Health and environmental issues
12. Solokha, O. A. Diagnosis and treatment of glenohumeral periarthropathy syndrome / O. A. Solokha, N. N. Yakhno // Nev. magazine - 2006. - No. 1. - P. 26-31.
13. Volker, Z. Rehabilitation treatment after endoprosthetics of the shoulder joint (translated from German) / Z. Volker, F. Dime // Treatment. physics and sports. honey. - 2009. - .№ 3/63. - P. 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. - P. 20-24
15. Lorenz, Bohler. Technik der Knochenbruchbehandlung: in 2 volumes / Verlag von Wilhelm Maudrich, 1938. - 6th ed. - T. 1, 2.
16. “Ortho-S” (reinforced orthopedic center Ortho-S) orthopedic benefits for joints - treatment and prophylactic line [electronic resource]/Section: shoulder joint. - Access mode: http://www.orto-s.ru/catalogue/?id=0. - Access date: 09/18/2009.
17. MosMedClinic.ru [electronic resource] / A. E. Loskutov, Our experience in surgical treatment of fractures and fracture dislocations of the proximal humerus / A. E. Loskutov,
V. N. Tomilin (Dnepropetrovsk medical acad.) // Mater. scientific-practical conf. with international participation, Moscow, April 11, 2003 - Access mode: http:// www.mailto:mosmedclinic.ru. - Access date: 09/18/09.
18. Medical book on www.medbook.net.ru; medical book in “Garant-Inform” [electronic resource] / S. N. Popov. Physical rehabilitation (1.62 Mb) / S. N. Popov, 2005. -
P. 608. - Access mode: http://www.medbook.net.ru/49.shtml. - Access date: 09/18/2009.
19. Miytrener.com [electronic resource] / E. V. Andrianova. Comprehensive rehabilitation for shoulder dislocations in athletes / E. V. Andrianova. - Access mode: http://miytrener.com/index.php. - Access date: 09/18/2009.
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. - Access mode: http://orthoinfo.aaos.org/menus/orthopedics.cfm. - Access date 09/20/2009.
21. Expodata.ru [electronic resource] / K. V. Lyadov. Possibilities of restoring mobility of the shoulder joint with its stiffness using new technologies / K. V. Lyadov, M. R. Makarova, N. I. Shishkin (National Medical and Surgical Center named after N. I. Pirogov, Moscow ) // II Int. Congress "Restorative Medicine and Rehabilitation"
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22. Medi (Germany) [electronic resource] / Products for the shoulder joint. - Access mode: http://www.steportho.ru/section48/. - Access date: 09/18/2009.
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: 09.18.2009.
24. Ortos2005-2008 [electronic resource] / Joint clamps and restraints ORLETT (Germany), OPTY (Lithuania). - Access mode: http://www.ortos.by/. - Access date: 09/22/2009.
25. Paralife 2001-2009 [electronic resource] / V. A. Kachesov. Fundamentals of intensive self-rehabilitation / V. A. Kachesov // Medicine: ed. BDC-PRESS group 2007 (HTML document Paralife2001-2009). - Access mode: http://paralife.narod.ru/1adaptation/kachesov/2007/contents.htm. - Access date: 09/18/2009.
26. TECH2U, 2007-2009. Orthopedic devices: corsets, bandages, belts [electronic resource] / Section: shoulder joint (med-magazin.ru, ortomed.ru). - Access mode: http://tech2u.ru/catalog/_?cat-egories_ro=437. - Access date: 09/18/2009.
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28. Central Library for Physical Education and Sports, 2001 (Central Branch Library for physical culture and sports) [electronic resource] / N.V. Manak. Practical aspects of using the method of manual development of post-immobilization contractures of the shoulder joint in patients at the inpatient stage of rehabilitation (Belarusian University of Physical Culture) / N. V. Manak //post. in print 03/18/2008.- Access mode: http://lib.sportedu.ru/index.htm. - Access date: 09/18/2009.
29. Dr Jose De Andms, Spain. Treatment of postoperative pain quality 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. - Access date: 11/18/2009.
30. Kved.ru [electronic resource]/ The role of occupational therapy in the system of sanatorium-resort treatment. - Access mode: http://www.kved.ru/php/content.php?id=476. - Access date: 12/20/2009.
Received 02/09/2010
UDC 616.329-002.828:616.98.578.828HIP
ORAL CANDIDIASIS 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 clinical picture of oropharyngeal candidiasis. In most cases, the development of infection is caused by monocultures of C. albicans (82%). The detection or absence of growth of fungal pathogens did not depend on the immune system. The number of detected fungi differed significantly in HIV-infected patients with different immunological status. 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.
