Treatment of thrush in HIV and AIDS. Oral candidiasis due to HIV infection Causes of thrush in women and men

Oral candidiasis is a dysbiotic lesion of the oral mucosa, which develops with the abundant proliferation of yeast-like fungi of the genus Candida, which are an associate of the normal human microflora. Under certain conditions, fungi can cause various pathological processes in the human body: oral candidiasis, skin candidiasis, vaginal candidiasis, candidiasis sepsis, etc. Candidiasis of the oral mucosa is often observed in children (in the neonatal period, infancy and young age), as well as in elderly people. For example, candidiasis is more common in children 3-10 years old and in patients over 60 years old. Candidal stomatitis and glossitis are usually detected in newborns and in women after menopause.

Causes

The causative factors of oral thrush are yeast fungi of the genus Candida. They parasitize squamous epithelial cells consisting of several layers. This is due to the high content of glycogen in these cells, which these fungi “really love.” These pathogens do not always lead to the development of inflammation. Their pathogenicity varies widely and largely depends on the state of the human body (general and local), the number of living fungi and the state of the microbiocenosis in the oral cavity. Primary infection with candida occurs in different ways:

• During pregnancy (intrauterine method);
• During childbirth, if the woman's genital tract is infected. Moreover, this does not depend on whether there are clinical manifestations of urogenital candidiasis or not;
• During contact between mother and child or medical personnel with the baby.

However, not every infection of a child leads to the subsequent development of stomatitis. This largely depends on the disruption of microbiocenotic relationships in the oral cavity. Normal microbiocenosis is a reliable factor of protection against various infectious and inflammatory complications. Normally, the following microorganisms should live in the oral cavity in certain quantities:

• Streptococci;
• Lactobacilli;
• Staphylococcus;
• Candida.

At the same time, bacteria from the E. coli group should never be detected in the oral cavity. They always talk about an imbalance in the microbial landscape and an increased risk of developing inflammatory conditions, incl. and candidiasis. Common causes predisposing to candidal stomatitis are:

• Irrational use of antibacterial drugs;
• Pathological course of the neonatal period, incl. and caused by prematurity or postmaturity;
• Conducted radiation treatment, incl. and frequent repetitions of radiographic examination of the dental system;
• Operations;
• Intestinal infections;
• Impaired absorption due to pathology of the digestive system;
• Allergies;
• Decreased immunity;
• Impaired metabolism.

Local factors also play an important role:

• Violation of the rules of hygienic oral care;
• Immaturity of the mucous membrane in children;
• Traumatic damage to the mucous membrane of various types;
• Multiplicity of carious process;
• Wearing orthodontic appliances;
• Abuse of carbohydrates (various sweets and baked goods);
• Inflammatory diseases of the dental system.

Classification

SYMPTOMS AND TYPES OF CANDIDIASIS OF THE ORAL CAVITY Symptoms of oral candidiasis depend on the general condition of the patient, the type of candidiasis and the severity of the disease. Depending on the type of candidiasis in a person, the following symptoms are possible:

Symptoms

Representatives of the genus Candida are capable of reproducing on absolutely any tissue within their habitat: on the surface of the cheeks, tonsils, tongue, in the area of ​​​​the corners of the lips or on their border. Depending on the location, it is customary to distinguish forms of the disease that differ slightly in symptoms. In order to begin timely treatment of oral candidiasis, it is necessary to learn to identify its first signs and successfully differentiate them from other pathologies. A symptom that is characteristic of any variant of the disease can provide serious assistance in primary diagnosis. This is the presence of a specific coating on the mucous membranes and skin, which allows one to suspect the presence of “thrush” even during a cursory examination. Overlays for candidiasis In the case of a short course of the disease, the formations that appear on the mucous membrane have a “curdled” white color. The surface of the plaque often shines when illuminated, which simplifies the process of detecting deposits in the area of ​​the tongue root. The appearance of such formations is point-like, with a certain distance of one focus from another. But after 5-8 days they begin to merge and form a single layer (“crust”). If pathological foci are removed by cutting after their formation, a clean surface of the mucous membrane will remain at the site of the defect, without noticeable damage. This operation does not require much effort, and you can use a regular spoon or medical spatula as a tool. In the case of a prolonged course, candidal overlays undergo the following changes:

• the color of the formations changes and acquires a dirty gray or yellowish tint, due to the formation of protein filaments from fibrin contained in the “crusts”;
• It becomes quite difficult to clean the mucous membrane on your own, since the fungus begins to penetrate deep into normal tissues. An additional obstacle to cleansing is the formation of the fibrin skeleton;
• When candidal formations are separated, damaged epithelium begins to appear, with the presence of pinpoint bleeding and individual tissue defects.

These pathological formations can occupy both a local area (tonsils, surface of the tongue) and the entire cavity. Other signs of oral candidiasis are of additional importance, but they are also important to take into account in order to make the correct final diagnosis and reduce the risk of diagnostic error.

