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Fungal Infection In Hiv Patient

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Fungal Infections Causes And Risk Factors

How Can We Prevent Fungal Infections? | Professor Neil A.R. Gow

Causes

Fungal infections occur when fungi come in contact with a person with decreased immunity levels, and the persons immune system is unable to fight the infection. Fungi spores travel easily through the air and can be inhaled to cause infections.

Risk Factors

There are certain people who are at an increased risk of fungal infections. These include:

  • People with a weak immune system, such as patients with AIDS, HIV, cancer, and diabetes and the elderly and small children.
  • People who are in regular contact with people experiencing fungal infections.
  • People who are frequently exposed to areas that breed fungi, such as common showers and locker rooms.
  • People who sweat profusely.
  • People who have a genetic condition that predisposes them to fungal infections.

What You Need To Know About Fungal Infections

Your CD4 count is important. Youre at greatest risk for fungal infection when your CD4 count is less than 200. Keeping your CD4 count above 200 may help you avoid serious illness.

Anti-retroviral therapy is important. Starting ART helps slow the progress of HIV and can reduce your chances of getting a fungal infection.

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal meningitis. Because of this, its important to seek treatment as soon as possible to try to avoid serious infection.

Fungal infections can look like bacterial or viral infections. If youre taking medicine to fight an infection and you arent getting better, ask your doctor about testing you for a fungal infection.

Where you live matters. Some disease-causing fungi are more common in certain parts of the world. If you have HIV/AIDS and live in or visit these areas, youre more likely to get these infections than the general population.1 For more information on travel related illnesses, please see the CDC Travelers Health site.

Your activities matter. Disease-causing fungi can be found in air, dust, and soil, especially soil that contains bird or bat droppings. Doing activities that disturb the soil, like gardening, cleaning chicken coops, construction, demolition, and visiting caves can cause you to inhale more fungi and increases your chance of infection.2

HIV/AIDS and Fungal Infections

United States
Global

Various Drug Interactions May Play A Role In The Success Of Anti

The coexistence of epidemics of HIV, tuberculosis and malaria and opportunistic infections, such as those found in Africa, make drug interactions unavoidable to a great extent . In one study, interactions involving nevirapine and ketoconazole revealed a 72% decrease in the ketoconazole concentration upon co-administration. The concurrent administration of fluconazole and nevirapine resulted in a 33% increase in nevirapine and thus was a probable cause of toxicity .

Most tuberculosis regimens include rifampicin, which is a potent inducer of cytochrome P450 enzymes. The concomitant administration of rifampicin with fluconazole has led to noteworthy changes in the pharmacokinetic parameters of fluconazole, including a 39% increase in its elimination rate constant and a 28% shorter elimination half-life in AIDS patients . Similarly, the concurrent administration of rifampicin with ketoconazole and itraconazole markedly reduces the serum concentrations of these anti-fungal drugs . In one study, two patients co-infected with HIV-tuberculosis on both anti-tubercular drugs and azoles were reported to present for several months with recurrent episodes of OPC despite the presence of susceptible Candida strains, which could be explained by the previously discussed drug interactions .

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People With Weakened Immune Systems

Opportunistic infections are infections that happen because a persons immune system is weakened. These illnesses can be caused by bacteria, viruses, or fungi. Many fungal infections are opportunistic infections.

Fungal infections can also happen in people without weakened immune systems

Fungal infections that are not life-threatening, such as skin, nail, or vaginal yeast infections, are common.

Some infections can be more serious. Lung infections like Valley fever or histoplasmosis can happen in people who live in or visit certain areas.

Microscopy Culture And Identification

Fungal infections in histopathology

Depending on the clinical symptoms and organ system involved, relevant clinical samples were collected with complete universal precautions. The samples were subjected to direct microscopy using Gram staining, KOH mounts, and India ink preparations, depending on the type of specimen and the suspected infection in the patient. Standard recommended procedures were used for diagnosis and isolation, which included a battery of tests .

