Deep Fungal Infection in Japanese AIDS Cases

• Published in: Nihon Ishinkin Gakkai zasshi Vol. 35; no. 3; pp. 225 - 231
• Main Authors: Koike, Morio, Takizawa, Touichirou, Funata, Nobuaki, Hishima, Tunekazu, Igari, Touru, Sakoma, Takaaki, Kawamura, Touru
• Format: Journal Article
• Language: English
• Published: The Japanese Society for Medical Mycology 1994
• Subjects: AIDS; deep fungal infection; HIV-encephalopathy; opportunistic infection; secondary malignancy
• ISSN: 0916-4804; 1882-0476
• DOI: 10.3314/jjmm.35.225

The pathology of AIDS is classified into three major categories; HIV-related lesions such as lymph node lesion and HIV-encephalopathy, opportunistic infection, and secondary malignancies such as Kaposi's sarcoma and malignant lymphoma. Thirty five autopsy cases of AIDS among Japanese 33 males and two were females, were analysed. Among risk factors, 22 homosexuals, nine hemophiliacs, two heterosexuals and one blood transfusion were found. One was of unknown risk factor, and there were no intravenous drug abusers. Opportunistic infection was one of the major clinical symtoms and specifically related to the direct cause of death. Among opportunistic pathogens cytomegalovirus was the most frequent involving various organs, such as adrenals, lungs and brain. The second most frequent was Pneumocystis carinii (PC) which was found in 15 cases. Two of these 15 cases showed pneumothorax due to cystic transformation of PC pneumonia caused by interstitial infection of PC and thrombosis of the pulmonary arterial branches with PC. As a deep fungus infection, Camdida spp. was the most frequent, accounting for five cases. Candida infection was found in the oral cavity, esophagus, lungs, and urinary bladder, and one case presented systemic dissemination. Cryptococcosis, aspergillosis and nocaridiosis were found in two cases, respectively. One case of cryptococcosis was disseminated, while the other was only localized in the lung with mild foreign body giant cell reaction. Conidiophores were demonstrated histologically in one aspergillosis in a man who had been operated on for lung cancer. One case of nocardiosis showed contiguous infection of the mediastinum and pericardium from the right upper lobe, the other showed conspicuous pneumonia of the left upper lobe associated with dissemination in left lower lobe and right lung. Each case of deep fungal infection was associated with other pathogens, and some were associated with secondary malignancies or HIV-encephalopathy. Such a complex combination of various lesions is the most typical of AIDS, causing complex and severe clinical symptoms.