INFECTIONS IN  AIDS Dr.T.V.Rao. MD
Why AIDS is Different from other Infections <ul><li>AIDS is a incurable condition produced by HIV1 or HIV2 </li></ul><ul><...
What went wrong in  AIDS <ul><li>Immune system is a complex and complicated organ - it sometimes fails to work to protect ...
HIV infection causes <ul><li>Secondary Immunodeficiency  disorder. </li></ul><ul><li>Initiated with destruction of CD4 typ...
AIDS causes overall Defect <ul><li>Overt failures of Immune system manifests with reduced ability to resist Infections </l...
HIV virus infects CD4 lymphocytes and destroys
When you says it is AIDS <ul><li>Infected with HIV1 or HIV 2 </li></ul><ul><li>When the CD4 cells drop to < 200/mm 3 </li>...
Relation of AIDS to Infections <ul><li>Relevant or chronic infections </li></ul><ul><li>Inability to clear Infections afte...
Defining AIDS in relation to Infections <ul><li>Many indicator diseases vary from one Geographic region to another. </li><...
Common AIDS defining Illnesses in the past and continues <ul><li>Pneumocystis jiroveci pneumonia </li></ul><ul><li>HIV was...
AIDS defining illness at present <ul><li>1. Recurrent bacterial infections. </li></ul><ul><li>2. Invasive cervical carcino...
PRROTOZAL INFECTIONS IN AIDS
Protozoa <ul><li>Toxoplasma gondii </li></ul><ul><li>Cryptosporidium parvum </li></ul><ul><li>Microsporidia spp </li></ul>...
Toxoplasmosis ( Toxoplasmosis gondii ) <ul><li>Domestic cats spread the disease to humans in vicinity </li></ul><ul><li>Av...
Toxoplasmosis <ul><li>Most important / common space  occupying lesion of brain in HIV infections </li></ul><ul><li>Clinici...
Produces space occupying lesions Cats spread the disease
Toxoplasmosis ( Diagnosis ) <ul><li>Serological tests may not confirm diagnosis in HIV ? AIDS patients. </li></ul><ul><li>...
Cryptosporidium <ul><li>A common cause of Diarrhea in AIDS patients  </li></ul><ul><li>Microscopic examination may confirm...
Cryptosporium oocysts in stool specimen
MICROSPORIDA <ul><li>Several species of Microsporidia  infect humans. </li></ul><ul><li>AIDS patients have higher predispo...
Microsporidia spp <ul><li>Microsporidal infections occurs along with Cryptosporial infections </li></ul><ul><li>Different ...
Isospora <ul><li>Present with gastrointestinal Manifestations clinically </li></ul><ul><li>Found in Intestinal tract </li>...
Giardiasis <ul><li>Caused by Giardia intestinalis </li></ul><ul><li>May produce Infections in Immunosupressed  </li></ul><...
Life cycle of Giardiasis Infection
Strongyloidosis - AIDS <ul><li>Caused by Strongyloides stercoralis </li></ul><ul><li>In AIDS / Immunosuppresed Filariform ...
Life cycle of Strongyloidosis
Entamoeba Histolytica  <ul><li>Amoebiasis is common in many geographic locations </li></ul><ul><li>Rarely attributed in th...
Life cycle of Entamoeba Histolyticum
Entamoeba histolytica <ul><li>Endemic in many developing countries, </li></ul><ul><li>Poor hygiene and in sanitary conditi...
Lesihmania donovani <ul><li>Infections are prevalent in Tropical Africa, South America, Mediterranean </li></ul><ul><li>Pr...
Life cycle of Lesihmania donovani
Viral Infections in  AIDS
Viruses infecting AIDS Patients <ul><li>Cytomegaloviruses </li></ul><ul><li>Herpes simplex </li></ul><ul><li>Varicella zos...
Cytomegalovirus <ul><li>CMV Retinitis most common cause of Retinal infections in AIDS </li></ul><ul><li>Also causes  </li>...
Isolation of CMV viruses <ul><li>Throat washing </li></ul><ul><li>Urine </li></ul><ul><li>grown on Human fibroblasts  </li...
Serology <ul><li>Most useful investigation in resource poor settings </li></ul><ul><li>Ig G estimation will inform only pa...
