Integrovaný blok

Mikrobiologie & Patologie & Infekce

Patologie

HIV & oportunních

infekcí

Jaroslava Dušková

Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

Jaroslava Duško

vá

Neuroimmunoendokrinní

regulace

Nadledviny

Imunitní buňky

TNF

IL-6

IL-1

Glukokortikoidy

CRF

ACT

H

IL-1 neuronální

synapse

n.vagus

+kortikoterapie !

Jaroslava Duško

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The reflex arc of axon reflex has neither an

integration center nor any synapse

Def.: a reflex resulting from

a stimulus applied to one

branch of a nerve, which

sets up an impulse that

moves

centrally to the point of

division of the nerve, where

it

is reflected down the other

branch to the effector organ

• Blood vessels, sweating

glands and mast cells are

most important effectors of

axon reflex in the skin

Mevlut YAPRAK: The axon reflex. Neuroanatomy (2008) 7: 17–19

Jaroslava Duško

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Procaccini C. et al.: Neuro-endocrine networks controlling immune system in health and disease.

Frontiers in Immunology , 2014, 5, 143,1-10

Neuroimmunoendocrine Regulations

Jaroslava Duško

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Patologie AIDS

Přímý efekt HIV

Oportunní infekce

Nádorové procesy Jaroslava Duško

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HIV-Related Lymphadenopathy – HIVRL

persistující generalizovana lymfadenopatie HIVRL trvání déle než tři měsíce

absence jiného důvodu pro lymfadenopatii

histologický průkaz folikulární hyperplázie

BIOPSIE

dif. dg.: HIV-Related Lymphadenopathy – HIVRL

infekce

lymfom

Kaposiho sarkom

Jaroslava Duško

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ARC Zvětšené zárodečné centrum

Jaroslava Duško

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ARC hypercelulární parafolikulární zóna

Jaroslava Duško

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sklerotizovanmý & kolabovaný lymfatický folikl

AIDS

Jaroslava Duško

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Angiofolikulární hyperplázie AIDS

Jaroslava Duško

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Neuropatologie AIDS

Přímý vliv HIV HIV encefalitis

leukoencefalopatie

vakuolární myelopatie

neuropatie

myopatie

vaskulitidy, AIDS-Dementia komplex, s HIV-asociovaná progresivní encefalopatie v dětství

Jaroslava Duško

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Brány vstupu do CNS

hematogenní (pyémie, sepse, virémie)

přímo

cestou plexus chorioideus

lokální zdroj

přímo (trauma)

roztavení kosti (sinusitis, otitis)

vv. emissariae

podél nervů (filla olfactoria)

Jaroslava Duško

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Jaroslava Duško

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HIV

encephalitis

Jaroslava Duško

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HIV encephalitis

Jaroslava Duško

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Patologie AIDSOportunní infekce

paraziti: toxoplasmosis

mykózy, mykobakterie, spirochety: Aspergillus, Candida, Cryptococcus

Mycobacterium avium intracellulare

Mycobacterium tuberculosis

Treponema pallidum

virové Cytomegalovirus

Herpes simplex

Herpes zoster

Polyoma PML

Jaroslava Duško

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Toxoplasmosis – lymphadenitis cervicalis profunda

Jaroslava Duško

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Jaroslava Duško

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Candidosis oesophagi

Jaroslava Duško

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Intertrigo

Jaroslava Duško

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Toxoplasmosis cerebri cysta

Jaroslava Duško

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Toxoplasmosis

Jaroslava Duško

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Toxoplasmosis stereotactic brain biopsy

Jaroslava Duško

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methenamine silver (sputum)

Cryptococcosis

polychrom (CSF)

Jaroslava Duško

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Cryptococcosis

PAS

Jaroslava Duško

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Jaroslava Duško

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Candidosis vaginae

Jaroslava Duško

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Jaroslava Duško

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Candidosis - sputum

Jaroslava Duško

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Candidosis – BAL polychrome // methenamine silver)

Jaroslava Duško

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Aspergilosis pulmonum

Jaroslava Duško

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TBC pulmonum cavernosa

Jaroslava Duško

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Aspergillosis sputum

fruiting head

polychrome

Jaroslava Duško

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Aspergilloma

Jaroslava Duško

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Aspergillosis BAL ( methenamine silver)

Jaroslava Duško

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Jaroslava Duško

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Mucor BAL (polychrome)

Jaroslava Duško

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Chinen K, Tokuda Y, Sakamoto A, Fujioka Y.:

Fungal infections of the heart:

a clinicopathologic study of 50 autopsy cases.

Pathol Res Pract. 2007;203(10):705-15.

cardiac fungal infection (CFI) incidence is increasing

a grim prognosis

an early diagnosis and aggressive therapy

among a total of 4396 autopsy cases 50 CFI patients (1.1%)

32 males and 18 females - mean age of 65.5 years

underlying diseases for CFI included solid malignant neoplasms (n=23), hematologic disorders (n=10), chronic renal diseases (n=7), liver diseases (n=5), diabetes mellitus (n=5), and other

none of the patients was diagnosed to have CFI antemortem!

most patients (n=45) demonstrated multi-organ fungal infections with myocardial involvement

causative pathogens were Candida (n=36), Aspergillus (n=9), Mucor (n=4), and Cryptococcus (n=1).

