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Singh A, Atallah S, Al-Shyoukh A, DaCunha M, Mizusawa M. Localized Talaromyces marneffei infection presenting as a tonsillar mass mimicking malignancy. IDCases 2020; 21:e00824. [PMID: 32489876 PMCID: PMC7256294 DOI: 10.1016/j.idcr.2020.e00824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
Talaromyces marneffei is an opportunistic fungal infection seen in immunocompromised patients including those with HIV/AIDS. It is usually seen in patients who live in or are from tropical Asia. In HIV patients, oropharyngeal and laryngeal lesions are usually part of disseminated infection. We describe a case of 63-year-old Vietnamese male with history of HIV/AIDS who presented with localized T. marneffei tonsillar infection without disseminated disease. Imaging studies showed a right tonsillar mass with right cervical lymphadenopathy which was initially thought to be malignancy. The patient underwent biopsy of the mass and histology showed noncaseating granulomas on hematoxylin and eosin stain as well as yeast on Grocott methenamine silver stain. Fungal culture of the biopsy specimen grew suede-like grayish-white colonies with diffuse underlying deep red color pigment which was identified as Talaromyces marneffei. The patient was treated with intravenous liposomal amphotericin B and achieved resolution of symptoms and tonsillar mass. In HIV/AIDS patients who are either from endemic regions or with history of travel to endemic areas particularly Southeast Asia and China, T. marneffei infection should be considered in differential diagnoses of a tonsillar mass.
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Affiliation(s)
- Annapoorna Singh
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - Sarah Atallah
- University of Missouri Kansas City School of Medicine, Kansas City, MO, United States
| | - Ahmad Al-Shyoukh
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - Matthew DaCunha
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
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Lamps LW, Lai KKT, Milner DA. Fungal infections of the gastrointestinal tract in the immunocompromised host: an update. Adv Anat Pathol 2014; 21:217-27. [PMID: 24911247 PMCID: PMC4061496 DOI: 10.1097/pap.0000000000000016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fungal infections are one of the most significant causes of morbidity and mortality in immunocompromised patients. The incidence of invasive fungal infections, including those of the gastrointestinal tract, has increased significantly as numbers of immunocompromised patients have increased. The diagnosis of fungal infections in immunocompromised patients may be particularly problematic as these patients may present with atypical clinical features. Although Candida and Aspergillus species represent the majority of fungi diagnosed in the immunocompromised patient population, other fungi are emerging as increasingly common pathogens, and this review will focus on several important emerging fungal infections in immunocompromised patients.
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Affiliation(s)
- Laura W Lamps
- *Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR †Department of Pathology, Brigham and Women's, Harvard Medical School, Boston, MA
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3
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Vu Hai V, Ngo A, Ngo V, Nguyen Q, Massip P, Delmont J, Strobel M, Buisson Y. La pénicilliose au Vietnam : une série de 94 cas. Rev Med Interne 2010; 31:812-8. [DOI: 10.1016/j.revmed.2010.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 07/19/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
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Ng GWY, Cheuk W, Lee MKP, Wu TC, Chau KF. Test and teach. Fever and disseminated lymphadenopathy in a SLE patient in Hong Kong. Diagnosis: Penicilliosis. Pathology 2006; 38:353-5. [PMID: 16916727 DOI: 10.1080/00313020600820724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- George W Y Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
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6
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Abstract
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.
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Affiliation(s)
- Molly T Hogan
- Division of Emergency Services, Harborview Medical Center, University of Washington School of Medicine, Box 359702, 325 9th Avenue, Seattle, WA 98104, USA.
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7
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Antinori S, Gianelli E, Bonaccorso C, Ridolfo AL, Croce F, Sollima S, Parravicini C. Disseminated Penicillium marneffei infection in an HIV-positive Italian patient and a review of cases reported outside endemic regions. J Travel Med 2006; 13:181-8. [PMID: 16706952 DOI: 10.1111/j.1708-8305.2006.00039.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We describe a case of disseminated Penicillium marneffei in a human immunodeficiency virus (HIV)-positive Italian man who stayed for 4 years in Chiang Ray province, northern Thailand. A review of the literature shows that penicilliosis, although unusual, may represent an emerging opportunistic infection among HIV-positive people traveling to endemic areas.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences, Section of Infections and Tropical Diseases, Luigi Sacco Hospital, University of Milan, Milano, Italy.
