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The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India.

Lanjewar DN - Patholog Res Int (2011)

Bottom Line: The HIV epidemic in the Asian subcontinent has a significant impact on India.There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries.Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

View Article: PubMed Central - PubMed

Affiliation: Sir J. J. Hospital and Grant Medical College, Byculla, Mumbai, Maharashtra 400008, India.

ABSTRACT
The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

No MeSH data available.


Related in: MedlinePlus

Coronal section of cerebrum shows well circumscribed areas of necrosis surrounded in thalamus.
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fig4: Coronal section of cerebrum shows well circumscribed areas of necrosis surrounded in thalamus.

Mentions: Bacterial pneumonia was the prime cause of death in 33 (14%) cases (lobar pneumonia; 13 cases and bronchial pneumonia: 20 cases). Clinically patients with bacterial pneumonia presented with breathlessness, fever, and weight loss. Histology of lungs in these patients showed Gram positive cocci (staphylococci and streptococci or both) in 27, Gram negative bacilli in 3, mixed Gram positive cocci, and Gram negative bacilli in 3, none were cultured. Minor lesions of bronchopneumonia were noted in additional 15 cases. Cryptococcosis was found in 18 (8%) patients and was the cause of death in all the cases. In 17 cases, cryptococcal meningoencephalitis was associated with wide spread visceral organ involvement while 1 case showed isolated cryptococcal meningitis. Cerebral toxoplasmosis was the fourth most common cause of death and was noted in 15 out of 223 (7%) cases. All cases with CNS toxoplasmosis were in the age range of 23 to 35 years. The ante mortem signs and symptoms of these cases included convulsions (10 cases), abnormal behavior (5 cases), and inability to walk (5 cases), drowsiness (4 cases) and slurred speech (2 cases). The clinical diagnosis offered in cases with CNS toxoplasmosis was TB meningitis (6 cases), tuberculoma brain (6 cases), pulmonary TB with HIV-infection (1 case), cerebrovascular accident with HIV infection (1 case), and HIV encephalopathy (1 case). None of the cases with CNS toxoplasmosis were suspected clinically. All the patients with CNS toxoplasmosis received antituberculous drugs; there was no improvement in clinical signs and symptoms and subsequently all the patients succumbed to death. Morphology of brain in these cases showed circumscribed necrotic lesions in the white matter, gray matter, basal nuclei, brain stem, and cerebellum (Figure 4). The microscopic examination of the brain showed features of diffuse cerebritis and areas of ischemic necrosis. The necrotic areas showed sparse inflammation and presence of pseudocyst, true cyst, and free forms of toxoplasma gondii. The blood vessels showed vasculitis with or without thrombi and few vessels showed changes of hypertrophic occlusive arteritis. Other opportunistic infections were not identified in these brains. 2/15 cases of cerebral toxoplasmosis showed cardiac toxoplasmosis (Figure 5).


The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India.

Lanjewar DN - Patholog Res Int (2011)

Coronal section of cerebrum shows well circumscribed areas of necrosis surrounded in thalamus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108477&req=5

fig4: Coronal section of cerebrum shows well circumscribed areas of necrosis surrounded in thalamus.
Mentions: Bacterial pneumonia was the prime cause of death in 33 (14%) cases (lobar pneumonia; 13 cases and bronchial pneumonia: 20 cases). Clinically patients with bacterial pneumonia presented with breathlessness, fever, and weight loss. Histology of lungs in these patients showed Gram positive cocci (staphylococci and streptococci or both) in 27, Gram negative bacilli in 3, mixed Gram positive cocci, and Gram negative bacilli in 3, none were cultured. Minor lesions of bronchopneumonia were noted in additional 15 cases. Cryptococcosis was found in 18 (8%) patients and was the cause of death in all the cases. In 17 cases, cryptococcal meningoencephalitis was associated with wide spread visceral organ involvement while 1 case showed isolated cryptococcal meningitis. Cerebral toxoplasmosis was the fourth most common cause of death and was noted in 15 out of 223 (7%) cases. All cases with CNS toxoplasmosis were in the age range of 23 to 35 years. The ante mortem signs and symptoms of these cases included convulsions (10 cases), abnormal behavior (5 cases), and inability to walk (5 cases), drowsiness (4 cases) and slurred speech (2 cases). The clinical diagnosis offered in cases with CNS toxoplasmosis was TB meningitis (6 cases), tuberculoma brain (6 cases), pulmonary TB with HIV-infection (1 case), cerebrovascular accident with HIV infection (1 case), and HIV encephalopathy (1 case). None of the cases with CNS toxoplasmosis were suspected clinically. All the patients with CNS toxoplasmosis received antituberculous drugs; there was no improvement in clinical signs and symptoms and subsequently all the patients succumbed to death. Morphology of brain in these cases showed circumscribed necrotic lesions in the white matter, gray matter, basal nuclei, brain stem, and cerebellum (Figure 4). The microscopic examination of the brain showed features of diffuse cerebritis and areas of ischemic necrosis. The necrotic areas showed sparse inflammation and presence of pseudocyst, true cyst, and free forms of toxoplasma gondii. The blood vessels showed vasculitis with or without thrombi and few vessels showed changes of hypertrophic occlusive arteritis. Other opportunistic infections were not identified in these brains. 2/15 cases of cerebral toxoplasmosis showed cardiac toxoplasmosis (Figure 5).

Bottom Line: The HIV epidemic in the Asian subcontinent has a significant impact on India.There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries.Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

View Article: PubMed Central - PubMed

Affiliation: Sir J. J. Hospital and Grant Medical College, Byculla, Mumbai, Maharashtra 400008, India.

ABSTRACT
The HIV epidemic in the Asian subcontinent has a significant impact on India. The AIDS associated pathology has not been well evaluated in a representative study hence very little is known about the spectrum of HIV/AIDS associated diseases in Indian subcontinent. To determine the important postmortem findings in HIV infected individuals in Mumbai, autopsy study was carried out. The patient population included patients with AIDS who died at the tertiary care hospital over a 20 year period from 1988 to 2007. A total of 236 (182; 77% males and 54; 23%) females) patients with AIDS were autopsied. The main risk factor for HIV transmission was heterosexual contact (226 patients; 96%) and 223/236 (94%) patients died of HIV-related diseases. Tuberculosis was the prime cause of death in 149 (63%) patients, followed by bacterial pneumonia 33 (14%), cryptococcosis 18 (8%), toxoplasmosis of brain 15 (6%), pneumocystis jiroveci (PCJ) 1 (0.5%) and Non-Hodgkin's lymphoma 7 (3%) cases. The major underlying pathologies are either preventable or treatable conditions. There is an urgent need for attention towards the diagnosis, issue of therapy, and care of HIV disease in developing countries. Reducing mortality in patients with AIDS from infections must be highest public health policy in India.

No MeSH data available.


Related in: MedlinePlus