Fungal Opportunistic Pneumonias in  HIV/AIDS Patients: An Indian Tertiary  Care Experience

Kaur, Ravinder; Mehra, Bhanu; Dhakad, Megh Singh; Goyal, Ritu; Dewan, Richa

doi:10.7860/jcdr/2017/24219.9277

Cited by 12 publications

(7 citation statements)

References 17 publications

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“…Aspergillosis ranked second after Pneumocystis infections in a recent study performed in India. 120 Incidence of IA ranging from 3.5 to 19 cases of IA per 1,000 person-year was observed in the nineties but has substantially decreased with improvement in antiretroviral therapy. 121,122 CD4 cell count less than 50 cells/μL represents a major risk factor while neutropenia, steroids, hematological malignancy, underlying lung disease, and diabetes are associated risk factors.…”

Section: Critically Ill Patientsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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Invasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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Section: Critically Ill Patientsmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis

Ledoux

Guffroy

Nivoix

et al. 2020

Semin Respir Crit Care Med

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“…In fact, paracoccidioidomycosis is the eighth most important cause of mortality among chronic infectious diseases, reaching rates of 1.65 deaths per 106 inhabitants ( de Oliveira et al, 2015 ). Collectively, these invasive fungal infections are more prevalent in immunocompromised patients ( Woyciechowsky et al, 2011 ; Kaur et al, 2017 ; Sungkanuparph et al, 2017 ). In addition, they are in general also associated with antifungal resistance, making their treatment ineffective for most cases ( Gullo et al, 2013 ; Chowdhary et al, 2014 ; Scorzoni et al, 2017 ).…”

Section: Plant Lectins For Treatment Of Fungal Infectionsmentioning

confidence: 99%

Targeting the Immune System with Plant Lectins to Combat Microbial Infections

et al. 2017

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The arsenal of drugs available to treat infections caused by eukaryotic and prokaryotic microbes has been declining exponentially due to antimicrobial resistance phenomenon, leading to an urgent need to develop new therapeutic strategies. Host-directed immunotherapy has been reported as an attractive option to treat microbial infections. It consists in the improvement of host defenses by increasing the expression of inflammatory mediators and/or controlling of inflammation-induced tissue injury. Although the in vitro antimicrobial and immunomodulatory activities of lectins have been extensively demonstrated, few studies have evaluated their in vivo effects on experimental models of infections. This review aims to highlight the experimental use of immunomodulatory plant lectins to improve the host immune response against microbial infections. Lectins have been used in vivo both prophylactically and therapeutically resulting in the increased survival of mice under microbial challenge. Other studies successfully demonstrated that lectins could be used in combination with parasite antigens in order to induce a more efficient immunization. Therefore, these plant lectins represent new candidates for management of microbial infections. Furthermore, immunotherapeutic studies have improved our knowledge about the mechanisms involved in host–pathogen interactions, and may also help in the discovery of new drug targets.

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“…18,35 Histoplasma capsulatum and Pneumocystis have emerged as potential global fungal pathogens of public health importance due to challenges in providing ART to those with HIV, including treatment failure and late presentation to HIV care. 36 In this survey, more than 74•0% and 78•5% of the African population do not have access to diagnostic services for histoplasmosis and PCP, respectively. This is an age-old problem as Oladele and colleagues 37 reported few data on histoplasmosis in the African region between 1952 and 2017.…”

Section: Discussionmentioning

confidence: 82%