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

Records of 31 patients with cancer who did not have known human immunodeficiency virus infection and who developed culture-proven cryptococcosis during the period of 1989-1999 (incidence of 18 cases per 100,000 admissions) were retrospectively reviewed. Several presentations of cryptococcosis were seen, including pulmonary in 19 patients (13 of which were symptomatic), disseminated in 6, meningeal in 3, and other, less common manifestations in 3. Hematologic malignancy (in 20 patients [65%]) was the most common underlying disease. Lymphopenia was present in 19 patients (61%). Previous steroid use was noted in 16 patients (51%). The diagnosis of cryptococcosis was rarely suspected; lung and brain malignancy were frequent initial impressions. Cryptococcosis was diagnosed postmortem in only 2 cases (6%). In cases of both pulmonary and meningeal cryptococcosis, the yield of invasive diagnostic procedures was good. Antifungal treatment was heterogeneous, but only 18% of patients who received it had treatment failure. Fluconazole monotherapy was successful in 92% of patients. In conclusion, cryptococcosis is rare in patients with cancer and appears to have a relatively good diagnostic yield and therapeutic outcome.
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PMID:Cryptococcosis in patients with cancer. 1134 May 47

The case of an asymptomatic HIV-infected patient with abnormal cryptococcal serology is presented. Cryptococcal infection was detected through a routine serum cryptococcal antigen (titer of 1:256). A second examination revealed no overt clinical symptoms. This raises the question of whether HIV-positive patients should be routinely screened for cryptococcal infection. The test measures antigen rather than antibody, and is an accurate means of detecting active infection. False positive tests are uncommon, and occur only at relatively low titers. However, cryptococcal infection does not follow an easily predicted pattern. Cryptococcosis in HIV is probably the result of recent infection, with a delimited latent phase. Transmission is via respiratory route, so that the organism first infects the lungs or the hilar lymph nodes, then invades the systemic circulation, and finally circulates through the body prior to development of clinical meningitis. Unknown risk factors predispose five to ten percent of AIDS patients to contract cryptococcosis; the others remain uninfected. U.S. clinicians who do routinely screen for cryptococcal infection find that very few asymptomatic patients are positively diagnosed. Therefore, many feel that the screening of asymptomatic patients is cost-ineffective. In the case presented, the patient's titer was so high that it must be a real value. Treatment should begin as soon as possible for this patient and others like him in order to prevent the onset of full-blown meningitis or other end-organ disease. Fluconazole (400 mg/day) is sufficient to treat the infection.
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PMID:Abnormal cryptococcal serology in an asymptomatic patient. 1136 66

Vaginal candidiasis is an infection caused by a fungus. Normally found in the vagina, it usually has no symptoms but can cause problems when it grows uncontrollably. The infection can be caused by antibiotics or chronic illnesses, such as diabetes or HIV. Symptoms include a white discharge, irritation, and itching which can cause small lesions. A physician can perform a pelvic exam to diagnose candidiasis. Anti-fungal cremes, including nystatin, clotrimazole, micona zole, or suppositories used for one to two weeks can treat candidiasis. Chronic cases may require oral anti-fungal medications. Oral Diflucan is being studied for the prevention of oral and vaginal candidiasis.
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PMID:[Vaginal candidiasis]. 1136 36

Fungal infections are common in people with HIV/AIDS, especially among those with CD4+ counts below 200. PI-based regimens have reduced the prevalence of some fungal infections, by repairing the immune system and acting directly on some organisms, particularly the fungus Candida. Despite these advances, some people still develop these infections. Fluconazole, a popular anti-fungal drug, has been used to treat yeast and other fungal infections. Some of these fungi are developing resistance to the drug. However, once-weekly treatments with Fluconazole are generally adequate in preventing infections in those people who have not already had severe fungal infections.
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PMID:Fluconazole and fungal infections. 1136 31

Cryptococcus neoformans is the most common cause of fungal meningitis in HIV and non-HIV-infected patients. The organism has a worldwide distribution, with cases typically occurring among patients with well-recognized specific underlying disorders associated with dysfunction of cell- mediated immunity. While the therapy for disease was studied extensively in the 1970s and the 1980s among non-HIV-infected individuals, most of the recently published data have concerned therapy for central nervous system cryptococcosis in HIV-infected patients. As a result, the current approach to therapy for central nervous system cryptococcosis in the non-HIV-infected patient represents a hybrid of the established "gold standard," which includes at least 6 weeks of combination therapy with amphotericin B and 5-flucytosine, and the more contemporary regimen, which consists of 2 weeks of induction therapy with an amphotericin B-containing regimen followed by fluconazole. Clearly, well-designed prospective studies are needed to define the best approach to therapy in these patients, but until then, we must rely on the results of the existing clinical trials and carefully interpret the results of the available retrospective data. At present, amphotericin B (deoxycholate or lipid-associated) is recommended as initial therapy for all non-HIV-infected patients with proven or suspected cryptococcal meningitis. Fluconazole plays an important role in consolidation therapy and among selected patients who require long-term chronic suppression. The potential role of the newer triazoles (voriconazole and posaconazole) is undetermined.
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PMID:Therapy of Cryptococcal Meningitis in non-HIV-infected Patients. 1147 28