Mycoses are among the most frequently reported diseases in both early and late stages in patients with HIV infection. Systemic and superficial mycoses caused by yeasts and, in particular, the genus Candida, are the most common form of fungal infections. Fungi of the genus Candida can cause a range of infectious lesions - from local damage to the mucous membranes and skin to life-threatening disseminated infectious processes with extensive damage internal organs and systems requiring diagnostic and medicinal measures. Of particular importance in recent years is the early detection of the disease and 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. At the end of the 19th and beginning of the 20th centuries, candidiasis was relatively rare. Oral candidiasis is one of the most common fungal infections (develops in 40-60% of patients). Of all Candida species, the most frequently isolated from patients with HIV infection is
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 detected. There are pseudomembranous, atrophic, chronic hyperplastic candidiasis, as well as angular cheilitis (which
most often caused by C. albicans, C. tropicalis,
C. rubra, C. famata) .
Angular cheilitis (Figure 1) appears as erythema or cracking of the corners of the lips. It can 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 commonly and most misdiagnosed manifestation of HIV in the oral cavity. The disease manifests itself as a red, flat, barely visible lesion on the dorsal surface of the tongue or the hard or soft palate. The 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 sour 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 in the form of soft, white, cheesy plaques on the mucous membrane of the cheeks, 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, and 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 leukoplakia of smokers; elements are located on the mucous membrane of the cheeks, hard and soft palate on both sides.
The purpose of the study was to study the structure of fungal pathogens in HIV-infected patients under observation in
consultation and dispensary office on HIV/AIDS at the Gomel Regional Infectious Diseases Clinical Hospital, and in HIV-infected patients in prison with clinical manifestations of oropharyngeal candidiasis.
Material and method of research
We examined 100 patients under observation in the consultation and dispensary office (hereinafter referred to as the CDC) for HIV/
Health and environmental issues
AIDS in the institution “Gomel Regional Infectious Diseases Clinical Hospital” (hereinafter referred to as UGOICB), who are not receiving antiretroviral therapy (hereinafter referred to as ART), and 20 patients in prison (hereinafter referred to as MLS) with clinical manifestations of oropharyngeal candidiasis.
Immunological status (determination of CD4 cells) was determined using a FACScan flow cytofluorometer using a lysis solution and immunoclonal antibodies, viral load, using the PCR method 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 undergoing dispensary observation were carried out on the basis of the clinical diagnostic laboratory of the UGOIKB. Using a sterile swab, swabs were taken from the affected areas and inoculated on Nickerson media. Growth was assessed after 72 hours. Microbiological studies of patients in MLS were carried out on the basis of the clinical diagnostic laboratory of the State Institution "Republican Scientific and Practical Center for Radiation Medicine and Human Ecology" in 2008-2009. Transportation was carried out for 2-3 hours in a tube with Amies transport medium (Nesha-Meywa, 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). For identification, plates (strips) containing dehydrogenated biochemical substrates were used (from 16 to 32 tests). Determination of sensitivity to antifungal drugs (flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole) was carried out using strips (ATB FUNGUS-3) from bioMerieux (France) in
И19-^J^^*32 □ 49 З*-*7
semi-solid medium adapted to the requirements of the standard dilution method of the Clinical Laboratory Standards Institute (CLSI)-NCCLS M-44, USA. To control the quality of susceptibility testing, control strains of the American Collection of Microorganisms (ATCC) were used.
Taking into account the non-normal distribution according to Kolmogorov-Smirnov, statistical analysis of the obtained data was carried out using the Mann-Whitney and Fisher tests (non-parametric statistics methods).
Results and discussion
The majority of HIV-infected patients undergoing dispensary observation at the HIV/AIDS CDC of the UGOIKB were residents of Svetlogorsk - 36%, Gomel - 30% and Zhlobin - 23%; the rest lived in the city of Rechitsa - 2%, the city of Lelchitsy - 1%, the city of Mozyr - 1%, the city of Bragin - 1%, the city of Narovlya - 2%, the city of Kalinkovichi - 2% and the city of . Oktyabrsky - 1%.
The age of the patients was 33.06 ± 0.54 years. Among them there were 53 (53%) men, 47 (47%) women. Patients were enrolled from 1994 to 2009. In all examined patients, the parenteral route of infection predominated (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. The majority 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 in combination with atrophic or pseudomembranous candidiasis was observed. Analyzing the data obtained, 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).
■ sexual □ intravenous B unspecified
Figure 4 - Routes of infection of the examined patients
Table 1 - Parameters of immune status and viral load in HIV-infected patients not receiving ART with detected Candida spp. and their absence
Candida spp. detected, 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
Health and environmental issues
HIV-infected patients were divided into two groups according to the number of C. albicans detected. The first group included patients who were found to have microbiota in an amount of 104 CFU/ml or higher; the second group included patients with a number
detected 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 in μl of blood, the number of sown C. albicans statistically significantly increases (Table 2).
Table 2 - Parameters of immune status in patients with HIV infection undergoing dispensary observation, with different levels of detection of fungal pathogens
Microorganisms % 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. Taking into account this classification, patients were divided into three categories according to immunological criteria. The first category included patients with a CD4 cell 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. Structure of fungal pathogens in HIV-infected patients
various immunological categories are presented in Table 3. According to Table 2, it can be seen 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 - Structure of fungal pathogens in HIV-infected patients 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 stayed in MLS from 0.3 to 3.9 years. The average age was 32.94 ± 0.94 years. During the period of microbiological monitoring, 4 different fungal and 3 non-fungal pathogenic microorganisms were identified in 18 patients. At the same time, the largest specific gravity among all isolated fungal species belonged to C. albicans (65%).
