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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Invasive fungal infections have emerged as major causes of morbidity and mortality in immunocompromised patients, particularly granulocytopenic and HIV-infected hosts. Diagnosis and treatment of these infections is determined by the type of fungus and the sites of infection. While Candida spp. and Aspergillus spp. are the most common causes of fungal infection in granulocytopenic patients, less common pathogens are emerging as new challenges. This article summarizes current approaches used in the National Cancer Institute's Pediatric Branch for management of invasive fungal infections.
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PMID:Management of immunocompromised patients with evidence of an invasive mycosis. 822 63

Fungal infections account for a large number of AIDS-index diagnoses and complicate the course of most patients with HIV disease. Infection with Cryptococcus neoformans is the most commonly encountered deep-seated fungal infection in AIDS and represents a major threat to HIV-infected people worldwide. Although most patients with cryptococcosis present with meningitis, pulmonary disease may occasionally dominate the clinical picture. Treatment of symptomatic pulmonary cryptococcosis remains amphotericin-B with or without 5-flucytosine. The toxicity and difficulty of administration of amphotericin-B has engendered interest in treatment alternatives with the new triazoles. As HIV infection has become more common in the American heartland, it has overlapped areas endemic for Histoplasma capsulatum, Coccidioides immitis, and Blastomycosis dermatitidis. Disease from these deep-seated fungal pathogens, whether from de novo exposure or reactivation, has protean manifestations. Common to all is a protracted, febrile, wasting illness, with or without respiratory symptoms. Treatment of choice for all these infections remains amphotericin-B, followed by lifelong-maintenance therapy with a triazole. In this article I review the microbiology, epidemiology, presentation, diagnosis, and treatment of AIDS-associated deep-seated fungal infections.
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PMID:Pulmonary fungal infections in HIV-infected persons. 827 79

Mycotic immunodiagnosis was performed in 325 patients with clinical evidence of systemic mycoses, over a 5-year period, from different hospitals of Mexico City. Results showed 168 individuals that presented one positive serological test to Histoplasma capsulatum antigens. From these, only 27 patients were serologically positive to two or more tests, such as tube precipitin, immunodiffusion, complement fixation, and ELISA, and developed signs and symptoms of a histoplasmosis clinically classified as primary pulmonary. Four of them presented an underlying disease including one positive HIV patient. Twenty-two came from endemic histoplasmosis zones of the country and most of them acquired the disease in caves or uninhabited houses. The diagnosis of histoplasmosis should be based on reliable laboratory data which could raise more significant information of its incidence in Mexico.
Mycoses
PMID:Retrospective serological study of histoplasmosis in Mexico. 831 58

HIV destroys the immune system, causing group of clinical signs which are referred to as AIDS. Some of these signs are cutaneous in nature. An acute rash on the trunk is associated with HIV seroconversion. It usually disappears in 8 days but can last for several hours or 30 days. Infectious manifestations of HIV infection are common. Candidiasis represents 90% of mycoses. It usually manifests on the tongue but can also occur on oral or genital mucosa. Antifungal medication usually treats it effectively. Yeastlike fungi cause seborrheic dermatitis, which is characterized by profuse inflammatory lesions resembling psoriasis. Topical and general antifungal medication do not effectively treat it. Dermacorticoids are more likely to be successful. Dermaphyte infections also occur HIV-infected persons. Organisms responsible for cutaneous profound mycoses, which tend to be rare but fatal, include Cryptococcus neoformans, Histoplasma capsulatum, sporotrichoses, scopulariopsis, and Pneumocystis carinii. Amphotericin B is the treatment of choice for manifestation of the first 2 organisms. Cutaneous viral infections in HIV-infected persons are caused by herpes simplex virus, herpes zoster, cytomegalovirus, Epstein Barr virus, Pox virus, and human papilloma virus. A patient who has had chronic cutaneous or mucosal herpes simplex infection for more than 1 month should be suspected of having HIV infection. Actclovir can treat herpes simplex infection, herpes zoster infection, and Epstein Barr virus (to make lesions disappear). Cytomegalovirus lesions are not specific. Cytomegalovirus infection is generally fatal. Cutaneous bacteria infections include banal infections (e.g., acne and folliculitis), syphilitic chancre lesions, and granulomatous tuberculosis. Protozoans and arthropods also cause cutaneous conditions in HIV-infected patients. Cutaneous neoplasms include Kaposi's sarcoma and other tumors (e.g., lymphomas). Other dermatoses are rare but may include psoriasis and toxidermia.
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PMID:[Cutaneous manifestations of AIDS]. 835 23

