Problems of health and ecology
12. Solokha, O. A. Diagnosis and treatment of the syndrome of humeroscapular periarthropathy / O. A. Solokha, N. N. Yakhno // Neur. magazine - 2006. - No. 1. - S. 26-31.
13. Volker, Z. Restorative treatment after shoulder arthroplasty (translated from German) / Z. Volker, F. Dime // Lech. physics and sports. honey. - 2009. - .No. 3/63. - S. 47-51.
14. Tsykunov, M. B. Complex application of cryotherapy in the system of rehabilitation measures for post-traumatic contractures of the shoulder joint / M. B. Tsykunov // Med. help. - 2004. - .№ 4. - S. 20-24
15. Lorenz, Bohler. Technik der Knochenbruchbehandlung: in 2 volumes / Verlag von Wilhelm Maudrich, 1938. - 6th ed. - Vol. 1, 2.
16. "Ortho-S" (reinforced orthopedic center Ortho-S) orthopedic aids for joints - treatment and prophylactic line [electronic resource] / Section: shoulder joint. - Access mode: http://www.orto-s.ru/catalogue/?id=0. - Access date: 18.09.2009.
17. MosMedClinic.ru [electronic resource] / A. E. Loskutov, Our experience in the surgical treatment of fractures and fracture-dislocations of the proximal humerus / A. E. Loskutov,
V. N. Tomilin (Dnipropetrovsk medical acad.) // Mater. scientific-practical. conf. with international participant, Moscow, April 11, 2003 - Access mode: http://www.mailto:mosmedclinic.ru. - Date of access: 18.09.09.
18. Medical book at www.medbook.net.ru; medical book in "Garant-Inform" [electronic resource] / S. N. Popov. Physical rehabilitation (1.62 Mb) / S. N. Popov, 2005. -
C. 608. - Access mode: http://www.medbook.net.ru/49.shtml. - Date of access: 18.09.2009.
19. Miytrener.com [electronic resource] / E. V. Andrianova. Comprehensive rehabilitation for dislocations of the shoulder joint in athletes / E. V. Andrianova. - Access mode: http://miytrener.com/index.php. - Date of access: 18.09.2009.
20. AAOS (American Academy of Orthopedic Surgeon) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) [electronic resource] / PDF version. Publication Date: May 2001. - Revised March 2006. Shoulder Problems Section. - Mode of access: http://orthoinfo.aaos.org/menus/orthopaedics.cfm. - Date of access 20.09.2009.
21. Expodata.ru [electronic resource] / K. V. Lyadov. Possibilities of restoring the mobility of the shoulder joint with its stiffness using new technologies / K. V. Lyadov, M. R. Makarova, N. I. Shishkin (N. I. Pirogov National Medical and Surgical Center, Moscow ) // II Intern. congress "Restorative medicine and rehabilitation
http://expodata.ru/. - Date of access: 18.09.2009.
22. Medi (Germany) [electronic resource] / Products for the shoulder joint. - Access mode: http://www.steportho.ru/section48/. - Date of access: 18.09.2009.
23. Mountain.RU 1999-2008 [electronic resource] / O. N. Milenin. Instability and habitual dislocation of the shoulder joint /
O. N. Milenin.- Access mode: http://www.mountain.ru/.- Access date: 18.09.2009.
24. Ortos2005-2008 [electronic resource] / Fixators and joint restraints ORLETT (Germany), OPTYu (.Lithuania).- Access mode: http://www.ortos.by/. - Date of access: 22.09.2009.
25. Paralife 2001-2009 [electronic resource] / V. A. Kachesov. Fundamentals of intensive self-rehabilitation / V. A. Kachesov // Medicine: ed. group BDC-PRESS 2007 (HTML document Paralife2001-2009). - Access mode: http://paralife.narod.ru/1adaptation/kachesov/2007/contents.htm. - Date of access: 18.09.2009.
26. TECH2U, 2007-2009. Orthopedic aids: corsets, bandages, belts [electronic resource] / Section: shoulder joint (med-magazin.ru, ortomed.ru). - Access mode: http://tech2u.ru/catalog/_?cat-egories_ro=437. - Date of access: 18.09.2009.
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28. TsOB for FKiS, 2001 (Central branch library for physical culture and sports) [electronic resource] / N. V. Manak. Practical aspects of the application of the technique of manual development of post-immobilization contractures of the shoulder joint in patients at the stationary stage of rehabilitation (Belarusian University of Physical Culture) / N. V. Manak // post. to print March 18, 2008. Access mode: http://lib.sportedu.ru/index.htm. - Date of access: 18.09.2009.
29. Dr Jose De Andms, Spain. Treatment of postoperative pain is good clinical practice. General recommendations and principles of successful pain treatment [electronic resource] / Dr Jose De Andros (translated and edited by Prof. A. M. Ovechkin) / / ed. comp. Astra Zeneca. - P.55. - Access mode ^bp:// www.esraeurope.org; http://www.postoppain.org. - Date of access: 11/18/2009.
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Received 09.02.2010
UDC 616.329-002.828:616.98.578.828HIP
ORAL CANDIDIOSIS IN HIV-INFECTED PEOPLE
T. M. Mikhed, E. L. Krasavtsev, D. D. Redko Gomel State Medical University
The article presents the structure of fungal pathogens of the oral mucosa in HIV-infected patients with a clinic of oropharyngeal candidiasis. In most cases, the development of infection is due to monocultures of C. albicans (82%). The fact of detection or absence of growth of fungal pathogens did not depend on the parameters of the immune system. The number of detected fungi in HIV-infected patients with different immunological status significantly differed. Fluconazole-resistant oropharyngeal candidiasis was detected in 38.4% of cases. All isolated fungal pathogens in the examined group of patients were sensitive to amphotericin B.
Key words: HIV infection, AIDS, candidiasis.
CANDIDOSIS OF MUCOUS MEMBRANES OF ORAL CAVITY OF THE HIV-INFECTED
T. M. Mihed, E. L. Krasavtsev, D. D. Redko Gomel State Medical University
The article presents the structure of fungal agents of mucous membranes of oral cavity of the HIV-infected. The majority of infection is caused by Candida albicans (82%). The fact of revealing of or absence of growth of fungi did not depend on the indicators of the immune status. The quantity of fungi of the HIV-infected with various immune status was definitely different. Fluconazole-refractory oropharyngeal candidosis was revealed in 38.4% of HIV-infected patients. Amfotericin B is effective among patients with oropharyngeal candidosis.
№problems of health and ecology
Key words: HIV-infection, AIDS, candidosis.
Mycosis is one of the most frequently reported diseases in both early and late stages in patients with HIV infection. Systemic and superficial mycoses caused by yeast fungi and, in particular, the Candida genus, are the most common form of fungal infections. Fungi of the genus Candida can cause a range of infectious lesions - from local lesions of the mucous membranes and skin to life-threatening disseminated infectious processes with extensive lesions. internal organs and systems requiring diagnostic and medical measures. Of particular importance in recent years is the early detection of the disease and the treatment of mycoses in HIV infection, in which candidiasis is often a marker of the disease.
Representatives of the genus Candida belong to yeast fungi, they were first isolated from lesions of the oral cavity by Langenbeck in 1839. In the late XIX - early XX centuries, candidiasis was relatively rare. Oral candidiasis is one of the most common fungal infections (it develops in 40-60% of patients). Of all the types of Candida in patients with HIV infection, most often isolated
C.albicans (60-90%), but other species are also possible (C. parapsilosis, C. krusei, C. glabrata, etc.). Often, more than two types of pathogens are found. There are pseudomembranous, atrophic, chronic hyperplastic candidiasis, as well as angular cheilitis (which is
ry cause more often C. albicans, C. tropicalis,
C. rubra, C. famata).
Angular cheilitis (Figure 1) appears as erythema or cracking of the corners of the lips. It may occur together with atrophic candidiasis and pseudomembranous candidiasis or separately from them; without treatment, the disease continues for an extremely long time.
Atrophic candidiasis is probably the least and most misdiagnosed manifestation of HIV in the oral cavity. The disease appears as a red, flat, subtle lesion on the dorsal surface of the tongue or hard or soft palate. Damage can take a "mirror" form: if it is present on the tongue, it is necessary to examine the palate for the presence of the same damage, and vice versa (Figure 2).