Specific Diagnosis <ul><li>May need PCR methods from various samples  </li></ul><ul><li>Molecular methods helps in Specifi...
Herpes Simplex <ul><li>AIDS patients suffer more often and most severe Infections </li></ul><ul><li>Herpes simplex 2 are i...
Produce simple lesions to disabling Disease
Herpes simplex <ul><li>Isolation of viruses </li></ul><ul><li>from throat washings </li></ul><ul><li>Cerebrospinal fluid <...
Varicella Zoster Virus <ul><li>Varicella zoster virus causes chicken pox in children and young </li></ul><ul><li>Latent in...
Herpes Zoster <ul><li>Produces most severe morbidity </li></ul><ul><li>Disease starts with pain on skin or mucous membrane...
Diagnosis of Herpes zoster <ul><li>A clinically diagnosed condition. </li></ul><ul><li>Laboratory testing confirms </li></...
Epstein Barr virus - AIDS <ul><li>Appear with intermittent manifestations </li></ul><ul><li>Manifest with lesions on the l...
Human Papilloma virus - AIDS <ul><li>There are >100 strains of Papilloma viruses </li></ul><ul><li>About 30 strains are tr...
Papova virus - AIDS <ul><li>JC virus a member of the group </li></ul><ul><li>Produce multifocal leucoencephalopathy </li><...
Other viruses - AIDS <ul><li>AIDS patients can be co infected with Hepatitis B and C </li></ul><ul><li>They share same rou...
Hepatitis B infection - AIDS <ul><li>Needs further evaluation on the progress of Infection </li></ul><ul><li>Infected pati...
Hepatitis C - AIDS <ul><li>Hepatitis  C is much more dangerous  in producing chronic complications than Hepatitis  B infec...
Molloscum contasiousm <ul><li>Lesion have propensity for spreading widely over the patients body </li></ul><ul><li>Usually...
Bacterial Infections in AIDS
Bacteria - AIDS <ul><li>Mycobacterium tuberculosis </li></ul><ul><li>Salmonella spp </li></ul><ul><li>Mycobacterium avium ...
Mycobacterium tuberculosis <ul><li>High prevalence of Tuberculosis in AIDS </li></ul><ul><li>High prevalence of AIDS assoc...
TB in Advanced AIDS <ul><li>Present with atypical manifestations, as </li></ul><ul><li>Absence of cavitations </li></ul><u...
Diagnosis of Tuberculosis <ul><li>X ray chest - the minimal investigation. </li></ul><ul><li>Sputum microscopy most import...
X – ray Chest remains the Most important Investigation in Tuberculosis
Sputum Microscopy the most important simple investigation
Acid fast bacilli detection by Florescent Methods are more sensitive
Atypical mycobacterium - AIDS <ul><li>Mycobacterium intracellulare occurs in the late stage of disease  ( with gross Immun...
MAI Complex <ul><li>Mycobacterium avium intracellulare identified as the most important Atypical mycobacterium infecting A...
Other Methods of Diagnosis to Tuberculosis <ul><li>Tuberculin test is less helpful in diagnosis of Tuberculosis  associate...
Other Bacterial Infections <ul><li>The abnormalities of the B cell function associated with HIV lead to infections with en...
Diagnosis ( Common Bacterial Infections ) <ul><li>Routine culture methods are adequate diagnosis. </li></ul><ul><li>Many r...
Salmonella ( non Typhoidal ) <ul><li>Can be isolated from Blood and stool cultures </li></ul><ul><li>A frequent pathogen i...
Staphylococcus aureus  <ul><li>Staphylococcal infections can produce, Abscess, Cellulitis,and Folliculitis, and Furuncles ...
Bacillary Angiomatosis <ul><li>Bartonella Henselae </li></ul><ul><li>Bartonella Quintana </li></ul><ul><li>Produce raised,...
Bacillary Angiomatosis <ul><li>Bartonella henselae manifest as zoonotic infection spread by young cats  </li></ul><ul><li>...
Fungi and Yeasts
Fungi and Yeasts - AIDS <ul><li>1 Pneumocystis jiroveci ( formerly carnii ) </li></ul><ul><li>2 Cryptococcus neoformans </...