The vast majority of fungal infections in this category of patients with HIV infection were caused by monocultures of C. albicans
(73.3%). The number of cultured C. albicans in these patients was 104 CFU/ml and higher. The CD4 cell count in these patients was 270.77 ± 56.38 per μl. Taking into account the 1993 CDC classification, 9% of patients were in the first immunological category, 45.5% of patients were in the second and third categories. 55.5% of the examined patients had a viral load of 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 foci of associations of C. albicans with representatives of non-albicans (1 case) and non-fungal (1 case) fungal pathogens. Non-fungal
Health and environmental issues
microorganisms (M. catarhalis, P. aeruginosa, S. aureus) and monocultures of non-albicans (C. krusei,
C.kefyr, C. cupitatum) were found in 4 and 3 HIV-infected patients, respectively. No growth was detected in 2 patients.
The use of antifungal drugs, in particular fluconazole, has made it possible to quickly and effectively cure fungal diseases of any location 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 aggravating the course of HIV infection and causing deaths. In particular, C. krusei strains 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]tic 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. When treating fluconazole-resistant candidiasis over a long period of time and with large doses of itraconazole, patients may develop strains resistant to both azoles; 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 detected in C. albicans to fluconazole in 38.4%, to itraconazole in 15.3%, and to flucytosine in 7.7%. All isolated fungal pathogens were sensitive to amphotericin B and voriconazole (Table 4).
side 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 -
S. cupitatum - - - - 1 100
Lesions of the mucous membranes of the oral cavity and upper respiratory tract in HIV-infected patients 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 treatment procedures in patients with HIV infection contributes to the formation of drug resistance in classical pathogens of mycoses and the emergence 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 and under observation in the HIV/AIDS consultation room at UGOIKB were caused by monocultures
C. albicans. Indicators of 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 number of sown C. albicans increases significantly.
73.3% of fungal diseases in HIV-infected patients in MLS were caused by monocultures of C. albicans. The combination of C. albicans with other types of fungal pathogens, as well as with non-fungal pathogens, was identified in 1 case each. Resistance to fluconazole in C. albicans was 38.4%. All isolated fungal pathogens were sensitive to amphotericin B and voriconazole. Considering the above, we can conclude that further active and widespread use of fluconazole in the treatment of candidiasis in HIV-infected patients in MLS is unpromising.
BIBLIOGRAPHICAL LIST
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. - P. 33-35.
2. HIV infection: clinical picture, diagnosis and treatment / V.V. Pokrovsky [et al.]: edited by. 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 fungi isolated from cancer patients / N. S. Bagirova [et al.] // Accompanying therapy in oncology. - 2004. - No. 4. - P. 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 DIFFERENT SUBTYPES OF CEREBRAL INFARCTION
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 most pronounced disturbances are in the cardiovascular system, and in cardioembolic stroke - in the function of external respiration.
Key words: cardiac arrhythmia, external respiration function, cerebral infarction.
CARDIAC RHYTHM IMPAIRMENT AND ALTERED FUNCTION OF EXTERNAL BREATHING IN DIFFERENT SUBTYPES OF SRTOKE
Belarusian 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 (ACI) constitute the most important medical and social problem, which is due to their high share in the structure of morbidity and mortality of the population, significant rates of labor loss and primary disability.
Today, about 9 million people in the world suffer from cerebrovascular diseases, the main place among which is cerebral infarction (MI). Mortality from cerebrovascular diseases is second only to mortality from heart disease and tumors of all locations and reaches economically developed countries 11-12 % .
Currently, cerebral infarctions account for 2/3 of all stroke cases. In 72% of cases, the main cause of the pathogenesis of MI is heart pathology. At the same time, the processes of changes in the blood vessels of the brain and heart are largely identical. 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 pathology of the cardiovascular system and the brain. This necessitates the need for 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 normally and in various pathological conditions. This is due to the introduction into clinical practice the 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 clarified ideas about the interdependence of cardiac pathology and cerebral hemodynamics. Thus, it has been established that cardiac dysfunction plays an important role in the pathogenesis, course and outcomes of stroke and, first of all, myocardial infarction. In turn, the development of the latter can aggravate or lead to cardiac arrhythmias.
This is a group of opportunistic infections caused by fungi of the genus Candida. Candida lesions are more common in HIV-infected people 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, and lungs are indicator diseases of the AIDS phase (by definition WHO, 1993).
The following features are characteristic of candidiasis occurring against the background of HIV infection: the disease affects young people, especially men; the process involves mainly the mucous membranes of the oral cavity, genitals and perianal area; in the clinical picture there is a tendency to the formation of extensive lesions, which are accompanied by pain, and there is a tendency to erosion and ulceration. There is candidiasis 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. albicansWITH.dubliniensis- a new resistant species of fungus that is isolated almost exclusively from oral candidiasis associated with HIV infection.
In vulvovaginal candidiasis in HIV-infected women, the causative agent is mainly WITH.glabrata, which often leads to the development of chronic recurrent 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, jamming, candidiasis of the folds, candidal paronychia and onychia (see section 16.1.4.4), candidiasis of smooth skin.
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 is most common and sometimes serves as the first manifestation of AIDS. It is believed that in half the cases of AIDS, oral candidiasis is a precursor to Kaposi's sarcoma.
According to epidemiological data, a third of people suffer from oral candidiasis. pain HIV infection, 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 is classified as a separate form of oral candidiasis. This pathology is associated with colonization by fungi of the genus Candida and oral candidiasis, often found in AIDS.