Diagnostics

For successful laboratory diagnosis of candidiasis it is necessary to ensure the correct collection of the necessary material from the patient. Materials for research can be: skin and nail scales, discharge from affected areas of the mucous membranes, pus, feces, urine, blood, bile, cerebrospinal fluid, tissue biopsies.
Materials that are delivered to the laboratory are examined in two directions: - microscopy of smears stained with methylene blue according to Gram; - inoculation on nutrient media - Sabouraud agar, wort agar or Candida agar. Large Quantity Detection budding cells with pseudomycelium in a native or colored preparation - a valuable diagnostic find. Single budding cells, found in a smear from the mucous membranes, do not have diagnostic value, since they are also detected in candida carriers . A single isolation of Candida fungus from the mucous membrane in an amount not exceeding 300 colonies per 1 ml is considered as candidiasis . The detection of a significant number of fungal cells during primary culture (from 100 to 1000 cells or more in 1 ml of washout) is interpreted as a sign of candidiasis. The diagnosis is confirmed if, upon re-seeding, a significant increase in the number of fungi is noted, even if there were few mushrooms during the initial sowing. Only quantitative studies in dynamics do culture method reliable support in the diagnosis of candidiasis . It is necessary to differentiate the normal presence of fungi in the human body from the pathological one. It is believed that the detection of Candida fungus in small quantities (up to 10 colonies during initial seeding per Petri dish) can be regarded as the norm. A repeated study of the same material over time after 5-7 days in healthy individuals gives a negative or the same result as with the first sowing. If the number of fungal colonies in re-inoculation grows to hundreds of colonies, then even in the absence of clinical signs of candidiasis, this fact should be regarded as a signal requiring further monitoring of the patient. And the absence of a significant increase in the number of fungi upon re-seeding is diagnosed as candidiasis. Under microscopy, round blastospore cells are visible in the pathological material. They reproduce by budding from the mother cell. Blastospores in yeast-like fungi are capable of filamentation (i.e., elongate and form a thread - pseudomycelium). Pseudomycelia differ from true mycelium in that they do not have a common shell. The detection of pseudomycelium during microscopy of pathological material is an important confirmation for the laboratory conclusion about the yeast-like nature of the pathogen. When sown on liquid nutrient media, the growth of yeast colonies over 1000 per 1 g of test material indicates that the isolated fungi are the etiological agent of the disease. 10-100 colonies per 1 g of pathological material are not a criterion for diagnosing candidiasis, but only a signal to continue the search for the pathogen. A sign of candidiasis is the sowing of up to 1000 cells from the mucous membranes in 1 ml of swab washout, in sputum - more than 500 cells, in feces - more than 1000 cells per 1 g, in bile - more than 300 cells in 1 ml. The presence of the pathogen in all preparations in large quantities and in an active state, in combination with a typical clinical picture, indicates the presence of a candidiasis infection in the patient. Various methods can be used to diagnose candida infection. serological reactions , since Candida mushrooms are full-fledged antigens: - agglutination reaction; - complement fixation reaction; - precipitation reaction; - passive hemagglutination reaction. Intradermal tests for fungal allergens with fungal antigens using the generally accepted method (intradermal injection of 0.1 ml) can detect hypersensitivity reactions of both immediate and delayed types.

Treatment

Before prescribing treatment, the doctor must confirm the diagnosis. To do this, he listens to the patient’s complaints, does a scraping from the oral mucosa, a clinical blood test, and determines the blood sugar level. After the test results are received, an individual treatment regimen is prescribed. In order to successfully cope with oral thrush in adults, it is necessary to begin treatment with chronic diseases: leukemia, diabetes, diseases of the gastrointestinal tract. Candidiasis is treated by a dentist or periodontist. If candida has affected not only the mucous membranes, but the process has spread to other organs, then the treatment is carried out by a mycologist or infectious disease specialist. There are general and local treatment of oral candidiasis.

What pills should I take for oral candidiasis?

General treatment candidiasis is based on taking medications that have a systemic effect on the body. They kill candida not only on the oral mucosa, but also in other organs and cure fungal carriage. Antifungal drugs (antimycotics) are divided into polyene antibiotics and imidazoles. Polyene antibiotics: Nystatin and Levorin. Apply 4-6 times a day after meals for 10-14 days. It is recommended to dissolve the tablets in order to enhance the effect of these drugs and extend the time of their action on the mucous membrane. Noticeable improvement occurs on day 5. The amount of plaque decreases and erosions heal.
If treatment with Nystatin and Levorin does not produce results, Amphotericin B is prescribed intravenously. Or Amphoglucamine tablets. Take after meals twice a day for two weeks. Imidazoles– Miconazole, Econazole, Clotrimazole. Dose 50-100 mg per day, course – 1-3 weeks. The duration and dosage depend on the age of the patient and the severity of the disease. Antimicrobial and antiparasitic agents that stop the growth of fungi have also proven themselves to be excellent:
Vitamins of group B (B2, B6), as well as C and PP are prescribed as a general tonic to boost immunity. They restore redox processes and the body’s natural defenses. It is recommended to take calcium gluconate for a month. It has a general strengthening effect and relieves allergies caused by candida. Diphenhydramine, Suprastin, Pipolfen, Fenkarol are prescribed as antiallergic drugs. During the same period, iron supplements are also used (Ferroplex dragees, Conferon). This is necessary to restore iron metabolism in the body, which is disrupted by candidiasis. For a speedy recovery, strengthening the immune system and preventing the spread of fungal infection, a candida vaccine is prescribed. The drugs Pentoxyl and Methyluracil are used for the same purpose. They activate the production of leukocytes and gamma globulins, which fight fungi. Local treatment - drugs that act on the mucous membrane and are not absorbed into the blood. They stop the growth and reproduction of candida, relieve unpleasant symptoms, and heal damage caused by the activity of the fungus: Sanitation of the oral cavity is of great importance, that is, the treatment of all diseases and inflammatory processes of the oral cavity. This includes healthy teeth, gums and proper care of dentures. They are treated with the same antifungal agents, except for aniline dyes.

