Carmen Ardeleanu *, Sabina Zurac **, Anca Zaharia * *, Luciana Lavric **, Gianina Micu **,
Eliza Gramada **, Alexandra Vrabie **, R. Andrei **, Florica Stăniceanu *, A Streinu-Cercel ***
* Conf Dr. Carmen Ardeleanu, prof dr. Florica Stăniceanu – Departamentul de Anatomie Patologică, Institutul Victor Babeș
** Sabina Zurac, Anca Zaharia, Luciana Lavric, Gianina Micu, Eliza Gramada, Alexandra Vrabie, Răzvan Andrei – Serviciul de Anatomie Patologică, Spitalul Clinic Colentina
*** Prof. dr. Adrian Streinu-Cercel – Clinica de Boli lnfecțioase, lnstitutul de Boli Infecțioase “Matei Balș”
Abstract
Coccidioidomycosis is one of the AIDS defining disease. In persons with normal immune response, the Coccidioides imitis infection may be asymptomatic or it may be clinical manifest (unspecific clinical and radiologic modifications) in 1-3 weeks from exposure. The coccidioidomycosis in immunodepressed persons has a marked dissemina tion potential, the main associated risk factor being the grade of lymphopenia (CD4+ T cells less than 200-250 cells/mm3). Coccidioidomycosis in HIV infected patients is most often localized in lungs (80%) and it has an unfavorable prognosis (70% rate of deaths). The meningeal disease is frequent but most often it occurs during a coccidioi domycotic septicemia than a well established separate disease. The cutaneous coccidioidomycotic disease also most often occurs as a cutaneous dissemination in a systemic coccidioidomycosis.Confirming Coccidioides imitis as a pathogen can be accomplished by different means. The seric identification of the anticoccidioidin antibodies in HIV infected patients has limited diagnostic value. There are seronegative patients with histopathologic and/or culture proved coccidioidomy cotic septicemia (23-25% of the cases) or patients with positive results in the absence of any sign of the disease (37.5% of the patient developed active coccidioidomycosis in the following two years) – risk factor for active coccidi oidomycosis occurrence. The histopathologic examination offers information about the tissular lesions – chronic granulomatous foci with giant multinucleated cells and central suppuration with Coccidioides imitis spherules or, sometimes with central caseation (differential diagnosis with tuberculosis). The treatment of the coccidioidomycosis in HIV infected patients is mandatory due to the risk of dissemination and frequent unfavorable evolution.