Clinically, a diamond-shaped or oval-shaped focus of papillary atrophy is detected in the middle of the back of the tongue, which has clear boundaries. Subjectively, as a rule, there is no sensation, but a burning sensation and tingling may be noted, which intensifies when eating.
Candidiasis of the corners of the mouth, or angular cheilitis, seizure occurs in 20% HIV- infected people. It may occur independently 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 coating, 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. When CD4 + T cells decrease 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 of the folds manifests itself mainly in the inguinal, gluteal, axillary folds, and perineum. Women often experience skin lesions under the mammary glands, in the vulva area. There is damage to the interdigital folds on the hands (most often the third interdigital fold).
The clinical picture is represented by areas of crimson erosion with a bluish tint, sharply demarcated from apparently healthy skin. Along 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 area of which the skin is thickened and covered with a white coating.
Candidiasis can not only appear in infected people, but also indicate the presence of the human immunodeficiency virus in the body. As a rule, with the rapid development of this disease, the patient is referred for a blood test.
The disease starts small. The mucous membrane of the oral cavity, back of the pharynx, and digestive organs are affected. When it comes to women, vaginal disease often occurs.
If the pathology is not diagnosed in time and treatment is not started, complications develop that can not only worsen the patient’s quality of life, 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 the immunodeficiency virus is absent in the body, 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 completely curable forms of the disease is intestinal candidiasis.
Fungi of the genus Candida can be present in the body of a healthy person for years without making themselves known. But if the microflora is disrupted, caused by some third-party disease, 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 frequent loose stools, which leads to dehydration of the body and loss of nutrients, vitamins and minerals necessary for normal life.
Most often, patients who have previously been diagnosed with the following suffer from this form of candidiasis:
- 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 (adrenal tumors, diabetes mellitus);
- Oncological diseases and pathologies of the hematopoietic system that require long-term cytostatic therapy as treatment;
- HIV infection;
- Allergic and autoimmune diseases requiring the use of glucocorticosteroids.
In addition, the patient himself can provoke candidiasis of the gastrointestinal tract: when trying to self-medicate simple infections with drugs not intended for this purpose, for example, using powerful reserve antibiotics.
Forms of manifestation
Non-invasive candidiasis or candidal dysbiosis is the most common form of intestinal fungal disease caused by uncontrolled growth of Candida in the intestinal lumen or individual hypersensitivity.
The main symptoms of the disease are: a feeling of discomfort in the abdomen, a change in stool consistency, diarrhea, and a deterioration in overall health. Fecal candidiasis - can manifest itself as a secondary process in duodenal ulcers, as well as in ulcerative colitis.
Invasive or diffuse candidiasis in the intestines is a rather rare form of the disease, which is characterized by the most severe course. It is accompanied by erosive-pseudomembrotic colitis, causing 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 drugs for a long time.
Perianal candidiasis - manifests itself as a pathology skin near the anus, often accompanied by herpes. In this form, gastric candidiasis is predominantly found in HIV-infected people infected through homosexual contact.
How to recognize
Gastrointestinal candidiasis manifests itself as follows:
- Pain in the stomach and lower abdomen;
- Loose stools, in which bloody and mucous patches can be traced;
- White inclusions of a cheesy consistency in the patient's stool;
- Lack of appetite, feeling of constant discomfort, heaviness and bloating;
- Unpleasant sensations during bowel movements.
The symptoms of intestinal candidiasis immediately become obvious to an experienced doctor due to the combination of distinctive features. Rectal candidiasis has similar symptoms, so only a doctor can distinguish them.
A mandatory sign of this type of thrush is frequent, unformed stools, pressing sensations, heaviness and a feeling of incomplete bowel movement. Characteristic signs of esophageal candidiasis are increased gas production, frequent urge to have bowel movements, sudden attacks of spasmodic abdominal pain and diarrhea, especially after eating food.
Additional signs that accompany intestinal candidiasis for the doctor may include skin problems. Pimples and acne, itchy spots, hives 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 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 using a comprehensive laboratory test. Only if a fungal infection is detected in the tests, the doctor can prescribe an appropriate course of treatment.
The treatment required for intestinal thrush is carried out using almost the same means as for 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 dysbiosis 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. For proven invasive forms of candidiasis, fluconazole, ketocanozole, and intraconozole are used.
You can also increase the effectiveness of medications containing fluconazole using traditional methods. So, to cure intestinal candidiasis, garlic is often used internally (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
To avoid the question of how to treat this disease, you need to take care of quality prevention in advance. Thus, people with low immune status are often prescribed the drug Diflucan. Doctors claim that it can prevent the onset of the disease.
If candidiasis has made itself felt and you have not found any signs of this disease, you need to follow these recommendations:
- Natural yogurt can inhibit the growth of fungus, so try to include this product in your diet as often as possible;
- Oral hygiene is important because fungal organisms are unlikely to grow 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 appropriate medications, prescribe treatment and give good recommendations. You cannot self-medicate, since the immune system of an HIV-infected person is already vulnerable, and you can provoke its decline by choosing the wrong correct treatment.
