Analysis of the scalp of women with AIDS subjected to autopsy: epithelial, follicular, and immunologic aspects.

Hair keeps the scalp warmer and slightly moister than the rest of the skin, which contributes to a favorable environment for mycotic, bacterial, and parasitic infections. It is well established that AIDS makes the patient more susceptible to opportunistic infections and cutaneous manifestations. Because of this, the aim of this study was to analyze scalp fragments of autopsied women with AIDS. Twenty-eight scalp samples of women aged between 18 and 46 years were observed. These women were divided into 2 groups: with AIDS (n = 14) and without AIDS (n = 14). We conducted histochemical (hematoxylin-eosin, Picrosirius, and Verhoeff), morphometric (Image J; National Institutes of Health, Hamilton, ON, Canada and KS-300 Kontron-Zeiss; Kontron Elektronik, Carl-Zeiss, Germany), and immunohistochemical (S-100) analyses of the scalp. In patients with AIDS, epithelial thickness, number of epithelial cell layers, number of immature Langerhans cells in the epidermis, and percentages of elastic fibers in the dermis were significantly lower, whereas telogen hair follicles were significantly higher. The percentage of collagen fibers in the dermis and the diameter of the epithelial cells were smaller in patients with AIDS, without significant difference. AIDS possibly causes immunologic and morphologic alterations in the scalp. This study may establish parameters for better clinical and morphologic diagnostic in patients with AIDS.

The influence of age, smoking, antiretroviral therapy, and esophagitis on the local immunity of the esophagus in patients with AIDS.

Studies have shown immunological and morphological alterations in the esophagus during the course of AIDS. Esophageal postmortem samples of 22 men with AIDS autopsied in a teaching hospital between 1982 and 2009 were collected. We carried out revision of the autopsy reports and medical records, morphometric analysis (Image J and KS-300 Kontron-Zeiss), and immunohistochemical (anti-S100, anti-IgA, anti-IgG, and anti-IgM) analysis of the esophagus. In accordance with most of the parameters evaluated, age and the smoking habit harmed the esophageal local immunity, whereas the use of antiretroviral therapy improved the immune characteristics of this organ. Patients with esophagitis also presented immunological fragility of the esophagus. This leads to the conclusion that alterations in the esophageal epithelium of patients with AIDS are not only caused by direct action of HIV but also the clinical and behavioral characteristics of the patient.

Morphological and immunological changes in the skin of autopsied women with AIDS.

Acquired immunodeficiency syndrome (AIDS) is characterized by decreased immunity, making a patient more susceptible to opportunistic infections which can have cutaneous manifestations. The aim of this study was to evaluate the local immunity of the skin through morphological and immunohistochemical analysis. Skin samples of 52 women, 27 without AIDS and 25 with AIDS, autopsied in an academic referral hospital in Brazil were evaluated. The autopsy reports and medical records were reviewed, and histochemical Hematoxylin-eosin, Picrosirius red, and Verhoeff stains as well as morphometric (Image J and KS-300 Kontron-Zeiss) and immunohistochemical (S-100 and anti-IgA) analyses of the skin were performed. Women with AIDS presented a thinner epidermis than women without AIDS (33.33 [12.00-317.66] vs 67.42 [12.00-530.02] µm; p < 0.001), with a lower number of epithelial cell layers (4.00 [2.00-11.00] vs 4.00 [2.00-16.00]; p < 0.001), a smaller cell diameter (12.92 [6.00-28.87] vs 24.32 [6.00-33.12] µm; p < 0.001), and a lower number of Langerhans cells (LC) (12.58 [0.00-81.74] vs 31.44 [0.00-169.77] LC/mm(2); p < 0.001). The dermis contained more collagen fibers (8.20 % [2.40-19.40] vs 6.30 % [0.40-13.90]; p < 0.001). Some of these parameters were negatively correlated with viral load and positively correlated with the number of CD4+ T-lymphocytes. We conclude that a decrease of the local skin immunity in women with AIDS may contribute to the development of skin lesions.

The influence of gender and of AIDS on the immunity of autopsied patients' esophagus.

Previous studies have shown that males who have AIDS are more frequently affected by infectious diseases than females. The esophagus is the organ in the digestive tube that is more commonly affected by opportunistic infections during the syndrome. The aim of this study was to assess the influence of AIDS and of gender on local immunity of the esophageal epithelium. Fragments of the esophagus from 29 autopsied women and 37 autopsied men were collected at a university hospital from 1980 to 2009 and were divided in groups with and without AIDS. The IgA-, IgG-, and IgM-positive cells and Langerhans cells (LCs) were immunostained, respectively, with anti-IgA, anti-IgG, anti-IgM, and anti-S100. The software Image J was used to measure the esophageal epithelium and to count the epithelium cellular layers. Patients with AIDS, apart from gender, showed an increase in IgA-, IgG-, and IgM-positive cells and a reduction of Langerhans cells, in thickness and in number of cellular layers in the esophageal epithelium. However, among individuals with AIDS, men presented lower secretory expression of IgA-, IgG-, and IgM-positive cells than women and more intense reduction of LCs. Women have naturally presented better local esophageal immunity than men. Although AIDS possibly causes immunological and morphological alterations in the esophageal epithelium in both genders, women have better esophageal immunity, which may explain a greater frequency of hospital admissions due to infection of men with AIDS when compared with women.

The influence of AIDS on the morphometric and immune status of the uterine cervix of autopsied patients.

INTRODUCTION: Previous studies have shown that HIV infection is related to changes in the immune status of the mucosal surfaces. Such changes may also occur in the genital tract, since patients infected by HIV have the virus in their cervical secretions. METHODS: Fragments of the uterine cervix of 29 autopsied women were collected at a university hospital from 1985 to 2008, and were divided in groups with and without AIDS. Image J software was used to measure the cervical epithelium and to count the epithelial cellular layers. Langerhans cells (LCs) and IgG positive cells were respectively immunostained with anti-S100 and anti-IgG. RESULTS: Women with AIDS, when compared with women without AIDS, had thinner cervical epithelium (103.32 vs 116.71 µm), lower number of cellular layers (10.41 vs 13.66 µm), lower mean cell diameter (10.09 vs 11.51 µm), less number of total LCs (11.19 vs 23.08 LCs/mm(2)), and higher percentage of IgG positive cells (22.64% vs 16.06%). All these results were significant. CONCLUSION: AIDS causes alterations in the structure of the cervical epithelium and in its extracellular matrix, leading to alterations in the local and systemic immunity, and triggering signs and opportunistic infections in the uterine cervix in the course of the disease.

Associação entre megacólon chagásico e adenocarcinoma gástrico em uma mulher idosa / Association between chagasic megacolon and gastric adenocarcinoma in an elderly woman

O objetivo deste relato foi apresentar o caso de uma paciente com megacólon chagásico perfurado associado a colite isquêmica, que evoluiu para peritonite fecal aguda. A paciente era uma mulherbranca, 82 anos, com cianose, anasarca, melena, dor, distensão abdominal e sorologia positiva para doença de Chagas. Seu estado evoluiu para o óbito e a autópsia revelou megacólon chagásico com perfuração e peritonite aguda fecaloide purulenta, sendo esta última a causa imediata do óbito. Esteé, provavelmente, um dos poucos relatos de colite isquêmica, megacólon chagásico perfurado e peritonite fecal aguda associada a adenocarcinoma gástrico não diagnosticado antes do óbito.