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Vanittanakom N, Cooper CR, Fisher MC, Sirisanthana T. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 2006; 19:95-110. [PMID: 16418525 PMCID: PMC1360277 DOI: 10.1128/cmr.19.1.95-110.2006] [Citation(s) in RCA: 349] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Penicillium marneffei infection is an important emerging public health problem, especially among patients infected with human immunodeficiency virus in the areas of endemicity in southeast Asia, India, and China. Within these regions, P. marneffei infection is regarded as an AIDS-defining illness, and the severity of the disease depends on the immunological status of the infected individual. Early diagnosis by serologic and molecular assay-based methods have been developed and are proving to be important in diagnosing infection. The occurrence of natural reservoirs and the molecular epidemiology of P. marneffei have been studied; however, the natural history and mode of transmission of the organism remain unclear. Soil exposure, especially during the rainy season, has been suggested to be a critical risk factor. Using a highly discriminatory molecular technique, multilocus microsatellite typing, to characterize this fungus, several isolates from bamboo rats and humans were shown to share identical multilocus genotypes. These data suggest either that transmission of P. marneffei may occur from rodents to humans or that rodents and humans are coinfected from common environmental sources. These putative natural cycles of P. marneffei infection need further investigation. Studies on the fungal genetics of P. marneffei have been focused on the characterization of genetic determinants that may play important roles in asexual development, mycelial-to-yeast phase transition, and the expression of antigenic determinants. Molecular studies have identified several genes involved in germination, hyphal development, conidiogenesis, and yeast cell polarity. A number of functionally important genes, such as the malate synthase- and catalase-peroxidase protein-encoding genes, have been identified as being upregulated in the yeast phase. Future investigations pertaining to the roles of these genes in host-fungus interactions may provide the key knowledge to understanding the pathogenicity of P. marneffei.
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Affiliation(s)
- Nongnuch Vanittanakom
- Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Tsunemi Y, Takahashi T, Tamaki T. Penicillium marneffei infection diagnosed by polymerase chain reaction from the skin specimen. J Am Acad Dermatol 2003; 49:344-6. [PMID: 12894097 DOI: 10.1067/s0190-9622(03)00486-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a case of Penicillium marneffei infection in a patient with AIDS who had skin eruptions disseminated over the entire surface of his skin. We identified P marneffei from the skin biopsy specimen by polymerase chain reaction using a set of primers specific for this pathogen.
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Affiliation(s)
- Yuichiro Tsunemi
- Department of Dermatology, International Medical Center of Japan, Tokyo, Japan.
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10
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Samaranayake LP, K. Cheung L, Samaranayake YH. Candidiasis and other fungal diseases of the mouth. Dermatol Ther 2002. [DOI: 10.1046/j.1529-8019.2002.01533.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Many newly described or "re-emerging" infectious diseases may present to the dermatologist, often with potentially life-threatening implications. Prompt recognition and early intervention can greatly diminish the morbidity and mortality associated with these diseases.
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Affiliation(s)
- S M Manders
- Division of Dermatology, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School at Camden, Camden, New Jersey, USA.
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Vilar FJ, Hunt R, Wilkins EG, Wilson G, Jones NP. Disseminated Penicillium marneffei in a patient infected with human immunodeficiency virus. Int J STD AIDS 2000; 11:126-8. [PMID: 10678483 DOI: 10.1177/095646240001100212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of a 31-year-old man with systemic Penicillium marneffei infection acquired in Thailand and who developed endophthalmitis is described. This presentation has not previously been reported. He responded to combined treatment with intravenous and intravitreal amphotericin.