This disease has clear symptoms: patients complain of a burning sensation in the mouth, most often when eating salty or spicy foods and drinking acidic drinks. Clinical diagnosis is based on the appearance of the lesion as well as the patient's medical history and virological status.
Pseudomembranous candidiasis appears as soft, white, cheesy plaques on the buccal mucosa, tongue, or other mucous surfaces. These plaques are easily removed with a spatula and usually leave red or bleeding spots on the affected surface (Figure 3). Plaque consists of desquamated epithelium, keratin, fibrin, food debris, mycelial filaments, bacteria.
Figure 1 - Angular Figure 2 - Atrophic Figure 3 - Pseudomembranous
cheilitis candidiasis candidiasis
This form of candidiasis occurs in 83.3% of patients with HIV infection.
Much less common is chronic hyperplastic candidiasis, reminiscent of smokers' leukoplakia; elements are located on the mucous membrane of the cheeks, hard and soft palate on both sides.
The aim of the study was to study the structure of fungal pathogens in HIV-infected patients under observation in
consultative and dispensary office for HIV / AIDS in the institution "Gomel Regional Infectious Clinical Hospital", and in HIV-infected patients in prison with clinical manifestations of oropharyngeal candidiasis.
Material and research method
100 patients under observation in the consultative dispensary office (hereinafter KDK) for HIV/
Problems of health and ecology
AIDS in the Gomel Regional Infectious Diseases Clinical Hospital (hereinafter UGOIKB) who do not receive antiretroviral therapy (hereinafter referred to as ART), and 20 patients in prisons (hereinafter MLS) who have clinical manifestations of oropharyngeal candidiasis.
The immunological status (detection of CD4 cells) was determined using a FACScan flow cytometer using a lysis solution and immunoclonal antibodies, viral load, PCR in the laboratory of the UGOIKB and the laboratory of the HIV/AIDS Prevention Department of the Gomel Regional Center for Hygiene, Epidemiology and Public Health.
Microbiological studies in patients under dispensary observation were carried out on the basis of the clinical diagnostic laboratory of the UGOIKB. Smears were taken from the lesions with a sterile swab and inoculated on Nickerson's media. Growth was assessed after 72 hours. Microbiological studies of patients in the MLS were carried out on the basis of the clinical diagnostic laboratory of the Republican Scientific and Practical Center for Radiation Medicine and Human Ecology in 2008-2009. Transportation was carried out within 2-3 hours in a test tube with Amies transport medium (Nesha-Meyua, India). Identification, determination of the sensitivity of fungi and analysis of the data obtained were carried out using a miniAPI microbiological analyzer from bioMerieux (France). Plates (strips) containing dehydrated biochemical substrates were used for identification (from 16 to 32 tests). Determination of sensitivity to antifungal drugs (flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole) was carried out on strips (ATB FUNGUS-3) from bioMerieux (France) in
I19-^J^^*32 □ 49 Z*-*7
semi-liquid medium adapted to the requirements of the standard dilution method of the Clinical Laboratory Standards Institute (CLSI)-NCCLS M-44, USA. Control strains of the American Microorganism Collection (ATCC) were used for quality control of susceptibility testing.
Given the abnormal distribution according to Kolmogorov-Smirnov, the statistical analysis of the obtained data was carried out using the Mann-Whitney and Fisher test (methods of non-parametric statistics).
Results and discussion
The majority of HIV-infected patients under dispensary observation at the CDC for HIV/AIDS UGOIKB were residents of Svetlogorsk - 36%, Gomel - 30% and Zhlobin - 23%; the rest lived in Rechitsa - 2%, Lelchitsy - 1%, Mozyr - 1%, Bragin - 1%, Narovlya - 2%, Kalinkovichi - 2% and urban settlement . October - 1%.
The age of the patients was 33.06 ± 0.54 years. Among them, there were 53 men (53%), women - 47 (47%). The patients were certified from 1994 to 2009. In all examined patients, the parenteral route of infection prevailed (Figure 4).
C. albicans was isolated in 82% of patients, C. krusei was isolated in 3% of cases, and there was no growth in 15% of all studies. Most of these patients (63.4%) had characteristic clinical signs of pseudomembranous candidiasis, in 6.1% of cases signs of atrophic candidiasis were detected. In 8.5% of the examined patients, a clinical picture of angular cheilitis was observed in combination with atrophic or pseudomembranous candidiasis. Analyzing the obtained data, we see that in patients with no growth of Candida spp. there is a lower viral load (p> 0.05) than in patients with identified Candida spp. (Table 1).
■ genital □ intravenous B unspecified
Figure 4 - Ways of infection of the examined patients
Table 1 - Parameters of the immune status and viral load in HIV-infected patients not receiving ART, with detected Candida spp. and their absence
Candida spp. found, n = 85 19.89 ± 1.14, n = 75 413.017 ± 36.06, n = 80 317602.4 ± 61025.22, n = 51
Candida spp. not detected, n = 15 19.93 ± 2.56 421.234 ± 116.77 163941.3 ± 80605.34, n = 11
Problems of health and ecology
HIV-infected patients were divided into two groups according to the number of detected C. albicans. The first group included patients who had microbiota in the amount of 104 CFU/ml and more; The second group included patients with
identified C. albicans 103 CFU / ml and below. Analyzing the obtained groups of patients, it was found that with a decrease in the percentage of CD4 cells and the number of CD4 cells per µl of blood, the number of seeded C. albicans increases statistically significantly (Table 2).
Table 2 - Parameters of the immune status in patients with HIV infection who are under dispensary observation, with different levels of detection of fungal pathogens
Organisms % CD4 cells Number of CD4 cells per µl Viral load
4 C. albicans 10 CFU/ml and above, n = 41 17.6 ± 1.75*, n = 36 353.1 ± 46.8*, n = 38 433211.7 ± 119770.1, n = 22
3 C. albicans 10 CFU/ml and below, n = 41 22.57027 ± 1.44*, n = 37 491.08 ± 55.12*, n = 39 209538 ± 51631.19, n = 28
The classification of HIV infection for adults and adolescents, proposed by the Centers for Disease Control (CDC) in 1993, is the most common abroad and is also widely used in our practice. Given this classification, patients were divided into three categories according to immunological criteria. The first category included patients with a CD4 count of more than 500 cells per µl, the second - from 200 to 500 cells per µl, and the third - up to 200 cells per µl. The structure of fungal pathogens in HIV-infected
various immunological categories is presented in Table 3. Table 2 shows that C. albicans 104 CFU / ml and above was detected in the third immunological category in 51.61% of cases. In the first immunological category, C. albicans 103 CFU / ml is statistically significantly more often sown and lower than in the third immunological category. The development of pathology is directly related to a decrease in the number of CD4 cells and an increase in viral load and is an independent indicator of the progression of HIV infection.
Table 3 - The structure of fungal pathogens in HIV-infected people in various immunological categories
n = 31 51.61% 29.03%* 6.45% 12.91%
n = 40 32.5% 40% 2.5% 25%
20 patients from MLS with clinical manifestations of oropharyngeal candidiasis were examined. Patients were in the MLS from 0.3 to 3.9 years. The mean age was 32.94 ± 0.94 years. During the period of microbiological monitoring, 18 patients were found to have 4 different fungal and 3 non-fungal pathogens. At the same time, the largest specific gravity C. albicans (65%) belonged to all isolated fungal species.
The vast majority of fungal infections in this category of patients with HIV infection was due to monocultures of C. albicans
(73.3%). The amount of C.albicans inoculated in these patients was 104 CFU/ml and more. The number of CD4 cells in these patients was 270.77 ± 56.38 per µl. Considering the 1993 CDC classification, there were 9% of patients in the first immunological category, and 45.5% of patients in the second and third categories. In 55.5% of the examined patients, the viral load was less than 500 copies, respectively, 44.5% of patients had a viral load of more than 2500 copies.
At the same time, an important feature is the detection in the foci of associations of C.albicans with representatives of fungal pathogens non-albicans (1 case) and non-fungal (1 case). Non-fungal
Problems of health and ecology
microorganisms (M. catarhalis, P. aeruginosa, S. aureus) and non-albicans monocultures (C. krusei,
C.kefyr, C. cupitatum) were found in 4 and 3 HIV-infected, respectively. No growth was found in 2 patients.
