Opportunistic infections are infections that occur more frequently and are more severe in people with weakened immune systems such as those with HIV/AIDS. These infections include fungal, bacterial, viral, and parasitic infections that typically do not seriously affect those with healthy immune systems. Common opportunistic infections in HIV/AIDS patients include Pneumocystis pneumonia, tuberculosis, candidiasis, toxoplasmosis, cryptococcus, and cytomegalovirus. Antiretroviral therapy has significantly reduced the rates of opportunistic infections by suppressing HIV and allowing immune recovery. HIV/AIDS remains a major global public health challenge.

1. Opportunistic Infections (OI)
India had an estimated 3.5million HIV
positives in 2009(NACO)
DEEPA BABIN
ASST PROF MICROBIOLOGY
TMC

2. Background
Patients are susceptible to
bacterial, fungal, parasitic and
viral infections
HIV, Cancer chemotherapy,
bone marrow transplantation,
immune deficiency disorder or
blood disorders .
2
2

3. Definition
• An infection by a microorganism when
the body's immune system is impaired
and unable to fight off infection, as in
AIDS, Infants, neutropenia, and
congenital

4. AIDS (Aquired Immune Deficiency
Syndrome)
AIDS (Aquired Immune Deficiency
Syndrome) is the final stage and
natural progression of HIV (Human
Immunodeficiency Virus.)
These infections usually occur
when the CD4 cells drop below 200
cells/ul, i.e. immunocompromised
state.
It is estimated that as many as 40
million people worldwide suffer
from AIDS

5. Opportunistic Infections

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
month's 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. OI (CDC GUIDELINE 2011)
• PARASITES • BACTERIA
• Mycobacterium avium complex
• Isosporiasis, chronic • Tuberculosis
intestinal (greater than 1 • Pneumonia -recurrent
month's duration) • Progressive multifocal
leukoencephalopathy
• Toxoplasmosis of brain • Salmonella septicemia- recurrent
• Cryptosporidiosis, chronic • Neurosyphilis Syphilis
• Bartonellosis
intestinal (greater than 1
month's duration) • OTHERS
• Leishmaniasis • Wasting syndrome due to HIV
• Invasive cervical cancer
• Chagas Disease • Kaposi's sarcoma
• Malaria • Lymphoma, multiple forms
• Encephalopathy, HIV-related
• Isosporiasis

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. 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 virus
Lymphocytic interstitial
pneumonitis

10. Pneumocystis jiroveci
Most common one with Lung
infection, other organs like liver,
spleen,bonemarrow can also
infect.
Chest radiograph
Classically bilateral, diffuse
interstitial shadowing
Can be relatively normal even with
severe respiratory distress
Induced sputum and
Bronchoalveolar lavage
Can give definitive diagnosis

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. 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. 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. A Patient with HIV Wasting Syndrome
This can be clinically indistinguishable
from advanced TB

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. Gastrointestinal Infections
Causes:
Direct HIV infection
Bacterial/viral/protozoal/parasitic
infection
Presentations
• Watery/loose Diarrhoea,+/-
malabsorption due to villous
atrophy
• loss of appetite, nausea &
vomiting, progressive weight loss
N.B. bloody stool indicates
shigellosis/amoebic dysentry

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. 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. 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. Toxoplasmal meningitis
CNS infection of T gondii is
an AIDS indicator
CD4 cells >50 cells/ml
Meningitis
Diagnosis
Serology-Ab detection
PCR

21. Candidiasis
Causative organism:
Candida species
Sites of colonisation
– Gastrointestinal tract
– Genital tract women
Typical presentations :
Oral/vulvovaginal
thrush
Balanitis
+/- oesophageal
candidiasis

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. Oral Herpes
Causative organism:
Herpes simplex virus
Infection:
superficial painful ulcers;
Site:
mouth , around lips and
nose
Treatment:
5 days acyclovir 200mg

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. 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. Infective Dermatoses
• Scabies
• Seborrheic dermatitis

27. Giant granulomatous leishmanial ulceration
Visceral leishmaniasis
Has become more
Prevalent
Unusual presentations
Often occur
e.g.
Leishmania species
Normally causing only
Cutaneous disease,
Can present with
Visceral Leishmaniasis

28. HIV Related Malignancies
• Kaposi’s sarcoma
• Primary CNS lymphoma
• Carcinoma of the cervix
• Other lymphomas

29. This is the
person living
with
HIV/AIDS

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. HIV/AIDS is one of the greatest
worldwide public health
challenges of the modern age,
and as future health care
workers, it is of the utmost
importance that we maintain
awareness and continuing
knowledge of this
heartbreaking and deadly
scourge.

32. THANK YOU ALL
MY
DEAR STUDENTS