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Kaposi Sarcoma - Medical Malpractice
Kaposi sarcoma or KS was initially described by Moritz Kaposi, a Hungarian dermatologist, in 1872. It is what's known as a spindle cell tumour that shows up on the skin. It can then spread to other body areas, particularly in those who are immunosuppressed. It is related to a viral infection and, in many cases, this virus is HIV. Before the AIDS epidemic, the incidence was 0.1 in 100,000 cases. By 1981, Kaposi sarcoma became more common among homosexual men to the extent that about 40-50 percent of AIDS patients developed Kaposi sarcoma. The rate increased to 17.5 per 100,000 people but, with AIDS treatment, about 2.2 people per 100,000 get Kaposi sarcoma. The incidence in post-transplant patients is about 1 in 200 patients. There are about 2500 cases of Kaposi sarcoma noted yearly in the US at present. The highest incidence is in African American men. Kaposi sarcoma is common in central Africa and in the Mediterranean countries. It is more common in men.
AIDs-related Kaposi sarcoma tends to be aggressive but with more classic Kaposi sarcoma, there is a lesser aggressive course. In patients who receive the HAART treatment for AIDS, the disease is more indolent and doesn't tend to kill the person. The disease may actually go away completely.
Kaposi sarcoma is almost always associated with HIV infections in those exposed to the HIV virus and who are not treated with HAART (highly active anti retroviral therapy). Less than 2-3 percent of HIV infected patients will get Kaposi sarcoma. It is therefore considered an epidemic disease. It used to be the initial presenting finding in patients with HIV. Interestingly, there needs to be seroconversion to herpes virus 8 that brings on Kaposi sarcoma. It takes about 5-10 years after that to get Kaposi sarcoma after the seroconversion.
Doctors can predict the possibility of getting Kaposi sarcoma by checking the CD4 cell counts in the bloodstream and the amount of HIV-1 within the patient. If the CD4 cell count drops to below 500 per microliter, there is a higher rate of getting Kaposi sarcoma. Cigarette smoking, interestingly, can be protective against the disease in HIV patients. Rich patients tend to get Kaposi sarcoma more often than poor patients, although the reason behind this is unknown. Those who are immunosuppressed tend to get Kaposi sarcoma at a greater rate when the immunosuppression is because of transplantation. The same is not true if the immunosuppression is congenital. It takes about 15-30 months in order to get Kaposi sarcoma after a transplant.
Classic Kaposi sarcoma is 15:1 ratio greater in men than in women and occurs in Mediterranean peoples. The age at the time of onset of the disease is 50-70 years old. It is often complicated by lymphedema and venous stasis. Up to a third of patients with this type of KS also develop some other type of cancer secondarily, most commonly non-Hodgkin's lymphoma. The disease is related to asthma, a history of allergies and infrequent bathing. Some patients have a history of topical use of steroids.
Endemic African KS occurs primarily in men. It can be seen in children and women as well. The individual does not have to be HIV positive. Since AIDS has reached Africa, however, the incidence has gone up about 20 fold. Doctors don't know whether the KS is associated with a local immunosuppression problem or if it is something in the soil, because those who get the disease don't often wear shoes.
Ninety percent of all biopsies of Kaposi sarcoma show evidence of HHV-8 in the lesions. Most doctors believe you need HHV-8 in order to cause the disease to occur. Almost all patients get skin lesions and many get multiple skin lesions. Some can get gastrointestinal lesions and pulmonary involvement.
Doctors diagnose a KS lesion by doing a biopsy that shows the lesion under the microscope. There may be lymph node involvement so doctors often do a lymph node biopsy in an attempt to stage the disease. A chest x-ray may show KS in the lungs as well.LEGAL HELPLINE: ☎ 855 804 7125