Quantitative pathology of coccidioidomycosis in acquired immunodeficiency syndrome.

This study examines the laboratory aspects of diagnosis of coccidioidomycosis in 11 patients with acquired immunodeficiency syndrome (AIDS) and the qualitative and quantitative differences between host responses of AIDS and non-AIDS patients who died with disseminated coccidioidomycosis. Material obtained at bronchoscopy confirmed the diagnosis of pulmonary coccidioidomycosis in 67% (6/9) of the patients. Patients with AIDS had a generally poor granulomatous response and statistically significantly increased numbers of spherules in lung tissue compared with non-AIDS patients. Neither antifungal therapy nor duration of clinical disease influenced the number of organisms present. The findings suggest a parallel between AIDS-associated coccidioidomycosis and other granulomatous diseases such as leprosy and schistosomiasis, in which the type of granuloma formation and organism numbers are influenced by the T-lymphocyte milieu.

Pathology quiz case

Residents and fellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced and in triplicate. Photomicrographs and illustrations must be clear and submitted as positive color transparencies (35mm). Do not submit color prints unless accompanied by original transparencies. If photomicrographs are not available, the actual slide from the specimen will be acceptable. Material should be accompanieed by the required copyright transfer statement, as noted in Instructions for Authors. Material for the RESIDENT´S PAGE should be submitted to Joseph F. Walter, MD, Division of Dermatology, University of California Medical Center, San Diego, CA 92103. Reprints are not available. Funds for the color reproductions are provided in part by Neutrogena Dermatologics, Los Angeles.