Pneumocystis jiroveci <ul><li>Most common cause of Pneumonia in AIDS patients </li></ul><ul><li>Difficult to Diagnose </li...
Chest x-rays can guide in Diagnosis <ul><li>X-ray chest shows bilateral interstitial infiltrations. </li></ul><ul><li>CT s...
Microbiological Diagnosis <ul><li>Demonstration of organism in Bronchoalveloar lavages are more useful in confirmation </l...
Cryptococcus neoformans - AIDS <ul><li>C. neoformans produces Meningitis in HIV patients. </li></ul><ul><li>Can manifest w...
Microbiological Diagnosis <ul><li>CSF examination for presence of true yeast confirms diagnosis </li></ul><ul><li>India In...
Candida - AIDS <ul><li>Many AIDS  patients present with Oral Candidosis  </li></ul><ul><li>Esophageal candidosis produces ...
Common lesions in Candida infection.
Diagnosis of Candidal infections <ul><li>Microscopical examination of various specimens </li></ul><ul><li>Culture on Funga...
Histoplasmosis <ul><li>Histoplasma capsulatum infections are common in USA </li></ul><ul><li>They are present as soil inha...
Histoplasmosis <ul><li>Severe disseminated Histoplasmosis develop in AIDS patients </li></ul><ul><li>Fungi can be isolated...
Coccidioidomycosis <ul><li>Coccidioides immitis - a dimorphic fungus </li></ul><ul><li>Patients with AIDS can manifest wit...
<ul><li>C.immitis, is a established pathogen </li></ul><ul><li>C.posadasii was recently attributed to infections in AIDS p...
Seborrhic Dermatitis <ul><li>Produced by Malassezia fur fur </li></ul><ul><li>A common infection in Non HIV patients </li>...
Neoplasms in -AIDS
Kaposi's Sarcoma <ul><li>Human herpes virus type 8 predisposes Kaposi’s sarcoma in AIDS patients. </li></ul><ul><li>Lesion...
Lymphomas <ul><li>Non Hodgkin's large cell type  </li></ul><ul><li>Associated with Epstein Barr virus </li></ul>
Squamous cell Carcinoma <ul><li>Associated with Human papilloma virus </li></ul><ul><li>Cervix and Anus are involved </li>...
 
 
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  1. 1. INFECTIONS IN AIDS Dr.T.V.Rao. MD
  2. 2. Why AIDS is Different from other Infections <ul><li>AIDS is a incurable condition produced by HIV1 or HIV2 </li></ul><ul><li>It is estimated that 10 Billion HIV particles are produce and Destroyed every day. </li></ul><ul><li>CD4 Lymphocytes which plays Major role in Immunity are destroyed. </li></ul><ul><li>Makes Every AIDS patients venerable to infections, and uncommon malignant conditions. </li></ul>
  3. 3. What went wrong in AIDS <ul><li>Immune system is a complex and complicated organ - it sometimes fails to work to protect </li></ul>
  4. 4. HIV infection causes <ul><li>Secondary Immunodeficiency disorder. </li></ul><ul><li>Initiated with destruction of CD4 type of T Lymphocytes, Monocytes. </li></ul><ul><li>Lead to onset of AIDS ( Acquired Immuno deficiency syndrome ) </li></ul><ul><li>Manifest with various opportunistic infections. </li></ul><ul><li>In some cases present with various forms of cancer. </li></ul>
  5. 5. AIDS causes overall Defect <ul><li>Overt failures of Immune system manifests with reduced ability to resist Infections </li></ul>
  6. 6. HIV virus infects CD4 lymphocytes and destroys
  7. 7. When you says it is AIDS <ul><li>Infected with HIV1 or HIV 2 </li></ul><ul><li>When the CD4 cells drop to < 200/mm 3 </li></ul><ul><li>Present with one of the 26 different opportunistic infections. </li></ul>
  8. 8. Relation of AIDS to Infections <ul><li>Relevant or chronic infections </li></ul><ul><li>Inability to clear Infections after standard regimes of Antibiotic therapy </li></ul><ul><li>Unusual Infections </li></ul>
