Micosis sistémicas en pacientes con virus de la inmunodeficiencia humana/sida

Histoplasmosis is a systemic infection caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, primary pulmonary infection can spread to the skin and meninges. Clinical manifestations appear in patients with a CD4⁺ lymphocyte count of less than 150 cells/μL.Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis and Coccidioides posadasii. It can present as diffuse pulmonary disease or as a disseminated form primarily affecting the central nervous system, the bones, and the skin.Cryptococcosis is caused by Cryptococcus neoformans (var. neoformans and var. grubii) and Cryptococcus gattii, which are members of the Cryptococcus species complex and have 5 serotypes: A, B, C, D, and AD. It is a common opportunistic infection in patients with human immunodeficiency virus (HIV)/AIDS, even those receiving antiretroviral therapy.Histopathologic examination and culture of samples from any suspicious lesions are essential for the correct diagnosis of systemic fungal infections in patients with HIV/AIDS.     

HIV感染者53例皮肤黏膜疾病和性传播疾病的临床分布

目的探讨贺州市53例HIV感染者皮肤黏膜疾病及性传播疾病的病种分布、临床表现以及经性途径感染艾滋病变化的特点。方法回顾分析53例HIV感染者在门诊就诊期间皮肤黏膜及性传播疾病的种类、特征及实验室检查资料。结果 HIV感染者传播途径以性传播者占84.91%;皮肤黏膜损害复杂,以真菌、病毒感染等为主;疾病种类依次为性病、带状疱疹、湿疹、银屑病、泛发体癣等8种;有2种以上皮肤黏膜疾病者8例(15.09%);性传播疾病以早期梅毒为主13例(24.53%)。结论 HIV感染者皮肤黏膜损害以真菌、感染最多,性传播途径是HIV感染的主要途径之一,泛发的皮肤黏膜病变和合并性病感染可作为诊断HIV感染的依据之一。     

Cryptococcosis

Cryptococcosis is a systemic fungal infection, caused by encapsulated yeast of the genus Cryptococcus, C neoformans and C gattii. These environmental microorganisms live in pigeon and other bird droppings, as well as in the fruit and bark of various trees. Infection in humans and other animal species usually occurs by inhalation and less frequently through the skin and by ingestion of the fungus. Most infections have a benign course and resolve spontaneously; however, the incidence of cryptococcosis has increased considerably, mainly due to diverse causes of immunodeficiency, particularly AIDS. Cryptococcus neoformans infections are common, worldwide, and severe forms are seen in immunocompromised patients. Cases caused by C gattii predominate in tropical or subtropical regions.     

Emerging systemic fungal infections

Systemic mycoses are a heterogeneous group of infections caused by different species of fungi that mainly affect individuals with primary or secondary alterations of immunity. In recent years, there has been an increase in the incidence of infections related to migration, AIDS, and other causes of immunosuppression, such as solid organ and bone marrow transplantation; oncological, hematological, and autoimmune diseases; and the use of new drugs. In this paper, we outline the microbiological and epidemiological characteristics of 3 fungi: Aspergillus spp, Fusarium spp, and Penicillium spp. We describe the clinical manifestations of disease with emphasis on those that should alert the dermatologist to make an early diagnosis. We detail the various tools for early diagnosis, prevention, and the epidemiology of different antifungals available for treatment and their mechanism of action and therapeutic efficacy.     

Neurologic complications of AIDS

Clinical symptoms of the central and peripheral nervous system occur in about 40% of patients wit HIV infection. At autopsy, CNS lesions can be demonstrated in even higher percentages. Primary sequelae of HIV infection--either due to direct viral effects or the immunopathologic response of the human host--are acute aseptic meningitis or mengingo-encephalitis, HIV encephalopathy, myelopathy, neuropathy, and myositis. Secondary consequences of immunodeficiency in AIDS are opportunistic infections with other viruses, bacteria, fungi, and protozoa, e.g. CMV, HSV and HZV encephalitis, mycobacterial CNS infections, neurosyphilis, cryptococcal meningitis, and last but not least cerebral toxoplasmosis. The main secondary malignoma of the CNS is lymphoma. Together these disorders form a complex spectrum of central and peripheral neurological symptoms.     