Typically, for candidiasis in infected people, the following drugs are prescribed:
- Clotrimazole. These are tablets that need to be taken up to 5 times a day for 2 weeks. They cannot be chewed or swallowed; they simply dissolve in the mouth. A side effect from taking it is stomach upset;
- Nystatin. The dosage 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 mouth for as long as possible;
- Clotrimazole is a drug for the treatment of vaginal candidiasis. The form of the medicine is a cream, but sometimes suppositories are also used. You need to use the drug for one week;
- Miconazole. The treatment regimen with this drug is similar to the previous one;
- Terconazole works in the same way as the two previous drugs, but its mode of action is more advanced. It is able to eliminate candidiasis in 3 days;
- Itraconazole This medicine is used to treat pathologies of the esophagus. The tablets are usually taken three times daily for one month;
- Ketoconazole. The regimen for taking this medication is selected by the doctor for each patient individually.
If the fungus becomes resistant to many types of drugs, then 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 death sentence. It can be cured if you follow all the recommendations of your doctor.
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 in the case of esophageal lesions, opportunistic infections themselves have recently become less likely to cause diarrhea in HIV-infected people. However, in general, the frequency of diarrhea has not decreased very much - this is due to the fact that diarrhea can be caused by some antiretroviral drugs included in HAART regimens.
In addition, patients with HIV infection, like people with normal immunity, are susceptible to common intestinal infections. But as CD4 cell counts decline, they become more vulnerable to opportunistic infections that affect the small and large intestine.
The most common causes of diarrhea in HIV-infected people are bacteria that cause common intestinal infections (for example, 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, and astroviruses can also be detected. picornaviruses and coronaviruses.
The clinical significance of this is not yet completely clear. Among the protozoa, the most active causative agents of chronic diarrhea in patients with AIDS are Cryptosporidium parvum and Microsporidia spp. (Enterocytozoon bieneusi and Encephalitozoon 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 small intestinal mucosa (enteritis) results in profuse, watery diarrhea, which leads to dehydration, electrolyte disturbances, and malabsorption. Abdominal pain is cramping and is usually localized in the umbilical region.
With inflammation of the colon mucosa (colitis), stool is frequent, in small portions, often mixed with mucus, blood and pus. Characterized by tenesmus, urgency and pain in the rectal area. Abdominal pain is usually not cramping in nature and is localized in the lower abdomen.
Physical examination. 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 CD4 lymphocyte count.
Stool examination. A stool sample is examined for the presence of protozoa, cultured on bacterial media, tested for Clostridium difficile toxins, and tested for the presence of white blood cells. The diagnostic accuracy of stool culture is higher with repeated cultures.
If there are no leukocytes in the stool, a modified Ziehl-Neelsen stain of stool smears is performed to detect Cryptosporidia spp. staining with special dyes to identify microsporidia and testing for Giardia lamblia antigens.
If Mycobacterium avium-intracellulare infection is suspected, disseminated infection can be detected by blood culture or bone marrow biopsy, but this is not evidence of gastrointestinal involvement.
X-ray studies. X-ray contrast examination of the passage of barium suspension through the small intestine and irrigoscopy when examining HIV-infected patients with diarrhea are not informative. A CT scan of the abdomen and pelvis can reveal thickening of the walls of the colon, indicating colitis and the need for colonoscopy.
Endoscopic examination of the upper gastrointestinal tract and colon is an invaluable diagnostic method for diarrhea in patients with AIDS. In addition to the ability to directly examine the mucosa, it allows you to take samples for histological examination.
When making a differential diagnosis, it should be remembered that diarrhea in HIV-infected people can be caused by taking drugs included in the HAART regimen. This is indicated by the cessation of diarrhea when the drugs are discontinued and its resumption when HAART is restarted.
For 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 for chronic diarrhea of unknown etiology.
Candidiasis is one of the fungal infections caused by a fungus of the genus Candida. Candidiasis with HIV can be more intense and pose a direct threat to life. This fungus is present in moderate quantities in the microflora of every healthy person. Some people are active carriers of the fungus without experiencing any discomfort. But the 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 development can be triggered by a weakening of the body’s protective function (local immunodeficiency) or by the human immunodeficiency virus (HIV). 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 fatal disease.
Candida albicans does not only appear in AIDS. Even those strains and manifestations of the fungus that are found in patients with HIV can be signs of hypovitaminosis, dysbacteriosis, or a consequence of taking antibiotics in a person who is not a carrier of HIV infection.
What symptoms are you worried about?
The most common cause of HIV is candidiasis of the oral mucosa.
Most often, Candida affects the mucous membranes of the body - the mouth, genitals, and can also develop in the corners of the mouth, causing angular cheilitis, in the folds of the skin - under the breasts in women, in the axillary and buttock folds, in the perineum and even in the interdigital folds on the hands. More rare is the manifestation of Candida fungus on smooth skin. The symptoms of the disease are shown in the table:
Type of candidiasis Characteristic symptoms Oral candidiasis It appears as a white coating on the tongue, palate and buccal mucosa. Painful sensations when eating, a burning sensation in the mouth are possible. Thrush in women Regular cheesy discharge, itching, pain during sex, discomfort when urinating, unpleasant odor. Candida cheilitis Painful cracks (jams) in the corners of the mouth, covered with a whitish coating that can be easily removed. Candidiasis of the folds It manifests itself as crimson-colored erosions, which may have a bluish tint and peeling of the skin at the edges. Candidiasis of smooth skin It manifests itself in the same way as candidiasis of the folds and is usually its consequence. Feature of the flow
Candidiasis in HIV-infected people often forms in the oral cavity. Later it may manifest as candida cheilitis. In people infected with AIDS, the fungus is prone to rapid development, relapse and the manifestation of obvious symptoms of the disease in a short time. From the mouth it can very quickly pass into the esophagus and cause digestive problems, even blocking the digestive tract due to swelling of the mucous membrane. Also, patients with AIDS are characterized by atypical forms of the fungus. For example, folliculitis, which can cause ulcers at the site of the follicles, and later partial baldness.