  9. 9. Defining AIDS in relation to Infections <ul><li>Many indicator diseases vary from one Geographic region to another. </li></ul><ul><li>Majority are only Endogenous infections which were acquired in the past and only reactivated in the present scenario. </li></ul><ul><li>Some are exogenous infections particular to geographic location where the patient lives. </li></ul><ul><li>Eg Toxoplasmosis, Cryptococcosis ( common in Africa ) </li></ul>
  10. 10. Common AIDS defining Illnesses in the past and continues <ul><li>Pneumocystis jiroveci pneumonia </li></ul><ul><li>HIV wasting syndrome </li></ul><ul><li>Candidiasis </li></ul>
  11. 11. AIDS defining illness at present <ul><li>1. Recurrent bacterial infections. </li></ul><ul><li>2. Invasive cervical carcinoma. </li></ul><ul><li>3 Pulmonary tuberculosis. </li></ul>
  12. 12. PRROTOZAL INFECTIONS IN AIDS
  13. 13. Protozoa <ul><li>Toxoplasma gondii </li></ul><ul><li>Cryptosporidium parvum </li></ul><ul><li>Microsporidia spp </li></ul><ul><li>Leshmania donovani </li></ul><ul><li>Isospora belli </li></ul>
  14. 14. Toxoplasmosis ( Toxoplasmosis gondii ) <ul><li>Domestic cats spread the disease to humans in vicinity </li></ul><ul><li>Avoiding cats, and cat feces makes a difference to HIV infected. </li></ul>
  15. 15. Toxoplasmosis <ul><li>Most important / common space occupying lesion of brain in HIV infections </li></ul><ul><li>Clinicians track the Diagnosis </li></ul><ul><li>Usually diagnosed by C T scans </li></ul><ul><li>MRI is highly sensitive than C T </li></ul>
  16. 16. Produces space occupying lesions Cats spread the disease
  17. 17. Toxoplasmosis ( Diagnosis ) <ul><li>Serological tests may not confirm diagnosis in HIV ? AIDS patients. </li></ul><ul><li>Look for alternative, more specific methods like Brain Biopsy </li></ul><ul><li>Sabin – Feldman dye test. </li></ul><ul><li>ELISA may be guiding in complex presentations in resource poor settings. </li></ul>
  18. 18. Cryptosporidium <ul><li>A common cause of Diarrhea in AIDS patients </li></ul><ul><li>Microscopic examination may confirm Diagnosis </li></ul><ul><li>Detection of Oocysts in fresh stool </li></ul><ul><li>Staining the stool samples with modified acid fast stains </li></ul><ul><li>Fluorescent Microscopy with Monoclonal tagged antibodies may confirm the specific Diagnosis </li></ul>
  19. 19. Cryptosporium oocysts in stool specimen
  20. 20. MICROSPORIDA <ul><li>Several species of Microsporidia infect humans. </li></ul><ul><li>AIDS patients have higher predisposition </li></ul>
  21. 21. Microsporidia spp <ul><li>Microsporidal infections occurs along with Cryptosporial infections </li></ul><ul><li>Different species cause opportunistic infection in Immunosuppresed and AIDS patients </li></ul><ul><li>1 Encephalitozoon helium </li></ul><ul><li>2 Virraforma cornae </li></ul><ul><li>In intestine - Enterocytozoon beeneusi </li></ul>
  22. 22. Isospora <ul><li>Present with gastrointestinal Manifestations clinically </li></ul><ul><li>Found in Intestinal tract </li></ul><ul><li>Fresh specimens of stool specimens examined for Oocysts </li></ul>
  23. 23. Giardiasis <ul><li>Caused by Giardia intestinalis </li></ul><ul><li>May produce Infections in Immunosupressed </li></ul><ul><li>Manifest with diarrhea and malabsorption syndrome </li></ul><ul><li>Examination of stool will reveal Cysts and Trophozoites. </li></ul>
  24. 24. Life cycle of Giardiasis Infection
  25. 25. Strongyloidosis - AIDS <ul><li>Caused by Strongyloides stercoralis </li></ul><ul><li>In AIDS / Immunosuppresed Filariform larva may penetrate gut directly in large numbers and produce overwhelming infection with fatal outcome </li></ul>
  26. 26. Life cycle of Strongyloidosis
