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Author: admin, 05.02.2015This HIV-positive patient presented to a dental office exhibiting signs of a secondary erythematous candidiasis infection. The immune system in suffers with HIV undergoes a dramatic reduction in its effectiveness, resulting in the greater possibility of secondary infections, as in this example of an AIDS patient with symptoms of oral candidiasis.
The patient is a 47-year-old HIV-positive man who has been out of medical care for several years. The immune system in suffers with HIV undergoes a dramatic reduction in its effectiveness, resulting in the greater possibility of secondary infections, as in this example.
Antiretroviral therapy was restarted and prophylaxis against Pneumocystis jiroveci pneumonia and Mycobacterium avium complex infection was started.The patient underwent an upper endoscopy with biopsies. It was clear that the patient was not taking his antiretroviral medications.On his fourth presentation—18 months after the initial one—the severe oral candidiasis did not improve with fluconazole.
Shortly after the discharge, the patient called the clinic and said the itraconazole was not working. The patient began to appear in the GI clinic unannounced, asking for someone to dilate his esophagus. He lost weight and eventually agreed to a percutaneous endoscopic gastrostomy (PEG) feeding tube, which he used at night to stave off further weight loss.CandidaOral candidiasis is the most common fungal infection, and the HIV epidemic caused its incidence to rise considerably. During the 1980s, nearly 90% of patients with HIV infection had oral candidiasis at some point during their illness. In patients with poorly controlled or uncontrolled HIV infection, however, the risk of this infection remains.There are numerous strains of Candida species, of which Candida albicans is the most common. Of note, C albicans is markedly sensitive to the azoles (fluconazole, voriconazole, itraconazole) but C glabrata and C krusei are not.With the HIV epidemic, there was a marked increase in the use of fluconazole—an easy, well-tolerated treatment that was commonly prescribed in intermittent doses for recurrent outbreaks.
Newer formulations, liposomal amphotericin B (LAmB) and amphotericin B lipid complex (ABLC), are better tolerated.ConclusionThis patient’s advanced HIV disease made him vulnerable to the dramatic growth of Candida in his esophagus. Successive azoles did not afford any degree of disease management, and the patient was unable or unwilling to keep follow-up appointments or adhere to medication regimens, for both his esophagitis and his HIV disease. While his PEG feeding tube prevented further weight loss, the patient’s infection continued to worsen.
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