The use of antimycotic drugs, in particular, fluconazole, made it possible to quickly and effectively cure fungal diseases of any localization in patients with HIV infection. However, due to the emergence of resistance and the lack of effective antifungal drugs in these patients, fungal diseases are one of the main causes that aggravate the course of HIV infection and cause deaths. In particular, strains of C. krusei are considered clinically resistant to fluconazole and their in vitro sensitivity to this drug is not determined (according to CLSI recommendations). In addition, it is noted that species of the genus Candida, such as C. glabrata, Table 4 - Resistance to antimycotics of g]ic lesions in patients with HIV infection
C. dubliniensis or some strains of these species are also resistant to fluconazole, and this resistance may be genetically determined. In the treatment of fluconazole-resistant candidiasis for a long time and with high doses of itraconazole, strains resistant to both azoles may occur in patients; however, only 30% of fluconazole-resistant strains were insensitive to itraconazole. According to other observations, among the strains resistant to fluconazole, there were no cultures resistant to itraconazole.
As a result of our microbiological study of patients who were in the MLS, resistance was found in C. albicans to fluconazole in 38.4%, to itraconazole - in 15.3%, to flucytosine - in 7.7%. All isolated fungal pathogens were susceptible to amphotericin B and voriconazole (Table 4).
ancestral pathogens isolated from foci of myco-
Microorganisms Number of resistant strains
fluconazole itraconazole flucytosine
abs. % abs. % abs. %
C. albicans 5 38.4 2 15.3 1 7.7
C. krusei 1 100 0 - 1 100
C. kefyr 0 - 0 - 0 -
C. cupitatum - - - - 1 100
Lesions of the mucous membranes of the oral cavity and upper respiratory tract in HIV-infected people can be caused by a wide range of fungal pathogens, both in associations and in monoculture. The use of a wide range of chemotherapy drugs and an increase in the number of diagnostic and therapeutic procedures in patients with HIV infection contributes to the formation of drug resistance in classical pathogens of mycoses and the appearance in the etiology of mycoses of pathogens resistant to the action of such a widely used antifungal drug as fluconazole.
Conclusion
82% of fungal diseases in HIV-infected patients not receiving ART, who are under observation in the HIV/AIDS consultative dispensary at UGOIKB, were due to monocultures
C. albicans. The parameters of the immune status in patients did not differ from the fact of detection or absence of fungal pathogens, but the number of their detection was statistically significantly different. With a decrease in the percentage of CD4 cells and the number of CD4 cells per µl of blood, statistically
The amount of C. albicans sown is significantly increased.
73.3% of fungal diseases in HIV-infected patients in MLS were due to C. albicans monocultures. The combination of C.albicans with other types of fungal pathogens, as well as with non-fungal pathogens, was detected in 1 case. Fluconazole resistance of C.albicans was 38.4%. All isolated fungal pathogens were sensitive to amphotericin B and voriconazole. Given the above, we can conclude that further active and widespread use of fluconazole in the treatment of candidiasis in HIV-infected MLS is unpromising.
REFERENCES
1. Features of the etiology of fungal diseases in patients with HIV infection and drug resistance of identified fungal pathogens to fluconazole / N. Yu. Makarova [et al.] // Epidemiology and infectious diseases. - 2003. - No. 2. - S. 33-35.
2. HIV infection: clinic, diagnosis and treatment / VV Pokrovsky [et al.]: ed. ed. V. V. Pokrovsky. - 2nd ed. - M.: GEOTAR-MED, 2003. - 488 p.
3. Levonchuk, E. A. Candidiasis of the skin and mucous membranes: textbook. allowance / E. A. Levonchuk. - Mn., 2007. - 31 p.
Problems of health and ecology
4. Borovsky, E. V. Atlas of diseases of the mucous membrane of the pharynx and oral cavity in HIV infection / E. V. Borovsky, N. F. Danilevsky. - M.: Medicine, 1981. - 455 p.
5. In vitro activity of fluconazole and voriconazole against yeast isolated from cancer patients / N. S. Bagirova [et al.] // Accompanying therapy in oncology. - 2004. - No. 4. - S. 1-7.
6. Identification and expression of multidrug transporters responsible for fluconazole resistance in Candida dublidiensis / J. P. Moran // Antimicrob. Agents Chemother. - 1998. - Vol. 42, No. 7. - P. 1819-1830.
7. Itraconazole solution: higher serum drug concentrations and better clinical response rates than the capsule formulation in acquired immunodeficiency syndrome patients with candidosis / I. D. Cartiedge // J.Clin.Pathol. - 1997. - Vol. 50, No. 2 6. - P. 477-480.
Received 10/19/2009
UDC 616.12-008.318+616.24-008.4]:616.831-005.4 HEART RHYTHM DISORDERS AND CHANGES IN EXTERNAL RESPIRATORY FUNCTION IN VARIOUS BRAIN INFARCTION SUBTYPES
O. V. Nikolaeva
Belarusian Medical Academy of Postgraduate Education, Minsk
49 patients with cerebral infarction were examined. All patients underwent Holter ECG monitoring and spirography. Group 1 included 25 (51%) patients with atherothrombotic stroke, group 2 included 24 (49%) patients with cardioembolic stroke. It has been shown that in atherothrombotic stroke the disorders of the cardiovascular system are most pronounced, and in cardioembolic stroke - from the function of external respiration.
Key words: cardiac arrhythmia, respiratory function, cerebral infarction.
CARDIAC RHYTHM IMPAIRMENT AND ALTERED FUNCTION OF EXTERNAL BREATHING IN DIFFERENT SUBTYPES OF SRTOKE
Belarussian Medical Academy of Post-graduation Education, Minsk
49 patients with stroke were examined. Holter monitoring and research function of external breath were made in all the examinations. In the 1st group, which included 25 (51%) patients with atherothrombotic and in the 2nd group, which included 24(49%) patients with cardioembolic stroke. In the first group infringements of the cardiovascular system are the most expressed, and in the second one - function of external breath.
Key words: cardiac arrhythmias, function of external breath, stroke.
Introduction
Acute cerebrovascular accidents (ACV) constitute the most important medical and social problem, due to their high proportion in the structure of morbidity and mortality of the population, significant indicators of labor losses and primary disability.
Today, about 9 million people in the world suffer from cerebrovascular diseases, the main place among which is occupied by cerebral infarction (MI). Mortality from cerebrovascular diseases is second only to mortality from heart disease and tumors of all localizations and reaches an economically developed countries 11-12 % .
Currently, cerebral infarction accounts for 2/3 of all cases of stroke. In 72% of cases, the main cause of the pathogenesis of MI is the pathology of the heart. At the same time, the processes of changes in the vessels of the brain and heart are largely identical to each other. In particular, there is a high degree of severity of the atherosclerotic process, sometimes reaching a significant degree,
which determines the similarity of pathogenetic mechanisms in the development of the pathology of the cardiovascular system and the brain. This is the reason for the need for a joint and coordinated tactics for the management of patients with stroke by cardiologists and neurologists.
In recent years, the relationship between the cardiovascular and nervous systems has been widely studied both in normal conditions and in various pathological conditions. This is due to the introduction into clinical practice latest methods(ultrasound and functional) studies of the heart and brain, which made it possible to establish the significance of cardiac pathology in the occurrence and course of stroke.
Research recent years significantly expanded and refined the understanding of the interdependence of cardiac pathology and cerebral hemodynamics. Thus, it has been established that cardiac disorders play an important role in the pathogenesis, course and outcomes of stroke and, first of all, MI. In turn, the development of the latter may exacerbate or lead to cardiac arrhythmias.
This is a group of opportunistic infections caused by fungi of the genus Candida. Candidal lesions in HIV-infected people are more common than any other infection. It has been clinically established that oral candidiasis is an early marker of HIV infection, and candidal lesions of the esophagus, trachea, bronchi, lungs are indicator diseases of the AIDS phase (by definition WHO, 1993).
Candidiasis occurring against the background of HIV infection is characterized by the following features: the disease affects young people, especially men; the process involves mainly the mucous membranes of the oral cavity, genitals and perianal region; in the clinical picture there is a tendency to the formation of extensive lesions, which are accompanied by soreness, there is a tendency to erosion and ulceration. There is a candidal lesion of internal organs (esophagus, trachea, etc.).
