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Chandler DJ, Walker SL. HIV and skin infections. Clin Dermatol 2024; 42:155-168. [PMID: 38142787 DOI: 10.1016/j.clindermatol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Widaty S, Oktarina C, Suling PL, Niode NJ, Miranda E, Andriani A, Amin S, Yenny SW, Bramono K. Mucocutaneous mycoses in people living with human immunodeficiency virus in Indonesia. Mycoses 2021; 65:323-330. [PMID: 34902221 DOI: 10.1111/myc.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To date, integrated care for people living with human immunodeficiency virus (PLHIV) has improved. However, although the management of mucocutaneous mycosis cases has improved, disease progression might be different in immunocompromised patients, which leads to variable clinical manifestations. OBJECTIVES To describe the characteristics of mucocutaneous mycosis cases in the PLHIV population and its associated factors in Indonesia. METHODS This retrospective study was conducted from January 2014 to December 2018 in four academic hospitals. Data were acquired from medical records with the inclusion of mucocutaneous mycosis patients with concurrent HIV infection. Analysis with the chi-squared test was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS A total of 1,796 cases of mucocutaneous mycoses were identified in 1782 PLHIV. The most common types of infection were candidiasis (63%), followed by dermatophytosis (35.1%), and malasseziosis (1.9%), which were significantly higher in PLHIV with CD4 level <200 cells/mm3 . The proportions of male gender (78.6% vs. 56.3%, p < .001), high level of education (48.0% vs. 64.1%, p < .001), office workers (73.8% vs. 64.1%, p < .001), combination of topical and systemic antifungal agents (59.1% vs. 48.5%, p = .006) and not receiving antiretroviral therapy (63.2% vs. 7.8%, p < .001) were significantly higher in PLHIV with a CD4 level <200 cells/mm3 . CONCLUSION In Indonesia, the most common fungal infection in PLHIV is candidiasis. This study also addressed the important matters regarding mucocutaneous mycoses in PLHIV. Education is an important measure to prevent the incidence of cutaneous mycoses in PLHIV, especially in high-risk groups.
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Affiliation(s)
- Sandra Widaty
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Caroline Oktarina
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Pieter Levinus Suling
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Universitas Samratulangi - Prof. Dr. Kandou General Hospital, R. W. Monginsidi (Malalayang), Manado, Indonesia
| | - Nurdjannah Jane Niode
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Universitas Samratulangi - Prof. Dr. Kandou General Hospital, R. W. Monginsidi (Malalayang), Manado, Indonesia
| | - Eliza Miranda
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Anni Andriani
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University - dr. Wahidin Sudirohuosodo General Hospital, Makassar, Indonesia
| | - Safruddin Amin
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University - dr. Wahidin Sudirohuosodo General Hospital, Makassar, Indonesia
| | - Satya Widya Yenny
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Andalas University - M. Djamil General Hospital, Perintis Kemerdekaan, Padang, Indonesia
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
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3
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Lewis D, Feldman S. Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Superficial Fungal Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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5
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Gupta AK, Ryder JE, Skinner AR. Treatment of Onychomycosis: Pros and Cons of Antifungal Agents. J Cutan Med Surg 2016. [DOI: 10.1177/120347540400800107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Antifungal agents are beneficial in the treatment of onychomycosis in the general population, as well as in children, the elderly, and immunocompromised individuals. Special patient populations can be more difficult to treat due to such factors as drug interactions with concomitant medications, adverse events, and poor compliance. In addition, there is limited information about the use of antifungal agents in special populations, e.g., children. Objective: The pros and cons of oral and topical antifungal agents are discussed, with focus on special patient populations. Methods: We searched MedLine (1966 to April 2003) for clinical studies evaluating the efficacy of oral and topical antifungal agents to treat onychomycosis. The key words used in conjunction with “onychomycosis” include: “terbinafine,” “itraconazole,” “fluconazole,” “amorolfine nail lacquer,” “ciclopirox nail lacquer,” “HIV,” “transplant patients,” “diabetes,” “children,” and “elderly.” Studies were excluded if published in a language other than English. Results: Studies have shown that antifungal agents can be of benefit in treating the elderly, children, and immunocompromised individuals (e.g., transplant patients, Down's patients, HIV patients, and diabetics) with onychomycosis. Conclusion: The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.