Skin manifestations in patients with HIV infection

Cutaneous manifestations are common in patients with HIV infection and mainly due to the immunodeficiency. In the initial stage of HIV infection, we frequently observe a rash of macular lesions. During the asymptomatic phase, the patients may typically show the following skin diseases: seborrhoic dermatitis, acneiform folliculitis, persistent herpes simplex, and infections with the human papilloma virus. In ARC and AIDS patients, 3 groups of skin disorders are found: cutaneous infections, skin tumors, and other mixed skin diseases. Herpes simplex and herpes zoster may develop into ulcerating and necrotising forms especially in patients with advanced immunodeficiency. The most frequent skin tumors in AIDS patients are the disseminated Kaposi's sarcoma and non-Hodgkin's lymphoma. More than 50% of the AIDS patients treated with trimethoprim/sulfamethoxazole developed a severe drug eruption. African and Caribbean patients with AIDS frequently suffer from pruritic skin lesions, the pathogenesis of which is not known. Aside from these cutaneous manifestations, a variety of other skin disorders have been reported in patients with HIV infection, ARC, or AIDS; future research will furnish definite proof whether they are correlated with HIV infection.     

HIV/AIDS皮肤病变的临床分析

目的 探讨HIV/AIDS患者皮肤粘膜病变的临床特征及其与疾病进展的相关性。方法 对45例HIV/AIDS患者的皮肤病变进行临床分析,并同时检测其CD4细胞计数与HIV病毒载量。结果 45例HIV/AIDS患者中有30创(66.7％)伴有皮肤病变,其中以真菌和疱疹病毒感染引起的皮肤病最常见,各占66.7％;其次为脂溢性皮炎,占36.7％;其它类型的皮肤病占50.0％。90.0％的AIDS皮肤病变发生在CD4细胞数<200个/μl,HIV-RNA载量>4 log。而HIV/且AIDS皮肤病变随着HARRT治疗后而缓解。结论 HIV/AIDS皮肤病变发生率很高,早期诊断与治疗对于监测HIV/AIDS患者疾病的进展有重大意义。     

Soluble II-2 receptor serum levels — a marker for disease progression in patients with HIV-1 infection

Summary Serum levels of soluble II-2 receptors (sII-2R) were measured in 88 patients with HIV infection, 28 patients from high-risk groups, and 28 normal donors. Elevated sII-2R levels were found in 46% of asymptomatic seropositive patients, in 68% of patients with persistent generalized lymphadenopathy, and in 81% of patients with AIDS. Mean sII-2R values increased with the progression of the disease and were most pronounced in patients with AIDS. A close correlation was found between sII-2R levels and beta₂-microglobulin (p<0.0001) and other prognostic parameters known to parallel clinical activity. In addition to being a valuable parameter in monitoring the course of the HIV infection, elevated sII-2R levels may also be involved in the down-regulation of II-2-dependent immune functions in AIDS.     

Charakterisierung der Interaktion zwischen Candida albicans und Wirtszellen

Basic research on the biology and immunology of microbial infection requires appropriate model systems. Currently most such studies involve animal studies which are a focus of ethical controversy. Possible alternatives, especially for localized infections, are provided by models using in vitro reconstituted human epithelium or epidermis (RHE). In recent years, these model systems have been successfully established to evaluate the effectiveness of topical anti-infectives, to characterize the role of fungal virulence factors, and to study the immune responses during localized Candida albicans infections. Most recently, these models have been supplemented with immune cells such as lymphocytes, polymorphonuclear leukocytes, mast cells or dendritic cells, to study their role during the course of infection and to characterize the interaction between the skin barrier and accessory immune cells. Although the most experience is with Candida albicans RHE infections, such model systems can also be used to study infections with other fungi or bacteria.     

Cutaneous disseminated histoplasmosis in AIDS patients in south Florida

Background Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions. Methods Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded. Results We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques. Conclusions Even in non-endemic regions, HIV-positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections.     