It should be noted that against the background of immunodeficiency, infectious agents can be quite rare species. Candidaspp:. WITH. sake,WITH. dubliniensis,WITH. lipolytica,WITH. quilliermondii,WITH. famata; resistant strains WITH. albicans.WITH.dubliniensis- a new resistant type of fungus, which is isolated almost exclusively in oral candidiasis against the background of HIV infection.
In vulvovaginal candidiasis in HIV-infected women, the causative agent is mainly the species WITH.glabrata, which often leads to the development of chronic relapsing forms of the disease and is also often detected in carrier forms.
Depending on the localization of the process, several clinical forms of candidiasis are distinguished: candidiasis of the oral cavity and pharynx (oropharyngeal candidiasis), median rhomboid glossitis, candidal cheilitis, seizure, candidiasis of the folds, candidal paronychia and onychia (see section 16.1.4.4), smooth skin candidiasis.
Candidiasis of the oral cavity and pharynx (oropharyngeal candidiasis). As a rule, in healthy young people who have not previously received antibacterial and corticosteroid drugs, oropharyngeal candidiasis is not detected. In contrast, among HIV-infected people, this form of pathology occurs most often and sometimes serves as the first manifestation of AIDS. It is believed that in AIDS, in half of the cases, oral candidiasis is a harbinger of Kaposi's sarcoma.
According to epidemiological data, one third of pain HIV-infected, and with the onset of the AIDS phase, it can be observed in 90% of patients.
Median rhomboid glossitis is a chronic atrophy of the papillae of the back of the tongue and stands out as a separate form of oral candidiasis. This pathology is associated with colonization by fungi of the genus Candida and candidiasis of the oral cavity, often found in AIDS.
Clinically, a focus of papillary atrophy of a diamond-shaped or oval shape is detected in the middle of the back of the tongue, which has clear boundaries. Subjectively, as a rule, there are no sensations, but there may be a burning sensation, tingling, which is aggravated by eating.
Candidiasis of the corners of the mouth, or angular cheilitis, jamming found in 20% HIV infected people. It can manifest itself or be accompanied by one of the above forms.
The clinical picture is represented by cracks in the corners of the mouth, covered with a whitish, easily removable plaque, painful.
The disease is prone to chronicity and frequent recurrence. Candida cheilitis (see section 16.1.4.4) is a chronic form of oral candidiasis. With a decrease in CD4 + T-cells to a level of less than 200 cells / μl of blood, the infectious process from the oral cavity and pharynx descends lower into the esophagus, trachea, and lungs.
candidiasis folds manifests itself mainly in the inguinal, gluteal, axillary folds, perineum. Women often have skin lesions under the mammary glands, in the vulva. There is a lesion of the interdigital folds on the hands (most often the third interdigital fold).
The clinical picture is represented by areas of crimson erosions with a bluish tinge, sharply demarcated from apparently healthy skin. On the periphery of the erosions there is a fringe of exfoliating white epidermis. In large folds, eroded areas alternate with areas of macerated epidermis, in the zone of which the skin is thickened and covered with a white coating.
Candidiasis can not only appear in infected people, but also talk about the presence of the human immunodeficiency virus in the body. As a rule, with the rapid development of this disease, the patient is sent for a blood test.
The disease starts small. The mucous membrane of the oral cavity, the back of the pharynx, and the digestive organs are affected. When it comes to women, there is often a vaginal disease.
If the pathology is not diagnosed in time and treatment is not started, then complications develop that can not only worsen the quality of life of the patient, but also lead to his death.
Interestingly, an analysis for the presence of candidiasis in the body can show a negative result only in HIV-infected patients, if there is no immunodeficiency virus in the body, then the test will always show a positive result, regardless of the degree of development of the disease.
How to treat intestinal candidiasis
Candidiasis (in popular words, thrush) is often mistakenly attributed to venereal diseases. At the same time, the fungus that causes candidiasis can equally well affect other organs - the skin and nails, the oral cavity, and the gastrointestinal tract. One of the most unpleasant forms, but quite curable forms of the disease is intestinal candidiasis.
Mushrooms of the genus Candida can be present in the body of a healthy person for years without making themselves felt. But if the microflora is disturbed, provoked by some third-party disease, the beneficial bacteria are no longer able to counteract the fungus, and it begins to multiply rapidly, causing an exacerbation of intestinal candidiasis.
This disease is especially dangerous for infants, because. candidiasis is accompanied by rapid loose stools, which leads to dehydration and the loss of nutrients, vitamins and minerals necessary for normal life.
Most often, this form of candidiasis affects patients who have previously been diagnosed with the following diagnoses:
- Diseases of the gastrointestinal tract in chronic forms;
- Physiological immunodeficiency (often observed during pregnancy, at an early age, in stressful situations);
- Pathologies of the endocrine system (tumors of the adrenal glands, diabetes mellitus);
- Oncological diseases and pathologies of the hematopoietic system, requiring long-term cytostatic therapy as a treatment;
- HIV infection;
- Allergic and autoimmune diseases requiring glucocorticosteroids.
In addition, the patient himself can provoke candidiasis of the gastrointestinal tract: when trying to self-treat simple infections with unintended means, for example, with the use of powerful reserve antibiotics.
Forms of manifestation
Non-invasive candidiasis or candida dysbiosis is the most common form of fungal intestinal disease caused by uncontrolled growth in the intestinal lumen of Candida or individual hypersensitivity.
The main symptoms of the disease are: a feeling of discomfort in the abdomen, a change in the consistency of the stool, diarrhea, and deterioration in general well-being. Fecal candidiasis - can manifest itself as a secondary process with a duodenal ulcer, as well as with ulcerative colitis.
Invasive or diffuse candidiasis in the intestine is a rather rare form of the disease, which is characterized by the most severe course. It is accompanied by erosive pseudomembrous colitis, which causes bloody diarrhea, and systemic damage to other organs.
In this form, the disease can manifest itself in cancer patients, HIV-infected people and people who take glucocorticosteroids, cytostatic or immunosuppressive agents for a long time.
Perianal candidiasis - manifests itself as a pathology skin near the anus, often accompanied by herpes. In this form of gastric candidiasis, it is predominantly found in HIV-infected people who became infected through homosexual contact.
How to recognize
Candidiasis of the gastrointestinal tract manifests itself as follows:
- Pain in the stomach and lower abdomen;
- Loose stools, in which bloody and mucous inclusions can be traced;
- White blotches of curdled consistency in the patient's stool;
- Lack of appetite, feeling of constant discomfort, heaviness and bloating;
- Discomfort during bowel movements.
Symptoms of intestinal candidiasis immediately become apparent to an experienced doctor due to the combination distinctive features. Rectal candidiasis has similar symptoms, so only a doctor can tell them apart.
A mandatory sign of this type of thrush is frequent, unformed stools, pressing sensations, heaviness and a feeling of incomplete emptying of the intestine. Characteristic signs of esophageal candidiasis are increased gas production, frequent urge to empty the bowels, sudden bouts of spasmodic pain in the abdomen and diarrhea, especially after eating.
Additional signs that accompany intestinal candidiasis for a doctor may be skin problems. Pimples and acne, itchy spots, urticaria and various types of dermatitis appear on the face, and in some cases on the back and other parts of the body.
Common signs of candidiasis in the intestines can also include increased fatigue, general malaise, irritability, drowsiness, sleep problems, and loss of appetite.
How to treat intestinal candidiasis or rectal candidiasis? First you need to accurately establish the diagnosis with the help of a comprehensive laboratory study. Only if the causative agent of a fungal infection is found in the analyzes can the doctor prescribe an appropriate course of treatment.
The treatment required by intestinal thrush is carried out by almost the same means as with other types of candidiasis. Traditionally, antibacterial and antifungal agents containing fluconazole or clotrimazole are prescribed.
At the same time, the active substance fluconazole shows the greatest effectiveness when used internally, therefore it is prescribed in the form of tablets and capsules. In addition, a course of drugs against intestinal dysbacteriosis is also prescribed.
All drugs are selected depending on the form of intestinal candidiasis. Treatment of non-invasive candidiasis requires resorptive antimycotics, such as nystatin, levorin, netamycin. With a proven invasive form of candidiasis, fluconazole, ketocanosole, intraconosole are used.