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Affiliation(s)
- Aditya K. Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Toronto, Ontario, Canada
- Mediprobe Research, London, Ontario, Canada
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Abstract
Genus Malassezia comprises of 14 species of “yeast like fungi,” 13 of which are lipophilic and 1 is nonlipophilic. They are known commensals and in predisposed individuals they commonly cause a spectrum of chronic recurrent infections. They rarely also cause serious illnesses like catheter-related blood stream infections, CAPD associated peritonitis etc., Though these fungi have been known to man for over 150 years, their fastidious nature and cumbersome culture and speciation techniques have restricted research. Since the last taxonomic revision, seven new species have been added to this genus. Their ability to evade the host immune system and virulence has increased the spectrum of the diseases caused by them. These agents have been implicated as causal agents in common diseases like atopic dermatitis recently. Though culture-based research is difficult, the new molecular analysis techniques and facilities have increased research in this field such that we can devote more attention to this genus to study in detail, their characteristics and their growing implications implications in the clinical scenario.
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Affiliation(s)
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
| | - Mahalakshmi Veeraraghavan
- Department of Dermatology and Venereology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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7
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The Spectrum of HIV-Associated Infective and Inflammatory Dermatoses in Pigmented Skin. Dermatol Clin 2014; 32:211-25. [DOI: 10.1016/j.det.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Bhagra S, Ganju SA, Sood A, Guleria RC, Kanga AK. Microsporum gypseum dermatophytosis in a patient of acquired immunodeficiency syndrome: A rare case report. Indian J Med Microbiol 2013; 31:295-8. [DOI: 10.4103/0255-0857.115656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Chudasama A, Patel V, Nivsarkar M, Vasu K, Shishoo C. Investigation of microemulsion system for transdermal delivery of itraconazole. J Adv Pharm Technol Res 2011; 2:30-8. [PMID: 22171289 PMCID: PMC3217682 DOI: 10.4103/2231-4040.79802] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A new oil-in-water microemulsion-based (ME) gel containing 1% itraconazole (ITZ) was developed for topical delivery. The solubility of ITZ in oils and surfactants was evaluated to identify potential excipients. The microemulsion existence ranges were defined through the construction of the pseudoternary phase diagrams. The optimized microemulsion was characterized for its morphology and particle size distribution. The optimized microemulsion was incorporated into polymeric gels of Lutrol F127, Xanthan gum, and Carbopol 934 for convenient application and evaluated for pH, drug content, viscosity, and spreadability. In vitro drug permeation of ME gels was determined across excised rat skins. Furthermore, in vitro antimycotic inhibitory activity of the gels was conducted using agar-cup method and Candida albicans as a test organism. The droplet size of the optimized microemulsion was found to be <100 nm. The optimized Lutrol F 127 ME gel showed pH in the range of 5.68±0.02 and spreadability of 5.75±1.396 gcm/s. The viscosity of ME gel was found to be 1805.535±542.4 mPa s. The permeation rate (flux) of ITZ from prepared ME gel was found to be 4.234 μg/cm/h. The release profile exhibited diffusion controlled mechanism of drug release from ME ITZ gel. The developed ME gels were nonirritant and there was no erythema or edema. The antifungal activity of ITZ showed the widest zone of inhibition with Lutrol F127 ME gel. These results indicate that the studied ME gel may be a promising vehicle for topical delivery of ITZ.
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Affiliation(s)
- Arpan Chudasama
- Department of Pharmaceutics, B V Patel PERD Centre, Ahmedabad, Gujarat, India
| | - Vineetkumar Patel
- Department of Pharmaceutics, B V Patel PERD Centre, Ahmedabad, Gujarat, India
| | - Manish Nivsarkar
- Department of Pharmacology & Toxicology, B V Patel PERD Centre, Ahmedabad, Gujarat, India
| | - Kamala Vasu
- Department of Medicinal Chemistry, B V Patel PERD Centre, Ahmedabad, Gujarat, India
| | - Chamanlal Shishoo
- Department of Pharmaceutics, B V Patel PERD Centre, Ahmedabad, Gujarat, India
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Ramos-e-Silva M, Lima CMO, Schechtman RC, Trope BM, Carneiro S. Superficial mycoses in immunodepressed patients (AIDS). Clin Dermatol 2010; 28:217-25. [DOI: 10.1016/j.clindermatol.2009.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Superficial fungal infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Barranco V. Proceedings and Transactions. Int J Dermatol 2008. [DOI: 10.1111/j.1365-4362.1997.tb04190.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Abstract
A 3-year-old boy presented with a 15 x 15-cm papulonodular lesion on his left shin of 8 weeks' duration. The lesion was considered a Majocchi's granuloma caused by Trichophyton tonsurans. He was treated with griseofulvin and topical clotrimazole and hydrocortisone cream and responded well after 8 weeks of treatment.
