Autopsies in HIV: still identifying missed diagnoses

Beadsworth, M.; Cohen, Danielle B.; Ratcliffe, Libuše; Jenkins, Neil; Taylor, William J.; Campbell, Fiona; Beeching, Nicholas J.; Azadeh, Bahram

doi:10.1258/ijsa.2008.008271

Cited by 17 publications

(15 citation statements)

References 18 publications

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“…One of the important utilities of autopsy is the correlation between antemortem and postmortem diagnosis. A recent review from the UK spanning 23 years showed that the autopsy findings altered the primary diagnosis in 70% of cases, and that 36% of opportunistic infections were not diagnosed prior to death (Beadsworth et al, 2009). An Indian series showed discordance between antemortem and postmortem diagnosis in 42% cases (Lanjewar, 2011).…”

Section: Resultsmentioning

confidence: 99%

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Pathology of HIV/AIDS: Lessons from Autopsy Series

Bychkov¹,

Yamashita²,

Доросевич³

2011

HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies

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Section: Resultsmentioning

confidence: 99%

“…Both false positive as well as false negative antemortem diagnoses are described (Martinson et al, 2007). Infections such tuberculosis, Cytomegalovirus and invasive mycoses are missed with the highest rate (Antinori et al, 2009;Beadsworth et al, 2009;Eza et al, 2006;Tang et al, 2006;Wilkes et al, 1988).…”

Section: Resultsmentioning

confidence: 99%

Pathology of HIV/AIDS: Lessons from Autopsy Series

Bychkov¹,

Yamashita²,

Доросевич³

2011

HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies

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“…Despite the global trend of reducing the number of necropsies due to an increased use of radiological and laboratory tests in pre-mortem diagnosis, necropsy remains important even today, as the discrepancy rates between pre-mortem and postmortem findings in AIDS vary from 42 to 74%. Despite significant advances in diagnostic procedures, false-positive and false-negative diagnosis in the absence of necropsy still exist 8 , 9 , 10 , 11 , 12 . Necropsies are essential procedures for the quality control in university hospitals, and have helped to further understanding of the most frequent diseases in patients with HIV/AIDS 13 .…”

Section: Introductionmentioning

confidence: 99%

Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

Guimarães

Silva

Micheletti

et al. 2017

Rev. Inst. Med. trop. S. Paulo

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Involvement of the digestive system in AIDS pathologies or injuries is frequent. Aiming at comparing the frequency, the importance that these lesions have for death and the survival time in patients using or not using HAART, we studied 322 necropsies classified as follows: Group A - without antiretroviral drugs (185 cases); B - one or two antiretroviral drugs or HAART for less than six months (83 cases); C - HAART for six months or longer (54 cases). In the overall analysis of the digestive system, changes were present in 73.6% of cases. The most frequent was Candida infection (22.7%), followed by cytomegalovirus (19.2%), Histoplasma capsulatum (6.5%), mycobacteria (5.6%), and Toxoplasma gondii (4.3%). T. gondii infection was more frequent in group A compared with group C, and cytomegalovirus (CMV) was more frequent in group A compared with groups B and C (p < 0.05); 2.2% of the deaths were due to gastrointestinal bleeding. Regarding the segments, only in the large intestine, and only cytomegalovirus, were more frequent in group A compared with group C. We conclude that digestive system infections are still frequent, even with the use of HAART. However, the average survival time in group C was more than three times greater than the one in group A and nearly double that of group B, demonstrating the clear benefit of this therapy.

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“…Macrophages fail to organize immune response and, instead of arranging a granuloma, they pro liferate chaotically and place themselves in sheets which may totally obscure normal tissue structures. Langhans giant cells are absent or rare [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge not many autopsy-based studies on morbidity and mortality of HIV/AIDS population including large numbers of patients have been performed in Europe, including Baltic the countries [3,7,22,36].…”

Section: Introductionmentioning

confidence: 99%

Multiform spectrum of pulmonary disease in lethal HIV infection cases in Latvia (2012–2016)

Kleina

Fjodorova

Dabužinskienė

et al. 2017

PoA

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In 2016, the proportion of HIV-infected persons in the Baltic countries was as follows: Latvia 18.5, Estonia 17.4, Lithuania 7.4 per 100,000 of population. The aim of our study was to evaluate the spectrum and morphology of combined lung pathologies in fatal HIV/AIDS cases in Latvia from 2010 to 2016. We did a retrospective review of the HIV/AIDS patients' medical autopsy case files and histological slides at the Pathology Centre of Riga Eastern Clinical University Hospital. All statistical data were processed in IBM SPSS Statistics 23. We analysed 455 cases -311 (69%) men, 134 (31%) women. The mean age of the analysed patients was 40 years (±9 SD, range 22-68). The conditions leading to death were opportunistic infections (OI) -28%, tuberculosis (TB) -23%, wasting syndrome complicated by nonspecific pneumonia and sepsis or HIV/AIDS unrelated conditions -27%, malignancies -11% (B large cell lymphoma, primary and secondary cancers of the lung, Kaposi sarcoma), and end stage liver disease -11%. Lungs were affected in 380 cases (83.5%). We identified 112 cases of tuberculosis (TB). In 21%, it was isolated pulmonary TB, in 79% -disseminated TB. Additionally, OI were proved in 26% of these patients. The prevalence of OI was higher in patients who died from isolated pulmonary TB. We also identified 10 cases of disseminated atypical mycobacteriosis. Opportunistic infections were diagnosed in 126 persons -77% (n=97) of them had one, but 23% (n=29) had two or more OIs. The most common isolated OI with lung involvement was https://doi.org/10.12697/poa.2017.26.2.06Papers on Anthropology XXVI/2, 2017, pp. 53-67 54 | R. Kleina, O. Fjodorova, A. Dabužinskienė, J. Nazarovs, O. Mahmajeva Pneumocystis jiroveci (PC) pneumonia (n=71, 15.6%); 10% had cryptococcosis, 1% -pulmonary aspergillosis and Candida pneumonia each. 40 patients (9%) had disseminated cytomegalovirus (CMV). Among the various combinations of oppor tunistic infections, the most common was PC+CMV. 81% of HIV patients were unemployed and prisoners with interrupted treatment. We concluded that our study revealed that combined opportunistic infections and TB were the most frequently observed pulmonary infections, followed by primary and secondary lung malignancies and bacterial pneumonia in HIV/ AIDS unrelated cases of multiorgan disease. Diagnostic difficulties occurred mainly in disseminated diseases due to nonspecific clinical presentation, similar appearance on imaging studies and limited bacterial diagnostic possibilities after death.

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Autopsies in HIV: still identifying missed diagnoses

Cited by 17 publications

References 18 publications

Pathology of HIV/AIDS: Lessons from Autopsy Series

Pathology of HIV/AIDS: Lessons from Autopsy Series

Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

Multiform spectrum of pulmonary disease in lethal HIV infection cases in Latvia (2012–2016)

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