  27. 27. Entamoeba Histolytica <ul><li>Amoebiasis is common in many geographic locations </li></ul><ul><li>Rarely attributed in the developing world as AIDS defining illness </li></ul><ul><li>Microscopic examination for Trophozoites will confrim the active infection </li></ul>
  28. 28. Life cycle of Entamoeba Histolyticum
  29. 29. Entamoeba histolytica <ul><li>Endemic in many developing countries, </li></ul><ul><li>Poor hygiene and in sanitary conditions predispose to infection </li></ul><ul><li>Examination of fresh specimens are highly essential </li></ul><ul><li>Differentiate E.histolytica from Entamoeba coli. </li></ul>
  30. 30. Lesihmania donovani <ul><li>Infections are prevalent in Tropical Africa, South America, Mediterranean </li></ul><ul><li>Produce Non specific manifestations </li></ul><ul><li>Demonstration of Amastigotes in Bone marrow biopsy and splenic aspirates confirms diagnosis. </li></ul>
  31. 31. Life cycle of Lesihmania donovani
  32. 32. Viral Infections in AIDS
  33. 33. Viruses infecting AIDS Patients <ul><li>Cytomegaloviruses </li></ul><ul><li>Herpes simplex </li></ul><ul><li>Varicella zoster </li></ul><ul><li>Human papilloma virus </li></ul><ul><li>Papovavirus / Papilloma virus. </li></ul><ul><li>Hepatitis B and C may be associated. </li></ul>
  34. 34. Cytomegalovirus <ul><li>CMV Retinitis most common cause of Retinal infections in AIDS </li></ul><ul><li>Also causes </li></ul><ul><li>Pneumonia </li></ul><ul><li>Disseminated disease </li></ul><ul><li>Gastroenteritis </li></ul>
  35. 35. Isolation of CMV viruses <ul><li>Throat washing </li></ul><ul><li>Urine </li></ul><ul><li>grown on Human fibroblasts </li></ul><ul><li>shows Cytomegalic changes and </li></ul><ul><li>Intranuclear inclusions. </li></ul>
  36. 36. Serology <ul><li>Most useful investigation in resource poor settings </li></ul><ul><li>Ig G estimation will inform only past infections </li></ul><ul><li>Ig M estimation will reveal current predisposition with CMV infection </li></ul><ul><li>Serological assays are not reliable in highly Immunosuppresed patients. </li></ul>
  37. 37. Specific Diagnosis <ul><li>May need PCR methods from various samples </li></ul><ul><li>Molecular methods helps in Specific Diagnosis </li></ul><ul><li>Establishes the viral Load in actively suffering patients. </li></ul>
  38. 38. Herpes Simplex <ul><li>AIDS patients suffer more often and most severe Infections </li></ul><ul><li>Herpes simplex 2 are identified as most prominent sexually transmitted infection world wide. </li></ul>
  39. 39. Produce simple lesions to disabling Disease
  40. 40. Herpes simplex <ul><li>Isolation of viruses </li></ul><ul><li>from throat washings </li></ul><ul><li>Cerebrospinal fluid </li></ul><ul><li>Stool </li></ul><ul><li>Serology - Not very specific in establishing Diagnosis </li></ul><ul><li>Polymerase chain reaction – Sensitive/Specific </li></ul><ul><li>Most useful establishing the Diagnosis of CNS infections. </li></ul>
  41. 41. Varicella Zoster Virus <ul><li>Varicella zoster virus causes chicken pox in children and young </li></ul><ul><li>Latent infection persists in ganglion </li></ul><ul><li>Reactivation of latent infection causes Varicela Zoster </li></ul><ul><li>AIDS are prone for Zoster manifestations. </li></ul>
  42. 42. Herpes Zoster <ul><li>Produces most severe morbidity </li></ul><ul><li>Disease starts with pain on skin or mucous membrane with eruptions supplied by one or more groups of sensory nerve routes </li></ul><ul><li>Usually diagnosed clinically </li></ul><ul><li>On many occasions Herpes zoster leads to suspicion of AIDS </li></ul>