How to rinse your mouth for candidiasis?

For thrush in the mouth, alkaline solutions and disinfectants are prescribed. They help cleanse the mucous membrane of plaque, remove accumulations of fungi, calm inflammation and speed up the healing of wounds. For rinsing use: It is necessary to rinse with these solutions every 2-3 hours, as well as after each meal and always at night. The course of treatment is 7-14 days. It is necessary to continue this procedure, even if relief came earlier.

Diet for oral candidiasis

Diet for oral candidiasis is of great importance. Unlimited consumption of confectionery products and products containing yeast provokes this disease. Spicy and sour foods irritate the mucous membranes affected by fungi. This causes pain and burning in the mouth. Therefore, during illness it is necessary that the dishes are semi-liquid and moderately warm. Avoid spices and acidic foods. After recovery, the diet can be expanded. But for 3-12 months, it is advisable to exclude from the diet foods that can cause recurrent disease.

Limit consumption	Recommended to use
Confectionery	Cereals
Products containing yeast	Yeast-free baked goods
Fatty meats and fish, smoked meats	Lean meat and lean fish, liver
Sweet fruits	Vegetables and herbs, especially garlic and carrots
Mushrooms	Dairy products
Tea coffee	Natural juices, herbal teas
Sweet carbonated drinks	Olive, coconut and flaxseed oil
Alcohol	Cranberries, lingonberries, blueberries, unsweetened fruits
Spices, ketchup, mayonnaise	Seeds, nuts

Food products are not a remedy and will not help get rid of thrush in the acute stage. However, following a diet promotes a speedy recovery.

Traditional methods of treating oral candidiasis

Traditional medicine offers many effective recipes for the treatment of oral candidiasis , which can complement traditional treatment:

• carrot juice used for rinsing. It contains a lot of vitamins, essential oils, and phytoncides. The nutrients in carrots help strengthen the oral mucosa. Use half a glass of juice 4 times a day for a month.

• Parsley root decoction. Pour 1 tablespoon of parsley roots into a glass of cold water. Bring to a boil, leave for an hour. Take 2 tablespoons 5-6 times a day. Keep it in your mouth for a long time and rinse. Bioflavonoids and essential oils help get rid of fungi within 7-10 days.

• Dill seed decoction. Pour a tablespoon of dry dill seeds into 0.5 liters of boiling water. Wrap and leave for an hour. Cool, strain and take 1/3 cup three times a day on an empty stomach. It is an excellent bactericidal and wound healing agent.

2010-03-09 23:57:03

Lyudmila asks:

What is candidiasis in HIV

Answers Medical consultant of the website portal:

Hello, Lyudmila! Candidiasis is an infectious and inflammatory lesion of the skin/or mucous membranes caused by fungi of the genus Candida. Candida are opportunistic microorganisms, and are normally present in small quantities on the skin and mucous membranes, without causing the development of disease. Activation of candida occurs in cases where there is a decrease in the activity of the immune system (for example, during HIV infection). Take care of your health!

2015-04-25 02:16:40

Lena asks:

Hello! I was diagnosed with candidiasis in my throat during a gastroscopy, it all started with the fact that 3 months ago I was very scared about my health after visiting a gynecologist, everything turned out to be fine, but phobias were based on this, it seemed to me that everything hurt me, in the end I had blood biochemistry done 2m ago normal, ultrasound of the abdominal and pelvic sections, stool and urine analysis, 1m ago general blood test, fluorography everything is normal, stomach is normal. I live in the USA, so I went through everything by appointment and it stretched to 3m, I drove myself crazy with sleepless nights and diets, because I thought I had a stomach ulcer or, worse, I had lost weight, and recently managed to gain back several kilos. As a result, I find out that there is candidiasis in the throat! I tested for HIV 4 years ago, and I always have only one partner - my husband! I am very concerned about the cause of candida in the throat. From the story: I was sick with a mild form of tuberculosis and finished a 7-month course of drugs 6 months ago, after that I took antibiotics a couple more times 3 months ago and 5 years ago for 10 days for cystitis. Is it possible that this candidiasis is due to antibiotics and due to severe stress for 3 months, because I excluded all fruits, vegetables, salads, ate only oatmeal, steamed meat, and potatoes. And another question: I was prescribed to take flaconazole for 21 days, two tablets on the first day and then one at a time, I took it for 5 days, the feeling of a lump in my throat disappeared, but it started to tingle, which was not the case before, is this a normal reaction? I will be very very grateful for your answer!!!

