PATHOMORPHOLOGICAL FEATURES OF CRYPTOCOCCOSIS OF THE LUNGS AND CNS IN CASE OF HIV-INFECTION/AIDS

Abstract

Background. Cryptococcosis is an important opportunistic infection that most commonly presents with meningitis or meningoencephalitis, especially in HIV-infected patients. Pulmonary disease is less common but is probably underdiagnosed because of the nonspecific nature of symptoms or the increased frequency of other pulmonary opportunistic infections.
 Aim: to investigate the pathomorphological features of cryptococcal lesions of the lungs and central nervous system in case of HIV infection/AIDS.
 Materials and methods. Pathomorphological examination was carried out on the autopsy material. HIV infection was diagnosed in the patients during life with serological verification and the patients were registered at the AIDS Center. Ziehl-Neelsen staining, and PAS reaction were used to detect cryptococci in lung and brain tissue. Standard histological preparations were examined under a microscope to clarify or establish the following data: the presence of cryptococci (both encapsulated and non-encapsulated), their localization and density, the presence of an inflammatory infiltrate and its severity.
 Results. The histopathology of lung lesions in cryptococcosis is characterized by the presence of granulomas with numerous cryptococci and a lympho-macrophagic reaction with multinucleated cells of the Langhans type. The total number of cryptococci in the field of vision (x400) is moderate to significant, their dissemination is uneven, localization is in the interstitium and among the inflammatory infiltrate, cryptococci are round in shape, including encapsulated, some deformed. Cryptococcosis of the brain in case of HIV infection/AIDS was characterized by the accumulation of numerous cryptococci in the expanded perivascular space and among the inflammatory infiltrate in meninges of the brain and cerebellum.
 Conclusion. Dissemination of cryptococcosis in the form of meningitis and meningoencephalitis is a prognostically unfavorable sign of the course of the disease. Cryptococcal lung disease was characterized by a polymorphic histological picture with the presence of an interstitial infiltrate and granuloma with multinucleated cells of the Langhans type and numerous cryptococci.