  43. 43. Diagnosis of Herpes zoster <ul><li>A clinically diagnosed condition. </li></ul><ul><li>Laboratory testing confirms </li></ul><ul><li>Virus can be isolated from vesicle fluid cultured on human cells </li></ul><ul><li>Immuno florescence </li></ul><ul><li>Complement fixation tests </li></ul><ul><li>Helps in atypical cases </li></ul>
  44. 44. Epstein Barr virus - AIDS <ul><li>Appear with intermittent manifestations </li></ul><ul><li>Manifest with lesions on the lateral border of tongue or mucous membrane </li></ul><ul><li>Histological examination Under Electron Microscopy </li></ul>
  45. 45. Human Papilloma virus - AIDS <ul><li>There are >100 strains of Papilloma viruses </li></ul><ul><li>About 30 strains are transmitted sexually </li></ul><ul><li>Can produce cervical cancer in women </li></ul><ul><li>Growing Importance in AIDS patients. </li></ul><ul><li>Diagnosis - </li></ul><ul><li>Abnormal pap smear suggestive </li></ul><ul><li>DNA technologies are emerging. </li></ul>
  46. 46. Papova virus - AIDS <ul><li>JC virus a member of the group </li></ul><ul><li>Produce multifocal leucoencephalopathy </li></ul><ul><li>Produce neurological and intellectual impairment </li></ul><ul><li>Can produce hemiparesis </li></ul><ul><li>Definitive diagnosis with Histological examination for virus with Biopsy specimens </li></ul>
  47. 47. Other viruses - AIDS <ul><li>AIDS patients can be co infected with Hepatitis B and C </li></ul><ul><li>They share same route of transmission as in drug abuse, Blood transfusion even sexual transmission </li></ul>
  48. 48. Hepatitis B infection - AIDS <ul><li>Needs further evaluation on the progress of Infection </li></ul><ul><li>Infected patients become chronic carriers </li></ul>
  49. 49. Hepatitis C - AIDS <ul><li>Hepatitis C is much more dangerous in producing chronic complications than Hepatitis B infection </li></ul>
  50. 50. Molloscum contasiousm <ul><li>Lesion have propensity for spreading widely over the patients body </li></ul><ul><li>Usually sexually transmitted </li></ul><ul><li>AIDS patients are highly prediposed.. </li></ul>
  51. 51. Bacterial Infections in AIDS
  52. 52. Bacteria - AIDS <ul><li>Mycobacterium tuberculosis </li></ul><ul><li>Salmonella spp </li></ul><ul><li>Mycobacterium avium intracellulare </li></ul><ul><li>Streptococcus pneumonia </li></ul><ul><li>Staphylococcus aureus </li></ul><ul><li>Haemophilus Influenzae </li></ul><ul><li>Moraxella catarhalis </li></ul><ul><li>Rodococci equi </li></ul><ul><li>Bartonella quintana </li></ul><ul><li>Nocardia </li></ul>
  53. 53. Mycobacterium tuberculosis <ul><li>High prevalence of Tuberculosis in AIDS </li></ul><ul><li>High prevalence of AIDS associated with Tuberculosis. </li></ul><ul><li>An early disease in AIDS patients </li></ul><ul><li>Can occur even at minimal Immuno Suppression </li></ul><ul><li>TB in HIV may be reactivation of latent TB - common in Developing world. </li></ul><ul><li>Present with similar picture as in HIV negative patients, as long as CD4 counts are high </li></ul>
  54. 54. TB in Advanced AIDS <ul><li>Present with atypical manifestations, as </li></ul><ul><li>Absence of cavitations </li></ul><ul><li>Without hilar Lymphadenopathy </li></ul><ul><li>But may effect Lymphnodes – present with Lymphadenopathy </li></ul><ul><li>Involvement of Bone marrow, Liver </li></ul><ul><li>Bacteremia a leading clue to diagnosis </li></ul>
  55. 55. Diagnosis of Tuberculosis <ul><li>X ray chest - the minimal investigation. </li></ul><ul><li>Sputum microscopy most important Investigation </li></ul><ul><li>In advanced disease Smear positivity decreases, need culturing for Mycobacterium </li></ul><ul><li>Use of Florescent Microscopy is gaining importance for detection of AFB in HIV patients. </li></ul>
  56. 56. X – ray Chest remains the Most important Investigation in Tuberculosis