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Affiliation(s)
- Wen-Wei Feng
- Department of Dermatology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
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Troncoso A, Gulotta H, Benetucci J, Rodríguez Ríos E. Genital manifestations in women with AIDS. ACTA ACUST UNITED AC 2005; 4:16-9. [PMID: 15881707 DOI: 10.1177/154510970500400103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alcides Troncoso
- Infectious Diseases, Francisco J. Muñiz Hospital, School of Medicine, University of Buenos Aires, Argentina
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15
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Abstract
Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction. In this Seminar, three types of infection will be covered: tinea versicolor, piedra, and tinea nigra. Tinea versicolor is common worldwide and is caused by Malassezia spp, which are human saprophytes that sometimes switch from yeast to pathogenic mycelial form. Malassezia furfur, Malassezia globosa, and Malassezia sympodialis are most closely linked to tinea versicolor. White and black piedra are both common in tropical regions of the world; white piedra is also endemic in temperate climates. Black piedra is caused by Piedraia hortae; white piedra is due to pathogenic species of the Trichosporon genus. Tinea nigra is also common in tropical areas and has been confused with melanoma.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, UMDNJ-New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103-2714, USA.
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16
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Abstract
Pityriasis versicolor is a mild or chronic condition characterized by scaly hypopigmented or hyperpigmented lesions usually affecting the trunk. The lesions vary depending on tropical or temperate climates. The disease seems to occur mainly at adolescence when the sebaceous glands are more active. Malassezia yeasts have been implicated in the pathogenesis of this disease. The mycelial form of the fungus has been suggested to be the cause of lesions. Antifungal preparations have been used to treat the initial presentation effectively, although in a proportion of patients the disease tends to reoccur. They are available in a wide range of formulations and have been shown to be safe.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook Site), University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Wananukul S, Deekajorndech T, Panchareon C, Thisyakorn U. Mucocutaneous findings in pediatric AIDS related to degree of immunosuppression. Pediatr Dermatol 2003; 20:289-94. [PMID: 12869145 DOI: 10.1046/j.1525-1470.2003.20401.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The normal value of the absolute CD4-positive T-lymphocyte count is relatively high in normal infants and declines steadily until 6 years of age, whereas the CD4 percentage of the total lymphocyte count is constant. The immunologic categories according to the 1994 revised pediatric human immunodeficiency virus (HIV) classification, based on CD4-positive percentage of the total lymphocyte count, is classified into three categories: no evidence of suppression (> or =25%), moderate suppression (15-24%), and severe suppression (1-14%). Our objective was to determine the prevalence of mucocutaneous findings in pediatric acquired immunodeficiency syndrome (AIDS) related to the degree of immunosuppression. We prospectively examined 120 children less than 13 years of age who were born to HIV-seropositive women and developed definite HIV infection. The prevalence of mucocutaneous findings in those children who had severe, moderate, and no evidence of immunosuppression were 62%, 43%, and 20%, respectively. The mucocutaneous findings in patients in the moderate and severe suppression groups were significantly more common than in patients without evidence of immunosuppression (p < 0.001). In the moderate immunosuppression group, 11% had two mucocutaneous findings while 21% in the severe immunosuppression group had two or more mucocutaneous findings. The most common mucocutaneous finding was oral candidiasis (33%), which had a mean corresponding CD4 percentage of the total lymphocyte count of 11.3%. Herpes zoster was found in 6% of the patients (mean CD4 percentage of the total lymphocyte count = 13.5%). Chronic herpes simplex virus (HSV) stomatitis was found in 3% of the patients (mean CD4 percentage of the total lymphocyte count = 3%). Mucocutaneous manifestations are common in pediatric AIDS. The majority of these findings have an infectious etiology. The prevalence increases as the CD4-positive percentage of the total lymphocyte count decreases. More than one mucocutaneous finding can be found at the same time in patients with moderate or severe immunosuppression.
