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Query: UMLS:C0019693 (HIV)
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About half of the general population harbors Candida species in oral flora, and oral candidal infections are common. However, in immunocompromised or immunosuppressed patients, candidiasis may progress to life-threatening systemic disease. Patients with human immunodeficiency virus (HIV), acquired immunodeficiency syndrome, HIV disease, diabetes, or leukemia are particularly prone to serious systemic infection. Chemotherapy for cancer and bone marrow and organ transplantation also provide physiologic opportunities for candidal colonization. Topical therapy has the potential to prevent and treat candidiasis with less risk of side effects and drug interactions than systemic therapy. Among the effective topical agents are polyene antifungal antibiotics and imidazole compounds. Some of these agents have been found useful in prevention of serious candidal infection in high-risk patients; however, more study is needed in this area.
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PMID:Oral and pharyngeal candidiasis. Topical agents for management and prevention. 264 72

Fungal and mycobacterial infections are among the most common opportunistic infections in patients infected with human immunodeficiency virus (HIV). Candida infections are the bell-wether of progression to symptomatic HIV infection and candida oesophagitis often marks the onset of the acquired immunodeficiency syndrome (AIDS). More than 80% of AIDS patients have candida disease. Candida infections remain local and respond to treatment but tend to recur. Cryptococcal infections initially affect few HIV positive patients but involve 10-30% with AIDS. Meningitis is the usual presentation and dissemination is common. Amphotericin usually produces improvement but cure is infrequent, and maintenance therapy is advisable. Mycobacteria cause intracellular infections increasing in parallel with immunodeficiency. Mycobacterium avium-intracellulare is predominant, occurring with other opportunistic pathogens causing systemic and local symptoms with high bacterial density in infected cells. Multidrug treatment is best, but the results are disappointing. Tuberculosis is prevalent in certain groups of patients. It often presents with atypical clinical and pathological features. Anti-tuberculous treatment is effective and prophylaxis should be considered. Endemic fungi with mycobacteria cause sporadic infections. Opportunistic infections are the lethal arm of HIV infection. Diligent diagnosis and persistent treatment offer benefit to HIV-infected patients.
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PMID:Fungal and mycobacterial infections in patients infected with the human immunodeficiency virus. 265 13

Central nervous system (CNS) involvement is very frequently observed in pediatric AIDS. Clinical manifestations include encephalopathy, cognitive deficits, acquired microcephaly, neurological signs, myelopathy, and peripheral neuropathy. Neurological complications can be related to opportunistic viral infections such as encephalitis, atypical aseptic meningitis, progressive multifocal leukoencephalopathy, and myelitis. Nonviral syndromes include: toxoplasmosis, cryptococcal meningitis, candidiasis, Mycobacterium tuberculosis meningitis, and Mycobacterium avium subacute encephalitis. Bacterial infections, tumors, cerebrovascular complications, and peripheral neuropathies are not frequently observed in pediatric AIDS. The most severe complications of HIV infection is encephalopathy resulting from HIV infection of brain tissue. Direct HIV invasion of the CNS has been demonstrated. Clinical features of HIV encephalopathy are classified into three categories: (1) normal neurological findings; (2) static encephalopathy; and (3) progressive encephalopathy. AIDS dementia complex can be differentiated from the predominance of behavioral and cognitive disabilities.
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PMID:Acquired immune deficiency syndrome in childhood. Neurological aspects. 268 79

Pediatric victims of AIDS virus infection continue to increase. The major source of transmission is by birth from an HIV-positive mother. Recognition is often difficult because of the varied and misleading signs and symptoms. Only a few studies describe oral manifestations in children and adolescents. The most common oral findings include candidiasis, parotid salivary gland enlargement and herpetic infections. Oral involvement may reflect early signs and symptoms of HIV-related immunosuppression.
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PMID:Oral manifestations of pediatric AIDS. 269 5

Oral candidosis is the manifestation of candidosis earliest described. In fact pertinent cases are already to be found in the corpus hippocraticum. Exactly 150 years ago a fungus was found in lesions of orogastrointestinal candidosis by the German surgeon Langenbeck. For a long time, there was much dispute on the proper term for the most important causative organism of thrush and correspondingly for the proper name of the diseases caused. Today, Candida albicans is accepted by virtually everybody and the discussion on the name of the disease only focuses on the terms candidiasis and candidosis of which the latter seems preferable. Facing the scientific progress in the field of Candida and candidosis research and the permanent change of both the causative organism and the corresponding disease in the age of the HIV-infection (AIDS), it seems rewarding to review epidemiology, microbiology, nosology and treatment of oral and gastrointestinal candidosis.
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PMID:International Workshop on Oral and Gastrointestinal Candidosis: From Pathology to Therapy. Introduction. 2720 70