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Affiliation(s)
- F J Vilar
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, UK
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Abstract
Penicilliosis marneffei, a common mycosis among AIDS patients living in Southeast Asia, has been recently suggested for inclusion in the AIDS surveillance case definition. Infections with Penicillium marneffei were rare in the past, but infections with this dimorphic fungus have increased with the endemic of AIDS in the region. The reservoir of P. marneffei in nature is still unknown, although it seems likely that inhalation may be the route of entry of the organism leading to infection in humans. P. marneffei can cause two clinical types of the disease; focal and fatal progressive, disseminated infections, characterized by a variety of symptoms which can mimic those of other diseases. Oral P. marneffei lesions usually occur in patients with disseminated infections, presenting as shiny papules, as erosions or as shallow ulcers covered with whitish yellow, necrotic slough which may be found on the palate, gingiva, labial mucosa, tongue and oropharynx. Biopsy and culture provide definitive diagnoses, while serologic tests for both antibody and antigen are useful in rapid presumptive diagnoses as well as in surveillance studies of the prevalence and latency of the infection. Penicilliosis marneffei is a treatable disease, but late diagnosis and treatment may be fatal. Itraconazole and ketoconazole are the drugs of first choice for mild to moderately severe forms of the disease, whereas parenteral therapy with amphotericin B may be required for seriously ill patients. Recurrence of the disease is common, therefore maintenance is recommended. As reported, prophylaxis generating resistant strains are likely to develop.
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Affiliation(s)
- W Nittayananta
- Department of Stomatology, Faculty of Dentistry, Prince of Songkla University, Haadyai, Songkhla 90112, Thailand
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López-Martínez R, Neumann L, González-Mendoza A. Case report: cutaneous penicilliosis due to Penicillium chrysogenum. Mycoses 1999; 42:347-9. [PMID: 10424109 DOI: 10.1046/j.1439-0507.1999.00464.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of cutaneous penicilliosis in a young man, without immunological compromise is reported. The lesions in the neck were characterized by two exudative reddish-purple pruriginous and painless spots. Penicilliosis was diagnosed after serial laboratory studies based on the observation of hyphae by direct microscopic examination and histopathology. Cultures of the tissue obtained from the lesions, developed mould colonies with typical conidia of Penicillium chrysogenum, which was thermotolerant at 37 degrees C. The treatment with itraconazole was successful, and 15 days after cessation of therapy, no recurrence of infection was observed. The epidemiology of this type of mycosis is commented upon, as well as the rarity of infections produced by Penicillium, even as opportunistic pathogens. The isolation of P. chrysogenum from skin lesions is exceptional.
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Aftergut K, Cockerell CJ. Update on the cutaneous manifestations of HIV infection. Clinical and pathologic features. Dermatol Clin 1999; 17:445-71, vii. [PMID: 10410852 DOI: 10.1016/s0733-8635(05)70101-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Skin is the most commonly affected organ in patients with HIV. As such, cutaneous manifestations of HIV infection have been the subject of intense scrutiny as well as the topic of many articles. A broad range of infectious and noninfectious skin lesions may develop during the course of the disease. This article discusses the clinical and pathological cutaneous manifestations of HIV infection.