Answers Imshenetskaya Maria Leonidovna:

Good afternoon. Follow your doctor's recommendations. Candidiasis is most likely a consequence of long-term use of antibiotics and constant stress. You need to let go of the situation, relax, take an antifungal drug, and not focus on your condition. If it’s hard for you to cope on your own, seek help from a psychologist, go on vacation, maybe the doctor will prescribe you mild sedatives. Good luck to you

2011-02-17 20:26:47

Alexander asks:

Good afternoon Please tell me how to cure oral candidiasis due to HIV. I have been taking flucanazole 100 mg once a day for 14 days now. Then it passes and then appears again. Maybe I need to increase the dose? I'm on a diet.

Answers Oleinik Oleg Evgenievich:

Good afternoon What stage of HIV infection? Are you taking ART? Without this, treatment of candidiasis will be symptomatic and with a poor prognosis. Local use of a combination of various drugs is necessary: ​​antiseptics, competitive probiotics, ointment applications, lozenge resorption. Prescribing drugs in person in your situation will be incorrect. Please make an appointment with me. Be healthy!

2010-03-11 12:22:36

Julia asks:

How to cure oral candidiasis due to HIV?

Answers Oleinik Oleg Evgenievich:

Good afternoon For HIV infection, in which the number of CD cells is less than 500 and the viral load is more than 50,000, antiretroviral therapy is necessary. Treatment of other (opportunistic) infections, including fungal ones, will be symptomatic. The most radical method is to use fluconazole in tablet form, but only if the cytology of smears shows fungal mycelium growing into epithelial cells. In other cases, competitive probiotics (subalin, biogaia, etc.) can be used, again against the background of pathogenetic therapy. You can make an appointment with me - I will select an individual scheme for you. Be healthy!

2015-03-06 14:29:49

Julia asks:

Good afternoon For the second year now I have been bothered by burning sensations, tingling sensations of goosebumps crawling under the skin in my arms, legs, head and face without causing irritation. At first it was a slight tingling sensation in the left leg, then it moved to the wrist of the left hand, then it moved to the arm and leg on the right side and became symmetrical, and now it is a burning sensation that can manifest itself in different parts of the body, either symmetrically or asymmetrically , mainly in the elbows and knees. All joints began to twist and ache. I started to feel this tingling and pins and needles in my leg a week after unprotected sex. After it, on the third day, I felt a strong burning sensation in the genital area. She immediately turned to a gynecologist, began treating dysbacteriosis, and later treated ureaplasma. All other tests for STIs are normal.
But as for paresthesias, they never leave me for a single day after that contact. Having read that it could be HIV and hepatitis, I began to feel extremely anxious, especially in the first six months, while I was being tested for HIV and hepatitis. But after a year, “Control” tests, according to the AIDS center specialists, tested negative for antibodies to HIV, hepatitis, and syphilis. I became much less nervous, to be honest, I don’t even have the strength to be nervous anymore, but the paresthesias do not go away. And apparently there are some problems with the immune system, because vaginal candidiasis for a year after “that” simply cannot be treated, despite a variety of treatment regimens and courses. I saw a neurologist about paresthesia, but she said that This is due to stress, she prescribed the antidepressant Zoloft, but it only made the burning sensation in the arms and legs worse; after stopping the drug it became easier. About 2 weeks ago, on the advice of a gynecologist, I donated blood for antibodies to chlamydia: Immunoglobulins M - doubtful, G - negative. Please tell me, can my paresthesias be associated with chlamydia? If so, is it possible to get rid of paresthesia if chlamydia is treated, or is paresthesia permanent? Could this be a HIV infection (hepatitis) to which antibodies have simply not yet been developed? And what to do with these paresthesias? If this is due to stress, according to the neurologist, then why do they intensify when the legs, arms, body are heated, or after physical activity? Maybe I have multiple sclerosis or some kind of neuroinfection? Please help me with advice on which specialist to go to with all this, what to look for, what to take? I would be very grateful for your answer.

2014-09-14 09:30:22

Elena asks:

Hello, I have been worried about weakness in my legs and body for almost 2 months, at night the floor seems to move under my feet and when I bend over in the dark it moves to the side. In the morning and before lunch, you usually don’t feel much weakness; when you bend to the side during the day, you don’t notice it. but when I go out into the street I walk, my body sways due to weakness, when going uphill there is noticeable weakness in my legs, there is noise in my ears for many months, my tongue is covered in a coating and underneath it is white like lint, it doesn’t get cleaned off. Apparently it’s just a coating on the tongue. in July, at the end of the morning I got up, noticeable weakness in my legs, arms and body and the temperature rose to 37.4. after 9 days the fever went away but the weakness hasn’t gone away for 2 months, the weight hasn’t dropped, everything seems to be normal in the lymph nodes. In December there was something like an acute infection based on the symptoms - it started with malaise, weight loss in the sides, then the bones were broken for 3 days in the back and arms then my throat was very sore without a runny nose, my tongue was terrible, then there was severe weakness for a month and the temperature was 37.3. The stool was pale brown all December. This was the first symptom. And the tinnitus began. web was inactive, oak, tank urine was normal according to the immunogram (did only T and B lymphocytes), all cd3 and cd8 lymphocytes were increased, the cd4/cd8 ratio was reduced, cd4 was 823. then all the symptoms went away but terrible candidiasis of the tongue remained, noise in The ears and sides did not get better, although the weight did not fall and I did not lose weight in other places. from December to July the condition and the tank were normal. Only lymphocytes% and mch(33-33.5) were always elevated. Now since July I have been weak, shake constantly, have severe immunodeficiency, coated tongue, tinnitus. There are no other strange symptoms or changes in the skin, etc. The temperature does not rise, the weight is normal, I am not losing weight. I have no pain. I tested for HIV for infection from December to September the result was negative, for hepatitis at the end of June it was also negative. The last risk and contact was in November 2013. I tested for CMV IgM in early September, 1.5 months after the onset of weakness with fever in July, the result is questionable, but since November there have been no contacts with anyone. The other day I did a detailed immunogram and a clinical blood test, and this is what came out:
lymphocytes -2.72 (1.2-3.0)
cd3+lymphocytes 77/1.60- (60-80; 1.0-2.4)
cd3+cd4+ t-helpers-36/0.745(30-50;0.6-1.7)
cd3+cd8+ t-cytotoxic -39/0.810(16-39;03-1.0)
сd4/cd8- 0.92 (1.5-2.0)
cd16+cd56+nc cells - 12/0.248 (3-20;0.03-0.5)
cd19+ b-lymphocytes -8/0.182 (5-22;0.04-0.4)
cd25+ (activated T-B lymphocytes, monocytes, macrophages) --- there is a dash (norm 7-18; 0.06-0.4)
Reaction of inhibition of leukocyte migration:
Spontaneous-2.0 (1.8-4.0)
Fga (24 hours) -35 (20-60)
Immunoglobulins
IgA 1.74 (0.7-4.0)
IgM -4.37!!! (0.4-2.3)
IgG 14.7 (7.0-16)

