Fungal opportunistic (conditionally pathogenic) infections occur in 85-90% of all HIV-infected patients, and a significant part of them is accompanied by lesions of the bone and articular system.
Candidiasis arthritis with HIV infection
Candida albicans fungus is present in 90% of HIV-infected people, and very often, with the background of reduced immunity, fungal infection can give the clinic acute inflammatory articular lesions, dominant in the clinical picture. Particularly high risk in patients with long-term neutropenia (a decrease in the number of leukocytes-neutrophils).
Often, candidiasis develops in patients who have been taking antibiotics or glucocorticoids for a long time who have tuberculosis or cancer, patients with cirrhosis of the liver, diabetes and other chronic diseases, as well as after injuries, operations occurring against the background of HIV infection.
At the same time, the most common are monoarthritis of the knee joint and spondylitis of two adjacent vertebral bodies, less inflammation is observed in long tubular bones, while it is accompanied by pronounced local pain and manifestations of osteomyelitis.
To clarify the nature of the inflammation, an X-ray examination, an MRI and an open or needle biopsy are performed to determine the type of pathogen and its sensitivity to the drugs. As a rule, in the synovial fluid, the fungus (candida) is almost always detected, and in the synovial membrane biopsy - a special granulomatous inflammation.
The treatment of candidiasis is most often performed with the preparations of fluconazole, amphotericin B, and intraconazole is used for supportive therapy. In complicated cases accompanied by melting of bones, they carry out additional surgical treatment, without ending the treatment of AIDS and candidomycosis.
Sporotrichoznye arthropathies with HIV infection
The causative agent of this group of mycoses is Sporotrichum schenckii, which most often affects the skin and lymph nodes, but with pronounced weakening of the immunity, forms multiple cells, affecting the joints and bones, the central nervous system, respiratory organs, etc.
At sporotrichozhnyh arthritis pain in the joints of medium or low intensity, mainly joints in the process involve the upper extremities (elbow and shoulder), less often - small joints of the hands. For this type of fungal infection, the tendency of the process of spreading the process to the surrounding joints is characterized by soft tissues with the formation of fistulas. At expressed decrease of immunity there are possible fatal cases in the development of destructive forms of HIV-arthritis, accompanied by anemia, cachexia (depletion), lesion of the central nervous system and eyes.
At sporotrichosis, arthropathies combine operative treatment (arthroscopic debriding) of affected joints with intensive antifungal therapy (amphotericin B, intraconazole).
Cryptococcal arthropathy with HIV infection
The causative agent of this type of mycosis - Cryptococcus neoformans is pathogenic to humans only in conditions of significantly weakened immunity, so 90% of all cases of cryptococcosis are associated with AIDS.
Primary infection is most often associated with pulmonary disease and only in 10% of cases it is accompanied by a defeat of the bone and joint system. In this case, arthritis proceeds very hard and is often manifested by the destruction of bone tissue, the development of osteomyelitis.
Radiologically, this type of fungal bone defect is very similar to metastatic malignant neoplasms. But with the synovitis of the knee joint (and mainly affects only this joint) in the synovial fluid, there is a large number of cryptococci. Treatment is the same as with sporotrhosis.
Koktsidiomikoznye arthropathies with HIV infection
The causative agent of this type of mycosis is Coccidioides immitis, which primarily affects the respiratory organs, but with the hematogenous spread of the process at the stage of AIDS with a defeat of the bone and articular system. Most often acute arthritis develops in the knee joint, accompanied by edema, pain and limitation of volume of movements, phenomena of bursitis. In 70% of cases, arthritis becomes chronic, but the involvement of other parts of the bone and joint system in the spread of fungal infection from the foci of mycosis osteomyelitis can not be ruled out.
At the same time, isolating the pathogen from synovial fluid is very rare (no more than 5% of cases), but with the puncture of fungal foci, lesions of coccidia are more common. Very often arthropathy is observed against the background of fungal pneumonia and is accompanied by skin rashes, polyarthralgias, fever, erythema, adenopathy, signs of mycogen allergy. In such patients, frequent manifestations of bronchial obstruction, may be eosinophilia.
Treatment of coccidio-mucosal arthropathies is usually performed with fluconazole, itraconazole, amphotericin B, and if necessary, combined with surgical intervention.