Page 156

TUBERCULOSIS
ETO YUNG IDRAWING

154

ETO YUNG HYDATID DSE. LEFT SIDE YUNG IDRAWING

With cryptococcal infection, there is a chronic meningitis affecting

the basal leptomeninges, which are opaque and thickened
by reactive connective tissue that may obstruct the outflow of
CSF from the foramina of Luschka and Magendie, giving rise
to hydrocephalus. Sections of the brain disclose a gelatinous
material within the subarachnoid space and small cysts within
the parenchyma (“soap bubbles”), which are especially prominent
in the basal ganglia in the distribution of the lenticulostriate
arteries (Fig. 28-28A). Parenchymal lesions consist of aggregates
of organisms within expanded perivascular (Virchow-
Robin) spaces associated with minimal or absent inflammation
or gliosis (Fig. 28-28B). The meningeal infiltrates consist
of chronic inflammatory cells and fibroblasts admixed with
PULMONARY ASPERGILLOSIS

the fungus may appear as a tangled mass

within the cavity. The organisms are identified by their
characteristic morphology— thin septate hyphae with
dichotomous branching at acute angles which stain positive
for fungal stains such as PAS and silver impregnation
technique (Fig. 17.15). The wall of the cavity shows chronic
inflammatory cells.

A fungus ball composed of blue-staining hyphal

elements of Aspergillus is seen here in a bronchus.
Fungus balls may also form when fungi colonize cavitary
lesions of tuberculosis.

CEREBRAL MALARIA

MORPHOLOGIC FEATURES. Parasitisation and destruction

of erythrocytes are responsible for major pathologic
changes as under (Fig. 7.11,B):
1. Malarial pigment liberated by destroyed red cells
accumulates in the phagocytic cells of the reticuloendothelial
system resulting in enlargement of the spleen
and liver (hepatosplenomegaly).
2. In falciparum malaria, there is massive absorption of
haemoglobin by the renal tubules producing blackwater
fever (haemoglobinuric nephrosis).
3. At autopsy, cerebral malaria is characterised by
congestion and petechiae on the white matter.
4. Parasitised erythrocytes in falciparum malaria are
sticky and get attached to endothelial cells resulting in
obstruction of capillaries of deep organs such as of the
brain leading to hypoxia and death. If the patient lives,
microhaemorrhages and microinfarcts may be seen in the
brain.
The diagnosis of malaria is made by demonstration of
malarial parasite in thin or thick blood films or sometimes
in histologic sections (Fig. 7.12).
: