Candida aids hiv

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Candida aids hiv

Candida aids hiv

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  • Candida is an opportunistic fungus. Although opportunistic organisms do not cause disease in a person with a healthy immune system, they can cause pathology in immunosupressed patients. The compromised immune system in patients with AIDS allows Candida to cause disease in certain parts of the gastrointestinal tract and other systems. When Candida causes disease in the esophagus, it is referred to as esophageal candidiasis. In patients with AIDS, the most common etiology of esophagitis is Candida albicans. However, there are other Candida species that can also cause esophagitis in patients with AIDS, including Candida tropicalis , Candida Krusei , Candida glabrata and Candida parapsilosis. While these organisms can cause esophagitis, they do so more rarely than Candida albicans . Later on in this presentation, we will review other potential causes of esophagitis in patients with AIDS .


  • 1. ACQUIRED IMMUNODEFICIENCYSYNDROME (AIDS)• More than 39.5 million cases worldwide.• Considered almost 100% fatal and no known vaccinedeveloped so far.ROUTES OF TRANSMISSION: -1. Sexual contact2.Infected blood / blood products3.Intravenous drug abuse4.Transplacental transferDr. Adel Jumaan Binsaad 1‫ميكرو‬‫س‬1L1
  • 2. ‫المناعة‬ ‫نقص‬ ‫فيروس‬ ‫بنية‬‫البشرية‬Dr. Adel Jumaan Binsaad 2
  • 3. PATHOGENESIS: -• When virus enters the body, its DNA incorporatedinto primary target cell i.e. CD4+ helper Tlymphocyte.• Similar to other viral infections, antibodies to virusare formed but are not protective.• Virus can remain silent or cause cell death, as aresult, decrease in helper T- cells occurs, leading toloss in immune function.• There is an asymptomatic stage lasting for about 8– 10 years after which the final symptomatic stagedevelops.Dr. Adel Jumaan Binsaad 3
  • 4. CLINICAL FEATURES: -• After infection, patient may be asymptomatic ordevelop acute response similar to infectiousmononucleosis.• Acute response – fever, generalizedlymphadenopathy, sore throat, myalgia, diarrhea,maculopapular rash etc.• Acute response (Acute syndrome) clears within afew weeks and a variable asymptomatic phasefollows which may last for 8 – 10 years.• Symptomatic phase – opportunistic infections(pneumonia, CMV, HSV, TB etc) and neoplasticprocesses (Kaposi sarcoma, Non-Hodgkin’slymphoma etc). Dr. Adel Jumaan Binsaad 4
  • 5. Dr. Adel Jumaan Binsaad 5
  • 6. ORAL MANIFESTATIONSGroup 1 (lesions strongly associated withHIV):1. Oral candidal infections- Erythematous- Hyperplastic- Pseudomembranous2. Hairy leukoplakia3.HIV associated periodontitis- HIV gingivitis- HIV periodontitis- Necrotizing ulcerative gingivitis- Necrotizing ulcerative stomatitis4. Kaposi sarcoma (READ)5. Non-Hodgkin’s lymphoma (READ)6
  • 10. CANCRUM ORIS• Acute, rapidly progressing, localized, bacterialinfection of the orofacial tissues and jaws• Causative organisms – Fusobacterium necrophorum,Fusobacterium nucleatum and Prevotella intermedia.• Predisposing factors: include poverty, malnutrition,poor oral hygiene & sanitation, recent illness,malignancy and immunodeficiency states like AIDS.CLINICAL FEATURES: -Age incidence: Predominantly childrenbetween 1 – 10 years.Sex incidence: MaleSite predilection:Usually begins on gingivae as ANUG,then spreads facially / lingually to adjacent softtissues.10
  • 11. Dr. Adel Jumaan Binsaad 11
  • 12. Patch stagePlaque stageNodular stageKAPOSISARCOMADr. Adel Jumaan Binsaad 12
  • 13. Kaposis SarcomaDr. Adel Jumaan Binsaad 13
