[The topical problems of morphological diagnosis and the pathomorphism of HIV infection].

The paper analyzes the frequency of admissions to the S. P. Botkin Clinical Infectious Hospital and the City AIDS Center among patients with HIV infection and the structure of fatal outcomes. It is concluded that there is a considerable increase in mortality and the number of patients needing hospitalization. The dead HIV-infected patients autopsied at the Unit of Morbid Anatomy, S. P. Botkin Hospital, in the past years are characterized in detail. The topical problems of HIV infection the solution of which require the participation of pathomorphologists are discussed.

[Pathological anatomy of HIV infection according to data in Saint-Petersburg]. / Patologicheskaia anatomiia VICh-infektsii po materialam Sankt-Peterburga.

The results of postmortem investigation of 101 cases of HIV infection at its different stages in Saint-Petersburg are analyzed. The challenges to a pathologist performing the autopsy are discussed. There has been an increase in the number of deaths since 2000, among drug users in particular. Macrophacytic transformation and specific HIV-related encephalitis are among the most important changes directly associated with immunodeficiency virus. Among secondary infections, cryptococcosis, cytomegaly, pneumocystosis, and tuberculosis are most common and significant.

[Relationship between chronic viral hepatitis and hepatocellular carcinoma]. / Sviaz' khronicheskogo virusnogo gepatita i gepatotselliuliarnogo raka.

Recent years have seen a correlation between the rise in morbidity and lethality from chronic viral hepatitis and that of hepatocellular carcinoma. Present-day methods of hepatotropic viruses (HBV and HCV) identification point to a growing role of chronic viral hepatitis in etiology of cirrhosis which gives rise to hepatocellular cancers. A study of 49 cases based on sectional material established hepatocellular carcinoma development in smoldering chronic viral hepatitis caused by B or C virus or their combination. An immunohistochemical investigation (29) identified differences in hepatitis B and C virus antigen expression in tumor and adjacent hepatic tissue.

[Morphologic characterization of the contemporary dysentery caused by Shigella flexneri 2A]. / Morfologicheskaia kharakteristika sovremennoi dizenterii, vyzvannoi shigellami Fleksnera 2A.

There is a tendency in St. Petersburg since 1990s to an increase of dysentery morbidity and lethality mainly caused by Flexner Shigella 2a. Morphology of the disease in adults is given on the material of 286 necropsies in 1993-1994 in the S. P. Botkin Infectious Hospital. Males (mean age 50 years) and among them chronic alcoholics prevailed; females (mean age 70 years) were frequently with a grave cardiovascular pathology. Advanced inflammation (fibrinous, ulcerative and hemorrhagic) of all colon and distal part of the small bowel was a common finding. Hemorrhagic infarctions of the ileum which were not described so far were observed in 10% of the cases.

[The morphological characteristics of diphtheria in adults under current conditions]. / Morfologicheskie osobennosti difterii u vzroslykh v sovremennykh usloviiakh.

Clinico-anatomical analysis of 112 lethal cases of diphtheria in adults showed a grave course of the disease in chronic alcoholics at the age of 40-49 years. The morphological changes were characterized by a complex of typical changes at the primary focus, intracanalicular and hematogenous dissemination with high bacteremia. The morphology of pneumonia caused by Corynebacterium diphtheria is described for the first time. At the early stages of the disease infectious-toxic degeneration of the myocardium was documented with predominating alteration of the atrioventricular node or contractile myocardium. The above morphological features may be due to peculiarities of patients and decreased subjects as well as possible changes in the pathogen characteristics.

[Cardiac involvement in diphtheria today in adults]. / Porazhenie serdtsa pri sovremennoi difterii u vzroslykh.

Postmortem morphological examination of 102 cases with diphtheria who had died on the disease day 1-120 was performed. All the dead patients were adults. Dystrophic-necrotic processes in cardiac conduction and intramural nervous systems, in contractile myocardium developing on the disease day 1-8 were found. The severity and extent of these processes depended on toxic and hypoxic factors resultant from obturation or ventilation respiratory failure. Myocarditis progression undergoes 2 stages: early, exudative (beginning on the disease day 3) and late, productive (beginning on the disease day 9). The disease eventuated in myocardiosclerosis starting after 28-day course. Morphologically, diphtheritic cardiac lesion differed from cardiac damage caused by other acute infections.

[Rotavirus infection in adults]. / Rotavirusnaia infektsiia u vzroslykh.

Out of 8 patients who died at the age of 36-80 years rotavirus infection was diagnosed virologically as a main disease in 3 cases, usually in combination with other diseases. Characteristic features were as follows: acute onset, involvement of serous and mucous membranes of mainly small bowel, frequent serous peritonitis, possibility of generalization with the involvement of the gall bladder, liver, heart, lungs, kidneys. Typical histological changes were nuclear damage in various cells which increased in size and became bizarre in shape.

