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A morphological approach to the diagnosis of protozoal infections of the central nervous system.

Chimelli L - Patholog Res Int (2011)

Bottom Line: In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments.Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease).The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University Hospital, Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil.

ABSTRACT
Protozoal infections, though endemic to certain regions, can be seen all around the world, because of the increase in travel and migration. In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments. The CNS may be the only affected system; when not, it is often the most severely affected. Despite information obtained from clinical, laboratory, and imaging procedures that help to narrow the differential diagnosis of intracranial infections, there are cases that need confirmation with biopsy or autopsy. Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease). The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis. In this paper, a morphological approach for the diagnosis of protozoal infections affecting the CNS (amoebiasis, cerebral malaria, toxoplasmosis, trypanosomiasis, and microsporidiosis) is presented.

No MeSH data available.


Related in: MedlinePlus

Entamoeba histolytica trophozoites are spherical or oval, with granular, sometimes vacuolated cytoplasm and a round single nucleus. The amoebae are PAS positive (arrows).
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fig1: Entamoeba histolytica trophozoites are spherical or oval, with granular, sometimes vacuolated cytoplasm and a round single nucleus. The amoebae are PAS positive (arrows).

Mentions: Cerebral amebic abscesses have an inner zone of necrotic tissue and a broad outer zone with prominent congestion and vascular proliferation. A reactive gliosis and an infiltrate of lymphocytes, plasma cells, macrophages, and some neutrophils are seen in the surrounding brain. Trophozoites can usually be identified in the abscess wall, around vessels, in the necrosis, and at the advancing edge of the lesion. In certain occasions, it may be difficult to distinguish E. histolytica trophozoites within this tissue from macrophages. The trophozoites are spherical or oval, 10–60 μm in diameter, with granular eosinophilic, sometimes vacuolated cytoplasm, a round single nucleus with a small central karyosome and peripheral chromatin. Many have phagocytosed erythrocytes and occasionally pseudopodia can be seen. The amoebae are PAS positive, since the cytoplasm contains glycogen (Figure 1). Specific antisera can also be used to identify them by immunocytochemistry [2, 16].


A morphological approach to the diagnosis of protozoal infections of the central nervous system.

Chimelli L - Patholog Res Int (2011)

Entamoeba histolytica trophozoites are spherical or oval, with granular, sometimes vacuolated cytoplasm and a round single nucleus. The amoebae are PAS positive (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3140201&req=5

fig1: Entamoeba histolytica trophozoites are spherical or oval, with granular, sometimes vacuolated cytoplasm and a round single nucleus. The amoebae are PAS positive (arrows).
Mentions: Cerebral amebic abscesses have an inner zone of necrotic tissue and a broad outer zone with prominent congestion and vascular proliferation. A reactive gliosis and an infiltrate of lymphocytes, plasma cells, macrophages, and some neutrophils are seen in the surrounding brain. Trophozoites can usually be identified in the abscess wall, around vessels, in the necrosis, and at the advancing edge of the lesion. In certain occasions, it may be difficult to distinguish E. histolytica trophozoites within this tissue from macrophages. The trophozoites are spherical or oval, 10–60 μm in diameter, with granular eosinophilic, sometimes vacuolated cytoplasm, a round single nucleus with a small central karyosome and peripheral chromatin. Many have phagocytosed erythrocytes and occasionally pseudopodia can be seen. The amoebae are PAS positive, since the cytoplasm contains glycogen (Figure 1). Specific antisera can also be used to identify them by immunocytochemistry [2, 16].

Bottom Line: In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments.Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease).The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University Hospital, Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil.

ABSTRACT
Protozoal infections, though endemic to certain regions, can be seen all around the world, because of the increase in travel and migration. In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments. The CNS may be the only affected system; when not, it is often the most severely affected. Despite information obtained from clinical, laboratory, and imaging procedures that help to narrow the differential diagnosis of intracranial infections, there are cases that need confirmation with biopsy or autopsy. Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease). The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis. In this paper, a morphological approach for the diagnosis of protozoal infections affecting the CNS (amoebiasis, cerebral malaria, toxoplasmosis, trypanosomiasis, and microsporidiosis) is presented.

No MeSH data available.


Related in: MedlinePlus