To assess the relationship between oral lesions and antibodies to the human immunodeficiency virus, oral examinations of 803 homosexual males were conducted at the time of serologic testing. Nineteen percent were HIV seropositive. Thirty percent of antibody-positive subjects had one or more oral lesion(s), as compared with 7% of antibody-negative subjects (p less than 0.001). The presence of oral lesions was significantly associated with HIV seropositivity: a subject was 5.7 times as likely to have serum antibodies if he had one or more oral lesions (95% confidence interval, 3.5 to 9.1; p less than 0.001). This significant association with HIV seropositivity was only partially explained by cigarette smoking (adjusted odds ratio 3.1; 1.4-6.8; less than 0.006). Specific conditions that were significantly associated with seropositivity included candidiasis, hairy leukoplakia, periodontal disease, and Kaposi's sarcoma. Other diseases identified included acute necrotizing ulcerative gingivitis, mucocutaneous ulcerations, and oral warts. Oral findings may occur earlier in the natural history of infection than previously reported.
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PMID:Oral mucosal lesions: association with the presence of antibodies to the human immunodeficiency virus. 275 88

Between 1984 and 1987 (over two-and-a-half years) 30 hospitalized patients with HIV infections of different degrees of severity were ophthalmologically examined. Ocular involvement was found in 17 patients (approx. 57%). In 16 of these 17 patients with pathologic ophthalmologic findings (approx. 94%), AIDS was already fully developed. Ocular involvement is therefore a sign of poor prognosis. Fourteen patients had a microvascular retinal syndrome and four patients had infectious (chorio-)retinitis (causative organisms: cytomegalovirus in three cases, Cryptococcus neoformans in one). Further findings included sicca syndrome with superficial punctate keratitis in two cases, keratitis in one patient with generalized mucocutaneous candidiasis, Kaposi's sarcoma of the eyelids in two cases, Kaposi's sarcoma of the conjunctiva in one case, papilledema with cryptococcal meningitis in one case, and atypical hordeolum in one case. Morphologic and pathogenetic aspects of the ophthalmologic findings, their importance and course in AIDS patients, and therapeutic problems are discussed.
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PMID:[Eye involvement in AIDS]. 282 96

Seventy-one patients with oropharyngeal candidosis received treatment with fluconazole given as a single 50 mg capsule once daily. Of these patients 61 were HIV-antibody positive. Candidosis had been present in nearly all patients for a least one month prior to fluconazole treatment. The duration of daily therapy was 5-20 days and in many cases this was followed by a period of maintenance treatment using 50 mg fluconazole every 48 h. In all 42 symptomatic patients, clinical resolution of the infection occurred within 7 days. Significantly, this included the disappearance of dysphagia in four patients with proven candidal oesophagitis. A marked reduction, or eradication of oral yeasts occurred concomitantly in virtually all patients. Fluconazole was well tolerated by all patients and there were no significant changes in haematological or hepatic parameters that could be attributed to the drug. The results suggest that fluconazole is an appropriate treatment for oropharyngeal candidosis and comparative studies with other agents should now be conducted.
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PMID:Fluconazole in the management of oropharyngeal candidosis in a predominantly HIV antibody-positive group of patients. 283 59

The prevalence of oral colonization with Candida albicans was studied in 225 homosexual men, 99 of whom had HIV antibodies and in 175 heterosexual men. Oral candidal carriage was most prevalent among HIV seropositive homosexual men (77.8%). Rich growth of C. albicans in culture and findings of pseudomycelial elements in oral mucosal smear also correlated with HIV seropositivity. Pseudomycelial forms of C. albicans were demonstrated in mucosal smear from all patients with oral mucosal lesions suspected for candidiasis. However, 26/53 patients (49.1%) with positive smear had no clinical signs of oral candidiasis. The oral yeast flora was sampled twice in 85 homosexual men at an interval of 12-18 months. 71/85 patients (83.5%) were grouped into the same category of candidal colonization; carrier or noncarrier state, on both occasions. No statistically significant differences in numbers of CD 4 cells or CD 8 cells were observed between patients with respect to candidal colonization, when HIV seropositive and seronegative homosexual men were considered separately.
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PMID:Oral candida albicans in HIV infection. 295 72

Cutaneous manifestations of AIDS and AIDS-related complex were studied in a population of 1124 HIV seropositive patients at a hospital in Lusaka, Zambia. 115 of the patients had AIDS, and 1009 had AIDS-related complex. Drug eruptions occurred in 22 patients; 2 died of Stevens-Johnson syndrome subsequent to drug therapy for tuberculosis. The most frequently seen cutaneous manifestations were candidiasis, Kaposi's sarcoma, herpes zoster, seborrheic dermatitis, herpes genitalis, and papular dermatoses. The pruritic maculopapular eruption occurred in crops, healed, and recurred. It was one of the most unique dermatologic manifestations of AIDS found in Africa. Seborrheic dermatitis occurred frequently in patients who also had pulmonary tuberculosis.
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PMID:Cutaneous manifestations of human immunodeficiency virus in Lusaka, Zambia. 297 91


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