Adherence of Candida albicans strains isolated from AIDS patients. Comparison with pathogenic yeasts isolated from patients without HIV infection

The adherence of yeasts to oral mucous cells is one of the main characteristics of the pathogenicity of this fungus. We studies adherence by means of a radiometric test to improve the method. We compared a sample of 40 strains of Candida albicans isolated from the buccal mucosa of HIV-infected patients with 40 strains isolated from non-HIV patients. We found that buccally isolated C.albicans strains from patients in the initial stages of AIDS adhered to oral mucous cells less than the buccally isolated C.albicans strains from subjects without HIV infection. Adherence among the strains of HIV patients increased with the disease stage until it exceeded that of the normal subjects in proportion to the decrease in the CD4/CD8 ratio. The selection of resistant strains by the preliminary antifungal treatments gave us a partial explanation for this increase. Further research should be carried out to compare these results with those obtained from atypical strains and species with high pathogenic potential, such as Candida dubliniensis, which is frequently isolated from advanced AIDS, in order to prevent systemic infections in these patients.     

Dermatologic diseases in patients with AIDS

This short review deals with the cutaneous manifestations of the acquired immune deficiency syndrome (AIDS), which comprise Kaposi's sarcoma, as an important marker disease for AIDS, as well as various skin infections caused by bacteria, fungi and viruses. In patients at risk of acquiring AIDS, an extensive immunological investigation should be performed if skin infections are established. In addition, a large number of cutaneous complications encountered in AIDS patients have an immunological background, e.g. an extreme hypersensitivity to trimethoprim-sulfamethoxazole. Therefore, the dermatological investigation of patients at risk of acquiring AIDS is urgently recommended as a regular part of the general check-up.     

Cutaneous infections associated with HIV/AIDS

With diminished and dysregulated cell-mediated immunity, HIV-infected individuals are susceptible to a myriad of skin infections. These infections include the conditions encountered in immunocompetent patients, as well as infections seen almost exclusively in the setting of HIV infection. The HIV/AIDS pandemic has made some previously rare infections more prominent. Although antiretroviral therapy has been helpful in relieving the burden of cutaneous infections in HIV-infected patients, it does not prevent all opportunistic infections in the skin and also has created new dilemmas.     

The pathology of HIV infection

The acquired immunodeficiency syndrome (AIDS) is the result of a human immunodeficiency virus (HIV) infection damaging the cell-mediated immune system. A wide range of opportunistic infections (OI) and tumours develop; additionally, HIV directly damages some organs. The patterns of opportunistic diseases (OD) are different in different parts of the world, depending on the local prevalence of latent and acquired infections and on the survival of HIV-infected patients. OD patterns change as people migrate. Recently introduced highly active anti-retroviral chemotherapy prevents many of the common OIs, but also introduces a new range of toxic pathological damage. Longer survival permits development of new HIV-related diseases. The pathology of HIV/AIDS is not static but changing.     

Original article title: "Comparison of therapeutic efficacy of topical corticosteroid and oral zinc sulfate-topical corticosteroid combination in the treatment of vitiligo patients: a clinical trial"

Background

The prevalence of infections by nontuberculous mycobacteria (NTM) has steadily increased over the past decades, especially in immunocompromised patients.

Case presentation

We present a patient with IgA-deficiency and mixed cutaneous infection by two slowly growing mycobacteria, Mycobacterium (M.) haemophilum and M. kansasii.

Conclusions

Cutaneous M. haemophilum infections most often result from HIV or transplantation-associated immunosuppression. Rarely, M. haemophilum may also infect healthy patients or iatrogenically immunosuppressed patients without transplantation. M. kansasii is one of the most frequent NTM and large awareness exists about its involvement in human diseases. Mycobacterial diagnosis of cutaneous infections should be considered in long-lasting skin lesions.     