  • 14. Group 2 (lesions less commonly associatedwith HIV):1. Aphthous ulcers (oropharyngeal region) (READ)2. Idiopathic thrombocytopenia (READ)3. Salivary gland disorders- Dry mouth and decreased salivary flow- Uni or bilateral swelling of major glands4. Viral infections (apart from EBV)- Cytomegalovirus- Herpes simplex virus- Human papilloma virus- Varicella - zoster virusDr. Adel Jumaan Binsaad 14
  • 16. HAIRY LEUKOPLAKIA• It is a chronic, localized infection.• Caused by: Epstein-Barr virus (EBV).CLINICAL FEATURES :- Asymptomatic, slowly spreading, non scrapable,papillary, greyish white lesion. Usually in young age males and located bilaterallyat the lateral borders of the tongue.Dr. Adel Jumaan Binsaad 16
  • 17. 17
  • 18. HISTOLOGICAL FEATURES• Lesion is characterized byhyperparakeratosis andacanthosis.• Epithelial cells areinfected by EBV whichappear as swollen cellswith ballooningdegeneration.• Characteristic pattern ofperipheral margination ofnuclear chromatin is seen,called nuclear beading.Dr. Adel Jumaan Binsaad 18
  • 19. DIAGNOSIS1. Screening test: ELISA is most commonly usedtest. But it can show false positive results.2. Western Blot test: It is a test to detect viralantibodies. More accurate than ELISA.Dr. Adel Jumaan Binsaad 19
  • 20. Candidiasis• Candidiasis is the mostcommon type of yeastinfection.• Candida ssp is anopportunistic fungus(yeast).• It can infect the mouth,vagina, skin, and urinarytract.• About 75% of women willget vaginal yeast infectionduring their life.Dr. Adel Jumaan Binsaad 20
  • 21. Candidal virulent factors:Candidal virulent factors:1. Ability to adhere to host tissues and prostheses(e.g. dentures) and form biofilm.2. Ability to form hyphae that helps in tissueinvasion.3. Ability to modify the surface antigen.4. Ability to produce extracellular phospholipase,proteinase, and haemolysin which break downphysical defence barriers. Candida species rarely cause disease in absenceof predisposing factors (opportunistic organisms) .Dr. Adel Jumaan Binsaad 21
  • 22. Predisposing factors1.1.Heavy smoking.Heavy smoking.2.2.Age (e.g. very young or very old).Age (e.g. very young or very old).3.3.Malignant and chronic disease.Malignant and chronic disease.4.4.Inadequate care of appliances.Inadequate care of appliances.5.5.Immunological and endocrine disorders (e.g.Immunological and endocrine disorders (e.g.diabetes mellitus).diabetes mellitus).6.6.Radiation to the head and neck.Radiation to the head and neck.7.7.Disturbed oral ecology by antibiotics,Disturbed oral ecology by antibiotics,Corticosteroides.Corticosteroides.8.HIV infection9.Cancer10.Dry mouth11. Pregnancy.Dr. Adel Jumaan Binsaad 22
  • 23. Signs and symptomsMost candidial infections are treatable and resultin minimal complications such as redness, itchingand discomfort, though complication may be severeor fatal if left untreated in certain populations.Thrush is commonly seen in infants, elderly people,and those with a weakened immune system.Children, mostly between the ages of three andnine years of age, can be affected by chronicmouth yeast infections, normally seen around themouth as white patches.Dr. Adel Jumaan Binsaad 23
  • 24. Thrush (pseudomembrane):Acute infection but may persist intermittentlyfor many months or even years in HIV-infectedpersons (Oropharyngeal thrush may spread intoesophagus), patients using corticosteroids,neonates and in patients with leukaemia.white patches on oral mucosa, tongue andelsewhere. Lesions resembling milk curds.Microbiologypatches consists of necrotic material anddesquamated parakeratotic epithelia, penetratedby yeast and hyphae.Dr. Adel Jumaan Binsaad 24
