PNEUMOCYSTIS CHRONIOSEPSIS AS AN OPTION OF PNEUMOCYSTIS INFECTION PROGRESSION: CASE REPORT

Abstract

Pneumocystis infection caused by Pneumocystis jiroveci tops the list of opportunistic infections, affecting mainly premature babies and people with various types of immunodeficiency disorders. Generalized forms of the disease in immunocompromised patients are extremely rare and do not have any pathognomonic symptoms, which often makes timely diagnosis and treatment difficult.
 The aim of the paper is to study clinical and morphological manifestations of generalized pneumocystosis and to clarify some aspects of its differential diagnosis as illustrated by an autopsy case.
 Materials and Methods. For histomorphological examination, autopsies of the liver, lung, pancreas, red bone marrow, brain, heart, and spleen were fixed in 10 % neutral formalin and embedded in paraffin. Sections of standard thickness were stained with hematoxylin-eosin; then histologic specimen were studied under a light microscope. The results of the histomorphological study were analyzed along with the medical history.
 Results. It has been shown that the following nonspecific clinical manifestations were specifically attributed to the generalized form of pneumocystosis: febrile fever, intoxication, non-productive cough, shortness of breath on little exertion, increased levels of hepatic transaminases, and leukocytosis. Histological manifestations included pneumocystis foci at different stages of development both in the parenchyma and in the interstitium of many internal organs, such as the liver, kidneys, spleen, brain, red bone marrow, lungs, and uterus. The preservation of the organ histoarchitectonics depended on the number of pneumocystis foci and the degree of organ damage.
 Conclusion. The generalized form of pneumocystis infection is very rare and it can be combined with other concomitant diseases. Moreover, it is characterized by a long asymptomatic period and complexity of laboratory diagnostics, so its mortality constantly increases. Generalized form of pneumocystis infection should be differentiated from acute respiratory diseases, cytomegalovirus infection, mycoplasmosis, chlamydia, toxoplasmosis, tuberculosis, sarcoidosis, neoplastic diseases, lymphogranulomatosis, and collagenoses, where the most precise methods are ELISA, indirect immunofluorescence test, immunofluorescence test, and PCR.