Opportunistic Infections (II) Fungi and protozoa, other hazards ISABEL F. LANTIGUA BESIDES . . . The importance of infections, whether caused by bacteria, fungi or viruses, which complicate the clinical course of patients with HIV has been recognized since the beginning of the AIDS epidemic. But, as highlighted by Santiago Moreno, of the Infectious Diseases Hospital Ramon y Cajal, “if something has changed dramatically in HIV with the introduction of HAART have been opportunistic diseases that now have much less impact. ” However, the therapy against AIDS has generated a new type of complications called inflammatory syndromes of immune restoration, ie infections that were dormant in the human body and the reconstruction of the immune system suffers AIDS patient thanks treatment are activated. Santiago Moreno explains that these inflammatory reactions are characterized appear shortly after initiation of HAART are associated with a profound reduction in viral load and increased CD4 lymphocytes. The positive fact is that if you improve with continued therapy.
Among the infections they are due to HIV easier way to expand distinguished: Virus infections: The most important today are the progressive multifocal leukoencephalopathy (PML) and those caused by cytomegalovirus and herpes zoster. “The cytomegalovirus retinitis were one of the most terrible and feared complications for HIV patients at the beginning of the epidemic. He left blind to most of those affected and had a very toxic treatment” recalls Dr. Moreno. HAART changed this situation. He died before arrival 95% of patients while this percentage has now dropped to 6%. In the case of PML, antiretroviral treatment has also increased the survival of people who suffer, from four to six months in the 80s, the current two years from the time the disease is diagnosed. Bacterial infections: “It is impossible to avoid exposure to bacteria that live with us it is very important for early diagnosis, as bacterial infections can become responsible for up to 30% mortality in HIV patients. “. This is highlighted Juan Gonzalez del Castillo, the San Carlos Clinical Hospital of Madrid. According to this expert has “bacterial pneumonias are the leading cause of hospitalization and serve to indicate if recurring, the disease of AIDS. ” The main responsible for these pneumonia in HIV-positive patients is ‘Streptococcus pneumoniae’.
Specifically, the annual incidence of pneumonia caused by this bacterium varies between 18,000 and 46,000 AIDS patients, compared to 1,000 produced per person per year in the general population. The ‘Pseudomonas aeruginosa’ is a cause of serious infections in HIV patients, according to Dr. Gonzalez del Castillo, “in recent years has detected a significant increase of the same in patients with AIDS. ” Other organisms that threaten those affected by HIV is the ‘Salmonella’. The risk of infection by this bacterium is between 20 and 100 times higher in these patients than in healthy individuals. The same applies to the ‘Campylobacter’ presents a germ infections in people with HIV with a frequency 39 times higher than in the rest of the population. As for skin conditions, this specialist Clinical Madrid highlights caused by syphilis, whose ulcerated lesions facilitate HIV transmission. Fungal infections: These disorders remain a major problem in developing countries. “Thrush has been the most common opportunistic infection in patients with HIV infection during the first decade of the epidemic, the date on which up to 90% of patients had this complication at some point,” says Juan Berenguer, Unit Infectious Diseases hospital Gregorio Maranon. “Fortunately, HAART has swept the clinical scene,” he adds. Other infections of this family are aspergillosis, caused by Aspergillus’, which are the most abundant fungi in the environment of human beings and histoplasmosis, which is endemic in North America (especially in Indiana, Kansas and Tennessee), Central America, South America and Cuba and Puerto Rico. “This disease is more severe in patients with AIDS than in other patients and up to 20% of patients the disease is fulminant” says Dr.
Berenguer. Protozoal diseases “. Opportunistic infections are still around and still kill, even though it lowered its incidence is why it is very important to prevent them in seropositive patients,” says Dr. Daniel Podzamczer, of the Infectious Diseases at the University of Bellvige (Barcelona ). Among the opportunistic infections caused by protozoa one of the most frequent is the Toxoplasma encephalitis, caused by the ‘Toxoplasma gondii’. This body has a high incidence in the general population in Europe, up to 80% and the percentage is even higher in HIV +. It is also common leishmaniasis, which is an endemic infection in 88 countries, including Spain, and more frequent in patients with AIDS than in the rest of the population. One common pathologies presenting patients with HIV infection is diarrhea. Thus, some opportunistic parasites have become particularly important, such as ‘Cryptosporidium’ that “until recently led patients to lose up to 20 kilos in a few days,” recalls Dr. Podzamczer. START