Mycoses in AIDS Patients

328 Pages·1990·20.815 MB·English

by  Francis W. Chandler (auth.), Hugo Vanden Bossche, Donald W. R. Mackenzie, Geert Cauwenbergh, Jan Van Cutsem, Edouard Drouhet, Bertrand Dupont (eds.)

Mycoses in
AIDS Patients
Mycoses in
AIDS Patients
Edited by
Hugo Vanden Bossche
Janssen Research Foundation
Beerse, Belgium
Donald W. R. Mackenzie
CentralPublicHealth Laboratory
London, UnitedKingdom
Geert Cauwenbergh and Jan Van Cutsem
Janssen ResearchFoundation
Beerse, Belgium
Edouard Drouhet and Bertrand Dupont
InstitutPasteur
Paris, France
PLENUM PRESS • NEW YORK AND LONDON
LIbrary of Congress CatalogIng-In-PublIcatIon Data
Symposium on Topics 1n Mycology on Mycoses 1n AIDS Pat1ents (1989
Paris. France)
Mycoses 1n AIDS patients I edited by Hugo Vanden Bossche ... let
a1.J.
p. em.
"ProceedIngs of the Th1rd Sympos1um on Topics 1n Mycology on
Mycoses in AIDS Pat1ents. held November 20-23. 1989. in Paris.
France"--T.p. verso.
Includes b1bliograph1cal references.
Inc1udes 1ndex.
1. Mycoses--Congresses. 2. AIDS (Diseasel--CompI1cations and
seouelae--Congresses. 3. Opportunistic infections--Congresses.
I. Vanden Bossche. H. II. Title.
[DNLM, 1. Acqu1red Immunodef1ciency Syndrome--compl1cation.
2. Mycoses--compl1catlon--congresses. WD 308 S98967m 1989]
RC117.A2S93 1989
616.97'92015--dc20
DNLM/DLC
for L1brary of Congress 90-14250
CIP
ProceedingsoftheThird SymposiumonTopicsin Mycologyon Mycoses
in AIDS Patients, held November20-23, 1989,in Paris, France
ISBN-13:978-1-4612-7912-9 e-ISBN-13:978-1-4613-0655-9
DOl:10.1007/978-1-4613-0655-9
©1990Plenum Press, New York
Softcoverreprintofthehardcover1stedition1990
A Division ofPlenum PublishingCorporation
233 SpringStreet, New York, N.Y. 10013
All rights reserved
No partofthis book may be reproduced, stored ina retrieval system, or transmitted
in any form or byany means, electronic, mechanical, photocopying, microfilming,
recording, orotherwise, without written permission from the Publisher
PREFACE
The World Health Organization estimates that at least five million
people worldwide are infected with human immunodeficiency virus (HIV)
Of these about 100,000 are in Asia and Oceania, 500,000 in Europe, 2
million in the Americas and 2.5 million in Africa (Mann, 1989). The
acquired immunodeficiency syndrome is characterized by a derangement
in cell-mediated immunity leading to opportunistic infections with for
example Mycobacterium spp., Candida spp., Cryptococcus neoformans,
Pneumocystis carinii, Toxoplasma gondii and Cryptosporidium.
The third symposium on "Topics in Mycology" brought together 265
experts from 32 countries to discuss the epidemiology, immmunological
and pathogenetic aspects of AIDS and its opportunistic infections in
general and fungal infections in particular.
Pneumocystis carinii pneumonia is by far the commonest
opportunistic infection in AIDS patients. The nature and
classification of P. carinii is still controversial. In search for
its true taxonomic affinities an introductory paper formulates a
number of key questions. Candidosis is another frequent opportunistic
infection. A number of papers discuss the possibility that selective
pressures may operate on Candida albicans within the AIDS population
and influence its nature: this might have an impact on prophylaxis and
curative and/or suppressive therapy.
AIDS has become the leading predisposing factor for
cryptococcosis. Other infectious complications in AIDS patients
include histoplasmosis and coccidioidomycosis. In contrast,
paracoccidioidomycosis and blastomycosis are rare, as are
aspergillosis and sporotrichosis. However, an unusual mycosis,
penicilliosis (caused by Penicillium marneffei) has been proposed as
indicative of AIDS. HIV infection and/or treatment may induce the
appearance of other rare mycoses such as trichosporonosis,
saccharomycosis and fusariosis. A great number of scientists of high
international standing discuss the epidemiological, immmunological and
clinical aspects of these mycoses and generate a number of questions
that should stimulate further research.
These Proceedings, which are comprised of the papers presented at
this symposium, contain a wealth of information on AIDS-indicative
mycosis, dermatomycosis and rare mycoses encountered in some HIV
positive patients, and provide up-to-date information on fungal models
in immunocompromised animals, on pharmacokinetics and on the mode of
action of antifungals of use in immunocompromised patients. The