Candidiasis in this combination is rarely curable due to weak immunity.
Features of the course in HIV-infected people:
- It appears more often in men with HIV than in women.
- Treatment rarely works.
- 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 fungi are 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 sign of the disease is the presence of plaque on the oral mucosa.
Thrush in immunodeficiency is diagnosed much more often, which is due to reduced immunity. That is why pathology is noted already at the initial stages of infection.
Candidiasis occurs during the latent (clinical) stage of HIV infection. This is the second stage of 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 mucous membrane of the cheeks and on the surface of the tongue. The plaque layer quickly increases and becomes difficult to remove. Eating becomes difficult, burning and pain appear.
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 increases, which slightly rise above the surface of the mucous membrane, sometimes merging into one large spot, reminiscent of lichen planus. The 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 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 dorsum 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 copious white discharge, itching and burning in the vagina, and pain when urinating. Knowing that this pathology can occur in a completely healthy woman, before starting treatment it is necessary to undergo a full examination to confirm or cancel the preliminary diagnosis.
Fungus on the tongue 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 and bad microbes. If this does not happen, then oral thrush begins to develop rapidly.
According to statistics, oral fungus most often occurs in women, especially during pregnancy. The diagnosis is less common in men. 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 due to infection through airborne droplets (through kissing, oral sex, through dishes, or due to improper hygiene standards).
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. You need to crush the tablet and add 1 ampoule of vitamin B12 to the resulting powder. It is necessary to lubricate the fungus-affected areas well with the composition every time after eating. You can simply chew the tablet and hold it in your mouth for a while.
Your 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 swab and placed behind the cheek. The following tablets can help: Fluconazole, Mycomax, Decamine, Fluorocytosine and Ketoconazole. Sangviritrin has proven itself to be excellent - it is a special solution for lubricating soft tissues and rinsing mucous membranes. The drug has no side effects or contraindications and is approved for pregnant women and newborns.
Local antibiotics are also prescribed. The most popular are Caramel Dicaina and Levorin. They need to be placed behind the cheek or under the tongue and held until dissolved. These medications may take effect the next day. Dryness and itching in the mouth disappear. A little later, the white coating also disappears.
Do not forget to follow the rules of personal hygiene: rinse your mucous membranes regularly, 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 consult a specialist in time and start proper treatment, the chances of a successful recovery will increase day by day.
Rice. 11. Shingles is most severe in adults with severe suppression of the immune system, which is observed, among other things, in AIDS.
This stage of HIV infection is characterized by pronounced symptoms of impaired cellular immunity, and the clinical manifestations are nothing more than the 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).
Stage IIIB of HIV infection represents a detailed picture of AIDS, characterized by profound suppression of the immune system and the development of opportunistic diseases that occur in severe form, threatening the patient’s life.
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, you feel severe dryness in the mouth, irritation and redness of the mucous membrane, swelling of the soft tissues of the mouth and tongue. In places where pathogenic fungi accumulate, areas of white plaque (often visible on the tongue) can be observed, having a relief shape and a cheesy consistency. At first, the 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 moves 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 coating with a cotton swab, but then it will be difficult to get rid of it - it becomes the cause of hellish pain. Blood appears and the pain intensifies. When swallowing saliva, discomfort also occurs.
Women may develop herpes. It “settles” on the mucous membranes. Already at an early stage of the disease, it happens that ulcers and warts appear on the genitals, and complex infectious diseases of the pelvic organs appear. The first manifestations of HIV are characterized by cold-like symptoms. Later they can develop into a febrile state, when a person sweats heavily both day and night, regardless of weather conditions.
Repeated 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, symptoms of the disease can affect various human organs and systems. An unreasonable increase in temperature, which fluctuates between 38-40 degrees. It can last up to 10 days. Cough and pain in the body and head, severe weakness and sweating are observed during this time. Vomiting may occur, nausea may persist for a long time, muscle pain, and spasms.
The duration of the disease until the patient’s death also cannot be predicted and does not depend on the patient’s gender. True, women are more susceptible to stress and depression due to a terrible disease. It is worth paying more attention to going to the doctor, especially the gynecologist. Timely treatment of diseases of the pelvic organs will significantly alleviate the patient’s condition.
The development of the disease is when secondary manifestations occur, and during this period the symptoms become obvious. But there are also quite a lot of diseases in which the lymph nodes swell. However, such a symptom still sends a person to the hospital, since the thoughts that it is serious appeal to the will of the mind. Any doctor with such manifestations will always prescribe a test 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 this terrible disease in women is much slower than in men. But a number of experts attribute this to the fact that girls and women try to maintain their health in order and monitor it more closely.
