Pathology of the peripheral nervous system in unselected AIDS autopsies
Peripheral nerves and spinal ganglia of 27 unselected patients who died with acquired immunodeficiency syndrome (AIDS) were examined at autopsy by histology, immunocytochemistry, in situ DNA hybridization, and electron microscopy to charcterize type of lesions and to detect opportunistic agents and HIV in peripheral nervous system (PNS) tissue.
Specific pathology was found in 4 cases only, including CMV ganglionitis, toxoplasmic ganglioneuritis, infiltration by high grade B cell malignant lymphoma, and necrotizing vasculitis affecting little- and mediumsized epineural vessels.
Unspecific pathology of variable severity was present in 22 cases. In 18 of them, the main finding was an uncharacteristic spinal ganglionitis with infiltration by haematogenous cells which expressed CLA and HLA-DR antigens and occasionally were in close contact with ganglion cells. Inflammatory infiltration of nerve, mainly perivascular and scant, was less common (5 cases). Other changes included loss of sensory cells associated with proliferation of satellite cells and Nageotte’s nodules, hypertrophic nuclear changes of satellite cells featuring dark, enlarged nuclei, and hyperplasia of Schwann cells.
Viral antigens (HIV, CMV, JCV, VZV and HSV) or viral DNA (CMV and HSV) were not detected. No HIV particles were found at ultrastructural examination.
We conclude that opportunistic infections and neoplasms rarely affect the PNS in AIDS, even at the late stage studied in this autopsy series; this contrasts with pathology of the CNS in AIDS. Moreover, the nonspecific inflammatory infiltration affecting spinal ganglia more frequently than perpheral nerves might support a hypothesis that PNS pathology in HIV-infected patients is related to an immune-mediated attack on the neuronal component.
KeywordsHuman Immunodeficiency Virus Herpes Simplex Virus Schwann Cell Satellite Cell Acquire Immune Deficiency Syndrome
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