Fungal Infections

Table of Contents

• What Are Fungal Infections?
• Candidiasis (Includes Yeast Infections and Thrush)
• Cryptococcal Meningitis
• Histoplasmosis
• Aspergillosis
• Coccidioidomycosis (Valley Fever)
• Conclusion

What Are Fungal Infections?

A fungus is a kind of germ. Many fungi (plural form of fungus) exist normally in and on our bodies, and in the surrounding environment, for example in soil, dust, food, water, and plants. Most fungi are harmless to humans, but there are several that can cause harmful infections, especially in people living with HIV (HIV+).

Candidiasis (Includes Yeast Infections and Thrush)

Candidiasis is a very common fungal infection usually caused by Candida albicans. This yeast-like fungus is found in all healthy people. The immune system and bacteria normally found in the body generally keep Candida in check. When Candida is not kept in check, it can cause problems like yeast infections or thrush, which are described below.

When there is an overgrowth of Candida, it can cause problems in the mouth, food pipe (esophagus), or vagina. This happens more often when the immune system is weakened by HIV or when you take antibiotics. Antibiotics can kill helpful bacteria that keep Candida in check.

The medications used to fight Candida are anti-fungal drugs called "azoles." Examples are Nizoral (ketoconazole), Diflucan (fluconazole), Sporanox (itraconazole), Vfend (voriconazole), or Noxafil (posaconazole). Pregnant women should not take oral azoles (pills or liquids), as they may cause damage to the developing baby. Topical azoles used inside the vagina like Monistat (miconazole) or Gyne-Lotrimin (clotrimazole) creams, however, are safe for use during pregnancy. In addition, several of the anti-fungal drugs interact with specific HIV drugs such as the protease inhibitor Norvir (ritonavir) and non-nucleoside reverse transcriptase inhibitors such as Sustiva (efavirenz), Viramune (nevirapine), Edurant (rilpivirine), and Intelence (etravirine).

Candidiasis can come back repeatedly. Some health care providers prescribe anti-fungal drugs on a long-term basis, but this can lead to drug-resistant Candida that is more difficult to treat.

Candidiasis of the Vagina (Vaginal Candidiasis, Vaginitis, or Yeast Infection)

• May occur with normal CD4 cell counts (above 500), but more likely to develop at lower CD4 counts
• Symptoms include itching, burning, and pain around the vagina, labia (vaginal lips), or anal area and thick, whitish, sometimes curd-like vaginal discharge
• Antibiotics, steroids, birth control pills, and foods high in sugars or starches (breads, pastas, and alcohol) all promote the growth of Candida
• Douching reduces levels of helpful bacteria in the vagina and is not recommended
• Alcohol and nicotine promote the growth of yeast
• Because yeast grows best in moist areas, wearing looser-fitting pants or underwear can help prevent yeast infections. Cotton underwear breathes better than underwear made of polyester or nylon, and can also help reduce yeast growth.

Treatment:

• Local treatment with over-the-counter creams like Monistat or Gyne-Lotrimin or Mycelex (clotrimazole) or prescription anti-fungal creams
• For difficult-to-treat infections, oral prescription anti-fungal drugs may be needed
• Alternative treatment: Acidophilus, which is a live bacterial culture found in oral supplements, yogurt, or kefir as well as in vaginal suppositories

Candidiasis of the Mouth (Thrush)

• Usually occurs with CD4 cell count less than 300
• Symptoms include whitish coating of the tongue and/or the inside of the cheeks
• May affect appetite and make food taste funny
• More likely to occur in diabetics and when steroid medications such as prednisone or certain asthma inhalants are being taken
• Because sugar is food for Candida and helps it grow, limiting how much sugar you eat can help prevent thrush. Sugars are found in foods such as candies and sweets, soft drinks, fruit juices, and maple syrup. Read the label to help you limit other forms of sugar, including corn syrup, fructose, and glucose.
• Eating yogurt or drinking kefir with active, live bacterial cultures like acidophilus can help prevent thrush. "Friendly" or "good" bacteria like acidophilus can help control the growth of Candida.

Treatment:

• Local treatment with clotrimazole lozenges
• Oral anti-fungal medications that work throughout the body
• In most severe cases, amphotericin B is used, but it can have serious side effects
• Alternative treatments:
  • Mouthwash containing gentian violet, which stains the mouth purple and can stain clothing
  • Mouthwash containing tea-tree oil
  • Saltwater rinse using 1/2 teaspoon salt to 1 cup warm water
  • Placing lemon juice in the mouth several times a day

Candidiasis of the Esophagus (Esophageal Candidiasis)

• Usually occurs at very low CD4 cell counts (less than 100)
• An AIDS-defining opportunistic infection
• Major symptom is painful swallowing or feeling like food is sticking in your chest
• Often diagnosed by history and clinical exam, can be confirmed by gastrointestinal endoscopy (a lighted tube inserted through your mouth into your food pipe)
• Possible in anyone who has thrush and a low CD4 cell count, but can occur even when thrush cannot be seen in the mouth.

Treatment:

• Oral anti-fungal medications; fluconazole is most commonly used