HIV infection made itself known loudly 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 basic rules of hygiene and precautions, you can avoid the risk of contracting a fatal 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 bloodstream and the spread of viruses throughout the body. Changes in the patient’s body during this period are nonspecific and are so diverse and multiple that they create certain difficulties when a doctor diagnoses HIV infection during this period.
The causative agents are most often the following species: Candida albicans, C. tropicalis, C. parapsilosis, C. guillierinondii, C. krusei. They belong to yeast-like fungi and differ from true yeast in their ability to form mycelium and the absence of a sexual method of reproduction, i.e.
belong to non-spore-forming yeasts. Can grow on agar nutrient media. Antigens of pathogens have allergenic and antigenic properties, but antibody titers are high only in 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 tracts and are part of the normal microflora. They are also widespread in nature (on fruits, vegetables, dairy products, etc.). The disease usually occurs as a result of endogenous infection. Most often this is caused by Candida albicans.
Candidiasis develops especially often in HIV-infected individuals. Aspergillosis and candidiasis are the most common opportunistic mycotic 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, injuries, surgeries, insertion of catheters into blood vessels, peritoneal dialysis, intravenous drug administration, etc.
In visceral forms of candidiasis, foci of necrosis and neutrophilic inflammatory infiltration are noted. In 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 quantity, since with low immunity their quantity exceeds the norm. And the main cause of thrush occurs when local immunity and general immunity in the body decrease.
Symptoms of thrush in men
Itching and persistent burning in the area of the glans penis and foreskin;
White plaque 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 used externally (cream, suppositories or vaginal tablets), while others are used internally (capsules or tablets for oral administration).
For candidal balanoposthitis (this is when the foreskin and glans penis are affected), local treatment will be sufficient. Clotrimazole cream is used for treatment. This cream is applied in a small layer to the foreskin and glans penis twice a day for 5 to 7 days.
A single dose of fluconazole (150 mg orally) is also possible, but in most cases this is not necessary. Here are all the commercial names of fluconazole - Diflazon, Medoflucon, Diflucan, Forkan, Mikosist, Flucostat.
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-daktarin);
Natamycin (commercial name Pimafucin);
With all this, the drug nystatin (part of such drugs 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 unsuccessful method for treating 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 occurs in an acute phase and is difficult to treat. The lesions are localized in the genital area and in the mouth. Erosion spreads quickly, causing a lot of discomfort and unpleasant sensations. Candiosis is the first sign of significant progression of immunodeficiency, in the absence of other factors. Foci of fungal infection are localized in different places in the patient. Most often, erosions appear in the mouth, on the nails, genitals, anal area, and esophagus. This disease can have quite serious consequences. For example, damage to the esophagus leads to the proliferation of the mucous membrane. The lumen gradually narrows or is completely blocked. That is why oropharyngeal candidiasis in HIV-infected people must be treated immediately.
Patients with AIDS are also characterized by debilitating folliculitis. The disease affects the hair follicles on the head and under the arms. Small purulent blisters form on the skin, which eventually burst, turning into ulcers.
A gray-white coating forms on the mucous membrane. Under the 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. Oral candiosis with HIV can be localized in the corners of the mouth. In this case, epithelial hyperplasia develops and cracks appear.
Thrush is a form of fungal disease. Another name for it is bacterial vaginosis. Don't think that thrush is a sign of HIV. In people with immunodeficiency, it occurs much more often, since the body’s protective functions are significantly weakened. However, such a pathology can also occur in completely healthy women.
Vaginal itching. Vaginal irritation. Pain when urinating, burning. White discharge. Before you find out how to treat candidiasis in the mouth with HIV, you need to undergo a full medical examination and pass all the necessary tests. Most often, doctors prescribe complex medications, antibiotics. It all depends on the stage of development of immunodeficiency.
Candidiasis in HIV-infected people often forms in the oral cavity. Later it may manifest as candida cheilitis. In people infected with AIDS, the fungus is prone to rapid development, relapse and the manifestation of obvious symptoms of the disease in a short time. From the mouth it can very quickly pass into the esophagus and cause digestive problems, even blocking the digestive tract due to swelling of the mucous membrane. Also, patients with AIDS are characterized by atypical forms of the fungus. For example, folliculitis, which can cause ulcers at the site of the follicles, and later partial baldness.
Candidiasis in this combination is rarely curable due to weak immunity.
Features of the course in HIV-infected people:
- It appears more often in men with HIV than in women.
- Treatment rarely works.
- 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 that result from decreased immunity. Microbes quickly enter the body, and one or another illness begins, which may be accompanied by more severe symptoms than in people not infected with HIV.
An incubation period that can last 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 when antibodies to HIV are produced 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. It can also take a long time for HIV infection to progress. The most important characteristic of AIDS, which always manifests itself so clearly that it is simply impossible not to notice it, is incredibly enlarged lymph nodes. They are visible in the armpits, groin and even in the collarbone area.
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 can remain in an “inactive” state (state of inactive replication) from 2 weeks to 3-5 years or more, while the patient’s general condition does not noticeably worsen, but antibodies to HIV antigens are already appearing in the blood serum.
