Opportunistic infections (oi) deepa


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Opportunistic infections (oi) deepa

  1. 1. Opportunistic Infections (OI)India had an estimated 3.5million HIVpositives in 2009(NACO) DEEPA BABIN ASST PROF MICROBIOLOGY TMC
  2. 2. BackgroundPatients are susceptible tobacterial, fungal, parasitic andviral infectionsHIV, Cancer chemotherapy,bone marrow transplantation,immune deficiency disorder orblood disorders . 2 2
  3. 3. Definition• An infection by a microorganism when the bodys immune system is impaired and unable to fight off infection, as in AIDS, Infants, neutropenia, and congenital
  4. 4. AIDS (Aquired Immune Deficiency Syndrome)AIDS (Aquired Immune DeficiencySyndrome) is the final stage andnatural progression of HIV (HumanImmunodeficiency Virus.)These infections usually occurwhen the CD4 cells drop below 200cells/ul, i.e. immunocompromisedstate. It is estimated that as many as 40million people worldwide sufferfrom AIDS
  5. 5. Opportunistic Infections
  6. 6. OI (CDC GUIDELINE 2011)• Fungal • VIRUS• Candidiasis of bronchi, • Cytomegalovirus disease trachea, esophagus, or lungs (particularly CMV retinitis) oral thrush, vaginitis • Herpes simplex 1,2 : chronic• Coccidioidomycosis ulcer(s) (greater than 1 months duration); or• Cryptococcosis(Meningitis) bronchitis, pneumonitis, or• Histoplasmosis esophagitis• Pneumocystis carinii • Herpes zoster pneumonia • Human papilloma virus• Aspergillosis • Hepatitis B• Penicilliosis(P. marneffi) • HHV-6 and HHV-7 Disease • Varicella-Zoster Virus Disease • Human Herpesvirus-8 Disease • Molluscum contagiosum
  7. 7. OI (CDC GUIDELINE 2011)• PARASITES • BACTERIA • Mycobacterium avium complex• Isosporiasis, chronic • Tuberculosis intestinal (greater than 1 • Pneumonia -recurrent months duration) • Progressive multifocal leukoencephalopathy• Toxoplasmosis of brain • Salmonella septicemia- recurrent• Cryptosporidiosis, chronic • Neurosyphilis Syphilis • Bartonellosis intestinal (greater than 1 months duration) • OTHERS• Leishmaniasis • Wasting syndrome due to HIV • Invasive cervical cancer• Chagas Disease • Kaposis sarcoma• Malaria • Lymphoma, multiple forms • Encephalopathy, HIV-related• Isosporiasis
  8. 8. Respiratory Infections• Bacterial pneumonias (LRTI) can be very serious & recurrent• As Cell Mediated Immunity depletes, opportunistic infections such as Pneumocystis , severe fungal and viral pneumonias may occur.
  9. 9. Respiratory Infections Bacterial: Fungal: Pneumococcal, Cryptococcosis, Klebsiella, E.coli, Histoplasmosis, Heamophilus, Pneumocystis jiroveci Staphylococcal Aspergillosis, pneumonias, Tuberculosis, MAC. Viral: Other: Kaposi’s sarcoma, Cytomegalovirus Herpes simplex virusLymphocytic interstitial pneumonitis
  10. 10. Pneumocystis jiroveciMost common one with Lunginfection, other organs like liver,spleen,bonemarrow can alsoinfect.Chest radiograph Classically bilateral, diffuse interstitial shadowing Can be relatively normal even with severe respiratory distressInduced sputum andBronchoalveolar lavage Can give definitive diagnosis
  11. 11. Mycobacterium tuberculosis• 85,000 new cases of tuberculosis in United States in 2009 (6% among children <15 years of age)• Number of these that were HIV infected is uncertain• Incidence of TB in HIV-infected 100 times higher than in uninfected• Extrapulmonary and miliary TB more common• Congenital TB has been reported• Drug-resistant TB can be transmitted
  12. 12. Diagnosis of Pulmonary TB• Sputum examination – Negative Sputum does not exclude TB! – Sputum negative PTB more common in HIV+ – Only 50% sensitive• Chest radiograph – No “typical” TB X-ray – TB can create almost any abnormality, or even none
  13. 13. Diagnosis of Extrapulmonary TB• Often very difficult – CXR often normal and sputum if available is negative• If lymph nodes enlarged - aspirate• If meningism present - lumbar puncture• If septic arthritis or abscess - aspirate – Always request ZN Stains on samples
  14. 14. A Patient with HIV Wasting SyndromeThis can be clinically indistinguishable from advanced TB
