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Pérez Arellano JL, de Górgolas Hernández-Mora M, Gutiérrez Rodero F, Dronda Núñez F. [Bacterial, mycobacterial and fungal opportunistic infections in HIV-infected immigrants: diagnosis and treatment]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 5:22-30. [PMID: 18590663 DOI: 10.1157/13123264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The number of HIV infected immigrants has increased sharply in Spain. These patients are prone to contracting several different types of opportunistic infections, including bacterial, mycobacterial, fungal and parasitic infections. The present article provides an in-depth review of bacterial and fungal infections, with particular emphasis on those not endemic in our country.
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Affiliation(s)
- José Luis Pérez Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
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Campos MVS, Penna GO, Castro CND, Moraes MAPD, Ferreira MS, Santos JB. [Paracoccidioidomycosis at Brasilias university hospital]. Rev Soc Bras Med Trop 2008; 41:169-72. [PMID: 18545838 DOI: 10.1590/s0037-86822008000200007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 03/07/2008] [Indexed: 11/22/2022] Open
Abstract
Seventy-six paracoccidioidomycosis patients attended at the university hospital of Brasília from 1984 to 2005 were studied. 82.9% were male and the mean age was 42 years. 54.9% of the patients were engaged in farming activities. Among the patients with the chronic form, 87% were smokers and 55.3% consumed alcohol. Among 71 patients without HIV/AIDS coinfection: a) paracoccidioidomycosis was recurrent in 21 (29.6%); b) the chronic or mixed form affected 77.5% of patients, predominantly in the oropharynx (70.9%) and lungs (67.3%), with lymph node lesions in 29.8%, laryngeal lesions in 27.3% and cutaneous lesions in 16.4%; c) in the acute/subacute form, lymph node lesions predominated (81.3%), followed by cutaneous lesions in 43.8%, which resulted in severe disease in 62.5% and moderate disease in 37.5%. Five patients had HIV/AIDS coinfection and three of them presented disseminated fungal infection together with marked immunosuppression.
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Paracoccidioidomycosis (South American Blastomycosis) of the Larynx Mimicking Carcinoma. Am J Med Sci 2008; 335:149-50. [DOI: 10.1097/maj.0b013e3180a6f1e5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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56
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Fernanda Reis Gavazzoni Dias M, Mesquita J, Lima Filgueira A, De Souza W. Human neutrophils susceptibility toParacoccidioides brasiliensis: an ultrastructural and cytochemical assay. Med Mycol 2008; 46:241-9. [DOI: 10.1080/13693780701824411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mayer KH, Karp CL, Auwaerter PG, Mayer KH. Coinfection with HIV and Tropical Infectious Diseases. II. Helminthic, Fungal, Bacterial, and Viral Pathogens. Clin Infect Dis 2007; 45:1214-20. [DOI: 10.1086/522180] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 07/07/2007] [Indexed: 01/19/2023] Open
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Trindade MAB, Valente NYS, Manini MIP, Takahashi MDF, Anjos CFD, Benard G, Naafs B. Two patients coinfected with Mycobacterium leprae and human immunodeficiency virus type 1 and naive for antiretroviral therapy who exhibited type 1 leprosy reactions mimicking the immune reconstitution inflammatory syndrome. J Clin Microbiol 2006; 44:4616-8. [PMID: 17021066 PMCID: PMC1698401 DOI: 10.1128/jcm.01425-06] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two case reports of patients with human immunodeficiency virus type 1 (HIV-1) infection who developed leprosy are presented. Both developed type 1 leprosy reactions in the absence of antiretroviral therapy. Reactions have been described for a number of HIV-1- and Mycobacterium leprae-coinfected patients and have been considered to be part of an immune reconstitution inflammatory syndrome (IRIS) since the reactions were usually linked to the administration of highly active antiretroviral therapy. The reports of our two patients suggest that the type 1 reactions in patients with leprosy and HIV may not always be an IRIS manifestation but may be akin to the classical reactional state described for the natural course of leprosy infection, which occurs in leprosy patients due to the fluctuations of the antimycobacterial immune response, whether they are coinfected with HIV or not.
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Affiliation(s)
- M A B Trindade
- Department of Dermatology, Medical School of the University of São Paulo, Rua Cristiano Viana 450, ap. 163, São Paulo CEP 05411-000, Brazil.
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Godoy P, Lelis SSR, Resende UM. Paracoccidioidomicose e síndrome de imunodeficiência adquirida: relato de necropsia. Rev Soc Bras Med Trop 2006; 39:79-81. [PMID: 16501773 DOI: 10.1590/s0037-86822006000100016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Descrição de um caso de paracoccidioidomicose generalizada em homem de 59 anos com síndrome de imunodeficiência adquirida, sem diagnóstico clínico prévio, observado à necropsia. Houve disseminação do fungo para vários órgãos, caracterizando-se, especialmente nos linfonodos, reativação aguda de processo antigo. O relato acrescenta-se ao número relativamente reduzido dos anotados na literatura médica.
