MORPHOLOGICAL VERIFICATION OF PULMONARY ASPERGILLOSIS

Aspergillosis of the lungs is an infectious disease caused by fungi of the genus Aspergillus, which can affect lung tissue, causing inflammation, necrosis and loss of function. This disease is becoming increasingly relevant due to the increasing number of patients with weakened immune systems, such as patients with chronic respiratory diseases (for example, COPD, asthma, etc.). The disease can occur in various forms, from acute and subacute to chronic and invasive, which makes diagnosis difficult and requires an individualized approach to treatment. Differential diagnosis of the pulmonary form of aspergillosis should be performed with tuberculosis, sarcoidosis, pneumonia (destructive forms), tumor processes and their metastases.

The article presents a clinical case of disseminated pulmonary aspergillosis in a woman, in which it became difficult to clinically diagnose the pathological process without morphological verification.

This clinical case shows that a pathologist should carry out a thorough morphological verification of the granulomatous process, taking into account clinical and laboratory data, radiation diagnostics and additional research methods, taking into account the peculiarities of the histological picture in each granulomatous disease. Differential diagnosis of granulomatous formations makes it possible to exclude other types of granulomatosis, in particular in tuberculosis, during histological examination of thoracobiopsy material. Timely morphological verification of the clinical diagnosis will make it possible to choose an adequate treatment strategy and assess the prognosis of the disease. Aspergillosis worsens the course of the underlying pathological process.

Aspergillosis of the lungs is a serious threat to health, especially among patients with weakened immune systems.

Early detection and accurate diagnosis of the disease play a key role in its successful treatment.

1. Gavrisjuk V.K., Krivec V.A. Aspergillez legkih: klinicheskie formy, diagnostika, lechenie. Ukrainskij pul'monologicheskij zhurnal. 2015; 4: 69-74.

2. Liskina I.V., Kuzovkova S.D. Aspergilloma. Mezhdunarodnyj medicinskij zhurnal. 2011; 4: 41-48.

3. Denning D., Cadranel J., Beigelman C. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur. Respir. J. 2016; 47: 4568. https://doi.org/10.1183/13993003.00583-2015

4. Denning D.W., Cadranel J., Beigelman-Aubry C., Ader F., Chakrabarti A., Blot S., Ullmann A.J., Dimopoulos G. Diagnosis and treatment of chronic pulmonary aspergillosis: clinical guidelines of European Society for Clinical Microbiology and Infectious Diseases and European Respiratory Society. Pulmonologiya. 2016; 26 (6): 657-679. https://doi.org/10.18093/0869-0189-2016-2-6-665-7679

5. Gerardi T., Cartellà A., Mombelli M., Christe A., Ogna A. Aspergillus et poumon [Aspergillus and the lung]. Rev. Med. Suisse. 2024; 20 (895): 2126-2129. https://doi. org/10.53738/REVMED.2024.20.895.2126

6. Gupta C., Das S., Dar S.A. Chronic pulmonary aspergillosis in patients with post-TB sequelae. Int. J. Tuberc. Lung. Dis. 2024; 28 (12): 600-602. https://doi.org/10.5588/ ijtld.24.0163

7. Jaggi T.K., Agarwal R., Tiew P.Y., Shah A., Lydon E.C., Hage C.A., Waterer G.W., Langelier C.R., Delhaes L., Chotirmall S.H. Fungal lung disease. Eur. Respir. J. 2024; 64 (5): 2400803. https://doi.org/10.1183/13993003.008032024

8. Jenks J.D., Salzer H.J.F., Hoenigl M. Improving the rates of Aspergillus detection: an update on current diagnostic strategies. Expert. Rev. Anti. Infect. Ther. 2019; 17 (1): 39-50. https://doi.org/10.1080/14787210.2018.155805 4

9. Matsumoto K., Goto M., Kamikokura Y., Takasawa K., Kobayashi N., Aoyama T., Murakami T., Kamikokura M., Ikechi Y., Kawahata T., Tanaka K., Takatori S., Fujishiro D., Okamoto K., Makino Y., Nishikawa Y., Takasawa A. Molecular and ultrastructural morphological analyses of highly metamorphosed Aspergillus fumigatus on human formalin-fixed paraffin-embedded tissue. Med. Mol. Morphol. 2024; 57 (4): 326-332. https://doi.org/10.1007/s00795024-00402-2

10. Costa-Pinto R, Bellomo R. COVID-19-associated pulmonary aspergillosis we should take an individualised approach with early treatment too. Intensive Care Med. 2024; 50 (12): 2231-2232. https://doi.org/10.1007/s00134024-07583-5

11. Stepanova A.A. Vasil'eva N.V. Aravijskij R.A. Borzova Ju.V. Jelektronno-mikroskopicheskoe izuchenie aspergilleza legkih cheloveka na primere arhivnogo biopsijnogo materiala. Problemy medicinskoj mikologii. 2014; 16 (3): 70-79.