  15. 15. Mycobacterium avium Complex• Appear as isolated lymphadinitis• Recurrent fever, weight loss, failure to thrive, neutropenia, night sweats, chronic diarrhea, malabsorption, abdominal pain• Lymphadenopathy, hepatomegaly, splenomegaly• Respiratory symptoms• Diagnosis-Biopsy,AFB stain,Blood culture,PCR
  16. 16. Gastrointestinal InfectionsCauses: Direct HIV infection Bacterial/viral/protozoal/parasitic infectionPresentations• Watery/loose Diarrhoea,+/- malabsorption due to villous atrophy• loss of appetite, nausea & vomiting, progressive weight lossN.B. bloody stool indicates shigellosis/amoebic dysentry
  17. 17. Diarrhoea Acute Chronic- Bacterial - CMV• Salmonella - Mycobacterium avium• Shigella complex• Campylobacter - Parasites• Clostridium difficile • Microsporidia- Enteric viruses • Cryptosporidia• adenovirus • Cyclospora cayetanensis• astrovirus • Giardia lamblia • Isospora belli
  18. 18. Neurological Infections Cryptococcal Meningitis• Most frequent systemic fungal infection in HIV infected persons• Symptoms: headache, neck stiffness, cranial .B. nerve palsies,+/- coma; fever is rare• Prognosis is poor with :Raised skin lesions resulting from dissemination of the yeast no treatment. in an imunocompromised patient
  19. 19. Syphilis• Treponema pallidum• Neurosyphilis• Rate of congenital syphilis 50 times greater among infants born to HIV-infected mothers• All infants born to mothers with reactive nontreponemal and treponemal test should be evaluated with a quantitative nontreponemal test, e.g., slide test, rapid plasma reagin (RPR)
  20. 20. Toxoplasmal meningitisCNS infection of T gondii is an AIDS indicatorCD4 cells >50 cells/mlMeningitisDiagnosisSerology-Ab detectionPCR
  21. 21. CandidiasisCausative organism:Candida speciesSites of colonisation– Gastrointestinal tract– Genital tract womenTypical presentations : Oral/vulvovaginal thrush Balanitis +/- oesophageal candidiasis
  22. 22. Oral Hairy leukoplakia• Common in HIV immunosuppressed• Characterised by fine linear, warty growths on edge of tongue.• Can be mistaken for candidiasis• Caused by Epstein Barr virus/?HPV• No specific treatment; good oral hygeine
  23. 23. Oral HerpesCausative organism:Herpes simplex virusInfection:superficial painful ulcers;Site:mouth , around lips andnoseTreatment:5 days acyclovir 200mg
  24. 24. Skin Conditions• Herpes Zoster• Reactivation of previous varicella (chicken pox)• Very common• Can occur early in HIV disease• Multi-dermatomal, recurrent Causes acute, severe pain• Risk of debilitating post herpetic neuralgia (PHN more common in older aptient)• Disfiguring keloid formation• Diagnosis clinical
  25. 25. HIV and Genital Herpes• More extensive disease• Frequent recurrences• Chronicity• Associated high genital viral load• Important cofactor for transmission of HIV• Treatment of fist episode as standard however higher doses may be required for longer periods especially in chronic cases
  26. 26. Infective Dermatoses• Scabies• Seborrheic dermatitis
  27. 27. Giant granulomatous leishmanial ulcerationVisceral leishmaniasis Has become more PrevalentUnusual presentations Often occur e.g. Leishmania speciesNormally causing only Cutaneous disease, Can present withVisceral Leishmaniasis
  28. 28. HIV Related Malignancies• Kaposi’s sarcoma• Primary CNS lymphoma• Carcinoma of the cervix• Other lymphomas
  29. 29. This is theperson living with HIV/AIDS
  30. 30. The Role of ARVs in Opportunistic Infections• Antiretroviral therapy(ARV)• ARVs improve the immune status, and therefore, enhance how the host fights disease – keeping it free from infections that might otherwise have taken the opportunity to occur.• Widespread use of Highly Active Anti Retroviral Therapy (HAART) has been associated with considerable – Reduction in mortality – Reduction in morbidity – Reduction in social isolation
  31. 31. HIV/AIDS is one of the greatestworldwide public healthchallenges of the modern age,and as future health careworkers, it is of the utmostimportance that we maintainawareness and continuingknowledge of thisheartbreaking and deadlyscourge.