Jaroslava Duško

vá

Progressive Multifocal

Leucoencephalopathy

PME

luxol blue

Jaroslava Duško

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Cytomegalovirosis

Jaroslava Duško

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CMV

Jaroslava Duško

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Herpes anogenitalis

Jaroslava Duško

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Herpes

Jaroslava Duško

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Herpes labialis

Jaroslava Duško

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B8467/12

Gingivostomatitis herpetica,

obj. 4x

Jaroslava Duško

vá

B8467/12

Gingivostomatitis

herpetica,

obj. 20x

Jaroslava Duško

vá

Bendayan D, Litman K, Hendler A, Polansky V.: Liver tuberculosis

in an HIV patient: diagnosis and management.Indian J Tuberc. 2010 Jul;57(3):152-6.

Pulmonary and Tuberculosis Department, Shmuel Harofe Hospital, Beer Yaakov, Israel

Hepatic involvement is common in miliary and extra-pulmonary

tuberculosis but is usually clinically silent.

A patient that presented with prolonged fever and hepatomegaly.

Liver biopsy revealed non-necrotizing granulomas that led in turn to the

diagnosis of generalized tuberculosis and HIV infection.

Diagnosis of hepatic tuberculosis requires a high degree of suspicion

especially in AIDS patients who show atypical presentations.

Good results have been obtained with the four drug regimen.

Jaroslava Duško

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Mycobacterium avium intracellullare

Jaroslava Duško

vá

Pneumocystis jiroveci pneumonia

Jaroslava Duško

vá

„Snowball“ with

icicle effect

Pneumocystis

jiroveci

Jaroslava Duško

vá

Chinen K, Tokuda Y, Sakamoto A, Fujioka Y.:

Fungal infections of the heart:

a clinicopathologic study of 50 autopsy cases.

Pathol Res Pract. 2007;203(10):705-15.

cardiac fungal infection (CFI) incidence is increasing

a grim prognosis

an early diagnosis and aggressive therapy

among a total of 4396 autopsy cases 50 CFI patients (1.1%)

32 males and 18 females - mean age of 65.5 years

underlying diseases for CFI included solid malignant neoplasms (n=23), hematologic disorders (n=10), chronic renal diseases (n=7), liver diseases (n=5), diabetes mellitus (n=5), and other

none of the patients was diagnosed to have CFI antemortem!

most patients (n=45) demonstrated multi-organ fungal infections with myocardial involvement

causative pathogens were Candida (n=36), Aspergillus (n=9), Mucor (n=4), and Cryptococcus (n=1).

Jaroslava Duško

vá

Trichomoniasis

Jaroslava Duško

vá

Steven I. Hajdu, MD, FIAC

Memorial Sloan-Kettering

Cancer Center, USA

(dressed in three layers of

protective garbs to do an

AIDS autopsy)

Jaroslava Duško

vá

Nejběžnější maligní nádory

u pacientů s AIDS

Kaposihp sarkom HHV 8

Lymfom HHV 8, EBV

(extranodální DLBCL)

dlaždicový karcinom HPVJarosla

va Dušková

Kaposi´s sarcoma KSHV, HHV-8

Sarcoma idiopathicum multiplex haemorrhagicum Kaposi

Four

forms • Classic (not HIV ass), Ashkenazy Jews, old,

localized

• Endemic African KS , young and children,

LN and viscera spread, aggressive

• Transplantation ass. LN and viscera spread,

aggressive

• HIV infected LN and viscera spread, aggressiveJaroslava Duško

vá

Jaroslava Duško

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Sarcoma Kaposii

HHV-8

Jaroslava Duško

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Sarcoma Kaposii

Jaroslava Duško

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Kaposi sarcoma

Jaroslava Duško

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Kaposi sarcoma

Jaroslava Duško

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dr. Moritz Kaposi

• dr. Moritz Kohn narozen

v Kaposvaru Maďarsko1837

• pracoval u prof. Hebry 1865

• chodil s jeho dcerou Marthou

Hebra 1867

• změnil si jméno na Kaposi

1871

• změnil si náboženství 1872

• popsal sarcoma idiopathicum

multiplex haemorrhagicum 1872

• oženil se s Marthou Hebra 1872

• zemřel ve Vídni 1902

Jaroslava Duško

vá

nH ML (colon and mesenterium involved)

Jaroslava Duško

vá

Neuropatologie AIDS -

tumory

Primární mozkový lymfom

většinou B typ

často multicentrický

v některých prokázán EB virus

Kaposiho sarkom (HHV8)

výjimečně meta do CNS

Jaroslava Duško

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Primary cerebral B cell lymphoma

Jaroslava Duško

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Dobře diferencovaný spinocelulární karcinom u pacientky s AIDS

Jaroslava Duško

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SIL H

Jaroslava Duško

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F68, CLL biopsie imunokompromitovaného pacienta

Dva rychle rostoucí tumory pravé horní a

dolní končetiny

Excize: 33x18x22 mm a 23x14x14 mm

Jaroslava Duško

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Endoteliální proliferace s atypiemi

HE 4x

HE 40x

Jaroslava Duško

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Endoteliální markery pozitivní

CD 31

ERG 1

Jaroslava Duško

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ImunohistochemieKSHV (HH8) -

Ki-67 (MIB1) 10%

Jaroslava Duško

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Warthin Stary impregnation 40x

Jaroslava Duško

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Bioptická zpráva

Floridní cévní proliferace s argyrofilními

tyčkami

bacilární angiomatóza

Reaktivní proces vyvolaný

Bartonella sp.

PSEUDOTUMOUR !!!

Jaroslava Duško

vá