lecture 34 - Aids complications Flashcards
HIV infection leading to aids
-Someone with HIV infection can be asymptomatic, and if controlled with correct medication will not lead to aids
AIDS - acquired immunodeficiency syndrome
-main 2 things you can get with this
- candida albicans oesophagitis (oral and oesophageal mucosal disease due to this)
- Cryptococcus neoformans (meningitis)
Fungi - e.g yeast
Moulds
candidia albicans
cryptococcus neoformans
Moulds - dermatophytes, aspergillus species
Candida albicans
- yeast
- commensal of mouth, gut, vagina
- overgrowth related to antibacterial therapy, immune suppression, hormonal effects, foreign bodies
Causes - oral or vaginal trush
-nail candidiasis , nappy rash
-immune system ususally keeps this under control however when it cannot be controlled can become overgrown and lead to damage
What does candida albicans look like on microscopy?
It is seen as black yeast, with hyphae on gram stain
-grows well on blood agar
Cure
- give an antifungal agent
- nystatins suspension
- or can use azole pessaries or cream on skin if needed
Cryptococcus neoformans
- yeast
- comes from pigeon faces or eucalyptus trees
- environmental contamination is common
- pulmonary infection - due to inhalation of aerosolised fungus from environment
- totally controled in peopel with normal immune system however if have AIDS or someone with immunosupression
- is spread via blood to CSF
- meningitis in immunodeficient people
- chronic lymphocytic meningitis - slow deterioation of mental state, with head ache and fever
Diagnoisis
treatment
Many wbcs in csf
-lymphocyte not PMN predominance, protein raised, glucose low
- Encapsulated yeasts seen with india ink stain
- c. neoformans grows on agar
treatment - IV amphotericin B, iv or oral fluconazole 6 weeks therapy
Dermatophytes
mould fungi
- require keratin for growth
- can cause superficial infections of skin, hair and nails
- cause tinea, capitis, corporis, cruris, pedis
- human or animal hots
- microsporum species
- trichophyton species
- epodermaophton species
Diagnosis
-pick a few of the flakes off, and then culture, can see under microscope
treatment - topical azole, clotrimazole, econazole
for nails - use oral agents - terbinafine
Aspergilluys fumigatus
- A spore bearing branching mould
- widespread in rotting vegetation
- a rare cause of severe disease in neutropenic patients
- can also cause allergic broncopulmonary aspergillosis
Amphotericin B - IV for weeks
- Liposomal amphotericin B
- voriconazole, other azoles
- surgery
Antifungal drugs
Amphotericin B - binds ergosterol - disrupts cytoplasmic membrane
-IV
Azoles - inhibit synthesis of ergosterol, oral, non toxic
-e.g fluconazole, ketoconazole, voriconazole
CSF
- want to find out when there is somethign wrong with head
- can start with CT scan
- meningitis - get many WBCs neutrophils, lymphocytes, bacteria or viruses present
- low glucose, high protein
Diagnostic thinking
fever and confsuion
-possible CNS infection
Sore mouth and oesophagus -possible candiasis
Male partner - possible HIV infection
Test CSF, examine mouth for trush, perform HIV test
