Fungal infection opportunistic

Pneumogstis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a proto2oan infection of the central nervous system, is activated in AIDS patients when the 004 count drops and severe impairment of ceU-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as CTyptococcalmeningitis, are extremely common in AIDS patients, and Histop/asma capsulatum appears when ceU-mediated immunity has been destroyed by the HIV vims, leading to widespread infection of the lungs, Hver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

TABLE 81-3. Therapeutic Approach to Opportunistic Fungal Infections... 

Tuberculosis (frequently disseminated or extrapulmonary at clinical presentation), invasive fungal infections, and other opportunistic infections have been observed in patients receiving infliximab. Some of these infections have been fatal (see Warnings). 

Immunosuppression in general is associated with two other unwanted effects. Firstly, there is not only an increased risk of bacterial, viral and fungal infections but also various opportunistic infections occur. The second draw back is the risk for secondary tumors, especially lymphomas. 

In iron storage disease, ascorbic acid should be given only after adequate serum concentrations of deferoxamine have been attained, in order to prevent serious cardiac arrhythmia (14). Opportunistic fungal infections associated with deferoxamine may also involve the heart muscle and usually have a fatal outcome (15-17). 

Two novel alkaloids named manadomanzamines A and B were isolated from the Indonesian sponge Acanthostrongylophom spp. [58]. The compounds exhibited activities against HIV-1 and AIDS-opportunistic fungal infections. Oral and intravenous pharmacokinetic studies indicated that the compounds have low metabolic clearance, a reasonably long pharmacokinetic half-life, which supports the value of these compounds as potential leads for further preclinical assessment and possible development [59]. Another marine sponge, Petrosia similis, afforded two compormds belonging to bis-quinolizidine alkaloids, namely petrosin and petrosin A [60]. Cell assays indicated that these compounds inhibited the early steps of HIV replication. In the extracellular HIV-1 RT inhibition assay, the compounds inhibited HIV-1 RT. 

During the past decades, the prevalence of opportunistic fungal infections has gained importance, particularly because clinical therapy is sometimes hampered... 

Purine analogues usually do not cause nausea and vomiting or hair loss, but they are associated with cumulative and prolonged myelosuppression and profound immunosuppression, which increases the risk of opportunistic infections such as fungal infections, Pneumocystis carinii pneumonia, and viral infections. 

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