Granuloma and cryptococcosis.
This review describes the general histopathological features of cryptococcosis in immunocompetent individuals, as well as in patients with acquired immunodeficiency syndrome (AIDS). Details of the histological examination of cryptococcal lesions are described, with the consideration of morphological modifications induced by treatment with highly active antiretroviral therapy (HAART). The essential histological features of cryptococcosis in individuals with impaired T-cell functioning are yeast-cell proliferation with a histiocytic response, but only minor lymphocytic and neutrophilic components. Several histological patterns of pulmonary cryptococcal lesions are introduced in this article, some of which could be graded with respect to the degree and type of inflammatory reaction. One pattern was a mild lesion consisting of scattered small foci of intraalveolar cryptococcal proliferation with a histiocytic response. Another pattern involved massive cryptococcal infection, which may have been simply more extensive than that in the mild lesion. Capillary involvement of alveolar septa should be understood as an important common finding in patients with AIDS who had not been treated with HAART. In those patients, the absence of T cells and a decreasing function of antigen-presenting activity in histiocytes were confirmed by immunohistological examination. These findings suggest that the lungs of AIDS patients without HAART offer little resistance to bloodstream dissemination by cryptococci. The unique histological feature demonstrated in patients treated with HAART is characterized by the presence of CD4+ cells, greater response of histiocytes and multinucleated giant-cell formation, and lack of massive capillary involvement.
Department of Pathology, Omori Hospital, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan. kaz@med.toho-u.ac.jp
Kazutoshi
K
Shibuya
Akiko
A
Hirata
Junko
J
Omuta
Miho
M
Sugamata
Susumu
S
Katori
Norihiko
N
Saito
Nozomu
N
Murata
Ayako
A
Morita
Keiji
K
Takahashi
Chikako
C
Hasegawa
Aki
A
Mitsuda
Tsutomu
T
Hatori
Hiroko
H
Nonaka
D017088:AIDS-Related Opportunistic Infections / Q000209:etiology / Q000473:pathology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000818:Animals; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D002196:Capillaries / Q000473:pathology; D003453:Cryptococcosis / Q000209:etiology / Q000473:pathology*; D003455:Cryptococcus neoformans; D015726:Giant Cells / Q000473:pathology; D006099:Granuloma / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000473:pathology; D013601:T-Lymphocytes / Q000473:pathology
D019380:Anti-HIV Agents