Opportunistic infections

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  • 1. Opportunistic Infections In Acquired Immune Deficiency Syndrome By Dr. Vijay Bhushanam
  • 2. Objectives • Discuss basic factors regarding Opportunistic infections (OIs) • See the frequency with which these OIs occur & Clinical features, Diagnosis & treatment of some OIs. • Discuss patient education messages for preventing OIs.
  • 3. AIDS Definition • CDC definition of an HIV +ve person as having AIDS -- Has had at least one of over 21 AIDS defining OIs and/or --Has had a CD4 cell count of 200 or less • NACO Definition: AIDS has been defined as the occurrence of life threatening opportunistic infections, malignancies, neurological diseases and other specific illnesses in patients with HIV infection and/or with CD4 count less than 200/cmm
  • 4. HIV Related infections and illnesses BACTERIAL VIRAL FUNGAL PARASITIC OTHER ILLNESSES Tuberculosis Varicella zoster Candidiasis Isosporiasis AIDS -dementia Bacterial respiratory infections Oral leukoplakia Cryptococcosis Microsporidi-osis Invasive cervical cancer Bacterial enteric infections HSV CMV Penicilliosis Cryptosporid-iosis Non-Hodgkin's lymphoma Pneumocystis jiroveci pneumonia Human herpes virus type 8 Giardiasis Toxoplasmosis Kaposi's sarcoma Atypical mycobacteriosis Human papilloma virus Strongyloidiasis
  • 5. The basics of OIs • HIV infects a type of WBC called CD4 cells • When the immune system loses too many CD4 cells OIs are more likely to develop • Different type of OIs develop at different levels of CD4 count, depending on the microbes or pathogens endemic in that particular region
  • 6. % of OIs in AIDS cases in INDIA NACO reported cases (n=5204) 0 10 20 30 40 50 60 70 80 90 100 TB Can Cryp. Dia HZ Tox Bact. Inf. PCP Cryp. Men KS
  • 7. Presenting symptoms & signs in AIDS patients NACO reported cases (n=5204) 0 10 20 30 40 50 60 70 80 90 100 Wt. loss Diarrhea Fever Asthenia Cough LAP
  • 8. Tuberculosis • Major world wide co-infection. • Clinical features:-cough, -hemoptysis, - weight loss, -evening rise of temp. • Diagnosis: sputum for AFB, chest X-ray, culture of specimen from the site (in case of extra PTB), Skin test (PPD) • Treatment: DOTS as per RNTCP
  • 9. Candidiasis • Oral Candidiasis may be the initial sign of HIV infection. • Clinical features: -oral thrush, -dysphagia • Diagnosis: C/F, KOH preparation of the scrapings • Treatment: Gentian violet, Clotrimazole, Miconazole in mild cases (Oral Can.) & Fluconazole in severe cases (esophageal Can.)
  • 10. Cryptosporidiosis • Found in about 35% of AIDS diarrheal cases. • Clinical features: -watery diarrhea, -Abdominal bloating, -profound weight loss . • Diagnosis: Microscopy • Treatment: Paromomycin/ Azithromycin. Response is poor with all available therapies. Prevention of malnutrition & symptomatic relief vital in management.
  • 11. Pneumocystis carinii Pneumonia • Occurs in advanced HIV disease, when CD4 falls below 250 • Clinical features:-fever, -dry cough, -chest pain, -shortness of breath. • Diagnosis- C/F, sputum tests, X-ray • Treatment-TMP-SMZ (co-trimoxazole)
  • 12. Cytomegalovirus • Never occurs unless CD4 cell count less than 50 • Most typically affects the eyes • Clinical features:-Blurry vision, - Respiratory, CNS & Gastrointestinal complications. • Diagnosis: specialist (ophthalmologist) examination • Treatment: Gancyclovir, Foscarnet.
  • 13. Cryptococcal meningitis • Most common cause of meningitis in AIDS • Clinical features: -headache, fever, -nausea and vomiting, -confusion and impaired consciousness, -signs of meningism (only in about 40%) • Diagnosis: CSF examination (Indian ink staining, Ag Titre) • Treatment: Amphotericin B/Fluconazole with or without 5-flucytosine.
  • 14. Toxoplasmosis • Commonest cause of focal cerebral lesions in HIV/AIDS • Clinical features: -focal neurological deficit (FND), -Seizures, intracranial hemorrhage, -altered mental state and coma • Diagnosis: CT Brain • Treatment: Sulfadiazine or Clindamycin, plus Pyrimethamine & Folinic acid.
  • 15. Mycobacterium Avium Complex • Usually occurs only if the CD4 count is less than 75 • Clinical features:-Flu like fever, -chills, sweats, -anemia, fatigue. • Treatment-Clarithromycin, ethambutol • Note: certain infections like Histoplasmosis, Blastomycosis, Mycobacterium Avium intra cellular (MAC) have not been reported from our country so far
  • 16. Patient Education • Best way to prevent OIs is to keep immune system strong • Appropriate medication at certain CD4 cell levels can prevent many OIs (prophylaxis) • Treatment options available if OIs develop • After recovery from OIs on-going maintenance treatment is still needed • Can stop prophylaxis or maintenance treatment if CD4 cell count goes up • Should not discontinue any treatment without discussing first with Doctor
  • 17. &… General preventive measures: • Prevent exposure to ill patients. • Personal hygiene (washing hands etc.) • Avoid contact with raw food, soil, cats, bird excreta, litter boxes etc. • Wash vegetables before cooking, avoid raw meat intake, drink boiled water. • Use condoms during sexual contact.
  • 18. Thus…. • OIs develop in an HIV infected individual depending on the CD4 count & microbial environment • Most common OIs are TB, Candidiasis, Cryptosporidiosis, Herpes zoster, Toxoplasmosis, PCP • Patient education plays vital role in preventing OIs
  • 19. Thank you