Cycle 47 (0-120)
Phagocytic activity of neutrophils:
Phagocytic index 70 (40-82)
Phagocytic number 3.46 (4.0-8.3)
According to clinical analysis:
Hemoglobin 131 (130-160)
red blood cells 4.17 (4.0-5.0)
color index 0.94(0.85-1.05)
platelets 219(180-320)
leukocytes 5.6(4-9)
rod 3(1-6)
segmented 49(47-72)
eosinophils 1(0.5-5)
lymphocytes 39(19-37)
monocytes 8(3-11)
soe 5(2-10)
RBC 4.17
Hct 0.378
Mcv 90.6
mch 31.4
mchc 347
Plt 219
MxD% 0.4
NeUt% 0.534
Lym# 2.2
Mxd# 0.4
NeUt# 3.0
RDw-sd 44.1
Rdw-cw 0.128
PDw 12.6
MPv 10.0
P_LCR 0.250
I am very worried about the increase in immunoglobulin igm by 2 times, since there cannot be a primary infection of some kind, since there have been no contacts for a long time, no inflammation, no colds. The other day I had an ultrasound of the abdominal cavity + kidneys, an ultrasound of the glands, an ultrasound of the pelvis - everything no pathologies, a smear for oncocytology and flora at the gynecologist is completely normal. I’m suddenly afraid of some kind of oncology, I don’t understand the reason for this state of immunodeficiency and weakness for 2 months, please tell me where the problem could be, I really don’t want to start it if it’s something serious. I haven’t taken any pills in the last year, my tongue has been terrible since December

Answers Agababov Ernest Danielovich:

Elena, Any chronic infectious process can cause the indicated picture, as well as changes in your tests, start with a consultation with a therapist.

2014-07-19 11:30:03

Julia asks:

Good afternoon doctor! Please tell me whether in your practice you have encountered HIV-infected people who, at an early stage, when IFA does not yet detect antibodies, have symptoms of peripheral neuropathy due to the effect of the virus itself on the nerve cells of the body. 2-3 weeks after risky contact with a person whose status is unknown, burning, tingling, and generally symmetrical paresthesias appeared in the arms and legs, later throughout the body and remain to this day (6th month). Vaginal and oral candidiasis is also present for the third time. The stress has been wild for six months now. The last IFA (antibody) test at 24 weeks was negative. His partner, according to him, also tested negative at 25 weeks. The doctors at our local speed center are already sending me to a psychiatrist. And more questions: can a virus, when it enters the body, first invade the cells of the nervous system, which is why there is no immune response in the blood? What immune factors delay the production of antibodies? And are there cases when HIV is diagnosed only on the basis of clinical data, and antibodies are not detected at all? Thanks a lot. I would be very grateful for your answer.

Answers Sukhov Yuri Alexandrovich:

Hello. Julia. Where are you from? There have been cases where ELISA is negative, but HIV is present, but very rarely, and even after 2-3 weeks... definitely not. Please note that immunodeficiencies are possible without HIV/AIDS, it’s just that the problem of HIV infection is on everyone’s lips. All your questions (and questions to the answers you receive!) take 1.5-2 hours of time; I can only suggest going to an infectious disease specialist at your place of residence or agreeing with me about a personal one (possibly via Skype, as long as it’s not about the examination, but only theoretical issues) scheduled consultation. In "weeks" - Are you pregnant? And there are still a lot of questions on the merits... Sincerely, Yu Sukhov.