To increase the effectiveness of drugs containing fluconazole, you can also use alternative methods. So, in order to cure intestinal candidiasis, garlic is often used inside (in the amount of 10-12 cloves), and for rinsing the mouth after eating - an infusion of chamomile, sage, oak bark, calendula and celandine.
Treatment of candidiasis in patients with HIV
In order not to raise the question of how to treat this disease, you need to take care of high-quality prevention in advance. So, people with a low immune status are often prescribed the drug Diflucan. Doctors claim that he is able to prevent the onset of the disease.
If candidiasis has made itself felt, and you have not found signs of this disease, you need to follow these recommendations:
- Natural yogurt is able to inhibit the growth of the fungus, so try to include this product in your diet as often as possible;
- Oral hygiene is important, since fungal organisms are unlikely to multiply under sterile conditions;
- As for vaginal candidiasis, choose underwear made from natural fabrics to avoid this unpleasant phenomenon.
If the disease manifests itself, then you need to immediately visit a doctor. He will prescribe the appropriate drugs, prescribe treatment and give good recommendations. You can’t self-medicate, because the immune system of an HIV-infected person is already vulnerable, and you can provoke its decline by picking up proper treatment.
Commonly used drugs for candidiasis in infected people are:
- Clotrimazole. These are tablets to be taken up to 5 times a day for 2 weeks. They should not be chewed or swallowed, they simply dissolve in the mouth. A side effect from taking is indigestion;
- Nystatin. The regimen is similar to the previous drug. The medicine does not cause side effects;
- Amphotericin B. A certain amount of liquid is placed on the tongue about 4 times a day. Drops should be kept in the oral cavity for as long as possible;
- Clotrimazole is a drug for the treatment of vaginal candidiasis. The form of release of the drug is a cream, but sometimes candles are also used. You need to use the drug for one week;
- Miconazole. The scheme of treatment with this drug is similar to the previous one;
- Terconazole works in the same way as the previous two drugs, but its mode of action is more advanced. He is able to eliminate candidiasis in 3 days;
- Itraconazole. This is a medicine for the treatment of pathology of the esophagus. The tablets are usually taken three times a day for one month;
- Ketoconazole. The regimen for taking this medication is selected by the doctor for each patient on an individual basis.
If the fungus becomes resistant to many types of drugs, then the treatment is carried out in a hospital setting. Most often, droppers are used, through which strong or even aggressive drugs are administered that can defeat the causative agent of the disease.
Thus, candidiasis in HIV is not a sentence. It can be cured if you follow all the recommendations of the attending physician.
Diseases of the small and large intestine in HIV infection and AIDS
Diarrhea is a common complaint in HIV-infected people, especially if their CD4 count is below 100 µl -1 .
As with esophageal lesions, opportunistic infections themselves have recently become less likely to cause diarrhea in HIV-infected people. However, in general, the incidence of diarrhea did not decrease very much - this is due to the fact that diarrhea can be caused by some antiretrovirals that are part of HAART regimens.
In addition, HIV patients, like people with normal immunity, are susceptible to common intestinal infections. But as CD4 counts decline, they become more vulnerable to opportunistic infections that affect the small and large intestines.
The most common causes of diarrhea in HIV-infected people are bacteria that cause common intestinal infections (eg, Shigella flexneri, Salmonella enteritidis, Campylobacter jejuni, and Clostridium difficile).
Of the viruses in samples of the intestinal mucosa in HIV-infected people with diarrhea, cytomegaloviruses are most often detected. Adenoviruses, rotaviruses, astroviruses can also be detected. picornaviruses and coronaviruses.
The clinical significance of this is not yet fully understood. Among the protozoa, the most active causative agents of chronic diarrhea in AIDS patients are Cryptosporidium parvum and Microsporidia spp. (Enterocytozoon bieneusi and Encepha-litozoon intestinalis).
Mycobacterium avium-intracellulare infection, previously common among AIDS patients, is rare with HAART. Neoplasms, including Kaposi's sarcoma and lymphomas, as well as histoplasmosis, do not cause diarrhea.
Anamnesis. Inflammation of the lining of the small intestine (enteritis) is manifested by profuse watery diarrhea that leads to dehydration, electrolyte disturbances, and malabsorption. The pain in the abdomen is cramping and is usually localized in the umbilical region.
With inflammation of the colon mucosa (colitis), stools are frequent, in small portions, often mixed with mucus, blood and pus. Characterized by tenesmus, imperative urge and pain in the rectum. Abdominal pain is usually not cramping and is localized in the lower abdomen.
Physical research. His Data is non-specific. Fever usually indicates a bacterial or mycobacterial infection. With cytomegalovirus infection, ophthalmoscopy may reveal signs of retinitis.
The algorithm for examining an HIV-infected person with diarrhea depends on the conditions in which it is carried out, the clinical picture, physical examination data, and the number of CD4 lymphocytes.
Study of feces. A stool sample is examined for protozoa, bacterial cultures, Clostridium difficile toxins, and white blood cells. The diagnostic accuracy of stool culture is higher with repeated cultures.
If there are no leukocytes in the feces, a modified Ziehl-Neelsen stain of stool smears is performed to detect Cryptosporidia spp. staining with special dyes to detect microsporidia and testing for Giardia lamblia antigens.
If an infection with Mycobacterium avium-intracellulare is suspected, disseminated infection may be detected by blood culture or bone marrow biopsy, but this is not proof of GI involvement.
X-ray studies. X-ray contrast study of the passage of barium suspension through the small intestine and irrigoscopy in the examination of HIV-infected with diarrhea are not informative. Abdominal and pelvic CT may reveal thickening of the colonic wall, indicating colitis and a need for colonoscopy.
Endoscopic examination of the upper GI tract and colon is an invaluable diagnostic tool for diarrhea in AIDS patients. In addition to the ability to directly examine the mucosa, it allows you to take samples for histological examination.
In differential diagnosis, it should be remembered that diarrhea in HIV-infected people can be caused by taking drugs included in HAART regimens. This is indicated by the cessation of diarrhea when drugs are stopped and its recurrence when HAART is restarted.
In colitis caused by cytomegalovirus, ganciclovir is effective in more than half of cases, but for many other opportunistic infections, in particular those caused by Microsporidia spp. and Cryptosporidia spp.
there is no effective treatment yet. However, immune reconstitution with HAART may help treat diarrhea caused by Microsporidia spp. and Cryptosporidia spp. Symptomatic therapy is recommended - camphor tincture of opium, diphenoxylate / atropine and loperamide. Octreotide is ineffective in chronic diarrhea of unknown etiology.
Candidiasis is one of the fungal infections caused by the fungus of the genus Candida. Candidiasis with HIV can be more intense and pose a direct threat to life. In a moderate amount in the microflora of every healthy person there is this fungus. Some people are active carriers of the fungus without feeling any discomfort. But pathology in HIV-infected people has obvious manifestations and can cause death. In a supposedly healthy person, it may be a sign of HIV infection.
Reasons for development
Everyone has a fungus of the genus Candida, but it may not cause diseases or pathologies in a healthy person with sufficient body resistance. The weakening of the protective function of the body (local immunodeficiency) or the human immunodeficiency virus (HIV) can provoke development. Therefore, (affects the nasopharyngeal mucosa), which manifests itself in the first stages in 90% of HIV-infected people, is considered one of the markers of a deadly disease.
Candida albicans doesn't just show up in AIDS. Even those strains and manifestations of the fungus that occur in HIV patients may be signs of hypovitaminosis, dysbacteriosis, or a consequence of taking antibiotics in a person who is not a carrier of HIV infection.
What are the worrying symptoms?
Most often with HIV, candidiasis of the oral mucosa occurs.
