Archive for June 16, 2014

Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Updated Guidelines From the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America

Clinical Infectious Diseases May 1, 2014 V.58 N.9 P.1308-1311

Henry Masur1, John T. Brooks2, Constance A. Benson3, King K. Holmes4, Alice K. Pau1, and Jonathan E. Kaplan2

1National Institutes of Health, Bethesda, Maryland

2Centers for Disease Control and Prevention, Atlanta, Georgia

3University of California, San Diego

4University of Washington, Seattle

Correspondence: Henry Masur, MD, Critical Care Medicine Department, NIH Clinical Center, 10 Center Drive, Rm 2C145, Bethesda, MD 20892 (hmasur@nih.gov).

On May 2013, a revised and updated version of the Centers for Disease Control and Prevention/National Institutes of Health/HIV Medicine Association Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents was released online. These guidelines, since their inception in 1989, have been widely accessed in the United States and abroad. These guidelines have focused on the management of HIV/AIDS-related opportunistic infections that occur in the United States. In other parts of the world, the spectrum of complications may be different and the resources available for diagnosis and management may not be identical to those in the United States. The sections that have been most extensively updated are those on immune reconstitution inflammatory syndrome, tuberculosis, hepatitis B, hepatitis C, human papillomavirus, and immunizations. The guidelines will not be published in hard copy form. This document will be revised as needed throughout each year as new data become available.

PDF

http://cid.oxfordjournals.org/content/58/9/1308.full.pdf+html

June 16, 2014 at 9:08 am

ESCMID guideline for the diagnosis and management of Candida diseases 2012 – patients with HIV infection or AIDS.

Clin Microbiol Infect. 2012 Dec;18 Suppl 7:68-77.

Lortholary O1, Petrikkos G, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Cuenca-Estrella M, Donnelly JP, Garbino J, Groll AH, Herbrecht R, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Meersseman W, Richardson MD, Roilides E, Verweij PE, Viscoli C, Ullmann AJ; ESCMID Fungal Infection Study Group.

Author information

1Université Paris Descartes, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, APHP, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France. olivier.lortholary@nck.aphp.fr

Abstract

Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency.

Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era.

Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects.

For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible.

For vaginal candidiasis, topical therapy is preferred.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12042/abstract;jsessionid=ED72B78AE28198C491D62542586B7B5E.f03t01

PDF

http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12042/pdf

June 16, 2014 at 9:05 am

Síndrome de mononucleosis infecciosa en pacientes adolescentes y adultos

Rev Chilena Infectol 2003 V.20  N.4 P.235-242

INFECTOLOGÍA PRÁCTICA

ALBERTO FICA C.1

Infectious mononucleosis syndrome, characterized in typical cases by fever, sore throat, tonsillar exudates, cervical adenopathies and atypical lymphocytosis is associated in most cases to Epstein-Barr virus (EBV) infection.

Other potential causes for this syndrome are acute cytomegalovirus (CMV), Human Immunodeficiency Virus, Toxoplasma gondii or Human Herpes virus 6 infection.

These alternative etiologies evolve with a modified clinical picture that includes sometimes leukopenia or rash.

Diagnosis of EBV is easily accomplished by atypical lymphocytosis (> 10%), positive heterophil antibodies and IgM antibodies directed against the EB viral capsid antigen (VCA). The latter is needed for cases without positive heterophil antibodies.

Acute CMV infection is the second most important cause and can be diagnosed by CMV antigen detection, PCR or shell vial culture of blood samples, although experience with these tests among immunocompetent patients in primary care settings is sparse.

Acute primary HIV infection is an important cause for this syndrome and should not be neglected when other causes are discarded.

Third or fourth generation HIV ELISA tests, p24 antigen or HIV-PCR detection in blood samples allow recognition of this agent from the second or third week of inoculation.

T. gondii and human herpes virus 6 infection can be diagnosed by serological methods. Evolution of EBV or CMV infection is favorable with infrequent complications.

PDF

http://www.scielo.cl/pdf/rci/v20n4/art03.pdf

 

June 16, 2014 at 9:02 am


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