AIDS--mucous membrane manifestations

In the course of the infection with the human immunodeficiency virus (HIV), we frequently observe disorders of the mucous membranes and, occasionally, they present the first manifestation of HIV-induced immunodeficiency. Like in other organs, opportunistic infections and malignant tumors prevail as a result of the impaired immune system. Opportunistic infections are characterized by frequency (candidiasis), aggressive expansion, persistence, frequent recurrences, and resistance to therapy (gingivitis, parodontitis, herpes simplex, warts). Oral hairy leucoplakia is considered a specific lesion of HIV infection. Malignant tumors, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and squamous cell carcinoma, may cause marked morbidity in AIDS patients; occasionally, the clinical picture of Kaposi's sarcoma and non-Hodgkin's lymphoma is rather uncharacteristic. Other manifestations on the mucous membranes may arise in association with systemic reactions, such as drug eruptions, thrombocytopenic purpura, or acute HIV infection. The etiology of still other lesions of the mucous membranes (e.g. chronic recurrent ulcers, xerostomia, disorders of pigmentation) is incompletely understood. The awareness of these disorders of the mucous membranes in HIV infection is of diagnostic, therapeutic and epidemiological importance.     

Incidence of symptomatic urinary tract infections in HIV seropositive patients and the use of cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia.

OBJECTIVES--To determine the incidence of symptomatic urinary tract infections in HIV seropositive patients and to assess whether this varies with stage of disease, risk group or the use of co-trimoxazole as prophylaxis against Pneumocystis carinii pneumonia. METHODS--A retrospective case note review of 175 HIV-infected patients attending The Royal London Hospital between July 1988 and December 1992 was performed. A urinary tract infection was defined as a pure culture of > or = 10(5) colony forming units in a mid-stream specimen of urine from a patient with symptoms consistent with a urinary tract infection. RESULTS--Urinary tract infections occurred in 10 (5.7%) of 175 patients, with an incidence of 1.49 per hundred patient years. Urinary tract infections were significantly more common in patients with AIDS or a CD4 lymphocyte count below 0.2 x 10(9)/l (or both) when compared to those without AIDS and a CD4 lymphocyte count above 0.2 x 10(9)/l (5.4 vs. 0.5 urinary tract infections per hundred patient years, p = 0.00005). Women with AIDS or a CD4 count below 0.2 x 10(9)/l (or both) had an incidence of urinary tract infection of 18.5 per hundred patient years. No significant difference was found between the incidence of urinary tract infections in those taking co-trimoxazole as Pneumocystis carinii pneumonia prophylaxis and those taking alternative or no prophylaxis (2.6 vs 6.4 per hundred patient years, p = 0.39). CONCLUSIONS--Urinary tract infection represents a considerable health problem amongst HIV infected patients. Our data show that urinary tract infections are more common in patients with advanced compared with early HIV infection. Cotrimoxazole, when taken by patients as prophylaxis against Pneumocystis carinii pneumonia did not appear to reduce the incidence of urinary tract infection.     

珠海市HIV/AIDS初治病人123例流行病学及临床特征分析

目的观察珠海市HIV/AIDS初治病例的流行病学和临床特征,为本地区艾滋病防治提供依据。方法回顾性分析2005年1月-2011年12月本院收治的123例HIV/AIDS初治病例的临床资料。结果 HIV/AIDS初治病例中男:女1.93:1,20～50岁年龄组占91.05%;感染途径以性传播为主,其中异性间性传播47.97%,同性间性传播11.38%;常见临床症状为发热、腹泻和淋巴结肿大等,常见机会性感染有口腔真菌感染、肺孢子菌肺炎、结核病和带状疱疹等;CD4+淋巴细胞<100个/μL占47.15%,100～200个/μL占28.46%,200～350个/μL占23.58%,>350个/μL占0.81%。结论珠海市HIV/AIDS初治病例男性多于女性,以青壮年为主,感染途径以性传播为主。临床医生应加强对艾滋病的筛查及宣教工作,做到早发现和早治疗,遏制艾滋病蔓延。     

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

Background: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world’s population.Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013).Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed.Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases.Study limitations: This work is representative in the studied region.Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.