All Title Author
Keywords Abstract

ISRN AIDS  2012 

Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks

DOI: 10.5402/2012/486425

Full-Text   Cite this paper   Add to My Lib

Abstract:

Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry. 1. Introduction The human herpes virus-8 (HHV-8), also called Kaposi’s sarcoma herpes virus (KSHV), is the causative agent of all types of Kaposi’s sarcoma (KS), namely the classic, endemic, iatrogenic immunosuppression, and the epidemic/human immunodeficiency virus (HIV) related forms. The modes of acquisition of the KSHV and its transmission vary with age, gender, geography, and sexual practices [1]. Although the virus is omnipresent its incidence is highest in KS endemic regions such as sub-Saharan Africa (sSA). In Uganda, HHV-8 DNA was detected in 28 percent of oral swabs and 27 percent of blood samples of healthy asymptomatic subjects [2]. Hence, saliva is a potential source of transmission. KSHV is transmitted to children from maternal and nonmaternal sources in KS-endemic regions, and occurs via nonsexual routes [3–6]. It has been shown that, in sSA, infection occurs during childhood mainly via maternal saliva and breast milk [7, 8]. Anthropologic research in sSA has identified that premastication of foods of infants and children is traditional, and that saliva, semen, and vaginal fluids are used while engaging in nonsexual practices associated with childcare [9–11]. The sexual transmission of KSHV is more controversial. In the industrialized world, there is evidence of transmission between men having sex with men (MSM) via anal but not oroanal sex [7, 12, 13]. Heterosexual transmission is affirmed by some [14–18]. Others deny it [5, 19]. Since KSHV is

