PATHOMORPHOLOGICAL CHARACTERISTICS OF CRYPTOCOCCOSIS OF THE LUNGS AND KIDNEYS IN CASE OF HIV INFECTION/AIDS

Abstract

Background. The article presents the results of a retrospective analysis of twenty fatal cases of patients with HIV infection/AIDS and combined cryptococcosis. In the course of the research, presence, number and localization of fungal cells, morphological features, as well as the nature and expressiveness of the inflammatory cellular reaction in the tissues of the lungs and kidneys were determined, and a clinical and morphological comparison of the obtained results was carried out. The pathomorphological characteristics of kidney and lung damage are polymorphic, represented by multiple areas of necrosis, in some cases, by an inflammatory cell reaction in the form of granulomatous inflammation, as well as an cryptococci accumulation. The macroscopic picture is not very specific, which makes it necessary to carry out not only routine histological, but also additional histological diagnostic methods. In all cases, the cryptococcal lesion was generalized against the background of pronounced immunodeficiency. The nature and expressiveness of pathological changes depends on numerous factors, the leading ones of which are the level of immunosuppression, etiotropic therapy, and the duration of the disease. The purpose of the work is to assess and characterize the clinical and morphological characteristics of kidney and lung lesions in patients with cryptococcosis and HIV infection/AIDS.

Material and methods. Retrospective analysis of twenty fatal cases of patients with HIV infection/AIDS and combined cryptococcosis. A histological study was carried out using staining of tissue samples with hematoxylin and eosin.

Results. The pathomorphological pattern of lung and kidney damage is polymorphic. For cryptococcosis of the lungs, the predominance of capsule-less forms is more characteristic, which may be due to the primary affect that originates in the lungs, as an entrance gate, and the subsequent generalization of the infectious process. The average number of fungal cells per field of view was 90±9 for lung tissues with a ratio of encapsulated to non-encapsulated forms of 1:2±0.5. Granuloma formation was observed in 2 (10 %) of the investigated cases. For cryptococcosis of the kidneys, a special feature is the formation of pseudocysts with a massive accumulation of fungal tissues in their lumen. The average number of fungal cells per field of view was 50±10 with a ratio of encapsulated to non-encapsulated forms of about 1: 1±0.3. Alterative-necrotic changes also prevailed in kidney tissue samples in most of the studied samples.

Conclusions. Generalized cryptococcosis with damage to the lungs and kidneys in patients with HIV infection is observed with severe immunosuppression, the morphological picture is polymorphic, varying from pronounced alterative-necrotic changes to the formation of granulomas in isolated cases. Despite the fact that the leading cause of death is damage to the nervous system, the generalization of the infectious process leads to multiple organ failure, which should be taken into account in the context of thanatogenesis and when formulating a patho-anatomical diagnosis.