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Affiliation(s)
- K Aftergut
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA
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Valeyrie L, Botterel F, Minozzi C, Roger P, Bourrée P, Vittecoq D. Prolonged fever revealing disseminated infection due to Penicillium marneffei in a French HIV-seropositive patient. AIDS 1999; 13:731-2. [PMID: 10397571 DOI: 10.1097/00002030-199904160-00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T. A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. N Engl J Med 1998; 339:1739-43. [PMID: 9845708 DOI: 10.1056/nejm199812103392403] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Southeast Asia, disseminated infection with Penicillium marneffei is common among patients with human immunodeficiency virus (HIV) infection. Even after successful primary treatment, the relapse rate for this potentially fatal systemic fungal infection is about 50 percent. METHODS We conducted a double-blind trial in Thailand to evaluate itraconazole as secondary prophylaxis against P. marneffei infection in patients with the acquired immunodeficiency syndrome (AIDS) who were in complete remission after treatment for culture-proved P. marneffei infection. The patients were randomly assigned to receive either oral itraconazole (200 mg daily) or placebo as maintenance therapy. RESULTS Of the 72 HIV-infected patients who completed initial treatment for P. marneffei infection, 71 were enrolled in the maintenance study. None of the 36 patients assigned to itraconazole had a relapse of P. marneffei infection within one year, whereas 20 of the 35 patients assigned to placebo (57 percent) had relapses (P<0.001). Among the 20 patients who had relapses, P. marneffei was cultured from blood (15 patients), lymph-node tissue (3 patients), skin (3 patients), and sputum (1 patient). The median time to relapse was 24 weeks after the completion of the initial treatment (95 percent confidence interval, 19.0 to 36.1). Survival and toxic effects were similar in the two groups. CONCLUSIONS In patients infected with HIV who have completed successful primary treatment of P. marneffei infection, secondary prophylaxis with oral itraconazole is well tolerated and prevents relapses of this opportunistic infection.
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HAMILTON AJ. Serodiagnosis of histoplasmosis, paracoccidioidomycosis and penicilliosis marneffei; current status and future trends. Med Mycol 1998. [DOI: 10.1046/j.1365-280x.1998.00174.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Porras B, Costner M, Friedman-Kien AE, Cockerell CJ. Update on cutaneous manifestations of HIV infection. Med Clin North Am 1998; 82:1033-80, v. [PMID: 9769793 DOI: 10.1016/s0025-7125(05)70403-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The skin is affected in virtually all patients with HIV infection. Many articles and several books have been published that deal with these disorders for a number of reasons. First, cutaneous disease may serve as the initial or only problem that the patient suffers for much of the course of the HIV infection. Second, serious opportunistic infections may present for the first time in the skin, so that a skin lesion may be a harbinger of the patient's having a life-threatening illness. Third, skin disorders in these patients may appear unusual and hence may not be accurately diagnosed by clinical inspection alone. Furthermore, response to treatment may be poorer than expected. Thus, skin diseases in the HIV-infected patient are important and, in some cases, may be the most debilitating element of the patient's condition.
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Affiliation(s)
- B Porras
- University of Texas Southwestern Medical Center, Dallas, USA
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Sirisanthana T, Supparatpinyo K. Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. Int J Infect Dis 1998; 3:48-53. [PMID: 9831676 DOI: 10.1016/s1201-9712(98)90095-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Penicillium marneffei is a dimorphic fungus that can cause systemic mycosis in humans. It is endemic in Southeast Asia, the Guangxi province of China, Hong Kong, and Taiwan. Prior to the epidemic of human immunodeficiency virus (HIV), penicilliosis was a rare event. The incidence of this fungal infection has increased markedly during the past few years, paralleling the incidence of HIV infection. The patients usually present with fever, anemia, weight loss, skin lesions, generalized lymphadenopathy, and hepatomegaly. The skin lesions are most commonly papules with central necrotic umbilication. The average number of CD4+ T lymphocytes at presentation is 64 cells/mm3. The fungus is usually sensitive to amphotericin B, itraconazole, and ketoconazole. The response to antifungal treatment is good if the treatment is started early. After the initial treatment the patient may need to take an antifungal drug as secondary prophylaxis for life. New tests for the laboratory diagnosis of penicilliosis have been reported. Further studies of these tests, as well as the epidemiology, natural history, and management of this potentially fatal systemic fungal infection are needed.
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Affiliation(s)
- T Sirisanthana
- Department of Medicine, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
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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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Affiliation(s)
- J L Helton
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
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Abstract
Specific pathologic processes, particularly oral, esophageal, and intestinal infections, are common in the alimentary tract of AIDS patients. Many of these diseases are adequately assessed only by biopsy with histologic examination. Most are rare or unreported in immunocompetent hosts and are easily missed by those not familiar with them. This article describes the gross or endoscopic and histologic appearances and the diagnostic criteria for enteric pathologic processes seen in HIV-infected individuals.
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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
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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