Falangola M F, Reichler B S, Petito C K
Department of Pathology, University of Miami School of Medicine, FL 33136.
Hum Pathol. 1994 Oct;25(10):1091-7. doi: 10.1016/0046-8177(94)90070-1.
We reviewed the histological features of untreated toxoplasmosis in 18 cases with the acquired immunodeficiency syndrome (AIDS), eight of which were surgical biopsies and 10 of which were autopsy specimens. The results were compared according to the clinical status of the patient at the time the diagnosis of toxoplasmosis was made (early-onset v late-onset AIDS) and according to the source of the specimen (surgical biopsy specimen v autopsy specimen). Cerebral toxoplasmosis was the AIDS-defining illness in half of the cases (six surgical biopsy specimens and three autopsy specimens). Inflammation in these cases was moderate in 44% and severe in 56%. Fibrous capsules were found in five cases. Lymphocytes and plasma cells were more prominent than neutrophils. Cerebral toxoplasmosis developed in or was part of the terminal AIDS illness in the remaining nine cases (two surgical biopsy specimens and seven autopsy specimens). In this group inflammation was sparse in 44%, moderate in 55%, and severe in only 11%. Fibrous capsules were usually absent and neutrophils were the predominant cell type. Comparisons between surgical biopsy specimens and autopsy specimens showed moderate to severe inflammation and frequent fibrous encapsulation in all of the former specimens but only in those autopsy specimens in which toxoplasmosis was the initial manifestation of AIDS. Thus, this study demonstrates varied neuropathological patterns of untreated cerebral toxoplasmosis in patients with AIDS and correlates the inflammatory response in the brain with the clinical stage of the patient's human immunodeficiency syndrome (HIV) infection. Inflammation and fibrous encapsulation were common only in patients with early-onset AIDS in whom cerebral toxoplasmosis was the first manifestation of the illness. This study highlights important differences between the histology of this infection at surgical biopsy and at autopsy, and stresses the need to consider toxoplasma as a potential cause of encapsulated brain abscesses.
我们回顾了18例获得性免疫缺陷综合征（AIDS）患者未经治疗的弓形虫病的组织学特征，其中8例为手术活检病例，10例为尸检标本。根据弓形虫病诊断时患者的临床状况（早发型艾滋病与晚发型艾滋病）以及标本来源（手术活检标本与尸检标本）对结果进行了比较。在半数病例（6例手术活检标本和3例尸检标本）中，脑弓形虫病是艾滋病的定义性疾病。这些病例中44%炎症为中度，56%为重度。5例发现有纤维包膜。淋巴细胞和浆细胞比中性粒细胞更显著。其余9例（2例手术活检标本和7例尸检标本）中，脑弓形虫病发生在终末期艾滋病疾病中或为其一部分。该组中44%炎症稀疏，55%为中度，仅11%为重度。通常没有纤维包膜，中性粒细胞是主要细胞类型。手术活检标本与尸检标本的比较显示，所有前者标本均有中度至重度炎症且常有纤维包裹，但仅在那些弓形虫病为艾滋病初始表现的尸检标本中如此。因此，本研究证明了艾滋病患者未经治疗的脑弓形虫病有多种神经病理学模式，并将脑部的炎症反应与患者人类免疫缺陷病毒（HIV）感染的临床阶段相关联。炎症和纤维包裹仅在早发型艾滋病患者中常见，其中脑弓形虫病是疾病的首发表现。本研究突出了该感染在手术活检和尸检组织学上的重要差异，并强调需要将弓形虫视为包膜性脑脓肿的潜在病因。