Fungal culture was done on Sabouraud dextrose agar with chloramphenicol and with and without cycloheximide, blood agar, and brain heart infusion agar. Specimens were streaked in duplicate one set of inoculated slants was incubated at 25°C and the other at 37°C, and they were examined every other day for growth up to 46 weeks before discarding as negative. Samples inoculated on blood agar were incubated for 2448h and samples on brain heart infusion agar were incubated for 1-2 weeks . Fungal growth was identified by colony morphology, Gram staining, lactophenol cotton blue preparation, and Riddle’s slide culture as per standard recommended procedures . Identification and speciation of yeast isolates were done on the basis of germ tube production, morphology on corn meal agar with Tween 80 , HiCrome candida agar , carbohydrate fermentation tests, assimilation tests using yeast nitrogen base agar , and an automated Vitek-2 compact system as per standard recommended procedures.

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B What Is The Clinical Presentation Of Pneumocystis Pneumonia

The clinical presentation of PCP is non-specific and cannot reliably be distinguished from other infectious pulmonary processes. Typical symptoms include fever, dyspnea, and a cough that can be either non-productive or productive of scant sputum, but is rarely purulent. Although the disease can be fulminant, PCP in patients with HIV frequently presents with an indolent course. Patients may experience weeks of slowly progressive symptoms, including a sensation of chest discomfort or chest tightness and exercise intolerance. This is different from the presentation of PCP in medically immunosuppressed patients without HIV infection, which is more frequently acute and may rapidly progress to respiratory failure within days. Physical examination is also non-specific. Chest auscultation may reveal end-inspiratory crackles, but is frequently normal. Severe disease may be characterized by signs of acute respiratory failure. Hypoxemia is characteristic and can be mild , moderate , or severe .

What Weakens An Immune System

Some people are born with a weakened immune system. Others may have an illness that attacks the immune system such as HIV. Some medicines, like corticosteroids or cancer chemotherapy, can also lower the bodys ability to fight infections.

If you have a weakened immune system, you should be aware that fungal infections can happen. Learning about fungal infections can help you and your doctor recognize them early. This may help prevent serious complications.

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Calculating Fungal Disease Burden

Prevalence or incidence was calculated using data from published studies. Prevalence was calculated for allergic bronchopulmonary aspergillosis , severe asthma with fungal sensitisation , chronic pulmonary aspergillosis , recurrent vulvovaginal candidiasis , and tinea capitis and the remaining estimates were calculated as annual incidence. Due to paucity of data, we were not able to calculate both prevalence and incidence for each disease.

Candida Colonization And Cd4+ Cell Counts

Cryptococcus neoformans (And how it affects HIV/AIDS patients)

Several studies have shown a significant correlation between CD4+ T lymphocytes and Candida colonization. A lower count, especially below 200 CD4+ cells with or without statistical significance has been frequently associated with the increased occurrence of OPC . The Th17 cell functional subset within the CD4+ T cell lineage seems to be selectively depleted with the progression of HIV infection and appears to be the critical host determinant of the ability of C. albicans to overwhelm epithelial defenses and cause disease .

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Diagnosis Of Fungal Infections

Some fungal infections can be simply diagnosed by the signs and symptoms and do not require any tests, while others may require a biopsy. Here are some investigations that may be required: DermoscopyIt is an examination of the skin using skin surface microscopy. It does not involve any punctures or application of creams/lotions or other substances. It is used to diagnose several subcutaneous fungal infections.

Monitoring Of Response To Therapy And Adverse Events

For most patients with mucocutaneous candidiasis, response to antifungal therapy is rapid signs and symptoms improve within 48 to 72 hours. Short courses of topical therapy rarely result in adverse effects, although patients may experience cutaneous hypersensitivity reactions characterized by rash and pruritus. Oral azole therapy can be associated with nausea, vomiting, diarrhea, abdominal pain, or transaminase elevations. Periodic monitoring of liver function studies should be considered if azole therapy is anticipated for > 21 days, especially in patients with other hepatic comorbidities . The echinocandins appear to be associated with very few adverse reactions: histamine-related infusion toxicity, transaminase elevations, and rash have been attributed to these drugs. No dose adjustments are required in renal failure.

Immune reconstitution inflammatory syndrome with ART has not yet been reported for mucocutaneous candidiasis in patients with HIV infection. Indeed, ART is associated with a markedly reduced incidence of candidiasis.

