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Cytomegalovirus (CMV) disease of the brain in AIDS and connatal infection: a comparative study by histology, immunocytochemistry and in situ DNA hybridization

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Summary

Brain tissues from 45 patients with AIDS and two brains with connatal cytomegalic inclusion body disease were investigated for a cytomegalovirus (CMV) etiology of encephalitic lesions. Nineteen brains showed evidence of CMV infection by histology, immunocytochemistry (ICC) using two different antibodies (mono- and polyclonal), and in situ hybridization (ISH). Fourteen cases with typical cytomegalic cells in conventional histology [eight with focally necrotizing encephalitis/ventriculitis including the two connatal infections and six with nodular encephalitis (NE)] revealed CMV with any method. In 5 of 15 AIDS cases of NE without cytomegalic cells, CMV infection was established by ISH, whereas ICC remained negative in these cases. Typical lesions of human immunodeficiency virus (HIV)-induced multifocal giant cell encephalitis (HIV encephalitis) in 13 brains were never labeled for CMV. In necrotizing encephalitis/ventriculitis, cell types which labeled for CMV, with and without cytomegalic change, comprised neurons, astrocytes, oligodendrocytes, ependyma, choroid plexus, endothelia, and cells in periand endoneurium, and in leptomeninges. Both ISH and ICC were able to detect widespread non-cytomegalic CMV-infected cells in normal parenchyma, well beyound the necrotizing lesions, in two AIDS cases. Labeling patterns of nuclei versus cytoplasms varied between the three methods for CMV detection. We conclude that in CNS tissues with cytomegalic cells, ICC and ISH are of comparable sensitivity; however, a diagnosis of CMV disease is possible in such cases by conventional histology. For an in situ diagnosis of CMV infection in NE without cytomegalic cells in AIDS, ISH is the method of choice. A selective vulnerability to CMV infection of any specific cell type of the human CNS is absent. With our detection methods, typical lesions of HIV encephalitis do not show local co-infection by CMV.

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Authors and Affiliations

  1. Neurologisches Institut, Universität Wien, Schwarzspanierstrasse 17, A-1090, Wien, Austria

    M. Schmidbauer & H. Budka

  2. Institut für Pathologische Anatomie, Universität Wien, Schwarzspanierstrasse 17, A-1090, Wien, Austria

    W. Ulrich

  3. Kinder-Krebsforschungs-Institut (C.C.R.I), St. Anna-Kinderkrankenhaus, Wien, Austria

    P. Ambros

Authors
  1. M. Schmidbauer
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  2. H. Budka
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  3. W. Ulrich
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  4. P. Ambros
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Supported by The Lord Mayor's Medico-Scientific Fund Vienna, Austria

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Schmidbauer, M., Budka, H., Ulrich, W. et al. Cytomegalovirus (CMV) disease of the brain in AIDS and connatal infection: a comparative study by histology, immunocytochemistry and in situ DNA hybridization. Acta Neuropathol 79, 286–293 (1989). https://doi.org/10.1007/BF00294663

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  • DOI: https://doi.org/10.1007/BF00294663

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