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AIDS Treatment Data Network

(ATDN) Fungal Infection Overview


Treatment Review #18; April 1995

A recently completed study that compared clotrimazole to fluconazole to prevent fungal infections showed that fluconazole was more effective, particularly in people with 50 or fewer T4 cells. In addition, fluconazole was shown to reduce the frequency of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections. We updated the following fungal infection fact sheet to include this new information. It is still not recommended that all people take preventive treatment for fungal infections due to the possibility of resistance to treatment.

Thrush is the most common and least serious fungal infection in HIV+ people. It can affect the mouth, throat, skin, stomach, and vagina. In a person with a weakened immune system, thrush can cause more serious problems. This condition is sometimes called candidiasis, because the germs that cause it are called candida albicans. Other types of fungus have been discovered, however, so it may be necessary to try different drugs besides the ones that are used now. Some medications, such as antibiotics, steroids, and cancer medications, may cause thrush.

Oral thrush (in the mouth) looks like white or red patches. It can cause sore throat, pain when swallowing, and nausea. It can also make you not want to eat, make eating painful, and make food taste different. Treatments for oral thrush include mouthwash and tablets called troches. Some people try baking soda or hydrogen peroxide mixed with water to rinse the mouth. If the thrush is advanced, this isn't likely to work. Treatments for thrush include clotrimazole, fluconazole, and ketoconazole. These drugs have different brand names. These drugs sometimes lose their effects when taken for long periods of time, but new ways to use these drugs, and new drugs are being studied.

Some people try different home remedies. Using large amounts of garlic, and avoiding foods which contain sugar, yeast or dairy products are popular, although unproven ways to stop the growth of thrush.

Vaginal candidiasis is a common yeast infection of the vagina. Symptoms include severe itching, burning, and a thick discharge, often white in color. It is possible that an infection such as unrecognized tuberculosis may be causing a vaginal yeast infection. Nystatin tablets are used for treatment. Clotrimazole ointment is another treatment, which is sold over-the-counter as Gyne-Lotrimin, Lotrimin or Mycelex. Studies have shown that HIV-negative women only have to take the drug Diflucan one time to treat this condition. Always consult with your doctor before beginning any treatment.

Cryptococcal meningitis is a very serious fungal infection. It is caused by a fungus found mainly in dirt and bird droppings. Meningitis means swelling of the meninges. The meninges cover the brain and spinal cord. Symptoms can be hard to recognize as being caused by cryptococcal infection. Watch for fever, vomiting, headache, nausea, fatigue, loss of appetite, and a general feeling of not being well. Other symptoms are a stiff neck and, infrequently, seizures. Pneumonia may be an early sign of infection. Tell your doctor about symptoms right away.

A treatment that can be given by pill, in some cases, or by intravenous injection is fluconazole, or Diflucan. Most people prefer this treatment because it causes few side effects. Another common treatment for this condition is amphotericin B, which must be given by intravenous injection. Amphotericin B is used in more severe cases, as determined by performing a lumbar puncture (spinal tap).

Histoplasmosis can be a life-threatening fungal infection and commonly occurs in the Southwestern U.S. In the past, histoplasmosis was treatable only with intravenous amphotericin. Itraconazole is used today, although it may not be effective for treating histoplasmosis involving the central nervous system and brain, since it does not penetrate well into the cerebrospinal fluid, which is the fluid that surrounds the spinal cord and brain.

Blastomycosis is a fungal infection involving the lungs and occasionally spreading to the skin. The fungus is of unknown natural source. Most reported cases are from the southeastern states and the Mississippi River valley, and occur in men ages 20 to 40. When infection occurs in the lungs, a dry hacking or productive cough, chest pain, fever, chills, drenching sweats, and shortness of breath are initial symptoms. If untreated, the disease slowly causes death. Amphotericin B is highly effective. Improvement begins within a week, with rapid disappearance of organisms.


Copyright © 1995 -AIDS Treatment Data Network, Publisher. All rights reserved to AIDS Treatment Data Network. Reproduction of this article (other than one copy for personal reference) must be cleared through the AIDS Treatment Data Network. Email AIDS Treatment Data Network

Information in this article was accurate in April 1, 1995. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.