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People Living With Hiv/aids

As a person living with HIV/AIDS, you have many opportunities for a healthy and full life. You may also have some health challenges. One of those challenges is avoiding infections.

Many fungal infections are called opportunistic infections, which means that they usually affect people with weak immune systems. Because HIV weakens the immune system, you have a greater chance of getting some types of fungal infections, like cryptococcosis, coccidioidomycosis, histoplasmosis, and pneumocystis pneumonia .

Does Cytomegalovirus Increase Death Risk In Covid Patients

Fungal infections in HIV/AIDS

Previously, the infection was seen in immunocompromised patients or transplant patients who have had liver or kidney transplants, but now it is being seen in patients suffering from Covid-19. Clearly, having some kind of an underlying condition can increase the risk of these complications.

CMV tends to complicate Covid pneumonia and increase the chances of complications, which can increase ventilated requirement and degree of oxygenation in hospitalized patients. Thus, increase the risk of complications and may up mortality rate in patients.

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Availability Of Data And Materials

All data generated or analyzed during this study is included in this published article. This is a case report based on a patient taken care of Hospital Giselda Trigueiro. Data was obtained from the patients chart. Signed consent was obtained for this case report. Evidence supporting the case report were obtained via PubMed.

How Pneumocystis Pneumonia Spreads

PCP spreads from person to person through the air.15-17 Some healthy adults can carry the Pneumocystis fungus in their lungs without having symptoms, and it can spread to other people, including those with weakened immune systems.8

Many people are exposed to Pneumocystis as children, but they likely do not get sick because their immune systems prevent the fungus from causing an infection.18 In the past, scientists believed that people who had been exposed to Pneumocystis as children could later develop PCP from that childhood infection if their immune systems became weakened.8,19 However, it is more likely that people get PCP after being exposed to someone else who has PCP or who is carrying the fungus in their lungs without having symptoms.

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Types Of Fungal Infections

Fungal infections are broadly divided into five types on the basis of their severity. The symptoms of these infections vary and have been listed in the appropriate sections. Invasive Fungal InfectionsInvasive fungal infections are very dangerous and require detailed investigations for diagnosis followed by immediate medical intervention. They affect people with weak immune systems, and it is extremely rare for a person with a healthy immunity to develop this infection.Some common invasive fungal infections are

  • Candidemia and invasive candidiasis
  • Pneumocystis pneumonia

Allergic Fungal InfectionsAllergic fungal infections involve the respiratory system. Most allergic infections are not severe and do not have a major impact on health. Some people are prone to multiple allergies, and the presence of certain diseases tends to increase allergies. Allergic tendencies show up early in life and may disappear with age.Some important allergic fungal infections are

  • Allergic bronchopulmonary aspergillosis
  • Severe asthma with fungal sensitization
  • Thunderstorm asthma
  • Allergic fungal rhinosinusitis

Chronic or Deep Tissue Fungal InfectionsDeep tissue fungal infections are difficult to treat and cause long-term infection. It is believed that genetic factors may also lead to chronic fungal infections.They usually occur due to a physical injury or due to the presence of certain diseases, such as

Some of the common deep tissue fungal infections are

Mucosal Infections

  • Athlete’s foot

When To Stop Secondary Prophylaxis

What is the black fungus infecting COVID-19 patients

In situations where secondary prophylaxis has been instituted, no data exist to guide recommendations regarding its discontinuation. Based on experience with other opportunistic infections, it would be reasonable to discontinue secondary prophylaxis when the CD4 count has increased to > 200 cells/mm3 following initiation of ART .

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Special Considerations During Pregnancy

Pregnancy increases the risk of vaginal colonization with Candida species. Diagnosis of oropharyngeal, esophageal, and vulvovaginal candidiasis is the same in pregnant women as in those who are not pregnant.

