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. 2017 Sep;9(3):144-149.
doi: 10.1556/1646.9.2017.31.

Pathomorphological peculiarities of tuberculous meningoencephalitis associated with HIV infection

Volodymyr M Kozko  1 , Andriy V Bondarenko  1 , Anatoliy V Gavrylov  1 , Olga S Shevchenko  1 , Vitalii V Gargin  1
Affiliations

Pathomorphological peculiarities of tuberculous meningoencephalitis associated with HIV infection

Volodymyr M Kozko et al. Interv Med Appl Sci. 2017 Sep.

Abstract

Background and aims: One of the most severe manifestation displays of tuberculosis (TB) generalization is meningitis/meningoencephalitis. The purpose of this work was to improve the diagnostic efficiency of TB central nervous system (CNS) affection in human immunodeficiency virus (HIV)-infected persons.

Materials and methods: Meninges and cerebral tissues, taken from died patients, who were HIV-infected and dead from TB of CNS affection, were investigated histologically.

Results and discussion: Our examination showed that clinical course of the pathologic process loses the peculiarity of TB-undulating character, and changes in tissues have monomorphism that appears in the presence of the same type of granulomas with a few Pirogov-Langhans cells. Alterative reactions with formation of the large fields of caseous necrosis, necrotic focuses, areas of infiltration with polymorphic cellular elements went out on the first plan in the disorder of cerebrum in patients with the terminal stage of HIV infection. The tendency to decrease in inflammatory-proliferative processes was observed, which is confirmed by the presence of the poorly expressed cellular reaction on the peripheries of focuses of caseous necrosis.

Conclusion: Morphologic features of tuberculous meningoencephalitis in HIV-infected patients are the presence of edema, gliosis, trombovasculitis, small focal hemorrhage, tuberculous granuloma formation with a small number of Pirogov-Langhans cells, and the prevalence of alterative-exudative reactions.

Keywords: HIV infection; brain; histology; meningoencephalitis; tuberculosis.

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Figures

Fig. 1.
Fig. 1.
Inflammatory–infiltrative and necrotic changes surround vessels with perivasculitis (a, H&E staining, 100×); vasculatis with thrombus formation and degenerative process in surrounding cerebral tissue (b, H&E staining, 100×); development of fibrinopurulent meningitis (c, H&E staining, 100×); accumulation of lipofuscin in the bodies of neurons (d, H&E staining, 200×); uneven glial neuron distribution and reducing axons with presence of pericellular edema (e and f, Nissl staining, 400×)
Fig. 2.
Fig. 2.
Perivascular focus of gliosis in the presence of inflammatory cells (H&E staining, 200×)
See this image and copyright information in PMC

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