Pathology of cryptococcal meningoencephalitis: Analysis of 27 patients with pathogenetic implications
Pathology of cryptococcal meningoencephalitis: Analysis of 27 patients with pathogenetic implications
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DOI：
10.1016/s0046-8177(96)90459-1
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发表时间：
1996-08-01
期刊：
影响因子：
3.3
通讯作者：
Casadevall, A
中科院分区：
文献类型：
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作者：
Lee, SC;Dickson, DW;Casadevall, A
在隐球菌性脑膜脑炎 (CME) 尸检系列中，作者分析了 13 例人类免疫缺陷病毒 (HIV) 和 14 例非 HIV 相关病例的神经病理病变。大多数非艾滋病毒患者没有免疫抑制诱发疾病。病理结果分析显示，感染和未感染 HIV 的患者对 CME 的炎症反应存在显着差异。获得性免疫缺陷综合征 (AIDS) 患者均未出现肉芽肿性炎症，而大多数非 HIV 相关病例均出现肉芽肿，这支持了细胞介导的免疫在 CME 中的作用。两组的淋巴细胞浸润均由 T 细胞 (CD45RO+) 组成。在一些非 HIV 相关病例中，CME 未被诊断和治疗。在大多数 HIV 相关病例中，CME 具有脑炎成分，导致肉眼或显微镜下可见的真菌在脑实质内积聚，而在非 HIV 相关病例中，CME 往往局限于蛛网膜下腔和大的血管周围间隙（Virchow-Robin 间隙）。在非 HIV 相关病例中，酵母菌形式较少，且表现出更有限的情况。 相比之下，许多 HIV 相关 CME 病例中存在许多细胞外真菌。 AIDS 中 CME 的主要反应细胞是脑巨噬细胞和小胶质细胞，尤其是血管周围和血管旁位置的细胞。反应性星形胶质细胞仅限于大的破坏性病变和软膜下区域。在几名 HIV 相关 CME 患者中，大的实质隐球菌瘤含有新生隐球菌 (CN)，细胞壁色素沉着，提示黑色素。作者认为，艾滋病患者免疫功能的改变使得 CN 在大脑内（主要是细胞外）积聚，而巨噬细胞/小胶质细胞效应器功能的缺陷可能是导致病理改变的原因。此外，HIV 相关 CME 中共存的 CNS 过程可能导致病理学改变。作者得出的结论是，隐球菌性脑膜炎并不是一种仅限于脑脊液 (CSF) 空间的疾病，但对大脑的影响比想象的更为显着。增强 CNS-CSF 屏障处神经胶质细胞效应功能的治疗策略可能有助于改善治疗反应。版权所有 (C) 1996 W.B.桑德斯公司。
In this autopsy series of cryptococcal meningoencephalitis (CME), the authors analyzed neuropathologic lesions in 13 human immunodeficiency virus (HIV) and 14 non-HIV-related cases. Most non-HIV patients did not have immunosuppressive predisposing illness. Analysis of pathological findings revealed significant differences in the inflammatory response to CME in patients with and without HIV infection. None of the acquired immunodeficiency syndrome (AIDS) patients had granulomatous inflammation, whereas most non-HIV-associated cases had ganulomas, supporting a role for cell-mediated immunity in CME. Lymphocytic infiltrate in both groups consisted of T cells (CD45RO+). In some non-HIV-associated cases, CME was undiagnosed and untreated. In most HIV-associated cases, CME had an encephalitic component, resulting in grossly or microscopically visible accumulations of fungi within the brain parenchyma, whereas in non-HIV-associated cases, CME was often confined to the subarachnoid space and large perivascular spaces (Virchow-Robin spaces), In non-HIV-associated cases, yeast forms were fewer and showed a more limited distribution, In contrast, many extracellular fungi were present in many cases of HIV-associated CME. The principal reactive cell in CME in AIDS was brain macrophages and microglia, especially those in the perivascular and juxtavascular locations. Reactive astrocytes were limited to large destructive lesions and subpial regions. In several patients with HIV-associated CME, large parenchymal cryptococcomas contained Crytococcus neoformans (CN) with cell wall pigmentation, suggestive of melanin. The authors suggest that in AIDS patients altered immune functions allow CN to accumulate within the brain, predominantly extracellularly, and that deficient macrophage/microglial effector function may be responsible for the altered pathology. In addition, coexisting CNS processes in HIV-associated CME may contribute to the altered pathology. The authors conclude that cryptococcal meningitis is not a disease limited to the cerebrospinal fluid (CSF) space but affects the brain more significantly than suspected. Therapeutic strategies that enhance the effector function of glial cells at the CNS-CSF barrier may be useful for improving the response to therapy. Copyright (C) 1996 by W.B. Saunders Company.