CLINICAL CASE OF SIMULTANEOUS FLOW OF CYTOMEGALOVIRUS INFEC-TION AND PNEUMOCYSTOSIS WITH LUNG LESION IN HIV-INFECTED PA-TIENTS

Immunosuppression in HIV-infected patients is accompanied by activation of infection agents with the development of secondary HIV-associated opportunistic diseases, which most often affect the broncho-pulmonary system. Increasingly, cases of a combined course of several opportunistic infections are clinically recorded, which complicates their diagnosis [1]. The level of CD4 + in the blood is less than 200 cells per 1 ml - the limit below which the risk of multiple HIV-associated opportunistic infections increases several times. One of the probable co-infections is the development of cytomegalovirus pulmonitis and pneumocystic pneumonia with severe respiratory failure [2]. We reviewed 12 subjects in the Kyiv City AIDS Center who were on treatment of pneumocystic pneumonia among HIV-infected patients and selected 2 clinical cases with co-infection - pneumocystis and cytomegalovirus infections with lung disease. For histological study section material was used - bits of different parts of the lungs followed by usual histological treatment and staining micropreparations with hematoxylin and eosin. Microscopy of lung imprints was carried out in the bacteriological laboratory of the Kyiv City AIDS Center to verify the pathogens of pneumocystosis. Smears were prepared directly during autopsy with subsequent painting using the Romanovsky-Gimza method (ordinary and in the Walker modification). On the basis of the analyzed cases, we made the following conclusions. The combination of CMVI and pneu-mocystosis can lead to lung defeat with extremely severe course of disease, development of interstitial pneumonia, and fibrosing alveolitis. In addition, each of the infections can play the role of the leading agent-agent. Morphological picture of coinfection varies with such in the mono infectious process due to different degrees of severity of sclerotic changes, a wider range of inflammatory tissue reactions that can erase pathognomonic changes. In any case, the development of interstitial lung in-jury, especially in patients with severe immunosuppression, should be alert to possible co-infection. Because the clinical verification of one pathogen does not exclude the possibility of persistence of other opportunists. Since the microscopic methods of diagnostics under standard coloring techniques do not provide verification of the type of pneumocystosis, it is recommended, if necessary, to use immunohistochemical methods of dyeing biopsy, surgical material.