific central nervous system disorders between this and other study populations reinforce the need for continuing documentation of geographical trends in human immunodeficiency virus-associated disorders.
1984年8月至1990年9月期间，对达拉斯德克萨斯大学西南医学中心附属的公立支持医院中141例连续死于人类免疫缺陷病毒感染的患者进行了尸检神经病理学变化评估。112例（79%）发现形态学异常。巨细胞病毒是最常见的机会性感染，23例患者发现特征性病毒包涵体，另有6例患者有感染的推定证据。4例患者出现进行性多灶性白质脑病。6例患者发现革兰氏阳性细菌感染，3例患者发现分枝杆菌感染。机会性真菌感染包括隐球菌病（13例）、组织胞浆菌病（2例）和球孢子菌病（1例）。弓形虫病不常见，5例患者发现活动性或静止性病变。9例患者存在淋巴瘤，5例患者为原发性中枢神经系统淋巴瘤。28例患者发现多核巨细胞（人类免疫缺陷病毒）脑炎。另外26例患者在没有多核巨细胞、巨细胞病毒包涵体或全身性巨细胞病毒感染的情况下出现小胶质结节和/或更广泛的白质异常。21%的脊髓存在空泡样改变，且与神经系统巨细胞病毒感染高度相关。24例患者发现混合感染和/或肿瘤。这项调查记录了美国一个以前系列未涵盖的地理区域中人类免疫缺陷病毒感染个体神经病理学异常的高发生率。本研究人群与其他研究人群之间特定中枢神经系统疾病频率的差异强化了持续记录人类免疫缺陷病毒相关疾病地理趋势的必要性。