2014-07-16 18:08:44

Julia asks:

Good afternoon Please help me understand the immunogram. The reason for this examination was unprotected sexual intercourse, which happened 6 months ago. The fact is that after it I felt a strong burning sensation on the second day. I went to the gynecologist - dysbacteriosis. They prescribed zalain cream and suppositories. Was treated for 2 weeks. By this time, paresthesia appeared in the left leg, then in the arm. Over time, paresthesia (burning, crawling, tingling sensations) became symmetrical in the arms and legs. Then she was tested for sexually transmitted infections and ureaplasma was discovered. I was treated with antibiotics Unidox for 10 days + Fluzak 150 once.. At the end of the treatment, thrush again - treatment with “sporgal” for 5 days and suppositories “Klion d” for 10 days. After 2 months, thrush again - Livarol suppositories. Now vaginal candidiasis has been accompanied by oral candidiasis for a month (white coating and burning sensation on the tongue), which has not gone away for 1.5 months (I drink Fluzac 100 mg per day. Tests for HIV ifa (not 4th generation) in 3,6,17, 25 weeks are negative. The partner at 6,18, and 26 weeks is also negative. Paresthesias in the arms, legs, body, face are constantly present. With physical activity, after taking a warm bath, the paresthesias intensify. During these six months, herpes appeared 4 times. All this time, starting from the second day after the risk - severe anxiety. The neurologist whom I contacted about stress and paresthesia diagnosed an anxiety-depressive state. I tried to take the antidepressants she prescribed, but they made the paresthesia worse. A huge, simply unearthly request to help deal with an immunogram, which I decided to do on my own initiative in order to at least clarify something about my condition!
Analysis results. Res. Unit Ref.Value

Serum immunoglobulin A-2.73 g/l (0.7-4.0)
Serum immunoglobulin M-1.72 g/l (0.4-2.3)
Serum immunoglobulin G-11.07 g/l (7-16)
Total immunoglobulin E - 61.18 IU/ml (up to 100)
Complement component C3 - 1.14 g/l (0.9-1.8)
Complement component C4-2 -0.31g\l (0.1-0.4)
Functional activity of immune cells/CEC
-spontaneous 101 optical (80-125)
units
-induced- 386 optical(150-380)
units
-phagocytic index - 3.8 optical (1.5-3)
units
- proliferative activity of lymphocytes (RBTL) with mitogen Con.A 1.17 optical (1.2-1.68)
units
(CEC, large) - 10 wholesale. units (up to 20)
-circulating immune complexes
(CEC, average) - 89 opt. units (60-90)
-circulating immune complexes
(CEC, small) 173 wholesale. units (130-160)
Assessment of the lymphocyte subpopulation in the blood:
T-lymphocytes (CD3+, CD19-) 76.3% (54-83)
Helper/T-inducers (CD4+, CD8-) 52.1% (26-58)
T-suppressor/T-cytotoxic cells (CD4-, CD8+)
- 24,1 % (21-35)
immunoregulatory index
(CD4+, CD8-/CD4-, CD8+) - 2.2% (1.2-2.3)
Cytotoxic cells (CD3+, CD56+) - 4.9% (3-8)
NK cells (CD3-, CD56+) - 17.4% (5-15)
B lymphocytes (CD3-, CD19+) - 6% (5-14)
monocytes/macrophages (CD14) - 3.7% (6-13)
common leukocyte antigen
(OLA, CD45) 99.8%(95-100). I would be very grateful for your help. Please help me understand what these indications could mean - HIV, or some kind of autoimmune disease. and does such a decrease in immunity affect the production of antibodies to HIV? I've been living in hell for six months now. Help me please!

Most authors believe that the first clinical manifestations of AIDS after infection are lesions of the oral mucosa; according to others, the oral cavity is affected in the terminal stage of the disease, when the number of T4 lymphocytes in 1 μl of blood decreases to 200. Rapidly progressing generalized periodontitis, acute ulcerative necrotizing gingivostomatitis, and angular cheilitis are observed. Foci of periodontal lesions tend to develop osteomyelitis, and quite often a violent reaction to endodontic interventions develops. The appearance of these signs may indicate trouble in people at risk long before such manifestations as candidiasis or hairy leukoplakia.

By frequency, the most common diseases in the oral cavity are distributed as follows:

• candidiasis (88%)
• hairy leukoplakia (83%)
• HIV gingivitis (80%)
• HIV periodontitis (up to 60%)
• ulcerative-necrotizing gingivitis (20%)
• herpetic lesions (11-17%)
• Kaposi's sarcoma (4 to 50%)
• non-Hodgkin's lymphoma (4 to 30%)

Candidiasis is the most common fungal infection in HIV-infected people. Already at the beginning of the HIV pandemic, it was established that fungal infection of the oral mucosa is an early marker of HIV/AIDS and a prognostic indicator for the development of other opportunistic infections. Oropharyngeal candidiasis, vaginal candidiasis in women are constantly found in patients with HIV infection with a number of CD4 lymphocytes even more than 200 in 1 μl. And when they decrease to 100 cells in 1 μl, the development of candidal esophagitis is noted.

Esophageal candidiasis is one of the opportunistic infections observed in AIDS and is included in its important diagnostic criteria. Candidiasis of the oral mucosa, although not included in the prevailing manifestations, nevertheless occurs in 75% of AIDS patients.

