RESUMO
Based on a new morphological concept and classification of granulomatous inflammation: the polar granulomas, on the histogenesis of the tuberculoid granuloma of the positive Mitsuda test and on the relationship between the degree of histogenetic differentiation and behaviour of tumors, the Authors concluded that the "benign" or "malignant" behaviour of hanseniasis depends on the degree of tuberculoid differentiation of the lesions. If the lesion is histologically well differentiated toward a polar tuberculoid granuloma (tuberculoid hanseniasis) it will have a "benign" behaviour. On the contrary, if this differentiation is absent (virchowian hanseniasis) or poor (interpolar borderline hanseniasis) the behaviour of the lesion will be "malignant".
Assuntos
Granuloma/patologia , Hanseníase/patologia , Humanos , Antígeno de Mitsuda/imunologia , Hanseníase/imunologia , Macrófagos/patologiaRESUMO
According to the 15 autopsies performed at the Department of Pathological Anatomy, Escola Paulista de Medicina, São Paulo, Brazil, it was confirmed that acquired immunodeficiency syndrome (AIDS) occurs preferably in young homosexual males, who die in a short period of time of the disease, which leads to a consumptive state verified by cachexia of the cadavers. The most affected organs of this series were the lungs and encephalum, exactly the ones responsible for the immediate cause of death. In this series of autopsies there were 9 types of microorganisms represented by virus, bacteria, fungi, protozoans and two types of tumors, Kaposi's sarcoma and lymphoma of the central nervous system. From the microorganisms, the most frequent was the Cytomegalovirus and, from the tumors, Kaposi's sarcoma. The various types of microorganisms were frequently associated, principally in the central nervous and digestive systems. There was also association of microorganisms with tumors. Besides the lesions produced by microorganisms there were other associated alterations as brown atrophy of neuronia, which was related to the infiltration of cerebral lymphoma, and the lymphocytic depletion of lymphoid organs due to immunological exhaustion. Cellular reaction to microorganisms was practically none, principally with Pneumocystis carinii and Cryptococcus neoformans, the first one behaving as an inert mould in the pulmonary alveoli and the second proliferating freely in tissues. In two cases there was no granulomatous reaction to Mycobacterium tuberculosis. The primary lymphoma of the central nervous system should be interpreted as a microglioma, i.e., a reticulosarcoma of this system according to Hortega's school.
PIP: Clinical and autopsy findings obtained from 15 male patients treated for acquired immunodeficiency syndrome (AIDS) at 3 hospitals in Sao Paulo provided a clearer profile of AIDS cases in Brazil. Of the 12 patients whose sexual orientation was recorded, 9 were homosexual and 3 were bisexual. 75% were between the ages of 22-36 years; 14 were white. The duration of diseases ranged from 14 days-7 months in this series, confirming the rapid evolution of AIDS from 1st symptom to death. The most common clinical manifestations of disease were fever, cough, weight loss, diarrhea, and lymphadenopathy. Organs most frequently involved were the lungs (13 cases) and encephalum (9 cases). Microscopic findings revealed 9 types of microorganisms, fungi, and protozoa, the most common of which was Cytomegalovirus (7 cases). The cause of death was meningoencephalitis in 7 cases and panlobar pneumonia in 3 cases. The incidence of Kaposi's sarcoma (2 cases) was surprisingly low in this series. In addition to lesions produced by microorganisms, there were important associated lesions represented by lymphocytic depletion, acute myocarditis, brown atrophy of neuronia, acute pancreatitis, and liver cirrhosis. Several microorganisms and tumors in these AIDS patients were discovered only at autopsy, confirming the importance of necropsy to the study of the natural history of this disease. An unexpected pathological finding in this series was the absence of cellular reactions to microorganisms, particularly Pneumocystis carinii, Cryptococcus neoformans, and Mycobacterium tuberculosis.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Brasil , Humanos , Imunidade Celular , Linfoma não Hodgkin/etiologia , Linfoma não Hodgkin/patologia , Linfopenia/etiologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/etiologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/patologia , Sarcoma de Kaposi/etiologia , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologiaRESUMO
Some references of the history of Mitsuda reaction and its antigen, as well as for the results and significance of this unique reaction are presented. In spite of the great advances of modern immunology. Mitsuda reaction is still the best method for the diagnosis of the forms of hanseniasis and for the prognosis of the disease in patients and in healthy persons.
Assuntos
Antígenos de Bactérias/imunologia , Antígeno de Mitsuda/imunologia , Mycobacterium leprae/imunologia , Humanos , Hanseníase/diagnóstico , PrognósticoRESUMO
A detailed study on the histopathology of Mitsuda's reaction was made in 100 adult non-contact hanseniasis patients inoculated with lepromin A (armadillo). It was found that the histological structure of Mitsuda's reaction with lepromin A does not differ from the one observed with lepromin H. There is also no difference between the histological picture observed in healthy non-contacts and the one found in tuberculoid patients and in contact healthy persons. Mitsuda's reaction in non-contact hanseniasis patients presented variations of histological degree--Classes O (-) I (+/-) II (+) III (++) IV ( )--from no inflammatory reaction and positive bacilli, until formation of a complete tuberculoid granuloma and absence of bacilli. In 97% of the cases reaction was positive. Class III, i.e., represented by incomplete tuberculoid granuloma formed by epithelioid cells with follicular arrangement and lymphocytic halo, predominated in the series (42%). The findings of this research state, once again, that an efficient result of the Mitsuda's reaction depends fundamentally of the histological examination, since in only 16 cases the clinical reading coincided with histopathology. Disaccordance found on the remaining 84 cases was attributed to the secondary alterations (necrosis and suppuration) associated to the histological structure of the Mitsuda reaction follows the Jadassohn-Lewandowsky law and are in accordance with the morphological concept and classification of polar granulomas proposed by Michalany & Michalany.
Assuntos
Granuloma/patologia , Hipersensibilidade Tardia/patologia , Antígeno de Mitsuda/imunologia , Adulto , Humanos , Hanseníase/diagnóstico , MasculinoRESUMO
Sao apresentados alguns subsidios, sobretudo historicos, para a literatura da reacao de Mitsuda e de seu antigeno, bem como sobre os resultados e significado dessa extraordinaria reacao. Apesar dos grandes progressos da moderna imunologia, a reacao de Mitsuda constitue ainda o melhor metodo para o diagnostico das formas da hanseniase e para o prognostico da molestia, tanto em doentes como em individuos sadios