Most often, Candida affects the mucous membranes of the body - the mouth, genitals, it can also develop in the corners of the mouth, provoking angular cheilitis, in the folds of the skin - under the breasts in women, in the axillary and gluteal folds, in the perineum and even in the interdigital folds on the hands. More rare is the manifestation of the fungus of the genus Candida on smooth skin. Symptoms of the disease are shown in the table:
Variety of candidiasis Characteristic symptoms Candidiasis of the mouth It appears as a white coating on the tongue, arches of the palate and buccal mucosa. There may be pain when eating, a burning sensation in the mouth. Thrush in women Regular cheesy discharge, itching, pain during sex, discomfort during urination, unpleasant odor. Candida cheilitis Painful cracks (pain) in the corners of the mouth, covered with a whitish coating, which is easily removed. candidiasis folds It appears as crimson erosions, may have a bluish tint and peeling of the skin around the edges. Smooth skin candidiasis It manifests itself in the same way as candidiasis of the folds and, usually, is its consequence. Feature of the flow
Candidiasis in HIV-infected people often occurs in the mouth. Later it can be manifested by candidal cheilitis. In those infected with AIDS, the fungus is prone to rapid development, relapses and the manifestation of obvious symptoms of the disease in a short time. From the mouth, it can pass very quickly into the esophagus and cause digestive problems, up to blocking the digestive tract due to swelling of the mucous membrane. Also, AIDS patients are characterized by atypical forms of the fungus. For example - folliculitis, which can cause ulcers at the site of the follicle, and later - partial baldness.
Candidiasis in this combination is rarely curable due to weak immunity.
Features of the course in HIV-infected:
- Men with HIV appear more often than women.
- Treatment rarely brings results.
- Oral candidiasis in HIV occurs in 20% of cases, less often in the genital and perigenital areas.
- Manifestations of cheilitis spread faster and with high intensity.
- HIV-infected people may develop atypical strains of the fungus.
Candida fungus is a single-celled microorganism that is present in the body of any person. But with a positive HIV status, a laboratory test for the presence of candidiasis may show a negative result. The main symptom of the disease is the presence of plaque on the mucous membranes of the oral cavity.
Thrush with immunodeficiency is diagnosed much more often, due to reduced immunity. That is why pathology is noted already at the initial stages of infection.
Candidiasis occurs at the latent (clinical) stage of HIV infection. This is the second stage and the five existing stages of the disease. The rapid spread of Candida fungi in the patient's body leads to the appearance of plaque on the buccal mucosa and on the surface of the tongue. The plaque builds up rapidly and becomes difficult to remove. Difficulty eating, there is a burning sensation and pain.
In a short time, the development of infection leads to ulcerative-necrotic lesions:
- oral cavity;
- upper sky;
- gums;
- larynx;
- esophagus.
The number of foci of plaque formation increases, which slightly rise above the surface of the mucous membrane, sometimes merge into one large spot, resembling lichen planus. A hyperplastic form of candidiasis is usually localized on the mucous membrane of the hard and soft palate of the patient. It develops much faster in those who abuse nicotine.
Hyperplastic changes in the epithelial-epidermal structures lead to the appearance of chronic, long-term non-healing cracks, covered with a white or grayish coating that can be removed. Treatment of this form of the disease is necessary, otherwise the cracks not only do not heal, but also increase in size, causing the patient a lot of inconvenience and pain.
The erythematous form of the disease is acute atrophic candidiasis. Spots of white plaque are localized along the midline of the back of the tongue. A characteristic feature is atrophy of the filiform papillae of the tongue.
Another common form of the disease is thrush in women. It is accompanied by profuse white discharge, itching and burning in the vagina, pain when urinating. Knowing that this pathology can occur in a perfectly healthy woman, before starting treatment, it is necessary to undergo a complete examination to confirm or cancel the preliminary diagnosis.
Tongue fungus appears when a person's immune system is weakened. The immune system is able to fight bacteria, infections and fungi that invade the human body. It controls the ratio of good to bad microbes. If this does not happen, then the thrush in the oral cavity begins to develop rapidly.
According to statistics, most often the fungus of the oral mucosa occurs in women, especially during pregnancy. Men are rarely diagnosed. In men, thrush on the tongue can appear from smoking - tobacco smoke can disrupt the normal microflora of the oral cavity.
Thrush can occur in adults when infected by airborne droplets (with kisses, oral sex, through dishes or improper hygiene).
In order to get rid of oral candidiasis on the tongue, you have to use various drugs, tablets, creams, ointments, gels, solutions, sprays and aerosols. Nystatin powder is very effective. It is necessary to crush the tablet and add 1 ampoule of vitamin B12 to the resulting powder. It is necessary to lubricate the areas affected by the fungus well with the composition every time after eating. You can simply chew the tablet and hold it in your mouth for a while.
The doctor may prescribe Levorin tablets, which should not be taken during pregnancy. Clotrimazole ointment - effective remedy against candidiasis. The ointment should be applied to a cotton pad and put on the cheek. These pills can help: Fluconazole, Mycomax, Decamine, Fluorocytosine and Ketoconazole. Sangviritrin proved to be excellent - this is a special solution for lubricating soft tissues and rinsing the mucosa. The drug has no side effects and contraindications, it is allowed for pregnant women and newborns.
Local antibiotics are also prescribed. The most popular are Caramel Dikaina and Levorina. They need to be put on the cheek or under the tongue, hold until dissolved. These drugs may already work the next day. Dryness and itching in the mouth disappears. A little later, the white coating also disappears.
Do not forget to follow the rules of personal hygiene: regularly rinse the mucosa, brush your teeth at least 2 times a day and visit the dentist at least once every 3 months.
Thrush in the mouth is an unpleasant disease. But if you turn to a specialist in time and start the right treatment, the chances of a successful recovery will increase day by day.
Rice. 11. The most severe shingles occurs in adults with severe suppression of the immune system, which is observed, including with AIDS.
This stage of HIV infection is characterized by pronounced symptoms of impaired cellular immunity, and according to clinical manifestations, there is nothing more than an AIDS-associated complex, when the patient develops infections and tumors that are not found in the AIDS stage.
Rice. 12. Bacillary angiomatosis in HIV patients. The causative agent of the disease is a bacterium of the genus Bartonella.
Rice. 13. Signs of HIV in men in the later stages: damage to the rectum and soft tissues (photo on the left), genital warts (photo on the right).
IIIB stage of HIV infection represents a detailed picture of AIDS, characterized by deep suppression of the immune system and the development of opportunistic diseases that occur in severe form, threatening the life of the patient.
Treatment of oral candidiasis must be prescribed by a doctor. It is necessary to seek qualified help in time and not self-medicate. Plaque on the tongue and oral mucosa will disappear if the disease is treated correctly.
At the initial stage of the disease, severe dryness in the mouth is felt, irritation and redness of the mucous membrane, swelling of the soft tissues of the mouth and tongue occur. In places of accumulation of pathogenic fungi, one can observe areas of white plaque (often visible on the tongue), which have a relief shape and a curdled consistency. At first, white plaque looks like dots, but then large-scale formations form, which are a continuous film on certain areas of the mouth and tongue.
Attention! Thrush in adults begins to form on the cheeks, then goes to the gums, tonsils, then appears on the tongue, and can also affect the lips.
At the initial stage, you can try to remove the characteristic white plaque with a cotton swab, but then it will be difficult to get rid of it - it causes hellish pain. There is blood, the pain intensifies. When swallowing saliva, discomfort also occurs.
Women can get herpes. He "settles" on the mucous membranes. Already at an early stage of the disease, it happens that ulcers and warts appear on the genitals, complex infectious diseases of the pelvic organs appear. The first manifestations of HIV are characterized by symptoms similar to a cold. Later, they can flow into a feverish state, when both day and night, regardless of weather conditions, a person sweats a lot.
Recurrent candidiasis. The development of fungal diseases throughout the body. Ulcers of the mucous membranes. Pneumonia. During the period of strengthening and development of HIV in the body, the symptoms of the disease can affect various organs and systems of a person. An unreasonable increase in temperature, which ranges from 38-40 degrees. It can stay up to 10 days. Cough and pain in the body and head, severe weakness and sweating are observed during this time. Vomiting may open, nausea, muscle pain, spasms can last for a long time.
The duration of the disease up to the death of the patient also cannot be predicted and does not depend on the gender of the patient. True, women are more prone to stress and depression against the background of a terrible disease. It is worth paying more attention to going to the doctor, especially the gynecologist. Timely prescribed treatment of diseases of the pelvic organs will significantly alleviate the patient's condition.
The development of the disease, when secondary manifestations occur, and during this period the symptoms become apparent. But there are also a lot of diseases in which the lymph nodes swell. However, such a symptom still sends a person to the hospital, because the thought that this is serious appeals to the will of the mind. Any doctor with such manifestations will always prescribe a study for the presence of HIV.
If there chronic diseases, they make themselves felt harder and stronger. And this is more typical for women. According to some scientists, the development of a terrible disease in women is much slower than in men. But a number of experts attribute this to the fact that girls and women are trying to maintain their health in order and monitor it more closely.