actual status and perspectives in the treatment of mycoses in patients
with AIDS are highlighted.
The Symposium was organized in the "Institut Pasteur" (Paris), an
institute that, since its founding in 1887, has contributed to the
discovery of several pathogenic agents, a tradition renewed with the
discovery of two viruses: HIV-1 and HIV-2.
v
The Symposium was sponsored jointly by the Janssen Research
Foundation, the International Society for Human and Animal Mycology
and the Mycology Unit of the Pasteur Institute.
The Editors
Mann, J., 1989, Global AIDS into the 1990's, World Health, October
1989: 6.
ACKNOWLEDGEMENTS
The organizers are grateful to the Pasteur Institute (Paris), the
International Society for Human and Animal Mycology and the Janssen
Research Foundation for providing the opportunity to organize this
symposium.
Thanks are due to chairmen, speakers, authors and all participants
and especially to those who presented posters and contributed so much
to the discussions.
We have been greatly assisted in our organizational duties by Mrs.
M. Verbaandert, Mrs. H. Dergent, Mrs. A. Siegers, and Mrs. C.
Volkerick.
Special thanks are due to Mrs. H. Dergent for retyping the
manuscripts.
Hugo Vanden Bossche
Donald Mackenzie
Geert Cauwenbergh
Jan Van Cutsem
Edouard Drouhet
Bertrand Dupont
vii
CONTENTS
Introductory Papers
Epidemiology of AIDS and Its Opportunistic Infections .... ... 3
F.W. Chandler
Immunologic and Pathogenic Aspects of HIV Infections:
Current Hypothesis 13
D. Dormont
Mycoses in AIDS Patients. An Overview 27
E. Drouhet and B. Dupont
Pneumocystis carinii: A Nomadic Taxon... 55
D.W.R. Mackenzie
Candida and Candidosis in AIDS Patients
Epidemiology of Candida Infections in AIDS 67
F.C. Odds, J. Schmid and D.R. Soll
Candidemia in Patients with Acquired Immunodeficiency Syndrome 75
F.E. Chu, M. Carrow, A. Blevins and D. Armstrong
Immunological Aspects of Candidosis in AIDS Patients ..... ... 83
D.W. Warnock
Controversial Aspects of Candidiasis in the Acquired
Immunodeficiency Syndrome 93
J.D. Sobel
Cryptococcosis
Ecology of Cryptococcus neoformans and Prevalence of Its Two
varieties in AIDS and Non-AIDS Associated Cryptococcosis 103
K.J. Kwon-Chung, A. Varma and D.H. Howard
ix
Clinical Aspects of Cryptococcosis in Patients with AIDS. ... 115
J. Vandepitte
Immunological Aspects of Cryptococcosis in AIDS Patients .... 123
J. Muller
Dermatomycoses and Rare Mycoses in AIDS Patients
Dermatophytes and Pityrosporum in AIDS Patients 135
Ch. De Vroey and M. Song
Clinical Aspects of Dermatomycoses in AIDS Patients .... ..... 141
R.J. Hay
Unusual Mycoses in AIDS Patients..... 147
M.A. Viviani and A.M. Tortorano
Mechanism of Pathogenesis- Why Are Certain Mycoses Rare in
AIDS Patients ? 155
H.P.R. Seeliger and K. Tintelnot
Dimorphic Fungi
Histoplasma in AIDS Patients 163
M.G. Rinaldi
Coccidioides immitis in AIDS Patients 171
J.N. Galgiani, N.M. Ampel, C.L. Dols and D.G. Fish
The Major Endemic Mycoses in the Setting of AIDS:
Clinical Manifestations 179
J.R. Graybill, P.K. Sharkey, P. Johnson and S. Nightingale
Immunological Aspects of Dimorphic Fungi in AIDS .. 191
J.W. Murphy
Chemotherapy
Current Status and Perspectives of Antifungal Therapy. 199
J.E. Bennett
Fungal Models in Immunocompromised Animals..... 207
J. Van Cutsem
x
Mode of Action of Antifungals of Use in Immunocompromised
Patients. Focus on Candida glabrata and Histoplasma
capsulatum 223
H. Vanden Bossche, P. Marichal, J. Gorrens, D. Bellens,
M.-C. Coene, W. Lauwers, L. Le Jeune, H. Moereels and
P.A.J. Janssen
Pharmacokinetics of Antifungals 245
G. Cauwenbergh and J. Heykants
Skin Candidosis in AIDS Patients. Effects of Ketoconazole
and Itraconazole. Focus on Tissue Levels 255
H.C. Korting
The Modern Revolution in Antifungal Drug Therapy........... 265
J.R. Graybill
Treatment of Candidosis in AIDS Patients 279
G. Just, D. Steinheimer, M. Schnellbach, C. Bottinger,
E.B. Helm and W. Stille
Cryptococcal Meningitis in AIDS Patients- A pilot Study
of Fluconazole Therapy in 52 Patients 287
B. Dupont, I. Hilmarsdottir, A. Datry, M. Gentilini,
P. Dellamonica, E. Bernard, S. Lefort, J. Frottier,
P. Choutet, J.L. Vilde and the French study group
on fluconazole in cryptococcal meningitis in AIDS
patients
Oral Itraconazole Therapy of Cryptococcal Meningitis and
Cryptococcosis in Patients with AIDS 305
D.W. Denning, R.M. Tucker, J.S. Hostetler, S. Gill and
D.A. Stevens
Treatment of Dermatomycosis in AIDS Patients 325
H. Degreef
Index '" ,... .. ... ... . 329
xi
Introductory Papers