The incidence, aetiology and clinical significance of visceral mycoses in HIV-infected subjects were evaluated by a retrospective survey of the clinical and microbiological records of 237 consecutive AIDS patients followed-up since 1984. Seventy-four patients out of 237 (31.2%) (56 males, 18 females; 55 IV drug abusers, 7 heterosexuals, 6 homobisexuals, 3 blood recipients and 3 children with congenitally-acquired HIV infection) presented 77 different episodes of visceral fungal infection as a whole, represented by candidiasis in 56 cases (oesophageal 45, pulmonary 5, sepsis 2, eye involvement 2, endocarditis and invasive oropharyngeal infection in the remaining 2 patients), cryptococcosis in 17 cases (meningoencephalitis in all subjects, with disseminated infection in 11 of them), and aspergillosis in 4 cases (pulmonary 2, cerebral and cranio-facial in the remaining 2 patients). In 57 out of 74 patients (77%), visceral mycoses were diagnostic or concurrent with the diagnosis of AIDS. Fungal diseases, as a whole, showed a significantly higher incidence (p < 0.03) among drug abusers, whereas homobisexual men presented a significantly lower frequency (p < 0.001, chi-square test) than AIDS patients with other risk factors for HIV infection. The onset of cryptococcosis was significantly associated with the male sex (p < 0.005, Fisher exact test). All subjects suffering from a visceral mycosis were severely immunosuppressed, with a higher rate of neutropenia in patients developing Candida and Aspergillus spp. infection (23 out of 56 patients with visceral candidiasis and 3 out of 4 cases of aspergillosis had an absolute neutrophil count lower than 1500 cells/mm3), while a severe reduction in CD4+ lymphocyte count was more evident among patients with cryptococcosis (13 out of 17 patients had a CD4+ cell count lower than 50/mm3). After remission of the primary episode of fungal infection (obtained in 80.5% of cases), the incidence of relapse observed in a long follow-up period (mean time 57.6 +/- 39.2 weeks) was elevated both for patients with cryptococcosis (7 cases out of 17) and subjects with candidiasis (19 cases out of 53), with no significant difference among patients receiving a secondary prophylaxis or not (22 relapses observed in 53 patients treated with maintenance antifungals versus 4 episodes in 8 patients followed for a comparable mean time with no antimycotic treatment). Fifty-two out of 74 patients (70.3%) have died up to now; in 21 of them death was due to or associated with the visceral mycosis (cryptococcosis in 11 cases, candidiasis in 8, aspergillosis in 2).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The incidence, etiology and clinical significance of visceral mycoses in patients with AIDS]. 841 30

Disseminated histoplasmosis is an AIDS-defining illness that occurs in about 5% of AIDS patients residing in histoplasmosis-endemic areas of the United States (the Mississippi and Ohio river valleys). This disease develops as a result of acute infection and perhaps also as the result of reactivation of latent infection: cases reported from areas such as New York City, where histoplasmosis is not endemic, are most likely due to reactivation of an infection acquired earlier in a histoplasmosis-endemic area, while cases in histoplasmosis-endemic areas are most likely due to acute infection, especially in outbreak settings. Disseminated histoplasmosis in HIV-infected patients is usually associated with advanced immunosuppression, with CD4+ lymphocyte counts of < 75/mm3. Currently, histoplasmin skin testing of HIV-infected patients does not seem to be useful in detecting previous exposure and therefore is not helpful in identifying groups of patients who are at risk for dissemination and who should be targeted for preventive efforts. The current public health recommendation for HIV-infected patients is to avoid exposure to sites likely to harbor high levels of Histoplasma capsulatum, such as chicken coops and bird roosts. The role of chemoprophylaxis is not clear, but an ongoing study by the Mycoses Study Group is evaluating the role of prophylactic itraconazole. If strategies for the prevention of disseminated histoplasmosis in HIV-infected patients are to be improved, studies must better define the risk factors for this opportunistic infection, describe its natural history, and develop more reliable tests to predict its development.
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PMID:Disseminated histoplasmosis in persons infected with human immunodeficiency virus. 933 47