References

[1]  B. Biryahwaho, S. C. Dollard, R. M. Pfeiffer et al., “Sex and geographic patterns of human herpesvirus 8 infection in a nationally representative population-based sample in Uganda,” Journal of Infectious Diseases, vol. 202, no. 9, pp. 1347–1353, 2010.
[2]  C. Johnston, J. Orem, F. Okuku et al., “Impact of HIV infection and Kaposi Sarcoma on human herpesvirus-8 mucosal replication and dissemination in Uganda,” PLoS ONE, vol. 4, no. 1, Article ID e4222, 2009.
[3]  S. M. Mbulaiteye, R. M. Pfeiffer, D. Whitby, G. R. Brubaker, J. Shao, and R. J. Biggar, “Human herpesvirus 8 infection within families in rural Tanzania,” Journal of Infectious Diseases, vol. 187, no. 11, pp. 1780–1785, 2003.
[4]  S. Mbulaiteye, V. Marshall, R. K. Bagni et al., “Molecular evidence for mother-to-child transmission of Kaposi sarcoma-associated herpesvirus in Uganda and K1 gene evolution within the host,” Journal of Infectious Diseases, vol. 193, no. 9, pp. 1250–1257, 2006.
[5]  A. A. Adjei, H. B. Armah, F. Gbagbo, I. Boamah, C. Adu-Gyamfi, and I. Asare, “Seroprevalence of HHV-8, CMV, and EBV among the general population in Ghana, West Africa,” BMC Infectious Diseases, vol. 8, article 111, 2008.
[6]  L. M. Butler, W. A. Were, S. Balinandi et al., “Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda,” Journal of Infectious Diseases, vol. 203, no. 5, pp. 625–634, 2011.
[7]  R. Bagni and D. Whitby, “Kaposi's sarcoma-associated herpesvirus transmission and primary infection,” Current Opinion in HIV and AIDS, vol. 4, no. 1, pp. 22–26, 2009.
[8]  M. Dedicoat, R. Newton, K. R. Alkharsah et al., “Mother-to-child transmission of human herpesvirus-8 in South Africa,” Journal of Infectious Diseases, vol. 190, no. 6, pp. 1068–1075, 2004.
[9]  J. M. Wojcicki, “Traditional behavioural practices, the exchange of saliva and HHV-8 transmission in sub-Saharan African populations,” British Journal of Cancer, vol. 89, no. 10, pp. 2016–2017, 2003.
[10]  J. M. Wojcicki, R. Newton, M. I. Urban et al., “Risk factors for high anti-HHV-8 antibody titers (≥1:51,200) in black, HIV-1 negative South African cancer patients: a case control study,” BMC Infectious Diseases, vol. 3, article 21, 2003.
[11]  J. M. Wojcicki, C. Kankasa, C. Mitchell, and C. Wood, “Traditional practices and exposure to bodily fluids in Lusaka, Zambia,” Tropical Medicine and International Health, vol. 12, no. 1, pp. 150–155, 2007.
[12]  G. J. P. van Griensven, E. C. Boucher, and R. A. Coutinho, “Oro-anal sex and the occurrence of Kaposi's sarcoma,” Genitourinary Medicine, vol. 69, no. 1, pp. 77–78, 1993.
[13]  E. A. Engels, J. O. Atkinson, B. I. Graubard et al., “Risk factors for human herpesvirus 8 infection among adults in the United States and evidence for sexual transmission,” Journal of Infectious Diseases, vol. 196, no. 2, pp. 199–207, 2007.
[14]  M. A. Eltom, S. M. Mbulaiteye, A. J. Dada, D. Whitby, and R. J. Biggar, “Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria,” AIDS, vol. 16, no. 18, pp. 2473–2478, 2002.
[15]  L. Lavreys, B. Chohan, R. Ashley et al., “Human herpesvirus 8: seroprevalence and correlates in prostitutes in Mombasa, Kenya,” Journal of Infectious Diseases, vol. 187, no. 3, pp. 359–363, 2003.
[16]  C. Henke-Gendo and T. F. Schultz, “Transmission and disease association of Kaposi's sarcoma-associated herpes virus: recent developments,” Current Opinion in Infectious Diseases, vol. 17, no. 1, pp. 53–57, 2004.
[17]  O. Bagasra, D. Patel, L. Bobroski et al., “Localization of human herpesvirus type 8 in human sperms by in situ PCR,” Journal of Molecular Histology, vol. 36, no. 6-7, pp. 401–412, 2005.
[18]  A. Dupuy, T. Schulz, S. Chevret et al., “Asymmetrical transmission of human herpesvirus 8 among spouses of patients with Kaposi sarcoma,” British Journal of Dermatology, vol. 160, no. 3, pp. 540–545, 2009.
[19]  T. B. Campbell, M. Borok, B. Ndemera et al., “Lack of evidence for frequent heterosexual transmission of human herpesvirus 8 in zimbabwe,” Clinical Infectious Diseases, vol. 48, no. 11, pp. 1601–1608, 2009.
[20]  P. Monini, L. de Lellis, M. Fabris, F. Rigolin, and E. Cassai, “Kaposi's sarcoma-associated herpesvirus DNA sequences in prostate tissue and human semen,” The New England Journal of Medicine, vol. 334, no. 18, pp. 1168–1172, 1996.
