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[Fungemia in patients with HIV infection]
J Santos1, R Palacios, A Esteve
1Unidad de Infecciosos, Hospital Virgen de la Victoria, Málaga.
Objective:
To make an analysis of fungemia in HIV-infected patients in our hospital.
Patients And Methods:
We retrospectively (1989-1997) studied all HIV-infected patients with positive blood cultures for Candida sp., Cryptococcus neoformans or any other fungal infection.
Results:
C. neoformans was isolated in 11 patients (10 men and 1 woman): Six were treated with amphotericin B and 5 with fluconazole. 2 patients died during the acute phase and the infection relapsed in 3. Blood culture for Candida sp. were positive in 9 (8 men and 1 woman): only a case was nosocomial. Seven patients were intravenous drug users and the presenting manifestations were autolimited candidemia in 3, aortic and tricuspid endocarditis in 1 and 2 cases respectively and pneumonia in another one. Six C. albicans, 2 C. krusei and 1 C. glabrata were isolated. 3 patients received amphotericin B and 3 received fluconazole. 2 patients suffering from endocarditis died and so did the patient with C. glabrata infection. A patient, who denied having travelled to endemic areas, developed histoplasmosis; blood culture was positive for H. capsulatum. He initially had a good response to amphotericin B and itraconazole.
Conclusions:
Fungemia is not frequent in HIV-infected patients. Cryptococcosis and histoplasmosis occur in advanced HIV-patients and candidemia is fundamentally associated with intravenous drug use.
Insights
Fungal infections like cryptococcosis and histoplasmosis are common in advanced HIV disease. Candidemia in HIV patients is often linked to intravenous drug use.
Area of Science:
- Medical Mycology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Fungemia, or fungal bloodstream infections, can be a serious complication in immunocompromised individuals.
- Human Immunodeficiency Virus (HIV) infection significantly increases susceptibility to opportunistic infections, including fungal pathogens.
Purpose of the Study:
- To analyze the incidence and characteristics of fungemia in patients with HIV infection.
- To identify the specific fungal species causing fungemia and their association with patient demographics and clinical outcomes.
Main Methods:
- Retrospective analysis of HIV-infected patients with positive blood cultures for fungi between 1989 and 1997.
- Identification of fungal species, including Candida spp., Cryptococcus neoformans, and Histoplasma capsulatum.
- Review of patient treatment regimens and clinical outcomes, including mortality and relapse.
Main Results:
- Cryptococcus neoformans fungemia occurred in 11 patients, with significant mortality and relapse rates.
- Candida species fungemia was identified in 9 patients, predominantly associated with intravenous drug use and presenting with varied manifestations like endocarditis and pneumonia.
- Histoplasma capsulatum fungemia was observed in one patient, responding initially to antifungal therapy.
Conclusions:
- Fungemia is relatively infrequent in the studied HIV-infected patient population.
- Cryptococcosis and histoplasmosis are associated with advanced HIV disease.
- Candidemia in HIV patients is strongly linked to intravenous drug use.