Itraconazole at high doses has been shown to be teratogenic in animals, but the metabolic mechanism accounting for these defects is not present in humans, so the data supporting this finding may not be applicable to human pregnancy. Case series in humans do not suggest an increased risk of birth defects with itraconazole,34 but experience is limited. Human data are not available for posaconazole however, the drug was associated with skeletal abnormalities in rats and was embryotoxic in rabbits when given at doses that produced plasma levels equivalent to those seen humans. Evidence is inconclusive or inadequate for determining fetal risk associated with voriconazole use during pregnancy. An association with cleft palate and renal defects has been seen in rats, as well as embryotoxicity seen in rabbits. Human data on the use of voriconazole are not available, so its use is not recommended. In animals, multiple anomalies have been seen with exposure to micafungin, and ossification defects have been seen with the use of anidulafungin and caspofungin.35 Human data are not available for these drugs, thus their use in human pregnancy is not recommended.

Fungal Disease Diagnosis Is Life Saver For Patients With Hiv And Aids

A fungal disease diagnostic and educational programme has had a transformational impact on the mortality of HIV patients in Guatemala, according to new research.

And the programme, say scientists at the Asociacion de Salud Integral in Guatemala City and The University of Manchester, will save lives in countries across the developing world if implemented.

The study is published in the Journal of Fungi and funded by The Global Action Fund for Fungal Infections.

The research team studied 2,127 Guatemalan HIV patients between the ages of 25 and 41 of which 385 – or 18% – had a life-threatening fungal infection or tuberculosis.

The Mayan ethnic group in Guatemala had a high rate of advanced HIV disease – 65% – and fewer were on antiretroviral therapy.

Histoplasmosis – caused by a fungus called Histoplasma – was the most frequent infection , followed by tuberculosis which is often confused with fungal disease – and cryptococcosis . Some patients had 2 or 3 concurrent infections.

Guatemala has a high incidence of the Histoplasma, which grows in soil and bat caves.

The team found that infection gave a 5-fold greater chance of dying however overall the program decreased mortality by 7%. This reduction was achieved by rapid diagnosis and earlier, appropriate treatment.

Without diagnostic and educational support, doctors, they argue, are more likely to base their diagnosis on guesswork often resulting in incorrect diagnosis.

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Treatment Of Fungal Infections In Older Adults

The indications for the use of antifungal agents for management of specific fungal infections are the same for older adults and younger individuals. For treatment options for each of the major fungal infections, the reader is referred to the recent treatment guidelines for fungal diseases of the Infectious Diseases Society of America .

When To Start Secondary Prophylaxis

Incidence rate of systemic fungal infections in HIV/ AIDS ...

A randomized clinical trial14 in patients with HIV infection with CD4 counts < 150 cells/mm3 documented significantly fewer episodes of oropharyngeal candidiasis and other invasive fungal infections with continuous fluconazole therapy than with episodic fluconazole treatment for recurrences. This clinical trial also demonstrated no difference in the risk of developing clinically significant fluconazole resistance between the two groups among those receiving ART.

However, secondary prophylaxis for recurrent oropharyngeal or vulvovaginal candidiasis is not recommended by most HIV specialists unless patients have frequent or severe recurrences because therapy for acute disease is effective, mortality associated with mucocutaneous disease is low, potential exists for drug interactions and for the development of antifungal-resistant Candida, and prophylaxis is costly.

Rates of relapse are high in patients with azole-refractory oropharyngeal or esophageal candidiasis who have initially responded to echinocandins, voriconazole, or posaconazole therapy. In such patients, secondary prophylaxis should be instituted until ART produces immune reconstitution .

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Prevention Of Fungal Infections

Fungi are present all around us and it is impossible to completely protect oneself from fungi. Most fungi are very important for our health and wellbeing. However, the prevention of recurring fungal infections of the skin, hair, and nails is possible by maintaining high standards of hygiene and avoiding places where fungi tend to breed.

  • Always keep your hands and feet clean and dry. Remember to dry your skin properly between the toes before you put on your footwear.
  • Always wear well-fitted shoes and clean dry cotton socks that allow your feet to breathe.
  • Avoid sharing items of personal hygiene such as towels, nail clippers, scissors, and combs.
  • Do not ignore fungal infections such as Athletes’ foot and make sure you consult your doctor at the earliest. This helps to curb the infection in the initial stages and prevents it from spreading to your nails.

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