[A case of unusual sphingomyelinosis]. / Sluchai svoeobraznogo sfingomielinoza.

Sphingomyelinosis in a 1.5-year-old girl with unusual clinicomorphological manifestations without hepato- and splenomegaly is described. The diagnosis was established on the basis of postmortem biochemical examination of the brain.

[Placentitis induced by hepatitis viruses]. / Platsentity, vyzvannye virusami gepatita.

The results of morphological studies of 66 placentas from women suffering from various forms of viral hepatitis and HBs antigen carriers as well as results of a pathomorphological study of a late abortion, 3 stillborns and 2 newborns are presented. 33 placentas showed lymphocytic infiltration of varying degree and vasculitis. Of most importance were cellular changes, particularly in the decidua, with the appearance in the nuclei of inclusions similar to those found in the liver affected with viral hepatitis. A correlation is observed in some cases between liver changes in the mother, placental alterations and changes in the child.

[Brain cryptococcosis in HIV infection]. / Kriptokokkoz golovnogo mozga pri VICh-infektsii.

A 30-year-old female with HIV-infection (AIDS-stage) died with generalized, including meningoencephalitis, infection. Fungi found in the brain were identified as Cryptococcus neoformans. Fungal cells were also found in the lungs and in the necrotic phlegmon of soft tissue i. e. there was a generalized Cryptococcus infection.

[Klebsiella pneumonia today]. / Klebsielleznye pnevmonii v nastoiashchee vremia.

Analysis of incidence and morphology of Klebsiella pneumonia nowadays in the adults (10 observations), children (5 observations) and newborns (23 observations) is presented. The pneumonias account for 11.3% of total number of lobar pneumonias in the adults dying in 1979-1989. Klebsiella infection represent 16.1% of total number of autopsies a year according to the pediatric infection pathology department. Etiological role of Klebsiella is established in 21.5% of total number of autopsies of newborns for 1985-1988, pneumonia being 61% of total Klebsiella infections. Klebsiella pneumonias in the adults correspond in principle to the Friedländer's pneumonia studied in detail by V.D. Zinserling (1891-1960) and his students. Generalized forms of, as a rule, hospital Klebsiellosis with most grave lung damage, unknown up to now, are frequently observed in children. Klebsiellosis was combined practically in all cases both in the adults and children with other bacterial, viral and fungal infections. The degree of clinico-morphological manifestations may considerably vary.

[Criteria for the morphologic diagnosis of AIDS in autopsy material]. / O nektoroykh kriteriiakh morfologicheskoi diagnostikik SPIDa na sektsionnom materiale.

Our own lethal case of AIDS and the results of the study of other generalized viral infections, and literature data allow us to conclude that lymphoid system damage is the most characteristic feature of the disease. Hyperplasia of lymph nodes and the spleen occurs in the acute stage of the disease. Hyperplasia with subsequent desquamation of the sinus endothelium and alteration in dendritic reticular cells are found histologically. There is an accumulation in the sinuses of large cells with an abundant eosinophilic PAS-positive cytoplasm and a relatively clear nucleus, sometimes several nuclei are observed. Similar, in principle, changes as a manifestation of generalization, may occur in other organs, including alveolocytes and nephrothelium. All these changes suggest AIDS. The presence of immunodeficiency is confirmed by the unusually severe course of other infections, most frequently pneumocystosis.

[Clinico-morphological characteristics of leptospirosis]. / Kliniko-morfologicheskaia kharakteristika leptospiroza.

Observations in 5 patients dying with leptospirosis (at 6-30 days after the onset) caused by leptospira of the Hebdomadis serogroup are described. Bright jaundice developed due to severe serous liver centrilobular edema with pronounced dissociation of the liver cell bands, cholestasis, and cloudy swelling of hepatocytes. Albuminuria, oliguria, and uraemia were caused by acute tubular and interstitial nephritis. Hemorrhagic diathesis with small bleedings in the skin, mucous and serous membranes was associated with the impairment of permeability of microcirculatory vessels. Focal necroses of skeletal muscles, myocardiodystrophy, and focal myocarditis, serous leptomeningitis were also seen. Few leptospirae could be detected extracellularly (often attached to the outer host cell membranes) by Warthin-Starry's method of silver impregnation of paraffin sections and by indirect immunofluorescence, much more rarely could they be demonstrated by Levaditi's method of silver impregnation of pieces of the viscera. Most leptospirae were present in the liver in the case of death on the 6th day when no antibodies were yet present in the blood. Since the 9th day when the antibodies did appear, leptospirae gradually disappeared from the liver and were found in the kidneys. It is suggested that some leptospiral cytotoxic products play a role in the pathogenesis of leptospirosis.