It is impossible to say exactly how long it takes for HIV infection to appear. 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 transfusion of infected blood occurs, the latent period is shorter than during sexual transmission.
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 does not have 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 can be early manifestations of HIV infection.
The transition to the terminal stage of AIDS occurs when the level of CD4 lymphocytes decreases to 50 or below per 1 μl. During this period, an uncontrollable course of the disease is observed 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, and leukoencephalitis progresses. Symptoms of diseases overlap each other. The patient's body quickly becomes exhausted. 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 a patient with AIDS 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 when the level of CD4 lymphocytes decreases to 7% during the first year of the disease, the risk of HIV infection progressing to the AIDS stage increases by 35 times. Rapid progression of the disease is observed with transfusion of infected blood. Development of drug resistance of antiviral drugs. The transition of HIV infection to the AIDS stage is reduced in mature and elderly people. The combination of HIV infection with other viral diseases has a negative effect on the duration of the disease. Poor nutrition. Genetic predisposition. Timely initiation of highly active antiretroviral therapy (HAART). In the absence of HAART, the patient's death 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 from taking antiretroviral drugs. Adequate treatment of concomitant diseases. Adequate food. Rejection of bad habits. Effective methods for treating thrush in adults
Correct and effective treatment depends on the correct search for the cause. This helps avoid further relapses. If the form of thrush is mild, then tests and treatment can be prescribed by a dentist; if it is severe and advanced, then you need to contact an infectious disease specialist.
After receiving the test results, 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 exhibits at least one of the following symptoms, they should seek medical help:
Home treatment
Treatment should be aimed at controlling the rapidly developing infection. It is recommended to eat unsweetened yoghurts and rinse the mouth with solutions of potassium permanganate, Miramistin, Furacilin, chamomile or calendula. Helps great baking soda: Dissolve 2 dessert spoons in 1 cup of boiled water. Rinsing should be regular. It is necessary to rinse the mucous membrane 7 times a day.
It is necessary to properly plan your diet. Treatment of adults is not complete without observing this measure. You will have to give up smoked, sweet, salty and fatty foods. Candy should be excluded White bread, flour, nuts and cheese. These types of food only provoke the active proliferation of pathogenic bacteria.
Pay attention to your drinking regime. The main thing is not the amount of liquid you drink, but its quality and purity. Thrush 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 foods rich in vitamin C 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, the doctor prescribes antifungal drugs.
Fighting candidiasis in HIV-infected people - where to start?
Candida fungi in HIV can cause the progression of a complex and dangerous disease. As is known, these opportunistic microorganisms are present in the normal healthy microflora of the human body in small quantities. They are localized in the intestines, mouth, vagina and 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 later stages of progression of the fatal pathology.
Diagnosis of candidiasis in HIV
If there are obvious symptoms, a series of tests are carried out for the presence of fungi of the genus Candida. First of all, fungi are detected in the blood and urine. This helps determine how much the body is affected by the fungus. A swab of the throat and other affected mucous tissues is also taken. Skin and nail samples may be taken. Serological reactions in HIV-infected people remain negative, so isolation of the fungus from the spinal cord, intra-articular fluids and blood is of diagnostic importance. After collecting the material, a culture is performed to determine the type and genus of the fungus, as well as the number of pathogenic microflora microorganisms.
Treatment of candidiasis in patients with HIV
To avoid the question of how to treat this disease, you need to take care of quality prevention in advance. Thus, people with low immune status are often prescribed the drug Diflucan. Doctors claim that it can prevent the onset of the disease. However, there is an opinion that this medicine should not be taken for a long time, since fungal substances adapt to it and produce protective enzymes.
If candidiasis has made itself felt and you have not found any signs of this disease, you need to follow these recommendations:
- Natural yogurt can inhibit the growth of fungus, so try to include this product in your diet as often as possible;
- Oral hygiene is important because fungal organisms are unlikely to grow 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 appropriate medications, prescribe treatment and give good recommendations. You should not self-medicate, since the immune system of an HIV-infected person is already vulnerable, and you can provoke its decline by choosing the wrong treatment.
Typically, for candidiasis in infected people, the following drugs are prescribed:
- Clotrimazole. These are tablets that need to be taken up to 5 times a day for 2 weeks. They cannot be chewed or swallowed; they simply dissolve in the mouth. A side effect from taking it is stomach upset;
- Nystatin. The dosage 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 mouth for as long as possible;
- Clotrimazole is a drug for the treatment of vaginal candidiasis. The form of the medicine is a cream, but sometimes suppositories are also used. You need to use the drug for one week;
- Miconazole. The treatment regimen with this drug is similar to the previous one;
- Terconazole works in the same way as the two previous drugs, but its mode of action is more advanced. It is able to eliminate candidiasis in 3 days;
- Itraconazole This medicine is used to treat pathologies of the esophagus. The tablets are usually taken three times daily for one month;
- Ketoconazole. The regimen for taking this medication is selected by the doctor for each patient individually.
If the fungus becomes resistant to many types of drugs, then 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 death sentence. It can be cured if you follow all the recommendations of your doctor.
Dynamics of decreased immunity
Even if the disease is sluggish, without showing the main symptoms, 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 guess about the presence of certain deviations in indirect signs, which forces you to go to the clinic. When HIV develops, the body weakens not intensively, but very slowly.