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Affiliation(s)
- Siriwan Wananukul
- Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
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18
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Abstract
A expressão pitiríase versicolor define uma infecção fúngica superficial caracterizada por alterações na pigmentação cutânea. O distúrbio de pigmentação é devido à colonização do estrato córneo por um fungo dimórfico, lipofílico, encontrado na flora normal da pele, conhecido como Malassezia furfur. Trata-se de doença prevalente nos trópicos, mas também comum em climas temperados. Há vários tratamentos disponíveis com taxas elevadas de cura, porém as recorrências são freqüentes.
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Abstract
UNLABELLED Pityriasis versicolor is a common superficial fungal infection of the skin. It is caused by Malassezia spp., which are normal human saprophytes. Under certain conditions, both exogenous and endogenous, the fungus can convert from a yeast to a pathogenic mycelial form. This alteration results in mild inflammation of the skin, and in characteristic clinical and histological changes. The taxonomy of Malassezia spp. has recently been modified to include six obligatorily lipophilic species, all of which can be found on human skin, plus one non-obligatorily lipophilic species, which only rarely colonizes human hosts. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be aware of the role of Malassezia in the development of pityriasis versicolor, the clinical and histological changes arising from this dermatosis, and the diagnosis and treatment of this disorder.
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Affiliation(s)
- A K Gupta
- Department of Medicine, Sunnybrook and Women's College Health Science Center, Toronto, Ontario, Canada.
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20
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Innocenzi D. Skin diseases associated with HIV infection. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 2001; 94:1-38. [PMID: 11443884 DOI: 10.1007/978-3-642-59552-3_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- D Innocenzi
- Università degli Studi la Sapienza Roma Italia, Viale del Policlinico, 155, 00161 Rome, Italy
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Osaki T, Yoneda K, Yamamoto T, Ueta E, Kimura T. Candidiasis may induce glossodynia without objective manifestation. Am J Med Sci 2000; 319:100-5. [PMID: 10698094 DOI: 10.1097/00000441-200002000-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The causes of glossodynia in the absence of objective abnormalities range widely and differential diagnosis of glossodynia is very difficult. METHODS Based on the examination results of peripheral blood, stimulated and nonstimulated salivary flow rate (SFR), glossal pain threshold, and C. albicans cell culture and the response to treatment, we identified the cause of vague pain of the tongue in 98 patients who lacked objective findings and identified candidiasis as the cause of glossodynia in 26 patients. RESULTS These patients revealed hyposalivation and decreased glossal pain thresholds and C. albicans cell overgrowth. Pain thresholds in the painful portion (54.6+/-2.9 degrees C) were significantly decreased compared with those in the painless portion (57.7+/-3.4 degrees C) (P < 0.05) and the pain thresholds were largely increased after treatment (57.2+/-1.6 degrees C). Nonstimulated SFR before treatment was lower than that of age- and gender-matched healthy people, although stimulated SFR was decreased only slightly. C. albicans cell overgrowth was detected by the number of C. albicans colonies that formed in Sabouraud's agar plate (539.3+/-198.4/dish). After the subsidence of glossal pain by mouth washing with a 3% amphotericin B solution, the C. albicans colonies were decreased to 31.5+/-19.3/dish, which was almost same as the control level, 14.1+/-8.4/dish. CONCLUSION These results indicate that candidiasis in conjunction with hyposalivation may induce pain in the tongue without manifestation of objective abnormalities.