HIV infection loudly declared itself in the 80s of the 20th century. Scientists have not yet found a cure for the infection. But the ways and means of transmission have been studied in detail. Doctors never tire of repeating that by observing the elementary rules of hygiene and precautions, you can avoid the danger of contracting a deadly disease.
IIA - acute febrile stage of HIV. IIB - asymptomatic stage of HIV. IIB - stage of persistent generalized lymphadenopathy. The duration of the acute stage of HIV is from 2 to 4 weeks (usually 7 to 10 days). It is associated with a massive release of HIV into the systemic circulation and the spread of viruses throughout the body. Changes in the patient's body during this period are nonspecific and so diverse and multiple that it creates certain difficulties in diagnosing HIV infection by a doctor during this period.
The causative agents are more often the following species: Candida albicans, C. tropicalis, C. parapsilosis, C. guillierinondii, C. krusei. They belong to yeast-like fungi and differ from true yeasts in their ability to form mycelium and the absence of a sexual reproduction method, i.e.
belong to the non-spore-forming yeasts. Can grow on agar nutrient media. Antigens of pathogens have allergenic and antigenic properties, but antibody titers are high only with visceral candidiasis. Fungi of the genus Candida are often detected as saprophytes in the microflora of the oral cavity, intestines, and vagina.
Epidemiology
Yeast-like fungi of the genus Candida live on the skin and mucous membranes of the respiratory and gastrointestinal tract, are part of the normal microflora. They are also widely distributed in nature (on fruits, vegetables, dairy products, etc.). The disease usually occurs as a result of an endogenous infection. Most often this is due to Candida albicans.
Especially often candidiasis develops in HIV-infected individuals. Aspergillosis and candidiasis are the most common opportunistic fungal infections in AIDS patients. Penetration of candida into tissues can be facilitated by damage to the skin and mucous membranes, for example, damage to the gastrointestinal tract during perforations, trauma, surgical operations, the introduction of catheters into the vessels, peritoneal dialysis, intravenous drug administration, etc.
With visceral forms of candidiasis, foci of necrosis, neutrophilic inflammatory infiltration are noted. With visceral forms, the kidneys, brain, heart, liver, and spleen are most often affected.
This disease is not caused by the presence of fungi from the genus Candida, but by their number, since with low immunity their number exceeds the norm. And the main cause of thrush occurs with a decrease in local immunity and general immunity in the body.
Symptoms of thrush in men
Itching and persistent burning in the region of the glans penis and foreskin;
White bloom on the head of the penis;
Pain during urination;
Exists a large number of various drugs for the treatment of this disease. Some of them are applied externally (cream, suppositories or vaginal tablets), while others are used internally (capsules or tablets for oral administration).
With candidal balanoposthitis (this is when the foreskin and glans penis are affected), local treatment will suffice. For treatment, a cream with clotrimazole is used. This cream is applied in a small layer on the foreskin and glans penis twice a day in the interval from 5 to 7 days.
A single dose of fluconazole (150 mg orally) is also possible, but, in the majority of cases, this is not necessary. Here are all the commercial names of fluconazole - Diflazon, Medoflucon, Diflucan, Forkan, Mikosist, Flukostat.
Itching and burning in the area of the external reproductive organs;
Pain during sexual intercourse;
Isoconazole (or Gyno-travogen Ovulum);
Miconazole (Ginezol 7, Klion-D 100, Gyno-dactarin);
Natamycin (commercial name Pimafucin);
With all this, the drug nystatin (part of drugs such as Terzhinan and Polygynax) is a very outdated and ineffective drug.
Some doctors, when thrush appears, prescribe a solution of 5-10% borax in glycerin for topical use (in the vagina). This is a very old and practically ineffective method for the treatment of thrush.
In addition, with a milder course of this disease, instead of drugs for local treatment, one dose of fluconazole (150 mg orally) is also possible. Commercial names for fluconazole are Diflazon, Medoflucon, Diflucan, Forkan, Mikosist, Flucostat.
II. Stage of primary manifestations of HIV infection
Most often, the disease affects young male patients. The disease proceeds in an acute phase and is difficult to treat. The foci are localized in the genital area and in the mouth. Erosions spread rapidly, causing a lot of discomfort and discomfort. Candiosis is the first sign of a significant progression of immunodeficiency, in the absence of other factors. Foci of fungal infection are localized in the patient in different places. Most often, erosions appear in the mouth, on the nails, genitals, anal area, esophagus. This disease can have quite serious consequences. For example, damage to the esophagus leads to the growth of the mucous membrane. The lumen gradually narrows or completely overlaps. That is why oropharyngeal candidiasis in HIV-infected people must be treated immediately.
Undermining folliculitis is also characteristic of AIDS patients. The disease affects the hair follicles on the head and under the arms. Small purulent vesicles form on the skin, which eventually burst, turning into ulcers.
A gray-white coating forms on the mucous membrane. Under a layer of plaque, the surface of the palate, tongue and cheeks is covered with many painful ulcers. There is a burning sensation in the mouth. The signs of the disease are very similar to the symptoms of hypovitaminosis (B, B6, C). Pathology can develop over several months. Candidiasis of the oral cavity with HIV can be localized in the corners of the mouth. At the same time, hyperplasia of the epithelium develops, cracks appear.
Thrush is a form of fungal disease. Another name for it is bacterial vaginosis. Do not think that thrush is a sign of HIV. In people with immunodeficiency, it occurs much more often, since the protective functions of the body are significantly weakened. However, this pathology can also occur in perfectly healthy women.
Vaginal itching. Irritation of the vagina. Pain when urinating, burning. White discharge. Before you find out how to treat candidiasis in the mouth with HIV, you must undergo a complete medical examination, pass all the necessary tests. Most often, doctors prescribe complex drugs, antibiotics. It all depends on the stage of development of immunodeficiency.
Candidiasis in HIV-infected people often occurs in the mouth. Later it can be manifested by candidal cheilitis. In those infected with AIDS, the fungus is prone to rapid development, relapses and the manifestation of obvious symptoms of the disease in a short time. From the mouth, it can pass very quickly into the esophagus and cause digestive problems, up to blocking the digestive tract due to swelling of the mucous membrane. Also, AIDS patients are characterized by atypical forms of the fungus. For example - folliculitis, which can cause ulcers at the site of the follicle, and later - partial baldness.
Candidiasis in this combination is rarely curable due to weak immunity.
Features of the course in HIV-infected:
- Men with HIV appear more often than women.
- Treatment rarely brings results.
- Oral candidiasis in HIV occurs in 20% of cases, less often in the genital and perigenital areas.
- Manifestations of cheilitis spread faster and with high intensity.
- HIV-infected people may develop atypical strains of the fungus.
Pneumonia. The development of the disease is varied. The virus affects various organs, tissues and cells. The course of AIDS in humans is also associated with concomitant diseases, which lead to reduced immunity. Microbes quickly enter the body, and this or that illness begins, which may be accompanied by more severe symptoms than in people who are not infected with HIV.
An incubation period that can last up to a year. The infection spreads throughout the body in the presence of a healthy immune system. The transition to a new stage of the disease occurs at the time of the production of antibodies to HIV in the blood. Symptoms of the first degree, initial. Specific antibodies appear, but manifestations of the disease have not yet been observed. AIDS, which leads to death. Some doctors believe that the development of the disease to the stage of AIDS itself can last 12-15 years. Before a progressive state of infection with HIV can also take a long time. The most important characteristic of AIDS, which always manifests itself so clearly that it is simply impossible not to notice it, is the incredibly enlarged lymph nodes. They are visible in the armpits, groin and even in the region of the collarbones.
The incubation period of HIV infection is determined by the period from the moment of infection to clinical manifestations and / or the appearance of antibodies in the blood serum. HIV in the "inactive" state (the state of inactive replication) can be from 2 weeks to 3-5 years or more, while the general condition of the patient does not noticeably worsen, but antibodies to HIV antigens already appear in the blood serum.
It is impossible to say exactly how long HIV infection manifests itself. The duration of the incubation period is influenced by the route and nature of infection, the infectious dose, the age of the patient, his immune status, and many other factors. When transfusing infected blood, the latent period is shorter than when the infection is transmitted sexually.
