[Atypical mycoses--also a sequela of medical progress. Interview by Dr. rer. nat. Anita Schweiger].
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The histological study with Hotchkiss-Mc Manus staining and Grocott silver impregnation of tissues invaded by opportunistic fungi is a rapid and easy means of diagnosis. The inflammatory reactions around the fungus give the certitude that it is a pathogen and not a contaminant. The major opportunists among Canidida, Aspergillus, Mucor, Absidia and Cryptococcus species are presented in local and disseminated lesions, but all fungi, saprophytic in the normal host, can become pathogens in the immunodepressed patient.
CYTOMEGALOVIRUS INFECTION: Primary prophylaxis is logical in high-risk subjects (CD4 < 50) who are asymptomatic; per os ganciclovir is under evaluation. Systematic secondary prophylaxis relies on intravenous ganciclovir or foscarnet. HERPES SIMPLEX AND ZOSTER: Secondary prevention with acyclovir is not recommended due to the risk of resistance. Herpes zoster retinitis is an absolute indication for continuous oral treatment with acyclovir. CRYPTOCOCCUS: Oral fluconazol is required for secondary prophylaxis. CANDIDIASIS: Due to the risk of resistant strains, neither primary nor secondary prophylasis is recommended. HISTIOPLASMOSIS: Risk of recurrence justifies secondary prophylaxis with itraconazole or fluconazole. COCCIDIODOMYCOSIS: Secondary prophylaxis with amphotericin B or fluconazole is mandatory. ASPERGILLOSIS: Itraconazole is the best agent when prophylaxis is needed.
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Fungal infections of the central nervous system are uncommon in human immunodeficiency virus infected patients. The most frequently encountered is cerebromeningeal cryptococcosis. We report 3 clinicopathological cases of rarer fungal infections of the central nervous system in AIDS patients due to Candida and Aspergillus genders. In most cases, a systemic candida infection or aspergillus pulmonary infection preceded the onset of cerebral granulomas or abscesses. These infections usually occurred at the terminal stage of the disease and were associated with other neuropathologies. Neutropenia associated with lymphopenia represents a frequent risk factor along with intravenous catheter.
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An invasive mycosis may cause death in high-risk patients. An early systemic antimycotic therapy can save life. Therefore, a continuous mycological monitoring in one week intervals is necessary in high-risk patients beginning with the day of admission. This monitoring should be done three to five times a week when an organ manifestation is suspected. Due to the continuous monitoring, the assignment of the results is much easier for the clinician. The goal of the mycological monitoring is to obtain an early hint of a fungus infection. The results of the culture as well as serum titers of antigen and antibodies have to be interpreted in connection with the clinical picture of the underlying disease and the actual risk of infection. Negative results do not rule out a mycosis! Positive results do not always proof an invasive mycosis. Only by interpreting the time course of the mycological findings and the patient's clinical status, an invasive mycosis may be diagnosed with some certainty. In any case, additional procedures like radiological techniques (i.e. CT-scan), histology etc. should be used.