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Affiliation(s)
- T Osaki
- Department of Oral Surgery, Kochi Medical School, Nankoku-city, Japan
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22
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Osaki T, Yoneda K, Yamamoto T, Ueta E, Kimura T. Candidiasis May Induce Glossodynia without Objective Manifestation. Am J Med Sci 2000. [DOI: 10.1016/s0002-9629(15)40696-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Del Rosso JQ, Gupta AK. The use of intermittent itraconazole therapy for superficial mycotic infections: a review and update on the 'one week' approach. Int J Dermatol 1999; 38 Suppl 2:28-39. [PMID: 10515527 DOI: 10.1046/j.1365-4362.1999.00011.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Q Del Rosso
- Department of Dermatology, University of Nevada School of Medicine, Las Vegas, USA
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Abstract
Major developments in research into the azole class of antifungal agents during the 1990s have provided expanded options for the treatment of many opportunistic and endemic fungal infections. Fluconazole and itraconazole have proved to be safer than both amphotericin B and ketoconazole. Despite these advances, serious fungal infections remain difficult to treat, and resistance to the available drugs is emerging. This review describes present and future uses of the currently available azole antifungal agents in the treatment of systemic and superficial fungal infections and provides a brief overview of the current status of in vitro susceptibility testing and the growing problem of clinical resistance to the azoles. Use of the currently available azoles in combination with other antifungal agents with different mechanisms of action is likely to provide enhanced efficacy. Detailed information on some of the second-generation triazoles being developed to provide extended coverage of opportunistic, endemic, and emerging fungal pathogens, as well as those in which resistance to older agents is becoming problematic, is provided.
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Affiliation(s)
- D J Sheehan
- Pfizer Pharmaceuticals Group, Pfizer Inc., New York, New York 10017-5755, USA.
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Jang KA, Chung ST, Choi JH, Sung KJ, Moon KC, Koh JK. Eosinophilic pustular folliculitis (Ofuji's disease) in myelodysplastic syndrome. J Dermatol 1998; 25:742-6. [PMID: 9863288 DOI: 10.1111/j.1346-8138.1998.tb02494.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a case of eosinophilic pustular folliculitis (EPF, Ofuji's disease) in a 12-year-old male who suffered from myelodysplastic syndrome. Bone marrow study revealed an increase in the eosinophil cell line without peripheral blood eosinophilia in our case. We suggest that the immunologic abberations ascribed to myelodysplastic syndrome and the increase in the eosinophil cell line in the bone marrow might play roles in the development of EPF in our case.
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Affiliation(s)
- K A Jang
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Affiliation(s)
- P J Sunenshine
- The Department of Dermatology, UMD--New Jersey Medical School, Newark 07103, USA
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Chairman MJR, Myers SA, Sanchez MR. Guidelines of care for dermatologic conditions in patients infected with HIV. J Am Acad Dermatol 1997. [DOI: 10.1016/s0190-9622(18)30748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Yuan JH, Stolzenbach JC, Salamon CM, Snook SS, Schoenhard GL. Improvement of bioavailability of the HIV protease inhibitor SC-52151 in the beagle dog by coadministration of the CYP3A4 inhibitor, ketoconazole. Xenobiotica 1997; 27:489-97. [PMID: 9179989 DOI: 10.1080/004982597240451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
1. SC-52151, an HIV protease inhibitor, is mainly metabolized by CYP3A4 and is poorly bioavailable after oral administration. After i.v. administration of SC-52151 to the female beagle dog (2.5 mg/kg), SC-52151 was rapidly eliminated in plasma with an elimination half-life of about 1 h, a plasma clearance of 44 ml/min/kg and an apparent steady-state volume distribution of 2.2 litre/kg. The high value of plasma clearance of SC-52151 suggests an extensive hepatic first-pass metabolism since SC-52151 is highly protein bound and does not partition itself into red blood cells. 2. The extensive hepatic first-pass metabolism was reduced by coadministration of a CYP3A4 inhibitor, ketoconazole. 3. Dogs were dosed daily with ketoconazole at dose of 100 mg ketoconazole per dog (approximately 10 mg/kg) for 5 days prior to the initiation of coadministration of SC-52151 for 15 days. The doses used for SC-52151 was 0, 60 and 120 mg SC-52151/kg/day (divided t.i.d., 8-h dosing interval). Coadministration of ketoconazole improved the bioavailability of SC-52151 from 4.1 to 9.6% and also improved the Cmax of SC-52151 from 0.41 to 0.83 microgram/ml. 4. Although the absolute bioavailability of SC-52151 was still low (approximately 10%), the Cmax and AUC achieved in this study were satisfactory for conducting chronic toxicology studies. No toxicity associated with the coadministration of ketoconazole was evident. Results from this study suggest that coadministration of ketoconazole might be a practical approach to increase the exposure of SC-52151 in both preclinical and clinical studies.
