Isolated and combined pneumocystosis of the pulmonary in patients with HIV infection according to the results of pathomorphological study

Puzyreva L.V., Sitnikova S.V., Tolokh I.M., Kuzovkin A.N., Zablotskaya E.A., Iovova N.I., Balabokhina M.V., Musin M.A.

Omsk State Medical University, Omsk
Clinical TB Dispensary No. 4, Omsk
Infectious Clinical Hospital No. 1 named after Dalmatov D.M., Omsk, Russia
Clinical Medical Unit No. 9, Omsk, Russia
Center for the Prevention and Control of AIDS and Infectious Diseases, Omsk, Russia

The most common opportunistic disease in patients with HIV infection is Pneumocystis pneumonia, diagnosis of which is not difficult, and treatment significantly reduces the risk of death.
Purpose of the study. To analyze the results of a pathomorphological study of the lungs with isolated pneumocystis and in combination with other lung diseases (bacterial, cytomegalovirus pneumonia and pulmonary tuberculosis) in patients with HIV infection.
Materials and methods of research. The results of pathomorphological studies of patients with HIV infection (n=141), who were previously observed in hospitals in the region: patients with pneumocystis pneumonia (n=24), with pneumocystis pneumonia and bacterial pneumonia (n=52), with pneumocystis pneumonia and pulmonary tuberculosis (n=56), with pneumocystis and cytomegalovirus pneumonia (n=9).
Results. At the time of death, 72.7% of patients with HIV infection had a viral load level of more than 300000, and 83.7% had a CD4+ lymphocyte level of less than 41 cells/μl. In all patients, treatment with trimethoprim/sulfamethoxazole was started too late.
A pathological examination of patients with HIV infection and isolated Pneumocystis pneumonia revealed changes characteristic of this disease. Nosocomial microorganisms were identified in patients with pneumocystosis and bacterial pneumonia. At autopsy in patients with HIV infection with Pneumocystis pneumonia and pulmonary tuberculosis, the picture of tuberculosis was varied, heterogeneous and significantly different from classic granulomatous inflammation. With combined damage to the lungs by pneumocystis and cytomegalovirus, foamy, vacuole-like granular masses (PCS-positive), accumulations of neutrophilic leukocytes were observed in the lumens of the alveoli, and single cells of the “owl’s eye” type were detected.
Conclusion. A pathological autopsy confirmed mixed infection in patients with HIV infection.