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Affiliation(s)
- Pérsio Godoy
- Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Paniago AMM, de Freitas ACC, Aguiar ESA, Aguiar JIA, da Cunha RV, Castro ARCM, Wanke B. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases observed in an endemic region in Brazil. J Infect 2005; 51:248-52. [PMID: 16230222 DOI: 10.1016/j.jinf.2005.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the clinical characteristics of 12 patients with paracoccidioidomycosis (PCM) and human immunodeficiency virus (HIV) infection. METHODS The clinical manifestations, diagnosis, treatment, and outcome of PCM in 12 patients infected with HIV attended at a University Hospital of Mato Grosso do Sul, Brazil, were evaluated. RESULTS All patients were men, mean age 36.1 years old, and 11 had a diagnosis other than PCM as the aids-defining illness. Lymph nodes were the organs most often involved (10 patients, 83.3%), followed by lung involvement, usually with an interstitial pattern (seven patients, 58.3%), papule-nodular skin lesions with central ulceration in six (50%) and ulcerated lesions of oral mucous membrane in five (41.6%) patients. Pleural involvement occurred in one patient who presented large pleural effusion beside a pathologic rib fracture caused by P. brasiliensis. Seven patients showed involvement in more than one extrapulmonary organ. In eight (66.6%) cases the diagnosis was established by direct microscopy of clinical specimens. All patients used trimethoprim-sulfamethoxazole and seven patients were also treated with amphotericin B. Eight patients died with progressive PCM manifestations. CONCLUSION Our review demonstrates that PCM, an endemic systemic mycosis in Brazil, when associated with AIDS, behaves clinically as an opportunistic disease.
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Caseiro MM, Etzel A, Soares MCB, Costa SOPD. Septicemia caused by Paracoccidioides brasiliensis (Lutz, 1908) as the cause of death of an AIDS patient from Santos, São Paulo State, Brazil--a nonendemic area. Rev Inst Med Trop Sao Paulo 2005; 47:209-11. [PMID: 16138203 DOI: 10.1590/s0036-46652005000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The first case of Paracoccidioides brasiliensis in Santos (Brazil) leading to septicemia and death of an HIV-positive patient is reported here. The patient was a 34-year-old female that presented essential fever and was only diagnosed after death by positive blood culture. The authors underscore the atypical nature of the case, since the patient was a female at fertile age who was born and had always lived in Santos, which is a nonendemic area for this infection.
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Moraes-Vasconcelos DD, Grumach AS, Yamaguti A, Andrade MEB, Fieschi C, de Beaucoudrey L, Casanova JL, Duarte AJS. Paracoccidioides brasiliensis Disseminated Disease in a Patient with Inherited Deficiency in the 1 Subunit of the Interleukin (IL)-12/IL-23 Receptor. Clin Infect Dis 2005; 41:e31-7. [PMID: 16028144 DOI: 10.1086/432119] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 04/14/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Paracoccidioides brasiliensis is a facultative intracellular dimorphic fungus that causes paracoccidioidomycosis (PCM), the most important deep mycosis in Latin America. Only a small percentage of individuals infected by P. brasiliensis develop clinical PCM, possibly in part because of genetically determined interindividual variability of host immunity. However, no primary immunodeficiency has ever been associated with PCM. METHODS We describe the first patient, to our knowledge, with PCM and a well-defined primary immunodeficiency in the beta 1 subunit of the interleukin (IL)-12/IL-23 receptor, a disorder previously shown to be specifically associated with impaired interferon (IFN)-gamma production, mycobacteriosis, and salmonellosis. RESULTS Our patient had a childhood history of bacille Calmette-Guérin disease and nontyphoid salmonellosis and, at the age of 20 years, presented to our clinic with a disseminated (acute) form of PCM. He responded well to antifungal treatment and is now doing well at 24 years of age. CONCLUSIONS This unique observation supports previous studies of PCM suggesting that IL-12, IL-23, and IFN-gamma play an important role in protective immunity to P. brasiliensis. Tuberculosis and PCM are thus not only related clinically and pathologically, but also by their immunological pathogenesis. Our study further expands the spectrum of clinical manifestations of inherited defects of the IL-12/IL-23-IFN-gamma axis. Patients with unexplained deep fungal infections, such as PCM, should be tested for defects in the IL-12/IL-23-IFN- gamma axis.
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Abstract
A systemic and endemic emerging mycosis in Latin America, paracoccidioidomycosis, is characterised by its chronicity and by the severity of the disseminated form in healthy individuals, as well as in immunocompromised individuals co-infected with HIV, resulting, in the latter, in a mortality rate in the range of 30 - 45%. The long (several years) duration of treatment results from the immunosuppression induced by the disease or from the survival capacity of the fungus in tissue. A few controlled studies and case reports have shown that fast-acting azolic and sulfa derivatives are useful treatment alternatives for patients presenting milder forms of the disease. However, when using such drugs, treatment regimens of longer duration are required for the maintenance of patients with more severe forms. The search for new alternatives for treating the most severe forms is an ongoing challenge. Novel treatments may be found among new classes of drugs, drug combinations, or agents capable of modulating the immune response, such as a peptide derived from the 43-kDa Paracoccidioides brasiliensis glycoprotein.