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Affiliation(s)
- J H Yuan
- G.D. Searle R & D, Skokie, IL 60077, USA
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Abstract
A variety of superficial and deep mycoses may affect the immunocompromised patient. Among the superficial mycoses, candidal infections are common in all groups, but dermatophyte and pityrosporum infections may also be found. Although not primarily dangerous, they may lead to secondary bacterial infections and morbidity. Of the systemic mycoses, candidiasis, aspergillosis, and mucor-mycosis are frequently lethal and require early diagnosis and aggressive antifungal treatment. Endemic mycoses, such as histoplasmosis and coccidioidomycosis, may result in severe and often fatal infections in those patients with cellular immune alterations. The identification and prophylaxis of high-risk patients and the development of more effective antifungal therapies are beginning to have an impact on the control of fungal disease in this population.
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Affiliation(s)
- P L Myskowski
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Abstract
Cutaneous disorders occur with great frequency in patients with HIV infection and increase in number and severity as the disease progresses and immune function declines. In addition, the first findings related to HIV infection are often on the skin. Cutaneous infections with herpesviruses may be severe and atypical in their presentations; papillomaviruses and MC are common as well. Bacterial infections may be primary or secondary to other skin diseases; superficial and deep fungal infections are also prevalent. Papulosquamous disorders, including seborrheic dermatitis, psoriasis, and eczema, may be disfiguring and result in secondary complications. Neoplastic disorders, especially Kaposi's sarcoma, demand early diagnosis, to afford the patient maximal treatment options. All physicians must be aware of these cutaneous manifestations to decrease morbidity and improve quality of life in the HIV-infected individual.
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Affiliation(s)
- P L Myskowski
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Bournerias I, De Chauvin MF, Datry A, Chambrette I, Carriere J, Devidas A, Blanc F. Unusual Microsporum canis infections in adult HIV patients. J Am Acad Dermatol 1996; 35:808-10. [PMID: 8912591 DOI: 10.1016/s0190-9622(96)90089-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tinea capitis in men, even if infected with HIV, is infrequent. Microsporum species nail infections are extremely rare. In most cases Microsporum canis infection is usually easy to treat with antifungal agents. We describe two HIV-infected men with an unusual M. canis infection. Both patients had tinea capitis, presenting as alopecia in one and scaling of the scalp in the other. One patient also had tinea unguium caused by M. canis. Ketoconazole was ineffective in both patients; terbinafine was tried in one patient without benefit; itraconazole was effective in both, but treatment took many months and only one patient was cured.
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Affiliation(s)
- I Bournerias
- Department of Infectious Diseases, Hôpital de la Salpêtrière, Paris, France
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Uchigasaki S, Baba S, Kakinuma H, Suzuki H, Sawada S, Kasori J, Okamoto T. Pruritic papular eruptions and candidiasis due to HIV infection. J Dermatol 1996; 23:572-6. [PMID: 8854592 DOI: 10.1111/j.1346-8138.1996.tb02654.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present two patients with refractory papular eruptions and severe candidiasis. Both of them are positive for treponema pallidum and have suffered from pruritic papular eruptions (PPE) that had resisted therapy for years. Also, candidiasis appeared in the mouth, at intertriginous sites, and on the feet. The clinical features suggested immunodeficiency, and HIV tests were positive. Histologically, the specimen from the PPE lesion showed perivascular and perifollicular mixed cell infiltration. The fungus was identified by both Parker-KOH-mount examination and mycologic culture as Candida albicans. The pruritic papules were healed almost completely with oral antihistamine and topical corticosteroid treatment, and the candidiasis mostly disappeared after treatment with topical antifungal agents alone. We learned from these two cases that refractory PPE and severe candidiasis indicate a need for HIV testing.
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Affiliation(s)
- S Uchigasaki
- Department of Dermatology, Surugadai Nihon University Hospital, Tokyo, Japan
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33
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Abstract
This article examines the expression of fungal infections seen with different immunodeficiency states and discusses how the sequential appearance of different diseases serves as a harbinger of clinical disease progression. The effect of an immunocompromised state on the medical history, physical findings, and natural history of fungal infections are discussed. The appearance and increased frequency of rare fungal infections, made possible by immunosuppression, are highlighted.
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Affiliation(s)
- M A Conant
- Department of Dermatology, University of California Medical Center, San Francisco, USA
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