Hiv Patients With A C Infection example essay topic

Cryptococcosis is a chronic mycotic infection caused by Cryptococcus variation and Cryptococcus var. gatt ii, both considered opportunistic. Though the organism is usually harmless to humans, the yeast type fungus can severely affect those with severe immunosuppression, such as HIV and AIDS patients. In 1894 Greifswal Medical Society was presented with a paper by a pathologist named Busse, stating that he managed to isolate yeast from a woman's tibia. It was noted the resistance to sodium hydroxide. At the same time yet another physician, a surgeon noted an exact report of the same organism from the same patient; this condition was later named Busse-Busch ke disease. Later reports of infections ranged from simple colonization of the airways and asymptomatic infections of laboratory employees to meningitis or circulated disease.

The number one factor in whether a person may or may not become infected by a strain of crypto cocci is the immune status of the host; because most of the serious infections occur in patients with some form of immunosuppression. In fact, has now become a major life-threatening fugal infection in AIDS patients (King MD). The most common variation of Cryptococcus in the United States, and other mild climate regions of the world is C. var... This variation is usually found in the fecal droppings of pigeons. On the other hand C. var. gatt ii is found in the tropical regions of the world and grows in around some species of eucalyptus trees, not from birds. The rate of maturity of this organism is very fast each cell is expected to reach maturity in as little as 3 days (Larone 55).

Though this infection is prevalent in immunosuppress ed patients it is not limited to them, in fact C var. gatt ii does not commonly infect those patients with weakened immune systems but is more commonly found in those considered healthy and. This is opposed to the fact that C var causes most of the world wide infections and targets patients. This variation causes 85% of the infections in the United States amongst HIV patients (Cryptococcois). This yeast buds and forms yeast like round cells, usually 3-6 f'Ym in diameter. These cells have a polysaccharide capsule that surrounds each one, this capsule is composed of mannose, , and acid, and rarely are formed (King MD).

This fungus is identified by its appearance, biochemical tests, but mainly at its ability to grow at 37 cXC, because most nonpathogenic strains do not grow at that temperature. Also, majority of the strains of C use creatinine as a nitrogen source, which explains the growth in the pigeon feces; pigeon feces is rich in creatinine. Also, the pathogenic strains produce melanin, while the nonpathogenic stains do not (King MD). This organism's primary route of infection is through the respiratory tract, and does not usually transfer from human to human.

This is contracted by the inhalation of the yeast spores and basidiospores. Also, this organism has not been found to have an animal to human transmission. Because this yeast forms a capsule around each cell it makes it resistant to the immune-response. Once the body's phagocytes located in the respiratory tract reach the infection, the encapsulated yeast cells block recognition of the yeast. This result is the lack of response by the body's main defenses the leukocytes, white blood cells. The body's production of antibodies is crucial in the defense of this infection.

These antibodies increase the lymphocyte and macrophage response to the infection (King MD). The body's naturally inflammatory response does not apply to most infections. Actually, the lesions formed by C have no well-defined inflammatory response, only a cystic cluster of yeast. This organism lack identifiable endo- or ex- toxins resulting in the absence of necrosis, death of the surrounding tissue, in early infections.

Though necrosis is not noticed in the early stages of infection, necrosis may occur late in the infection because of fugal burden and distortion. Since necrosis is not identified early on in the disease, one of the first indications of infection is the development of meningitis. The development of meningitis can cause such life long problems as neurological damage or even death, the approximate mortality rate is 12% with meningitis caused by a infection (Cryptococcosis). Of patients that have a diagnosed with a central nervous system infection 80% die within 2 years of discovery of the infection. Also lesions of the skin are apparent in 10-15% of patients leading to things such as papules, pustules, or ulcers.

The formation of skin lesions in patients is another signature characteristic of this organism along with infections of the prostate and of the Medullary cavity of the bone. Because of the pulmonary invasion of the disease it is very likely that such problems like pneumonia, pulmonary nodules or even pleural effusion (King MD). Though the organism enters through the respiratory tract majority of the patients with the infection primarily in their lungs are. The respiratory symptoms of those patients with intact immune systems usually are asymptomatic or so mild that the patient does not need to seek medical attention. All physical signs and symptoms are ultimately determined by the status of the patient's immune response and capabilities (King MD). Patients with infection generally have to undergo antifungal therapy, though pulmonary is resolved with out medical treatment in patients.

HIV patients with a C infection are usually controlled with a life-long antifungal regimen with the goal of a permanent cure. AIDS patients are treated with a strong does of antifungal agents for approximately 14 weeks followed by a life time maintenance treatment. The treatment schedule consists of 2 weeks of Amphotericin B, possibly adding 2 additional weeks of Flucytosine, ending in a minimum of 10 weeks of Fluconazole therapy. Life long suppression is controlled by Fluconazole taken orally with weekly Amphotericin B treatment.

The patients that have been diagnosed with an infection of the central nervous system are generally administered similar treatment as patients with AIDS but are recommended to undergo weekly spinal fluid evaluations until a negative result can be found for 4 weeks straight. This proposes a bit of patient discomfort due to the spinal tap procedure (King MD). The medications used in treatment of infections vary in action and in side effects. Amphotericin B is used because of the rapid action and clinical improvement. The main action of Amphotericin B is the deterioration of the yeast cell wall, making it susceptible to the (Skidmore). Though treatment with Amphotericin B must be monitored regularly because of it, meaning the drug is metabolized in the kidneys and can possible cause kidney damage, a simple BUN (Blood Urea Nitrogen) and Creatinine blood test can monitor kidney function (Skidmore).

Flucytosine is generally used in addition to Amphotericin B because of its rapid development of resistance to the drug. This drug inhibits DNA and RNA synthesis in the yeast. Again side effects of the drug must be closely monitored; blood serum levels of Flucytosine must be measured to insure the body is not receiving toxic amounts of the drug (Skidmore). The most effective antifungal treatment is Fluconazole, this drug is water soluble which makes it easy to absorb when taken orally, but can also be give IV. Fluconazole causes direct damage to the phospholipids wall of the yeast (Skidmore). Fluconazole is an excellent long term therapy once Amphotericin B has take effect on acute infections.

Though Fluconazole is an effective prophylaxis it does not effect survival and is not considered cost-effective (Cryptococcois). In addition to medications a person may be referred to an infectious disease specialist for management. In rare occurrences a patient may need surgery to relieve pressure of central nervous infection with a shunt or for the repair of ventricular obstructions (Cryptococcosis, Medline). This disease can cause detrimental results in some patients but for the most part if a person is the chances of severe or chronic infection is rare.

The progression of medical treatment and research has opened many doors in the treatment and information acquired about this disease. With more advances to come hopefully a cure to such disease as HIV and AIDS is found so that those patients do not have to undergo the turmoil of this fungal infection.

Bibliography

Cryptococcois. ' CDC. Centers for disease control and prevention. 01 Mar. 2005.
Cryptococcosis. ' Medline Plus. Medline Plus. 01 Mar. 2005.
King MD, John W. 'Cryptococcosis. ' e Medicine. e Medicine. 01 Mar. 2005.
Larone, Davis H. Medically Important Fungi: A guide to Identification. 2nd ed. Washington DC: American Society of Microbiology, 1993.
Pfaff, H.J., M.W. Miller, and E.M. M rak. The Life of Yeasts. 5th ed. Cambridge: Harvard University Press, 1966.
Skidmore, ed. Mosby's Drug Guide. 3rd ed. New York: Mosby, 1999.