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Individuals infected with Human Immunodeficiency Virus (HIV) often develop multiple complications and comorbidities, among them, opportunistic infections. The highest incidence of opportunistic infections was reported in the group of patients with lower CD4 lymphocyte levels below 200 cells / mm. Candidiasis, toxoplasmosis and Pneumocystis Pneumonia (PCP) were the main representatives. The candidiasis and pneumocystosis are fungal infections caused by Candida spp agents and Pneumocystis jirovesi respectively, while toxoplasmosis is caused by Toxoplasma gondii. Candida spp. is present in the oral mucosa of human in a commensal way, when the individual becomes immunosuppressed, it becomes pathogenic. The main manifestation of oropharyngeal candidiasis in HIV-infected individuals is pseudomembranous candidiasis characterized by yellowish-white plates easily removable; while esophageal candidiasis presents with dysphagia and chest pain. The clinical diagnosis is predominantly oral fluconazole and remains the treatment of choice. It is believed that PCP occurs by a reactivation of a latent infection, person-person transmission and even through environmental sources. It is characterized by an insidious onset with progressive dyspnea, fever, nonproductive cough and chest discomfort that gets worse over the weeks. A bronchoscopy with bronchoalveolar lavage is the gold standard diagnosis. The treatment with trimethoprim-sulfamethoxazole is the recommended first line choice, prophylaxis should also be performed with the same drug when CD4 + lymphocytes <200 cells / mm³. Transmission of T. gondii occurs by direct ingestion of oocysts, by ingestion of raw meat or undercooked through blood transfusion, organ transplant or for via the placenta. It is believed that the toxoplasmosis in immunocompromised individuals, usually results from reactivation bradyzoites cysts .The symptoms include headache, confusion or altered mental status, fever, lethargy, seizures, among others. Diagnosis is made from the clinical, imaging and serology tests. The treatment of choice, a combination of pyrimethamine and sulfadiazine with prophylaxis with trimethoprim and sulfamethoxazole should also be performed when the CD4 + T lymphocytes <200 cells / mm³. Current knowledge on epidemiology, clinical features and treatment observed in these diseases are important in the management of patients with HIV and is the focus of this review.
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Author(s): Nayara de Arruda Caceres Mateus Mazorra Coelho Vieira Igor Fioresin Vieira Vanessa Figuereido Monteleoni Luiz Jorge Moreira Neto Simone Bonafe
Opportunistics Infections, Pneumocystosis, Oral-esophageal Candidiasis, Neurotoxoplasmosis and AIDS, Internal Medicine, HIV/AIDS