Pathology of Deep Mycoses on Immunocompromised Host.
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概要
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A large body of deep mycoses, candidiasis, aspergillosis, cryptococcosis and mucor mycosis, had been increasing as opportunistic infections in Japan. The increasing number of patients and importance of establishing correct diagnostic procedures have been pointed out by those in medical mycology research; however, the pathogenesis of these mycoses, an essential aspect of each disease, remains unsolved.<BR>Histopathological characteristics of deep mycosis onset in immunocompromised hosts were determined from autopsy cases of renal candidiasis in leukemic patients, endogenous candidial endophthalmitis, pulmonary aspergillosis and human and experimental pulmonary cryptococcosis, and the histological examinations are reported in this paper. A close relation between white blood cell (WBC) counts and the characteristics was found in renal lesions in candidial infection, e. g. the lesions developed in leukopenic patients displayed by prominent hyphal growth of <I>Candida</I> spp. appearing to disperse radially from the center, and less apparent inflammatory cell infiltrates. In contrast, necrosis and polymorphonuclear cell infiltrates, encompassing invaded and proliferated yeasts, were observed in the lesions which developed in patients retaining a normal WBC count. In a comparison of cases of candidial endophthalmitis treated and untreated with antifungal agents, the chemotherapy appeared to have the ability to convert purulent inflammation into granulomatous inflammation as a characteristic of this disease. An observation using time-lapsed filming of the growth of <I>Aspergillus</I> on rat mesenterium showed the importance of leukocytes in peripheral blood in defending against fungal invasion. Furthermore, comparative study of pulmonary cryptococcosis in immunocompromised and immunocompetent hosts using human and experimental lesions revealed that the development of so-called cystic lesion, characterized by lack of infiltrating inflammatory cells, may be a result of depression of CD4+ cells.<BR>It was considered that these results attributed the varied inflammatory reactions to the manifestation of the defense mechanism of the host against the invaded fungi. If an attempt to provide the pathological characteristic of deep mycosis in immunocompromised hosts are required, it will be an inflammatory reaction without exudation.
- 日本医真菌学会の論文
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