Fungal Lenfadenopatiler
Özet
Genel popülasyonda mantar enfeksiyonları çoğunlukla deriyle sınırlı kalırken; kronik hastalık, uzun süreli antibiyotik kullanımı, HIV/AIDS, malignite, kemoterapi ve iyatrojenik immünsüpresyon durumlarında mantarlar lenf düğümleri ve viseral organlara yayılabilmektedir. Fungal lenfadenitler sıklıkla granülomatöz ve nekrotizan inflamasyon paterni gösterir; kesin tanı ise PAS, GMS veya musikarmin gibi özel boyalarla mantar organizmalarının gösterilmesine dayanır. Bölümde özellikle Cryptococcus neoformans, Histoplasma capsulatum, Pneumocystis jirovecii ve Coccidioides immitis enfeksiyonları incelenmiştir. Kriptokok lenfadeniti özellikle ileri evre AIDS hastalarında görülür ve dar tabanlı tomurcuklanma yapan kapsüllü maya yapıları ile granülomatöz yanıtla karakterizedir. Histoplazmoz, retiküloendotelyal sistemi etkileyen yaygın enfeksiyonlarda lenf düğümlerini tutar ve hücre içinde 2–4 µm çapında, dar boyunlu tomurcuklanan mayalarla tanınır. Pneumocystis lenfadeniti nadir görülür ve genellikle yaygın enfeksiyonun bir parçasıdır; karakteristik köpüksü, eozinofilik eksüda içinde gümüş boyasıyla seçilen kistler içerir. Koksidioidomikoz lenfadeniti ise oldukça nadir olup, dokuda izlenen büyük sferüller ve endosporlar ile ayırt edilir. Tüm bu tablolarda ayırıcı tanıda tüberküloz, sarkoidoz, toksoplazma ve diğer granülomatöz/nekrotizan lenfadenitler dikkatle değerlendirilmelidir.
While fungal infections are mostly limited to the skin in the general population, fungi may disseminate to lymph nodes and visceral organs in conditions such as chronic illness, prolonged antibiotic use, HIV/AIDS, malignancy. Fungal lymphadenitis frequently presents with a granulomatous and necrotizing inflammatory pattern; definitive diagnosis relies on the histological demonstration of fungal organisms using special stains such as PAS, GMS, or mucicarmine. This section specifically examines infections caused by Cryptococcus neoformans, Histoplasma capsulatum, Pneumocystis jirovecii, and Coccidioides immitis. Cryptococcal lymphadenitis is particularly observed in patients with advanced AIDS and is characterized by a granulomatous response with encapsulated yeasts showing narrow-based budding. Histoplasmosis involves lymph nodes in disseminated infections affecting the reticuloendothelial system and is identified by intracellular yeasts measuring 2–4 µm in diameter with narrow-based budding. Pneumocystis lymphadenitis is rare and usually occurs as part of disseminated infection, featuring cysts highlighted by silver stains within a characteristic foamy eosinophilic exudate. Coccidioidomycosis lymphadenitis is exceedingly rare and is distinguished by the presence of large spherules and endospores in tissue. In all these entities, tuberculosis, sarcoidosis, toxoplasmosis, and other granulomatous or necrotizing lymphadenitides should be carefully considered in the differential diagnosis.
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