Cryptococcal meningitis, often seen in immunocompromised hosts, is also a disease of the immune-competent individual. The diagnosis of cryptococcal meningitis requires a lumbar puncture with measurement of the opening pressure, standard laboratory assessment including cell count, protein and glucose, fungal culture, and cryptococcal polysaccharide antigen. Serum cryptococcal antigen is of great diagnostic value in individuals infected with HIV. Hospital admission for initial therapy with amphotericin B desoxycholate is required. Adjuvant oral therapy with flucytosine for the first 2 weeks of therapy is strongly recommended. If flucytosine is not well tolerated, it may be discontinued with close monitoring and follow-up of cerebrospinal fluid (CSF) response to therapy. Good hydration and appropriate premedication concomitant to the use of amphotericin B are useful interventions preventing side effects. Occasionally, amphotericin B needs to be discontinued due to intolerance or side effects. After CSF sterilization is completed, therapy can be switched to oral fluconazole. Fluconazole is well absorbed orally. There is rarely a need to give intravenous fluconazole.
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PMID:Cryptococcal Meningitis. 1148 55

Mucocutaneous candidiasis is frequently one of the first signs of HIV infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole), have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles, itraconazole and fluconazole, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A concern in these patients is clinical relapse, which appears to be dependent on degree of immunosuppression and is more common following clotrimazole and ketoconazole than following fluconazole or itraconazole. Candida esophagitis is also of concern, since it occurs in more than 10% of patients with AIDS. Fluconazole is an integral part of the management of mucosal candidiasis. A cyclodextrin oral solution formulation of itraconazole has clinical response rates similar to fluconazole and is an effective alternative. In patients with fluconazole-refractory mucosal candidiasis, treatment options include itraconazole, amphotericin B oral suspension, and parenteral amphotericin B.
HIV Clin Trials
PMID:Therapeutic options for the management of oropharyngeal and esophageal candidiasis in HIV/AIDS patients. 1159 Apr 89

OBJECTIVES: Fluconazole-resistant oropharyngeal candidiasis (OPC) is a rapidly growing problem in HIV-infected patients. To better understand the pathogenesis of fluconazole resistance in this setting, asymptomatic candidal carriage was determined by means of oral swabs regularly performed in all patients without clinical signs of OPC seen at our HIV outpatient clinic. Controls were 204 asymptomatic healthcare workers without previous exposure to fluconazole. METHODS: Swabs were plated on three solid media and put in a Sabouraud broth. Phenotypically different colonies were identified to the species level. Susceptibility to fluconazole was determined using a disk diffusion test with 50 microg fluconazole disks on yeast nitrogen agar, with a cut-off value of 25 mm. RESULTS: Swabs were performed in 538 consecutive HIV-positive patients, of whom 216 (40%) had had prior episode(s) of OPC and/or were previously exposed to fluconazole. Yeasts were grown in 418/538 HIV-positive patients (78%), compared to 57/204 controls (28%) (p < 0.05). In HIV-positive patients, yeasts were grown in 189/216 (88%) of those with past fluconazole exposure, and in 229/322 (71%) without exposure (p < 0.05). A total of 589 isolates were grown in the 538 HIV-positive patients (451 C. albicans, 88 C. glabrata, 22 C. tropicalis, 11 C. krusei, and 17 isolates from 12 other species). Resistance to fluconazole was present in 121/589 (21%) Candida species isolates in HIV-positive patients and in 2/59 (3%) in controls. Among C. albicans isolates, there were 18 fluconazole-resistant strains in HIV-positive patients (4%) and none in controls.CONCLUSIONS: Using sensitive culture methods, oral yeast colonization was detected significantly more frequently in HIV-infected patients (78%) than in a control group of HIV-negative persons (28%). In addition, yeast colonization was quantitatively more important in patients with lower CD4+ lymphocyte counts and for those who had been exposed to fluconazole for episode(s) of OPC. Fluconazole-resistant C. albicans isolates were observed only in HIV-positive patients, and all patients (17/18) for whom this information could be ascertained had had prior exposure to fluconazole.
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PMID:Asymptomatic oral yeast carriage in HIV-infected patients: frequency and fluconazole susceptibility profile. 1186 74

All though extremely rare 10 years ago, antifungal drug resistance is becoming a major problem in certain populations, especially in those infected with HIV. This study was undertaken to study the resistance of Candida species isolated in our hospital to Fluconazole using Chrom agar Candida. The Candida strains which were routinely isolated from clinical specimens like blood, urine, sputum, pus, fluid and homograft isolates were included in the study. 142 Candida isolates were tested by using Chrom agar Candida incorporated with Fluconazole. 16 strains were found to be resistant to Fluconazole and 126 strains sensitive to Fluconazole. Nine were C. tropicalis, 3 C. krusei, 2 C. guillermondii, 1 Geotrichum candidum and one was an unidentified strain of Candida. The MIC of the 16 strains were done using RPMI 1640 medium by macro broth dilution method. MIC of 9 strains was 64 & > 64 ug/ml of 6 strains 32 ug/ml and 1 strain 16 ug/ml.
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PMID:Rapid identification of fluconazole resistance using Chrom agar Candida. 1202 18

This article reports on Pfizer's AIDS drug donation to South Africa. The donated drug, Diflucan, treats cryptococcal meningitis, a lethal brain infection that occurs in one out of 10 HIV patients. Its daily dose in South Africa costs about US$15, far more than poor people can afford. The HIV and AIDS Treatment Action Campaign, an advocacy group, had lobbied New York-based Pfizer for a year to reduce the drug's price. The donation offered hope among activists that other pharmaceutical companies would follow suit and offer HIV- and AIDS-related drugs at a discount or for free. After the announcement of the donation, the group is now lobbying Glaxo Wellcome, maker of Zidovudine. The group is asking to make the drug available for free to reduce the risk of vertical transmission. Glaxo Wellcome, however, has no plans of offering Zidovudine for free, although the drug was offered 75% cheaper in developing nations.
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PMID:Pfizer donates drug to South Africa's poor. 1229 55


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