  57. 57. Sputum Microscopy the most important simple investigation
  58. 58. Acid fast bacilli detection by Florescent Methods are more sensitive
  59. 59. Atypical mycobacterium - AIDS <ul><li>Mycobacterium intracellulare occurs in the late stage of disease ( with gross Immuno Supression ) </li></ul><ul><li>Needs newer methods of diagnosis, as </li></ul><ul><li>Direct examination and blood culture for AFB </li></ul><ul><li>Examination of Lymphnodes, Bone Marrow, and liver give better diagnostic options. </li></ul>
  60. 60. MAI Complex <ul><li>Mycobacterium avium intracellulare identified as the most important Atypical mycobacterium infecting AIDS patients </li></ul>
  61. 61. Other Methods of Diagnosis to Tuberculosis <ul><li>Tuberculin test is less helpful in diagnosis of Tuberculosis associated with AIDS </li></ul><ul><li>Even indurations of </li></ul><ul><li>> 5 mm to 10 mm are taken to consideration as positivity. </li></ul>
  62. 62. Other Bacterial Infections <ul><li>The abnormalities of the B cell function associated with HIV lead to infections with encapsulated bacteria, as reduced production of Ig G 2 , ,, cannot protect against the polysaccharide coat of such organisms. </li></ul><ul><li>HIV patients are predisposed with </li></ul><ul><li>1 Streptococcus pneumonia </li></ul><ul><li>2 Haemophilus influenzae </li></ul><ul><li>3 Moraxella catarrhalis. </li></ul>
  63. 63. Diagnosis ( Common Bacterial Infections ) <ul><li>Routine culture methods are adequate diagnosis. </li></ul><ul><li>Many respond to routine antibiotic treatment </li></ul><ul><li>But may need long term treatment to control to prevent relapses </li></ul>
  64. 64. Salmonella ( non Typhoidal ) <ul><li>Can be isolated from Blood and stool cultures </li></ul><ul><li>A frequent pathogen in HIV infection </li></ul><ul><li>Acquired orally produce disseminated infections. </li></ul><ul><li>Any organ can be involved </li></ul>
  65. 65. Staphylococcus aureus <ul><li>Staphylococcal infections can produce, Abscess, Cellulitis,and Folliculitis, and Furuncles </li></ul><ul><li>Routine culture methods are adequate to isolate the Bacteria </li></ul><ul><li>But Antibiotic resistance is concern in treating the patients. </li></ul>
  66. 66. Bacillary Angiomatosis <ul><li>Bartonella Henselae </li></ul><ul><li>Bartonella Quintana </li></ul><ul><li>Produce raised, reddish </li></ul><ul><li>highly vascular skin lesions </li></ul><ul><li>Mimic Kaposi's Sarcoma </li></ul><ul><li>May manifest as fever without clues </li></ul>
  67. 67. Bacillary Angiomatosis <ul><li>Bartonella henselae manifest as zoonotic infection spread by young cats </li></ul><ul><li>High level of suscipicion necessary for diagnosis. </li></ul>
  68. 68. Fungi and Yeasts
  69. 69. Fungi and Yeasts - AIDS <ul><li>1 Pneumocystis jiroveci ( formerly carnii ) </li></ul><ul><li>2 Cryptococcus neoformans </li></ul><ul><li>3 Candia spp </li></ul><ul><li>4 Dermatophytes </li></ul><ul><li>5 Histoplasma capsulatum </li></ul><ul><li>6 Coccidioides imitis </li></ul>
  70. 70. Pneumocystis jiroveci <ul><li>Most common cause of Pneumonia in AIDS patients </li></ul><ul><li>Difficult to Diagnose </li></ul><ul><li>If the CD4 counts are > 250, Pneumocystis is unlikely. </li></ul><ul><li>Damage the Alveolar epithelium </li></ul><ul><li>Impedes the gas exchange </li></ul><ul><li>Reduces the Lung compliance </li></ul>
  71. 71. Chest x-rays can guide in Diagnosis <ul><li>X-ray chest shows bilateral interstitial infiltrations. </li></ul><ul><li>CT scans are more informative </li></ul>
  72. 72. Microbiological Diagnosis <ul><li>Demonstration of organism in Bronchoalveloar lavages are more useful in confirmation </li></ul><ul><li>Wright – Giemsa stain will help to diagnose 50 – 80 % cases from Induced sputum </li></ul>