Moreover, candidiasis of the oral mucosa in patients at risk may be a valuable sign in the subsequent development of AIDS. Klein et al. (l984) compared 22 previously healthy patients with oral candidiasis of unknown etiology, the inverse (1:2) ratio T4/T8 lymphocytes and generalized lymphadenopathy, with a group of 20 similar patients who had no manifestations of candidiasis in the oral cavity. Thirteen of 22 patients with oral candidiasis (59%) developed underlying opportunistic infections or Kaposi's sarcoma (and therefore AIDS) within about 3 months. During the same time, in a group of 20 patients with lymphadenopathy and immunodeficiency, none developed them within 22 months. Therefore, dentists should be on guard with adult patients who have manifestations of candidiasis of the oral mucosa against the background of practical health.

Candidiasis is the most common lesion of the oral mucosa in patients with AIDS. Its common clinical manifestation is the pseudomembranous form, in which there is a significant number of foci of soft white-yellowish plaque. They are small in size (1-3 mm in diameter), raised above the level of the mucous membrane. Plaque is quite easily removed from the surface of the mucous membrane, exposing areas of the mucosa. They may have a clinically unchanged appearance, sometimes they show erythema or even erosion. Lesions are localized on the mucous membrane of the cheeks, floor of the mouth, tongue, palate, and gums. Individual foci of plaque can merge, forming irregular plaque-like areas that resemble leukoplakia or lichen planus.

Hyperplastic form candidiasis in HIV-infected people is usually localized on the mucous membrane of the cheeks, hard or soft palate. Its formation may be associated with tobacco smoking and in its external manifestations (whitish-gray color, rather dense plaque consistency) it resembles leukoplakia of smokers. But unlike leukoplakia, this plaque is still removed, exposing eroded areas of the mucous membrane. Sometimes the hyperplastic form of candidiasis is localized in the corners of the mouth - candidal angular cheilitis. In these cases, there is much less plaque, hyperplasia of the epithelial-epidermal structures in the corners of the mouth is noted, and chronic cracks in the red border are often formed. Due to constant trauma when eating or speaking, the lesion may become covered with crusts and, in the absence of appropriate treatment, increase in size.

Erythematous form(acute atrophic candidiasis) is characterized by a small amount of plaque against a background of erythematous spots. When localized, the lesion is usually located on the tongue along the back of the tongue along the midline. The filiform papillae in this area are atrophied, there is slight hyperemia with a small amount of plaque (erythematous form of candidiasis of the tongue).

In addition to these types of manifestations of candidiasis, angular cheilitis can also occur on the oral mucosa, which, however, can spread to other areas of the red border of the lips.

Treatment of candidiasis Treatment of the oral mucosa in patients with AIDS should be comprehensive with the use of local and general treatment and, necessarily, immunostimulants. Apply

Candidiasis due to HIV is one of the common infections that most often affects the oral cavity. In immunodeficiency, the pathology has a number of features, since pathogenic microorganisms actively develop against the background of weakened immunity.

Forms of the disease

Candidiasis in the presence of HIV infection develops at the second stage of the disease. Candida fungi, which are the causative agent, rapidly develop on the mucous membranes of the oral cavity and vagina. The pathological process manifests itself in the form of a white coating, the layer of which quickly increases. It is quite difficult to remove it, and over time pain and burning appears.

The pathological process can be localized to:

• upper sky;
• larynx;
• oral cavity;
• esophagus;
• gums.

In the absence of treatment, candidiasis in the mouth manifests itself in the form of plaque, the focus of which slightly rises above the surface of the mucous membrane. They merge and form a large spot. In appearance, it resembles the manifestation of red lichen.

The hyperplastic form is most often localized on the mucous membrane of the palate, which is characterized by rapid development in smokers. The resulting plaque is easily removed and is localized in the corners of the mouth.

The pathological process causes cracks to appear, which do not heal for a long time and become covered with a gray coating. Lack of therapy leads to an increase in the affected area. This form is accompanied by painful sensations. The erythermatous form is characterized by the formation of plaque on the tongue. The pathological process is localized on the middle back of the organ. The main symptom is atrophy of the tongue papillae.

Candidiasis in HIV-infected people may present with the classic symptoms of thrush. It manifests itself as itching, burning and the appearance of copious vaginal discharge. When urinating, discomfort and pain also occur.

Signs of thrush with immunodeficiency virus

Symptoms of the disease in the presence of HIV infection depend on the stage and form of the pathology. Candidiasis that develops in the oral cavity is manifested by a sore throat, impaired taste and difficulty swallowing. Among the external signs, red spots are observed on the surface of the tongue and the mucous membrane of the throat.

With esophageal thrush, external manifestations are completely absent. Patients complain of chest pain that occurs when swallowing food. Signs are characteristic only of candidiasis, which develops against the background of HIV infection.

Vaginal candidiasis is characterized by the presence of white vaginal discharge with a cheesy consistency. They are accompanied by burning and itching of varying intensity. Rashes are observed on the surface of the skin.

Candidiasis in HIV is much more common than in healthy women with negative test results.

Candida fungi and human immunodeficiency virus

Candida fungi are a single-celled microorganism that is present in the body of any person. But with a positive HIV status, a laboratory test for the presence of candidiasis may show a negative result. The main sign of the disease is the presence of plaque on the oral mucosa.

Thrush in immunodeficiency is diagnosed much more often, which is due to reduced immunity. That is why pathology is noted already at the initial stages of infection.

