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Pulmonary fungal infections in HIV-infected persons
1University of California, San Francisco.
Abstract:
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.
Insights
Deep-seated fungal infections are a major threat for individuals with Human Immunodeficiency Virus (HIV) disease. This review covers the diagnosis and treatment of these infections, including Cryptococcus neoformans and endemic fungi.
Area of Science:
- Mycology
- Infectious Diseases
- Immunology
Background:
- Fungal infections are common in patients with Human Immunodeficiency Virus (HIV) disease, significantly complicating their health outcomes.
- Cryptococcus neoformans is the most prevalent deep-seated fungal infection in Acquired Immunodeficiency Syndrome (AIDS), posing a global health risk.
- HIV infection prevalence is increasing in endemic areas of Histoplasma capsulatum, Coccidioides immitis, and Blastomycosis dermatitidis, leading to diverse clinical presentations.
Purpose of the Study:
- To review the microbiology, epidemiology, clinical presentation, diagnosis, and treatment of deep-seated fungal infections in patients with AIDS.
- To discuss current treatment strategies, including Amphotericin-B and newer triazoles, for AIDS-associated fungal infections.
Main Methods:
- Review of existing literature on AIDS-associated deep-seated fungal infections.
- Synthesis of information regarding the microbiology, epidemiology, diagnosis, and treatment of these infections.
Main Results:
- Cryptococcus neoformans is a leading cause of deep-seated fungal infection in AIDS, often presenting as meningitis but sometimes as pulmonary disease.
- Treatment for symptomatic pulmonary cryptococcosis typically involves amphotericin-B, with triazoles emerging as potential alternatives due to amphotericin-B's toxicity.
- Infections caused by endemic fungi like Histoplasma, Coccidioides, and Blastomyces in HIV-infected individuals present with varied symptoms, often a febrile wasting illness.
- The standard treatment for these endemic fungal infections is amphotericin-B, followed by long-term triazole maintenance therapy.
Conclusions:
- Deep-seated fungal infections represent a significant challenge in the management of HIV/AIDS patients.
- Effective diagnosis and treatment, including the use of amphotericin-B and triazoles, are crucial for improving outcomes in patients with AIDS-associated fungal infections.
- Ongoing research into alternative treatments is warranted due to the limitations of current therapies.