  • 25.  Thrush usually develops suddenly, but it maybecome chronic, persisting over a long period oftime.A common sign of thrush is the presence of creamywhite, slightly raised lesions in the mouth -usuallyon the tongue.The lesions, can be painful and may bleed slightlywhen we scrape them or brush your teeth.In severe cases, the lesions may spread intoesophagus, causing pain or difficulty swallowing.Thrush can spread to other parts of the body,including the lungs, liver, and skin.Dr. Adel Jumaan Binsaad 25
  • 26. Oral Candidiasis (Thrush(Thrush (pseudomembrane) is a yeast infection ofthe mucus membrane lining the mouth andtongue. Other oral manifestations includeerythematous and hyperplastic variants. 26
  • 27. Dr. Adel Jumaan Binsaad 27
  • 28. Thrush28
  • 29. Dr. Adel Jumaan Binsaad 29
  • 30. Dr. Adel Jumaan Binsaad 30
  • 31. Oral thrushDr. Adel Jumaan Binsaad 31
  • 32. Vulvovaginitis in women usingcontraceptive and associated with yeasty-smelling discharge, and vaginal itching.Dr. Adel Jumaan Binsaad 32
  • 33. Cutaneous candidiasis• Cutaneous candidiasisinclude:• Paronychia andonychomycosis.• Diaper candidiasis.• Intertrigo candidiasis.33
  • 34. Paronychia:-•Paronychia of the finger nails may develop in personswhose hands are subject to continuous wetting.•In chronic cases the infection may progress to causeonycho-mycosis with total detachment of the cuticlefrom the nail plate.Dr. Adel Jumaan Binsaad34
  • 35. ParonychiaDr. Adel Jumaan Binsaad 35
  • 36. Diaper (Nappy rash):-•Diaper candidiasis is common in infants underunhygienic conditions of chronic moisture and localskin maceration due to irregular change of uncleandiapers.• Caused by C.albicans derived from the lowergastrointestinal tract.• Scaly macules or vesicles,associated with pruritus.Dr. Adel Jumaan Binsaad 36
  • 37. Candidal intertrigo consists of vesicularpustules that enlarge, rupture and causefissures.• Seen especially in warm and moist surfacesand in the obese.37
  • 38. Mucocutaneous candidiasisMucocutaneous candidiasis• Involve both the skin and the oral and /or vaginalmucosae.• Chronic mucocutaneous candidiasis is rare andassociated with T-cells deficiency.Dr. Adel Jumaan Binsaad 38
  • 39. Systemic or deep candidiasisSystemic or deep candidiasis•Involve the lower respiratory tract and urinarytract, then lead to candidaemia; localization inmeninges, bone, kidney and eye is common.• Susceptible settings include prostheticimplantation, heart surgery, organ transplantationand long-term treatment with steroid orimmunosuppressive drugs.• Superficial infection rarely cause dissemination.• Untreated disseminated disease is fatal.Dr. Adel Jumaan Binsaad 39
  • 40. Diagnosis:Diagnosis:1.Demonstration of yeasts in Gram – stainedsmear, skin scraping (KOH), followed by culture.2.Serology or PCR or blood culture ( candidaemia)are helpful in diagnosis of disseminatedcandidiasis.3.Histopathological examination; helps to know thecausative agent (demonstration of hyphae) and inchronic candidal leukoplakial lesions.4.C.albicans C.dubliniensis differentiated fromother Candida species by their ability to producegerm tubes.5. Definitive identification based on fermentationtest and other biochemical tests.40
