Fungal arthropathy in HIV-infected

Fungal opportunistic (opportunistic) infections occur in 85-90% of all HIV-infected patients, and much of it is accompanied by lesions of bones and joints.

Candida arthritis in HIV-infected

The fungus Candida albicans is found in 90% of HIV-infected people, and very often against a background of reduced immunity fungal infection can give clinic of acute inflammatory joint lesions, dominating the clinical picture.Particularly high risk patients with a long-term neutropenia (decrease in white blood cell count, neutrophil count).

candidiasis often occurs in patients taking long-term antibiotics or glucocorticoids with tuberculosis or cancer, in patients with liver cirrhosis, diabetes and other chronic diseases, as well as after injuries, operations taking place on the background of HIV infection.

The most frequent monoarthritis of the knee joint and spondylitis of two adjacent vertebral bodies, less inflammation is observed in long bones, thus it is accompanied by severe local pain and symptoms of

osteomyelitis.

To clarify the nature of the inflammation is carried out X-ray, MRI, and an open or a needle biopsy to determine the type of pathogen and its sensitivity to the drug.As a rule, in the synovial fluid is almost always detected a fungus (Candida), and biopsy of the synovial membrane - a special granulomatous inflammation.

Treatment of candidiasis is most often carried drugs fluconazole, amphotericin B, and for maintenance therapy using itraconazole.In complicated cases, involving bones melt, conduct further surgery without stopping AIDS treatment and candidiasis.

Sporotrihoznye arthropathy in HIV-infected

causative agent of this group of fungal infections is Sporotrichum schenckii, which most commonly affects the skin and lymph nodes, but in severe weakening of immunity form multiple foci, affecting the joints and bones, central nervous system, respiratory system andetc.

involved joints of the upper extremities (elbow and shoulder) When sporotrihoznyh arthritis joint pain moderate or low intensity, mainly in the process, at least - the small joints of the hands.For this type of fungal infection is characterized by the spread of the trend of the surrounding joints, soft tissue with the formation of fistulas.In marked decrease in immunity can be fatal in the development of destructive forms of HIV, arthritis, accompanied by anemia, cachexia (wasting), central nervous system and eyes.

When sporotrichosis arthropathies combine surgery (arthroscopic debridzhment) affected joints with intensive antifungal therapy (amphotericin B, itraconazole).

Cryptococcal arthropathy in HIV-infected

causative agent of this type of athlete's foot - Cryptococcus neoformans is pathogenic to humans only in a considerably weakened immune system, so 90% of all cases of cryptococcosis associated with AIDS.

primary infection is often associated with lung disease and only 10% of cases it is accompanied by lesions of bones and joints.This arthritis occurs is very difficult and often manifest deterioration of bone tissue, the development of osteomyelitis.

Radiological this type of fungal infection is very similar to bone metastases of malignant tumors.But with the knee joint synovitis (and basically only the affected joint) is detected in synovial fluid of a large number of cryptococci.Treatment is the same as in sporotrichosis.

Koktsidiomikoznye arthropathy in HIV-infected

causative agent of this type of fungal infections is Coccidioides immitis, primarily affects the respiratory system, but hematogenous spread of the process at the stage of AIDS lesions of bones and joints.The most common acute arthritis developing in the knee, accompanied by swelling, pain and limitation of motion, phenomena bursitis.In 70% of cases of arthritis it takes a chronic course, but it is possible damage to other parts of bones and joints in the propagation of fungal infection of mycotic foci of osteomyelitis.

This isolate the pathogen from the synovial fluid rarely works (not more than 5% of cases), but puncture fungal lesions coccidia stand out more often.Very often arthropathy observed on the background of fungal pneumonia and is accompanied by skin rashes, polyarthralgia, fever, erythema, adenopathy, signs mikogennoy allergies.In such patients, frequent symptoms of bronchial obstruction may be eosinophilia.

koktsidiomikoznyh arthropathy Treatment is usually carried out with fluconazole, itraconazole, amphotericin B, and combined with surgery if needed.

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