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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

Acanthamoeba and Balamuthia spp have similar morphology. (a) Trophozoites have a pale granular cytoplasm (arrows), that stain well with Giemsa (b) Cysts have a double thicker cell wall (c), also shown in the insert (arrows).  (a) and (c), H&E; (b) and insert, Giemsa.
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fig4: Acanthamoeba and Balamuthia spp have similar morphology. (a) Trophozoites have a pale granular cytoplasm (arrows), that stain well with Giemsa (b) Cysts have a double thicker cell wall (c), also shown in the insert (arrows). (a) and (c), H&E; (b) and insert, Giemsa.

Mentions: The meninges and the parenchyma show foci of chronic granulomatous inflammation that tend to be angiocentric and may be necrotizing. The cell reaction is combined acute and chronic, but lymphocytes, macrophages, plasma cells, and foreign body and Langhans-type multinucleated giant cells predominate (Figures 3(b) and 3(c)). Acanthamoeba and Balamuthia species can encyst. Trophozoites and cysts may be clustered around inflamed vessels that may show fibrinoid necrosis, and also in areas relatively free of inflammation. The trophozoites are 14–40 μm in size that have a pale eosinophilic granular cytoplasm a prominent vesicular nucleus with a dense central nucleolus. Cysts slightly smaller have a double thicker cell wall. Cysts and trophozoites are well demonstrated with the Giemsa and PAS staining (Figure 4). The surrounding brain tissue is necrotic and shows marked astrocytosis and microgliosis. The morphology of the various amoebae that cause GAE is similar. The differentiation can be made by specific immunohistochemistry and molecular diagnostic methods [2, 16, 22].


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

Chimelli L - Patholog Res Int (2011)

Acanthamoeba and Balamuthia spp have similar morphology. (a) Trophozoites have a pale granular cytoplasm (arrows), that stain well with Giemsa (b) Cysts have a double thicker cell wall (c), also shown in the insert (arrows).  (a) and (c), H&E; (b) and insert, Giemsa.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Acanthamoeba and Balamuthia spp have similar morphology. (a) Trophozoites have a pale granular cytoplasm (arrows), that stain well with Giemsa (b) Cysts have a double thicker cell wall (c), also shown in the insert (arrows). (a) and (c), H&E; (b) and insert, Giemsa.
Mentions: The meninges and the parenchyma show foci of chronic granulomatous inflammation that tend to be angiocentric and may be necrotizing. The cell reaction is combined acute and chronic, but lymphocytes, macrophages, plasma cells, and foreign body and Langhans-type multinucleated giant cells predominate (Figures 3(b) and 3(c)). Acanthamoeba and Balamuthia species can encyst. Trophozoites and cysts may be clustered around inflamed vessels that may show fibrinoid necrosis, and also in areas relatively free of inflammation. The trophozoites are 14–40 μm in size that have a pale eosinophilic granular cytoplasm a prominent vesicular nucleus with a dense central nucleolus. Cysts slightly smaller have a double thicker cell wall. Cysts and trophozoites are well demonstrated with the Giemsa and PAS staining (Figure 4). The surrounding brain tissue is necrotic and shows marked astrocytosis and microgliosis. The morphology of the various amoebae that cause GAE is similar. The differentiation can be made by specific immunohistochemistry and molecular diagnostic methods [2, 16, 22].

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