Limits...
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

Toxoplasmosis—Microglial nodules (a, b) and “dirty” coagulative necrosis (c) containing a necrotic vessel with the features of endarteritis obliterans and thrombosis. H&E.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3140201&req=5

fig10: Toxoplasmosis—Microglial nodules (a, b) and “dirty” coagulative necrosis (c) containing a necrotic vessel with the features of endarteritis obliterans and thrombosis. H&E.

Mentions: There is much heterogeneity of CNS toxoplasma lesions, with overlapping patterns and sometimes temporal heterogeneity. The basic process is cell infection and associated inflammation, forming microglial nodules with surrounding astrocytosis. Necrosis of infected cells and surrounding tissues is usual, leading to expansion of the necrotic foci into the mass lesions that are usually seen. The necrosis is typically coagulative and “dirty”, with abundant fragments of nuclear debris (some of which are actually toxoplasma tachyzoites). Around the necrosis there are mononuclear and polymorphonuclear inflammatory cells, newly formed capillaries, edema, reactive astrocytes, and microglia. Vessels are surrounded or infiltrated by lymphocytes and macrophages with the appearances of a vasculitis, occasionally with fibrinoid necrosis, intimal proliferation, and thrombosis, with the features of endarteritis obliterans. Affected vessel may rupture, causing perivascular or larger haemorrhage (Figure 10).


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

Chimelli L - Patholog Res Int (2011)

Toxoplasmosis—Microglial nodules (a, b) and “dirty” coagulative necrosis (c) containing a necrotic vessel with the features of endarteritis obliterans and thrombosis. H&E.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig10: Toxoplasmosis—Microglial nodules (a, b) and “dirty” coagulative necrosis (c) containing a necrotic vessel with the features of endarteritis obliterans and thrombosis. H&E.
Mentions: There is much heterogeneity of CNS toxoplasma lesions, with overlapping patterns and sometimes temporal heterogeneity. The basic process is cell infection and associated inflammation, forming microglial nodules with surrounding astrocytosis. Necrosis of infected cells and surrounding tissues is usual, leading to expansion of the necrotic foci into the mass lesions that are usually seen. The necrosis is typically coagulative and “dirty”, with abundant fragments of nuclear debris (some of which are actually toxoplasma tachyzoites). Around the necrosis there are mononuclear and polymorphonuclear inflammatory cells, newly formed capillaries, edema, reactive astrocytes, and microglia. Vessels are surrounded or infiltrated by lymphocytes and macrophages with the appearances of a vasculitis, occasionally with fibrinoid necrosis, intimal proliferation, and thrombosis, with the features of endarteritis obliterans. Affected vessel may rupture, causing perivascular or larger haemorrhage (Figure 10).

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