The period from the moment of infection to the appearance of antibodies to HIV in the blood (seroconversion period, window period) ranges from 2 weeks to 1 year (up to 6 months in weakened people). During this period, the patient still lacks antibodies and, thinking that he is not infected with HIV, continues to infect others.
Examination of contact persons with HIV-infected patients allows diagnosing the disease at the “carrier” stage.
Rice. 2. Oral candidiasis and herpes rashes are indicators of a malfunction of the immune system and may be early manifestations of HIV infection.
The transition to the terminal stage of AIDS occurs when the level of CD4-lymphocytes decreases to 50 and below in 1 µl. During this period, an uncontrolled course of the disease is noted and an unfavorable outcome is expected in the near future. The patient is exhausted, depressed and loses faith in recovery.
The lower the level of CD4-lymphocytes, the more severe the manifestations of infections and the shorter the duration of the terminal stage of HIV infection.
The patient develops atypical mycobacteriosis, CMV (cytomegalovirus) retinitis, cryptococcal meningitis, widespread aspergillosis, disseminated histoplasmosis, coccidioidomycosis and bartonnellosis, leukoencephalitis progresses. Disease symptoms overlap. The patient's body is rapidly depleted. Due to constant fever, severe symptoms of intoxication and cachexia, the patient is constantly in bed. Diarrhea and loss of appetite leads to weight loss. dementia develops. Viremia increases, CD4-lymphocyte counts reach critically minimal values. Rice. 16. Terminal stage of the disease. Complete loss of the patient's faith in recovery. In the photo on the left is an AIDS patient with severe somatic pathology, in the photo on the right is a patient with a common form of Kaposi's sarcoma.
The duration of HIV infection is on average 10-15 years. The development of the disease is influenced by the level of viral load and the number of CD4-lymphocytes in the blood at the beginning of treatment, the availability of medical care, the patient's adherence to treatment, etc.
It is believed that with a decrease in the level of CD4-lymphocytes during the first year of the disease to 7%, the risk of the transition of HIV infection to the stage of AIDS increases by 35 times. The rapid progression of the disease is noted with the transfusion of infected blood. Development of drug resistance of antiviral drugs. The transition of HIV infection to the stage of AIDS is reduced in people of mature and old age. The combination of HIV infection with other viral diseases negatively affects the duration of the disease. Bad nutrition. genetic predisposition. Timely initiation of highly active antiretroviral therapy (HAART). In the absence of HAART, the death of the patient occurs within 1 year from the date of diagnosis of AIDS. It is believed that in regions where HAART is available, the life expectancy of HIV-infected people reaches 20 years. No side effects on taking antiretroviral drugs. Adequate treatment of comorbidities. Sufficient food. Rejection of bad habits. Effective treatments for thrush in adults
Proper and effective treatment depends on the correct search for the cause. This helps to avoid further relapses. If the form of thrush is mild, then a dentist can prescribe tests and treatment, if it is severe and neglected, then you need to contact an infectious disease specialist.
After receiving the results of the tests, the specialist will prescribe the optimal treatment regimen. First you need to get rid of obvious symptoms, and then start taking immunostimulating drugs that will help the body fight the fungus.
Candida fungi and human immunodeficiency virus
According to experts, the symptoms of the disease will depend on which parts of the body are affected by candidiasis in HIV-infected people. If a person shows at least one of the following signs, then he should seek medical help:
home treatment
Treatment should be directed at fighting the rapidly developing infection. It is recommended to eat unsweetened yogurts, and rinse the mouth with solutions of potassium permanganate, Miramistin, Furacilin, chamomile or calendula. Great help baking soda: dilute 2 dessert spoons in 1 cup of boiled water. Rinsing should be regular. It is necessary to wash the mucous membrane 7 times a day.
You need to properly plan your diet. Treatment of adults without compliance with this measure is not complete. We'll have to give up smoked, sweet, salty and fatty. Candy should be avoided White bread, flour, nuts and cheese. Such types of food only provoke the active reproduction of pathogenic bacteria.
Pay attention to your drinking regimen. The main thing is not the amount of liquid you drink, but its quality and purity. Milkmaid loves high level pH, so you need to drink drinks with sourness - fruit drinks: lingonberry, currant or cranberry, and juices: grapefruit, pineapple and lemon.
Add vitamin C-rich foods and probiotic nutritional supplements to your diet. Supplements help saturate the gastrointestinal tract with beneficial bacteria. Vitamin C stimulates the immune system and it successfully fights infections and bacteria. If home methods are powerless, then the doctor prescribes antifungal drugs.
The fight against candidiasis in HIV-infected people - where to start?
Candida fungi with HIV can cause the progression of a complex and dangerous disease. As you know, these opportunistic microorganisms are present in the normal healthy microflora of the human body in small quantities. They are localized in the intestines, oral cavity, vagina and on the skin. The immunodeficiency virus weakens the protective functions, which leads to the manifestation of the pathogenic characteristics of Candida fungi. Candiosis in HIV-infected people occurs very often (in 90% of patients), especially in the late stages of the progression of a fatal pathology.
Diagnosis of candidiasis in HIV
If there are obvious symptoms, a series of tests for the presence of fungi of the genus Candida is performed. First of all, fungi are detected in the blood and urine. This helps to determine how much the body is affected by the fungus. A swab of the pharynx and other affected mucous tissues is also taken. Skin and nail samples may be taken. Serological reactions in HIV-infected people remain negative, so the isolation of the fungus from the cerebrospinal, intraarticular fluids and blood is of diagnostic importance. After the material is taken, sowing is carried out, which allows to determine the type and genus of the fungus, as well as the number of pathogenic microorganisms of the microflora.
Treatment of candidiasis in patients with HIV
In order not to raise the question of how to treat this disease, you need to take care of high-quality prevention in advance. So, people with a low immune status are often prescribed the drug Diflucan. Doctors claim that he is able to prevent the onset of the disease. However, there is an opinion that this medicine cannot be taken for a long time, since the fungal substances adapt to it and produce protective enzymes.
If candidiasis has made itself felt, and you have not found signs of this disease, you need to follow these recommendations:
- Natural yogurt is able to inhibit the growth of the fungus, so try to include this product in your diet as often as possible;
- Oral hygiene is important, since fungal organisms are unlikely to multiply under sterile conditions;
- As for vaginal candidiasis, choose underwear made from natural fabrics to avoid this unpleasant phenomenon.
If the disease manifests itself, then you need to immediately visit a doctor. He will prescribe the appropriate drugs, prescribe treatment and give good recommendations. You can not self-medicate, because the immune system of an HIV-infected person is already vulnerable, and you can provoke its decline by choosing the wrong treatment.
Commonly used drugs for candidiasis in infected people are:
- Clotrimazole. These are tablets to be taken up to 5 times a day for 2 weeks. They should not be chewed or swallowed, they simply dissolve in the mouth. A side effect from taking is indigestion;
- Nystatin. The regimen is similar to the previous drug. The medicine does not cause side effects;
- Amphotericin B. A certain amount of liquid is placed on the tongue about 4 times a day. Drops should be kept in the oral cavity for as long as possible;
- Clotrimazole is a drug for the treatment of vaginal candidiasis. The form of release of the drug is a cream, but sometimes candles are also used. You need to use the drug for one week;
- Miconazole. The scheme of treatment with this drug is similar to the previous one;
- Terconazole works in the same way as the previous two drugs, but its mode of action is more advanced. He is able to eliminate candidiasis in 3 days;
- Itraconazole. This is a medicine for the treatment of pathology of the esophagus. The tablets are usually taken three times a day for one month;
- Ketoconazole. The regimen for taking this medication is selected by the doctor for each patient on an individual basis.
If the fungus becomes resistant to many types of drugs, then the treatment is carried out in a hospital setting. Most often, droppers are used, through which strong or even aggressive drugs are administered that can defeat the causative agent of the disease.
Thus, candidiasis in HIV is not a sentence. It can be cured if you follow all the recommendations of the attending physician.
The dynamics of the decrease in immunity
Even if the disease proceeds sluggishly, without showing the main signs, this does not mean that it is impossible to die from a common cold. The immune system cannot be touched or seen, and everything that happens to it is often hidden from us. We can only speculate about the presence of certain deviations in indirect evidence, which makes you go to the clinic. With the development of HIV, the body does not weaken intensively, but very slowly.