[21]  P. K. S. Chan, W. H. Li, M. Y. M. Chan, and A. F. B. Cheng, “Detection of human herpesvirus 8 in cervical cells of Chinese women with abnormal Papanicolaou smears,” Clinical Infectious Diseases, vol. 29, no. 6, pp. 1584–1585, 1999.
[22]  A. F. Audouin, P. Lopes, and Y. Lenne, “Kaposi's sarcoma of the uterine cervix and atypical condyloma in a female patient with a heart transplant (during the postpartal period),” Archives d'Anatomie et de Cytologie Pathologiques, vol. 36, no. 5-6, pp. 226–228, 1988.
[23]  S. B. Rajah, J. Moodley, D. J. Pudifin, J. Duursma, and K. Cooper, “Kaposi's sarcoma associated with acquired immunodeficiency syndrome presenting as a vulval papilloma. A case report,” South African Medical Journal, vol. 77, no. 11, pp. 585–586, 1990.
[24]  M. A. Macasaet, A. Duerr, W. Thelmo, S. D. Vernon, and E. R. Linger, “Kaposi sarcoma presenting as a vulvar mass,” Obstetrics and Gynecology, vol. 86, no. 4, pp. 695–697, 1995.
[25]  R. M. Riggs and J. McCarthy, “Vulvar Kaposi's sarcoma in a woman with AIDS: a case report,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 50, no. 9, pp. 730–732, 2005.
[26]  B. W. Laartz, C. Cooper, A. Degryse, and J. T. Sinnott, “Wolf in sheep's clothing: advanced kaposi sarcoma mimicking vulvar abscess,” Southern Medical Journal, vol. 98, no. 4, pp. 475–477, 2005.
[27]  K. H. Kim, J. I. Choi, K. H. Ryu et al., “Primary classic Kaposi's sarcoma of the penis in an HIV-negative patient,” Korean Journal of Urology, vol. 51, no. 11, pp. 803–806, 2010.
[28]  G. Wamburu, E. J. Masenga, E. Z. Moshi, P. Schmid-Grendelmeier, W. Kempf, and C. E. Orfanos, “HIV—associated and non—HIV associated types of Kaposi's sarcoma in an African population in Tanzania. Status of immune suppression and HHV-8 seroprevalence,” European Journal of Dermatology, vol. 16, no. 6, pp. 677–682, 2006.
[29]  O. W. Mwanda, P. Fu, R. Collea, C. Whalen, and S. C. Remick, “Kaposi's sarcoma in patients with and without human immunodeficiency virus infection, in a tertiary referral centre in Kenya,” Annals of Tropical Medicine and Parasitology, vol. 99, no. 1, pp. 81–91, 2005.
[30]  K. M. Chu, G. Mahlangeni, S. Swannet, N. P. Ford, A. Boulle, and G. Van Cutsem, “AIDS-associated Kaposi's sarcoma is linked to advanced disease and high mortality in a primary care HIV programme in South Africa,” Journal of the International AIDS Society, vol. 13, no. 1, article 23, 2010.
[31]  J. A. Gordon, “Kaposi's sarcoma: a review of 136 Rhodesian African cases,” Postgraduate Medical Journal, vol. 43, no. 502, pp. 513–519, 1967.
[32]  K. M. O'Connell, “Kaposi's sarcoma: histopathological study of 159 cases from Malawi,” Journal of Clinical Pathology, vol. 30, no. 8, pp. 687–695, 1977.
[33]  G. Slavin, H. M. Cameron, and H. Singh, “Kaposi's sarcoma in mainland Tanzania: a report of 117 cases,” British Journal of Cancer, vol. 23, no. 2, pp. 349–357, 1969.
[34]  S. M. Bluefarb, Kaposi's Sarcoma, Charles Thomas, Springfield, Ill, USA, 1957.
[35]  E. Katongole-Mbidde, C. Banura, and M. Nakakeeto, “Diagnostic implications of genital Kaposi's sarcoma,” East African Medical Journal, vol. 66, no. 8, pp. 499–502, 1989.
[36]  A. Z. Mohammed, E. J. C. Nwana, and A. N. Manasseh, “Changing patterns of Kaposi's sarcoma in Nigerians,” Tropical Doctor, vol. 35, no. 3, pp. 168–169, 2005.
[37]  M. B. Kagu, H. A. Nggada, H. I. Garandawa, B. H. Askira, and M. A. Durosinmi, “AIDS-associated Kaposi's sarcoma in Northeastern Nigeria,” Singapore Medical Journal, vol. 47, no. 12, pp. 1069–1074, 2006.
[38]  W. Phipps, F. Ssewankambo, H. Nguyen et al., “Gender differences in clinical presentation and outcomes of epidemic kaposi sarcoma in Uganda,” PLoS ONE, vol. 5, no. 11, Article ID e13936, 2010.
[39]  S. R. Long, M. J. Whitfeld, C. Eades, J. E. Koehler, A. P. Korn, and C. J. Zaloudek, “Bacillary angiomatosis of the cervix and vulva in a patient with AIDS,” Obstetrics and Gynecology, vol. 88, no. 4, pp. 709–711, 1996.
[40]  J. L. Urquhart, A. Uzieblo, and S. Kohler, “Detection of HHV-8 in pyogenic granuloma-like kaposi sarcoma,” American Journal of Dermatopathology, vol. 28, no. 4, pp. 317–321, 2006.

Full-Text

comments powered by Disqus