Infections of the Central Nervous System in Colombia: Analysis of 512 Non-Perinatal Autopsies
JC Mantilla-Hernandez, JA Diaz-Perez, EA Castilla, JA Garcia-Vera, P Aranda-Valderrama. Universidad Indusrial de Santander, Bucaramanga, Santander, Colombia; Fundacion para el Avance de la Anatomia Patologica, Citologia y Clinica Molecular, Bucaramanga, Santander, Colombia; Bethesda North Hospital, Cincinnati, OH; University of Cincinnati, Cincinnati, OH
Background: Central Nervous System (CNS) infections are caused by a diverse group of organisms. Correlation with gross examination, histopathologic evaluation and laboratory data typically yields a definite diagnosis.
Design: This prospective study analyzes neuropathologic findings in all academic autopsies performed between January 2004 and march 2009 at the Hospital Universitario de Santader in Bucaramanga, Colombia. Perinatal cases were excluded.
Results: Evidence of CNS infection was foun in 56 out of 512 non-perinatal autopsies. The mean age was 36.2 years with a male:female ratio of 1:1. In only 15 cases (26.7%) a correct premortem diagnosis was documented. Thirty one patients (55.35%) were HIV-positive. The final diagnoses included: Cerebral toxoplasmosis (17 cases – 30.4%), pyogenic meningitis (16 cases – 28.6%), Mycobacterium tuberculosis-associated meningoencephalitis (six cases - 10.7%), Cryptococcus neoformans meningoencephalitis (five cases – 9%), lymphocytic viral encephalitis (three cases – 5.4%), herpetic meningoencephalitis (two cases – 3.6%), rabies encephalitis (two cases – 3.6%), Chagas disease encephalitis (one case – 1.8%), Plasmodium falciparum meningoencephalitis (one case – 1.8%), cerebral mucormycosis (one case – 1.8%), meningoencephalitis due to Paracoccidioides brasiliensis (one case – 1.8%), and neurocysticercosis (one case – 1.8%). In several cases HIV infection modified the "classical" histopathologic findings.
Conclusions: A significant number of lethal CNS infections are diagnosed only after postmortem examination. Microbiological and histologic evaluation identify the etiologic agent in virtually all of the cases. Finally, HIV infection frequently modifies the "typical" gross and microscopic features of specific CNS infections.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 5, Monday Morning