Treatment of candidiasis in patients with HIV

Patients should know that if they have HIV infection, self-medication is strictly prohibited. This can cause serious consequences and complications.

First of all, it is important to eliminate the cause of the appearance of pathogenic microorganisms. Experts recommend increasing the amount of vitamin B, which will help support immunity.

If the skin is affected, antimiotic drugs are prescribed in the form of ointments and creams. Local medications have an effect directly on the site of the pathological process, accelerating the healing process. When the mucous membranes of the oral cavity are affected, therapy involves the use of medications in the form of a suspension, tablets or injections.

The course depends on the type and number of microorganisms and is prescribed by the attending physician. The stage of HIV infection and the patient's condition are also taken into account. In some cases, amphotericin injection may be prescribed.

Patients are also prescribed a special diet, which involves the exclusion of fatty, fried, salty and spicy foods. It irritates not only the intestines, but also the affected oral mucosa. Food should not be too hot or cold. It is necessary to introduce more fruits and vegetables into the diet. They contain vitamins and minerals that help support the immune system.

What are the dangers and consequences

In the absence of therapy, the disease enters an advanced stage. At the same time, the risk of HIV passing from thrush to AIDS increases. During this period, an increase in lymph nodes and the development of cancerous infectious diseases are observed.

Antiretroviral infection when affecting the oral mucosa in immunodeficiency manifests itself in the early stages. It is possible to carry out treatment prescribed by a doctor. The prognosis is more favorable and antifungal drugs will help prolong the patient’s life.

Candidiasis with HIV has a more aggressive course. But in the initial stages of development, laboratory tests do not establish the presence of bacteria in the body. Candidiasis can be identified by its characteristic symptoms. Patients need to begin treatment immediately, as serious complications develop if left untreated. That is why you should consult a doctor in a timely manner and follow all the specialist’s recommendations.

Candida fungi in HIV can cause the progression of a complex and dangerous disease. As is known, these opportunistic microorganisms are present in the normal healthy microflora of the human body in small quantities. They are localized in the intestines, mouth, vagina and skin. The immunodeficiency virus weakens the protective functions, which leads to the manifestation of the pathogenic characteristics of Candida fungi. Candiosis in HIV-infected people occurs very often (in 90% of patients), especially in the later stages of progression of the fatal pathology.

Candidiasis in HIV: features of the disease

In patients with immunodeficiency, this fungal disease has distinctive features, namely:

• Most often, the disease affects young male patients.
• The disease occurs in an acute phase and is difficult to treat.
• The lesions are localized in the genital area and in the mouth.
• Erosion spreads quickly, causing a lot of discomfort and unpleasant sensations.

Candiosis is the first sign of significant progression of immunodeficiency, in the absence of other factors. Foci of fungal infection are localized in different places in the patient. Most often, erosions appear in the mouth, on the nails, genitals, anal area, and esophagus. This disease can have quite serious consequences. For example, damage to the esophagus leads to the proliferation of the mucous membrane. The lumen gradually narrows or is completely blocked. That is why oropharyngeal candidiasis in HIV-infected people must be treated immediately.

Patients with AIDS are also characterized by debilitating folliculitis. The disease affects the hair follicles on the head and under the arms. Small purulent blisters form on the skin, which eventually burst, turning into ulcers.

Oral candidiasis in HIV

A fungal infection most often affects the oral mucosa. If any changes occur in this area, you should immediately contact a medical specialist and undergo a full examination of the body. Pseudomembrane candidiasis of the oral cavity is accompanied by the following symptoms:

• A gray-white coating forms on the mucous membrane.
• Under the layer of plaque, the surface of the palate, tongue and cheeks is covered with many painful ulcers.
• There is a burning sensation in the mouth.

The signs of the disease are very similar to the symptoms of hypovitaminosis (B, B6, C). Pathology can develop over several months. Oral candiosis with HIV can be localized in the corners of the mouth. In this case, epithelial hyperplasia develops and cracks appear.

Thrush (candidiasis) due to HIV infection

Thrush is a form of fungal disease. Another name for it is bacterial vaginosis. Don't think that thrush is a sign of HIV. In people with immunodeficiency, it occurs much more often, since the body’s protective functions are significantly weakened. However, such a pathology can also occur in completely healthy women.

The disease is accompanied by the following symptoms:

• Vaginal itching.
• Vaginal irritation.
• Pain when urinating, burning.
• White discharge.

Before you find out how to treat candidiasis in the mouth with HIV, you need to undergo a full medical examination and pass all the necessary tests. Most often, doctors prescribe complex medications, antibiotics. It all depends on the stage of development of immunodeficiency.

Treatment of candidiasis in HIV

Do not panic if you notice a white coating on your tongue; this does not indicate the presence of the disease. You can first see what oral candidiasis with HIV looks like in the photo. If the symptoms coincide, you should immediately contact a medical facility. Laboratory diagnosis of this disease is carried out in several stages:

• A blood test and biopsy material are examined to detect Candida fungi.
• A filamentous form of the microorganism is detected.
• Fungal infection in lesions is being studied.
• A urine test is collected.

Epitropic treatment of candidiasis in HIV infection is quite effective. The main goal of doctors is to destroy the cause of the progression of the pathology. Most often, special drugs are used to maintain immunity, as well as antifungal medications (Clotrimazole, Nystatin).

Thrush

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