How are fungal infections in pediatric HIV infection prevented and treated?

Updated: Mar 05, 2020
  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Thrush occurs in a third of patients with non–category C disease and in one half of patients with category C disease. Candidal esophagitis is an AIDS-defining condition and can result in severe dysphagia and anorexia; the diagnosis can be confirmed with endoscopy. Disseminated systemic fungemia is rare, but indwelling catheters and neutropenia increase a patient's susceptibility.

Primary prophylaxis is not generally recommended, but prophylaxis after repeated infections may be helpful. Prophylactic treatment is used in severe recurrent cases, but prolonged prophylaxis can lead to resistance.

Nystatin may not be helpful in managing repeated thrush or cutaneous infections, and topical clotrimazole or miconazole may be needed. Fluconazole, itraconazole, or ketoconazole may be needed if topical treatments fail or if candidal esophagitis develops. Candidal esophagitis recalcitrant to treatment with azole compounds and disseminated disease should be treated with amphotericin.


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