Exophiala jeanselmei and Mycobacterium chelonae were isolated from cutaneous nodules in a 73-year-old man with mycetoma of the right lower leg. Further evaluation revealed CD4+ lymphocytopenia without evidence of HIV infection. Antibodies to HIV 1/2, p24 antigen and HIV 1/2 (PCR) and reverse transcriptase activity were not detectable. The patient was not a member of any HIV risk group. He had not previously undergone therapy or suffered from immunodeficiency. This case clearly demonstrates that infections with opportunistic moulds and/or atypical mycobacteria should be taken into consideration not only in patients with classical immundeficiency diseases but also in apparently healthy patients because infection with these agents can be the first sign of underlying immunodeficiency.
Mycoses
PMID:Mycetoma due to Exophiala jeanselmei and Mycobacterium chelonae in a 73-year-old man with idiopathic CD4+ T lymphocytopenia. 855 88

At various clinics of IRCCS S. Matteo Hospital, Pavia, Italy, 269 blood cultures recovered from immunocompromised patients over 4 years have been examined mycologically. Of the 269 cultures, 101 were from HIV-infected patients and five were from cardiac transplant recipients. Of the total examined 96 blood cultures were positive (36%). The most frequent genus was Candida: C. albicans (48%), C. tropicalis and C. parapsilosis (8% each), C. glabrata and C. guillermondii (3% each). Cryptococcus neoformans was detected in 21 patients (22%).
Mycoses
PMID:Fungaemia in hospitalized patients. 856 14

Mycotic complications were registered in 21 out of 37 HIV-infected subjects. Oropharyngeal candidiasis was most common. It occurred prior to or concurrently with esophageal and skin candidiasis, fungemia, meningoencephalitis and disseminated lesions. With immunodeficiency progression, the prevalence and severity of mycosis go up. The causing fungi vary in great range: Candida albicans, Candida krusei. Candida tropicalis, Candida pseudotropicalis, Candida parapsilosis. Cryptococcus neoformans, Rhodotorula rubra, Penicillium chrysogenum.
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PMID:[The clinical picture of mycotic complications in HIV-infected patients]. 857 7

Thirty autopsies performed on infants and children with HIV infection and/or AIDS were reviewed for the presence and type of infection. Twenty-six (87%) demonstrated evidence of infection in addition to HIV at the time of postmortem examination. Pathogenic bacterial infectious were the most frequently encountered, seen in 15 of the cases. Nine of the 15 (60%) were due to gram-negative rods, most commonly Pseudomonas aeruginosa. Infections with gram-negative organisms often involved multiple organ systems and were frequently undiagnosed both pre- and postmortem because of variability in culture results and difficulties in identification both clinically and in tissue sections. Discussion is presented of unusual staining characteristics and filamentous morphology found with these pathogens. Other pathogenic bacteria encountered were Klebsiella pneumoniae, Escherichia coli, Enterobacter sp., and Staphylococcus. Fungal infections due to Candida species were present in nine cases (31%) but were invasive in only two of these. One instance of Aspergillus meningo-encephalitis was noted. Proven viral infections were present in five children (three cytomegalovirus, one herpes simplex, and one adenovirus). Pneumocystis carinii pneumonia was diagnosed in five of the patients (17%), and one instance of disseminated Mycobacterium avium-intracellulare was encountered.
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PMID:Infections in children with human immunodeficiency virus/acquired immunodeficiency syndrome: an autopsy study of 30 cases in south Florida, 1990-1993. 859 14


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