  73. 73. Cryptococcus neoformans - AIDS <ul><li>C. neoformans produces Meningitis in HIV patients. </li></ul><ul><li>Can manifest with pulmonary infections </li></ul><ul><li>Considered in all cases of AIDS manifesting with neurological manifestations suggestive of Meningitis. </li></ul>
  74. 74. Microbiological Diagnosis <ul><li>CSF examination for presence of true yeast confirms diagnosis </li></ul><ul><li>India Ink preparation of centrifuged samples of CSF helps. </li></ul><ul><li>Culturing on Fungal medium confirms with Biochemical tests </li></ul><ul><li>Now rapid testing for Antigen detection are available. </li></ul>
  75. 75. Candida - AIDS <ul><li>Many AIDS patients present with Oral Candidosis </li></ul><ul><li>Esophageal candidosis produces disabling complication </li></ul><ul><li>Vulvovaginal candidosis is problematic </li></ul><ul><li>Any organ can be infected </li></ul><ul><li>C.albicans the most prominent pathogen in AIDS </li></ul><ul><li>C.krusei and C.glabrata are other prominent isolates. </li></ul>
  76. 76. Common lesions in Candida infection.
  77. 77. Diagnosis of Candidal infections <ul><li>Microscopical examination of various specimens </li></ul><ul><li>Culture on Fungal medium </li></ul><ul><li>Biochemical tests for identification of species </li></ul>
  78. 78. Histoplasmosis <ul><li>Histoplasma capsulatum infections are common in USA </li></ul><ul><li>They are present as soil inhabitants </li></ul><ul><li>Loss of Cell mediated Immunity predisposes to Histoplasmosis </li></ul>
  79. 79. Histoplasmosis <ul><li>Severe disseminated Histoplasmosis develop in AIDS patients </li></ul><ul><li>Fungi can be isolated from Sputum, Urine, and Bone marrow </li></ul><ul><li>Diagnosis - Bone marrow smears stained with Giemsa stain give clues to diagnosis </li></ul><ul><li>Cultured on Sabourauds’ agar. </li></ul><ul><li>Serology – presence of antibodies to H antigen signifies active Histoplasmosis. </li></ul><ul><li>Testing for circulating Antigens more useful in disseminated Infections. </li></ul>
  80. 80. Coccidioidomycosis <ul><li>Coccidioides immitis - a dimorphic fungus </li></ul><ul><li>Patients with AIDS can manifest with disseminated diseases </li></ul><ul><li>Loss of Cell mediated immunity predisposes to generalized infections </li></ul><ul><li>AIDS patients present with rapidly fatal diffuse Reticuloendothelial pneumonitis.. </li></ul>
  81. 81. <ul><li>C.immitis, is a established pathogen </li></ul><ul><li>C.posadasii was recently attributed to infections in AIDS patient. </li></ul><ul><li>C.posadasii differs from C.immitis on DNA configuration </li></ul>
  82. 82. Seborrhic Dermatitis <ul><li>Produced by Malassezia fur fur </li></ul><ul><li>A common infection in Non HIV patients </li></ul><ul><li>AIDS patients are highly predisposed. </li></ul>
  83. 83. Neoplasms in -AIDS
  84. 84. Kaposi's Sarcoma <ul><li>Human herpes virus type 8 predisposes Kaposi’s sarcoma in AIDS patients. </li></ul><ul><li>Lesions are pigmented. </li></ul><ul><li>Well circumscribed lesions </li></ul><ul><li>May Involve Lymphatics, Lymphnodes,lungs and Gastrointestinal tract </li></ul>
  85. 85. Lymphomas <ul><li>Non Hodgkin's large cell type </li></ul><ul><li>Associated with Epstein Barr virus </li></ul>
  86. 86. Squamous cell Carcinoma <ul><li>Associated with Human papilloma virus </li></ul><ul><li>Cervix and Anus are involved </li></ul>
  87. 89. Created for benefit of Medical and Paramedical Health care workers in Developing world Dr.T.V.Rao MD E mail tvraodoctor2000@yahoo.co.in

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