Reichart P A, Philipsen H P, Schmidt-Westhausen A, Samaranayake L P
Abteilung für Oralchirurgie und Zahnärztliche Röntgenologie, Germany.
J Oral Pathol Med. 1995 Jul;24(6):276-81. doi: 10.1111/j.1600-0714.1995.tb01182.x.
A light and electron microscopic investigation of pseudomembranous candidiasis in HIV infection was undertaken as there is little data available on the ultrastructural features of the invasive phase of Candida in this disease. On examination of biopsy specimens of four patients, histopathology revealed the classic features of superficial candidiasis, including hyphal penetration down to the spinous cell layer, parakeratosis, acanthosis and spongiosis of the infected, superficial epithelium. However, in one case, hyphae traversed the entire epithelium and crossed the basal membrane, invading the adjacent connective tissue. Ultrastructural investigations revealed initial hyphal penetration through the intercellular spaces, possibly demonstrating thigmotropism. However, hyphal penetration was not solely confined to intercellular spaces, as some specimens demonstrated hyphal elements traversing both the cytoplasm and the nuclei of the spinous cells. In these areas of the epithelium appressoria-like appendages were often found at the hyphal tip. These phenomena, commonly described in plant fungi, have rarely been described in human material. Pools of desmosomes were seen in the vicinity of the hyphal pathways, implying that the penetration procedure is associated with detachment and congregation of desmosomes, possibly by enzymatic means. Interestingly, the host immune response to fungal invasion appeared to be minimal, as no immune-effector cells were seen closely associated with either the blastospores or the hyphae in any of the tissues examined. Whether the foregoing events are exaggerated by the abortive immune response seen in HIV-infected patients, or common in immunocompetent individuals during candidal invasion of epithelia, needs to be ascertained by further studies.
由于关于HIV感染中念珠菌侵袭期超微结构特征的数据很少，因此对HIV感染中的假膜性念珠菌病进行了光镜和电镜研究。在检查4例患者的活检标本时，组织病理学显示了浅表念珠菌病的典型特征，包括菌丝向下穿透至棘细胞层、角化不全、棘层肥厚以及受感染浅表上皮的海绵形成。然而，在1例病例中，菌丝穿过了整个上皮并穿过基底膜，侵入了相邻的结缔组织。超微结构研究显示，最初菌丝通过细胞间隙穿透，这可能显示了向触性。然而，菌丝穿透并不局限于细胞间隙，因为一些标本显示菌丝成分穿过棘细胞的细胞质和细胞核。在上皮的这些区域，菌丝尖端经常发现类似附着器的附属物。这些现象在植物真菌中常见，在人体材料中很少被描述。在菌丝途径附近可见桥粒聚集，这意味着穿透过程可能与桥粒的分离和聚集有关，可能是通过酶促方式。有趣的是，宿主对真菌侵袭的免疫反应似乎很微弱，因为在所检查的任何组织中，均未发现免疫效应细胞与芽生孢子或菌丝紧密相关。上述事件是因HIV感染患者中出现的免疫反应失败而加剧，还是在念珠菌侵袭上皮期间在免疫功能正常的个体中常见，需要通过进一步研究来确定。
