1/21. MRI in human immunodeficiency virus-associated cerebral vasculitis.Cerebral ischaemia caused by inflammatory vasculopathies has been described as complication of human immunodeficiency virus (HIV) infection. Imaging studies have shown ischaemic lesions and changes of the vascular lumen, but did not allow demonstration of abnormalities within the vessel wall itself. Two HIV-infected men presented with symptoms of a transient ischaemic attack. Initial MRI of the first showed no infarct; in the second two small lacunar lesions were detected. In both cases, multiplanar 3-mm slice contrast-enhanced T1-weighted images showed aneurysmal dilatation, with thickening and contrast enhancement of the wall of the internal carotid and middle cerebral (MCA) arteries. These findings were interpreted as indicating cerebral vasculitis. In the first patient the vasculopathy progressed to carotid artery occlusion, and he developed an infarct in the MCA territory, but then remained neurologically stable. In the second patient varicella zoster virus (VZV) infection was the probable cause of vasculitis. The clinical deficits and vasculitic MRI changes regressed with antiviral and immunosuppressive therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/21. molluscum contagiosum, involving the upper eyelids, in a child infected with hiv-1.BACKGROUND: infection with molluscum contagiosum has been reported in pediatric and adult patients with acquired immune deficiency syndrome (AIDS), but rarely affecting eyelids. We have studied the viral phenotype, hiv-1 plasma viremia, p24 antigenemia, alterations of cellular immune function, and the ophthalmological status in a 5-year old human immunodeficiency virus type 1 (hiv-1)-infected girl, who developed multiple molluscum lesions, bilaterally involving upper eyelids with extension over the face and nose. methods: Detailed ophthalmological examination and immunological and virological studies were performed in a pediatric patient with hiv-1 vertical infection having extensive infection with molluscum contagiosum. RESULTS: The pediatric patient was emetropic; tricomegalia was present bilaterally, and alteration of the microvessels of the conjunctiva (microangiopathy) was observable in both eyes and structural (fibrilar) degeneration of the vitreous architecture in both eyes. There was no ophthalmoscopic sign of infectious retinitis or retinal microangiopathy. She had lymphopenia, very low percentage and absolute number of CD4 T cells but increased percentage of CD8 T cells. The in vitro lymphocyte proliferative response to phytohemagluttinin (PHA) was depressed as compared to healthy controls. She had high levels of viral HIV rna in her plasma and of p24 antigen in her serum, and the phenotype of the isolated hiv-1 was determined to be syncytium-inducing (SI). CONCLUSION: Although healthy persons may develop molluscum contagiosum, usually unilateral, as far as we are aware this report is the first to document a case of molluscum contagiosum with bilateral eyelid involvement in an hiv-1-infected pediatric patient. Our observations suggest that this type of infection may be present in HIV-infected children, associated with high viral load and possibly an SI viral phenotype, severe immunoregulatory abnormalities, and poor clinical status.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/21. pneumocystis carinii infection in bilateral aural polyps in a human immunodeficiency virus-positive patient.pneumocystis carinii is an opportunistic infection found in patients with impaired immunity. Under favourable conditions the parasite can spread via the blood stream or lymphatic vessels and cause extrapulmonary dissemination. We report a case of P carinii infection presenting as bilateral aural polyps, otitis media and mastoiditis in human immunodeficiency (HIV)-positive patient with no history of prior or concomitant P carinii infection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/21. herpes simplex type 2 pneumonia.Extensive reviews of pulmonary infections in AIDS have reported few herpetic infections. Generally these infections are due to herpes simplex type 1. pneumonia due to herpes type 2 is extremely rare. We describe a 40 year-old HIV positive woman who complained of fever, cough and dyspnea for seven years. She had signs of heart failure and the appearance of her genital vesicles was highly suggestive of genital herpes. echocardiography showed marked pulmonary hypertension, right ventricular hypertrophy and tricuspid insufficiency. After a few days of hospitalization she was treated with Aciclovir and later with ganciclovir. An open pulmonary biopsy revealed an interstitial inflammation, localized in the alveolar walls. Some pulmonary arteries had widened walls and focal hyaline degeneration. immunohistochemistry indicated that the nuclei had herpes simplex virus type 2 in many endothelial cells (including vessels with widened walls), macrophages in the alveolar septa and pneumocytes. There was clinical improvement after treatment for herpes. We concluded that as a consequence of herpes infection, endothelial involvement and interstitial inflammation supervene, with thickening of vascular walls and partial obliteration of the vessel lumen. A direct consequence of these changes in pulmonary vasculature was pulmonary hypertension followed by heart failure.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
5/21. Submicroscopic profile of isospora belli enteritis in a patient with acquired immune deficiency syndrome.Small bowel mucosal fragments from a human immunodeficiency virus-positive female patient with chronic diarrhea were investigated by transmission electron microscopy, and isospora belli enteritis was documented. The submicroscopic profile was characterized by a moderate abnormality of mucosal architecture with reduction in height of villi and hypertrophy of crypts. Stages of both asexual (trophozoite, schizont and merozoite) and sexual (macrogametocyte) phases of the life cycle of the parasite were identified in the epithelium, always enclosed within a parasitophorous vacuole. Moreover, the presence of occasional extracellular merozoites in the intestinal lumen and in the lamina propria near or within lymphatic vessels was documented. These findings expand the current knowledge of this parasite regarding its capacity to survive in an extracellular environment and document a possible mechanism by which extraintestinal infection can take place.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/21. Disseminated cutaneous and meningeal sporotrichosis in an AIDS patient.We report the first proven case of sporothrix meningoencephalitis in an AIDS patient. The patient had dramatic, wide-spread ulcerative and infiltrative disease with progressive meningoencephalitis in spite of amphotericin and itraconazole therapy. sporothrix was cultured from premortem cerebrospinal fluid and seen in the meninges and in brain vessels at autopsy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/21. Immunopathological changes in human cerebral malaria.Pathogenic mechanisms in human cerebral malaria remain unclear. We reevaluate the role of cell-mediated immune mechanisms in the pathogenesis of this disease based on autopsy findings in a 34-year-old Caucasian male. Histologic examination of brain tissue showed typical features of severe malaria infection (sequestration of plasmodium falciparum-infected erythrocytes in vessels, cerebral oedema, petechial lesions and Durck granulomas). In addition to these classical changes, we found that leukocytes that stained positively in immunohistochemistry for CD68 and tumor necrosis factor-alpha (TNF) coexisted with infected erythrocytes in capillaries, whereas in venules the monocyte population outnumbered the erythrocytes. Notable expression of ICAM-1 on endothelial cell surface was detected by immunohistochemistry in vessels with sequestered cells but not in unaffected vessels. These changes are identical to those of the murine model of the disease, in which cell-mediated immune mechanisms and TNF have been implicated. in vitro, ICAM-1 has been shown to be a potential ligand for P. falciparum-infected erythrocytes. In malaria patients, high serum TNF levels, which have been detected in close correlation with disease severity, may thus favor adhesion to endothelial cells of either red or white blood cells via enhanced ICAM-1 expression. The present observations are further evidence for a role of cell-mediated immunity in the pathogenesis of human cerebral malaria.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
8/21. Cutaneous manifestations of histoplasmosis in the acquired immune deficiency syndrome.The clinical and histologic features of cutaneous histoplasmosis in three patients with acquired immunodeficiency syndrome (AIDS) are described. The patients presented with multiple discrete papules on the extremities, trunk, and face, some of which were follicular. Histologically, the skin biopsies were characterized by a sparse perivascular infiltrate with polymorphonuclear leukocytes, lymphocytes, and occasional histiocytes. Prominent leukocytoclasia and associated dermal necrosis were seen around the superficial blood vessels of the dermis. The histoplasma capsulatum organisms were for the most part extracellular and difficult to visualize on the hematoxylin and eosin-stained sections. A diagnosis of atypical leukocytoclastic vasculitis was considered. histoplasmosis is a relatively common mycosis among AIDS patients, and it is sometimes the first manifestation of the syndrome. The clinical and histologic findings described herein may be relatively common among AIDS patients and are quite different from those of classic disseminated histoplasmosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/21. Acute hepatic and renal failure caused by pneumocystis carinii in patients with AIDS.Clinical and pathological findings are described in two AIDS patients with pneumocystis carinii infection who received prophylactic treatment with nebulised pentamidine and developed unusual hepatic and renal failure. Histological examination showed clumps of P carinii massively obstructing hepatic sinuses and portal vessels in the first patient, and merular and intertubular capillaries in the second. These findings could explain the unusual clinical features, characterised by acute hepatic and renal failure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/21. pneumocystis carinii thyroiditis diagnosis by fine needle aspiration cytology: a case report.BACKGROUND: Extrapulmonary infection or dissemination of pneumocystis carinii (PC) is rare, but under certain conditions the parasite can spread via the bloodstream or lymphatic vessels. Systemic pneumocystosis most often involves the lymph nodes, stomach, spleen, liver, skin, pancreas, choroid and eye. Isolated lesions containing PC have also been identified in the thyroid. CASE: A 41-year-old homosexual male infected with the human immunodeficiency virus (HIV) developed a PC infection in the thyroid gland. The patient had had thrush and anal herpes since being diagnosed as HIV positive in 1984. In 1992 the patient developed a mass in the area of the right lobe of the thyroid gland. Smears from fine needle aspiration cytology of the thyroid mass revealed epithelioid cells. However, a cell block revealed numerous PC organisms on Gomori methenamine-silver stain; that finding was confirmed by an excisional biopsy. The patient had not previously been diagnosed with PC pneumonia. CONCLUSION: Our case of thyroid involvement with PC expands the clinical spectrum of extrapulmonary pneumocystosis in patients with the acquired immunodeficiency syndrome. We believe that in these patients the incidence of Pneumocystis thyroiditis will continue to rise and be reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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