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Benson CA, Kaplan JE, Masur H, Pau A, Holmes KK. Treating Opportunistic Infections among HIV-Infected Adults and Adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005. [DOI: 10.1086/427906] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Almeida OP, Jorge Junior J, Scully C. Paracoccidioidomycosis of the mouth: an emerging deep mycosis. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:268-74. [PMID: 12907695 DOI: 10.1177/154411130301400404] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral fungal infections (mycoses) have come into particular prominence since the advent of infection with Human Immunodeficiency Virus (HIV), and recognition of the Acquired Immune Deficiency Syndrome (AIDS), as well as the phenomenal increase in world travel with increased exposure to infections endemic in the tropics. Paracoccidioidomycosis is a rare mycosis worldwide but common in Brazil and some other areas in Latin America. It can be life-threatening and can manifest with a spectrum of clinical presentations, including frequent oral lesions. This paper reviews the more recent information on Paracoccidioidomycosis, emphasizing those areas most relevant in dental science.
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Affiliation(s)
- Oslei Paes Almeida
- Department of Oral Pathology, Dental School of Piracicaba-UNICAMP, Av. Limeira 901, CEP 13.414.903-CP 52, Piracicaba, SP, Brazil.
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Yamada H, Kotaki H, Takahashi T. Recommendations for the treatment of fungal pneumonias. Expert Opin Pharmacother 2003; 4:1241-58. [PMID: 12877634 DOI: 10.1517/14656566.4.8.1241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incidences of fungal pneumonias have increased in immunocompromised patients with HIV infection or receiving bone marrow replacement or solid organ transplantation. Fungal pneumonias including aspergillosis, cryptococcosis, candidiasis, coccidioidomycosis, histoplasmosis and blastomycosis are one of the major causes of morbidity and mortality among the immunosuppressed hosts. Therefore, clinicians should consider the most appropriate and aggressive treatment of fungal pneumonias in this population. This report outlines the state of the art in the treatment of fungal pneumonias and discusses recent advances in antifungal therapy. Practice guidelines for the treatment with commonly used antifungal agents including amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine, are very useful for clinicians to manage the diseases appropriately. Echinocandins and second-generation triazoles will hopefully help clinicians to overcome the limitations of the current therapy.
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Affiliation(s)
- Harumi Yamada
- Pharmacy Division, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
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68
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Abstract
São apresentados dados de atualização epidemiológica, clínica, diagnóstica e terapêutica relativos à paracoccidioidomicose. Discute-se a importância epidemiológica resultante do isolamento do Paracoccidioides brasiliensis a partir do tatu (Dasypus novemcinctus) em regiões do Brasil e Colômbia, assim como dos resultados de inquéritos soroepidemiológicos em cães e do surgimento do primeiro caso de paracoccidioidomicose doença em cão. As dificuldades de isolamento do fungo a partir do solo são correlacionadas com novos informes de investigação epidemiológica. São apresentados aspectos clínicos das manifestações da forma aguda da doença, assim como das manifestações da neuroparacoccidioidomicose e da enfermidade associada à infecção pelo HIV. Discute-se o papel da sorologia e da técnica da PCR no diagnóstico e dos possíveis avanços no tratamento da paracoccidioidomicose com os novos derivados triazólicos.
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69
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Abstract
Paracoccidioides brasiliensis causes one of the most prevalent systemic mycoses in Latin America--paracoccidioidomycosis. It is a dimorphic fungus that undergoes a complex transformation in vivo, with mycelia in the environment producing conidia, which probably act as infectious propagules upon inhalation into the lungs, where they transform to the pathogenic yeast form. This transition is readily induced in vitro by temperature changes, resulting in modulation of the composition of the cell wall. Notably, the polymer linkages change from beta-glucan to alpha-glucan, possibly to avoid beta-glucan triggering the inflammatory response. Mammalian oestrogens inhibit this transition, giving rise to a higher incidence of disease in males. Furthermore, the susceptibility of individuals to paracoccidioidomycosis has a genetic basis, which results in a depressed cellular immune response in susceptible patients; resistance is conferred by cytokine-stimulated granuloma formation and nitric oxide production. The latency period and persistence of the disease and the apparent lack of efficacy of humoral immunity are consistent with P. brasiliensis existing as a facultative intracellular pathogen.
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Affiliation(s)
- M Ines Borges-Walmsley
- Division of Infection and Immunity, Robertson Building, Institute of Biomedical and Life Sciences, University of Glasgow, G11 6NU., Glasgow, UK
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