  • 41. Treatment:Treatment:1. Superficial mycoses1. Superficial mycoses::• Correction ofCorrection of predisposing Factors.• Topically with nystatin or amphotericin orTopically with nystatin or amphotericin ormiconazole.miconazole.2. Systemic and disseminated candidiasis2. Systemic and disseminated candidiasis::• Intravenous amphotericin, either alone or inIntravenous amphotericin, either alone or incombination with flucytosine.combination with flucytosine.• Fluconazole effective for both Superficial andFluconazole effective for both Superficial andSystemic mycoses and itSystemic mycoses and it``s the drug of choice ins the drug of choice intreating Candida infection in HIV disease ( C.treating Candida infection in HIV disease ( C.krusei is resistant).krusei is resistant). Dr. Adel Jumaan Binsaad 41
  • 42. `Prevention:Prevention:as infection is endogenous, therefore preventionas infection is endogenous, therefore preventioninclude:include:1.1. Correction ofCorrection of predisposing factors.2. Compromised patients require long termprophylactic treatment continuously orintermittently with antifungal treatment.Dr. Adel Jumaan Binsaad 42
  • 43. Candidal oral manifestations include threevariants.Caused mainly by Candida albicans. OtherCandida spp. may also involved.Considered as opportunistic infections.Variants of oral candidiasis:1.Pseudomembranous2.Erythematous (atrophic) 3. Hyperplastic.Erythematous (atrophic) candidiasisCondition associated with corticosteroids, topicalor systemic broad-spectrum antibiotics or HIVdisease. May arise when pseudomembranes shed.Erythematous candidasis of palate is commonlyseen in elderly people wearing full-denture(candida associated denture stomatitis). 43
  • 44. Clinical featuresErythematous area (s) is asymptomatic.Lesions on the dorsum of the tongue present asdepapillated areas.Red areas seen on the palate in HIV disease.Erythematous candidiasis, dorsum of tongue44
  • 45. Erythematous candidiasis, hardpalateDr. Adel Jumaan Binsaad 45
  • 46. Hyperplastic candidiasis (candidal leukoplakia)Lesions: chronic, discrete raised areas,asymptomatic and usually occur on the insidesurface of one or both cheeks.Microbiology and histopathologyIncludes parakeratosis and epithelial hyperplasiawith candida invasion restricted to the upperlayers of epithelium.Associated with iron and folate deficiencies andwith defective cell-mediated immunity.It is premalignant.TreatmentTopical antifungals such as nystatin andamphotericin B.Fluconazole tablets _ useful in chronic infection.46
  • 47. Candida associated lesions1. Candida-associated denture stomatitis ( Denturesore mouth)•Chronic erythema and oedema of mucosa thatcontacts the fitting surface of the upper denture.•The mucosa below lower denture is rarelyinvolved.•Due to accumulation of plaque with bacteria andyeast on the fitting surface of denture and theunderlying mucosa.•Mechanical irritation or allergic reaction to thedenture material.Dr. Adel Jumaan Binsaad 47
  • 48. Denture stomatitis48
  • 49. Treatment:I.Removal of dentures at night.II. Regular disinfection by steeping dentures ine.g. chlorhexidine.III. Review of denture fitness to relieve trauma.IV. Diet with low content of fermentablecarbohydrates.V.Nystatin or amphotericin.2. Angular stomatitis (angular cheilitis)Clinical feature:Soreness, erythema and fissuring seen in one orboth angles of the mouth.Commonly associated with inadequate denture.Dr. Adel Jumaan Binsaad 49
  • 50. Condition seen in HIV disease.Condition is occasionally a sign of anaemia orvitamin B12 deficiency.MicrobiologyYeast and Staph. aureus (yellow crusting).TreatmentI.Topical antifungal therapy with nystatin,amphotericin B or miconazole.II.Neomycin and chlorhexidine.III.Adjustment dimension of dentures to preventsaliva retention, and moisture (encourage growthof candida) at the angles of the mouth.IV.Investigate for iron or vitamin B12 deficiencyor HIV.Dr. Adel Jumaan Binsaad 50
  • 51. Angular stomatitis (angular cheilitis)Dr. Adel Jumaan Binsaad 51