Transcript
INFECTIONS IN INFECTIONS IN AIDSAIDS
Dr.T.V.Rao. MDDr.T.V.Rao. MD
Why AIDS is Different from Why AIDS is Different from otherother
InfectionsInfections AIDS is a incurable condition produced by AIDS is a incurable condition produced by
HIV1 or HIV2HIV1 or HIV2 It is estimated that 10 Billion HIV particles It is estimated that 10 Billion HIV particles
are produce and Destroyed every day.are produce and Destroyed every day. CD4 Lymphocytes which plays Major role CD4 Lymphocytes which plays Major role
in Immunity are destroyed.in Immunity are destroyed. Makes Every AIDS patients venerable to Makes Every AIDS patients venerable to
infections, and uncommon malignant infections, and uncommon malignant conditions.conditions.
What went wrong in What went wrong in AIDSAIDS
Immune system is a complex Immune system is a complex and complicated organ - it and complicated organ - it sometimes fails to work to sometimes fails to work to
protectprotect
HIV infection causesHIV infection causes
Secondary Immunodeficiency disorder.Secondary Immunodeficiency disorder. Initiated with destruction of CD4 type of Initiated with destruction of CD4 type of
T Lymphocytes, Monocytes.T Lymphocytes, Monocytes. Lead to onset of AIDS ( Acquired Lead to onset of AIDS ( Acquired
Immuno deficiency syndrome )Immuno deficiency syndrome ) Manifest with various opportunistic Manifest with various opportunistic
infections.infections. In some cases present with various In some cases present with various
forms of cancer.forms of cancer.
AIDS causes overall AIDS causes overall DefectDefect
Overt failures of Immune system Overt failures of Immune system manifests with reduced ability to manifests with reduced ability to
resist Infectionsresist Infections
HIV virus infects CD4 HIV virus infects CD4 lymphocytes and destroys lymphocytes and destroys
When you says it is AIDSWhen you says it is AIDS
Infected with HIV1 or HIV 2Infected with HIV1 or HIV 2 When the CD4 cells drop to < When the CD4 cells drop to <
200/mm200/mm33
Present with one of the 26 different Present with one of the 26 different opportunistic infections.opportunistic infections.
Relation of AIDS to Relation of AIDS to InfectionsInfections
Relevant or chronic infectionsRelevant or chronic infections Inability to clear Infections after Inability to clear Infections after
standard regimes of Antibiotic standard regimes of Antibiotic therapytherapy
Unusual InfectionsUnusual Infections
Defining AIDS in relation toDefining AIDS in relation toInfectionsInfections
Many indicator diseases vary from one Many indicator diseases vary from one Geographic region to another.Geographic region to another.
Majority are only Endogenous infections Majority are only Endogenous infections which were acquired in the past and only which were acquired in the past and only reactivated in the present scenario.reactivated in the present scenario.
Some are exogenous infections particular Some are exogenous infections particular to geographic location where the patient to geographic location where the patient lives.lives.
Eg Toxoplasmosis, Cryptococcosis Eg Toxoplasmosis, Cryptococcosis ( common in Africa )( common in Africa )
Common AIDS defining Common AIDS defining IllnessesIllnesses
in the past and continuesin the past and continues
Pneumocystis jiroveci pneumoniaPneumocystis jiroveci pneumonia HIV wasting syndromeHIV wasting syndrome Candidiasis Candidiasis
AIDS defining illness at AIDS defining illness at presentpresent
1. Recurrent bacterial infections.1. Recurrent bacterial infections. 2. Invasive cervical carcinoma. 2. Invasive cervical carcinoma. 3 Pulmonary tuberculosis.3 Pulmonary tuberculosis.
PRROTOZAL PRROTOZAL INFECTIONS IN INFECTIONS IN
AIDSAIDS
ProtozoaProtozoa
Toxoplasma gondiiToxoplasma gondii Cryptosporidium parvumCryptosporidium parvum Microsporidia sppMicrosporidia spp Leshmania donovaniLeshmania donovani Isospora belliIsospora belli
ToxoplasmosisToxoplasmosis( Toxoplasmosis gondii )( Toxoplasmosis gondii )
Domestic cats Domestic cats spread the disease spread the disease to humans in to humans in vicinityvicinity
Avoiding cats, and Avoiding cats, and cat feces makes a cat feces makes a difference to HIV difference to HIV infected.infected.
ToxoplasmosisToxoplasmosis
Most important / common space Most important / common space occupying lesion of brain in HIV infectionsoccupying lesion of brain in HIV infections
Clinicians track the DiagnosisClinicians track the Diagnosis
Usually diagnosed by C T scansUsually diagnosed by C T scans
MRI is highly sensitive than C TMRI is highly sensitive than C T
Produces space occupying Produces space occupying lesionslesions
Cats spread the diseaseCats spread the disease
Toxoplasmosis Toxoplasmosis ( Diagnosis )( Diagnosis )
Serological tests may not confirm Serological tests may not confirm diagnosis in HIV ? AIDS patients.diagnosis in HIV ? AIDS patients.
Look for alternative, more specific Look for alternative, more specific methods like Brain Biopsy methods like Brain Biopsy
Sabin – Feldman dye test.Sabin – Feldman dye test. ELISA may be guiding in complex ELISA may be guiding in complex
presentations in resource poor presentations in resource poor settings.settings.
CryptosporidiumCryptosporidium
A common cause of Diarrhea in AIDS patients A common cause of Diarrhea in AIDS patients Microscopic examination may confirm Microscopic examination may confirm
DiagnosisDiagnosis Detection of Oocysts in fresh stoolDetection of Oocysts in fresh stool Staining the stool samples with modified acid Staining the stool samples with modified acid
fast stainsfast stains Fluorescent Microscopy with Monoclonal Fluorescent Microscopy with Monoclonal
tagged antibodies may confirm the specific tagged antibodies may confirm the specific DiagnosisDiagnosis
Cryptosporium oocysts inCryptosporium oocysts instool specimenstool specimen
MICROSPORIDAMICROSPORIDA
Several species of Several species of Microsporidia Microsporidia infect humans.infect humans.
AIDS patients have AIDS patients have higher higher predispositionpredisposition
Microsporidia sppMicrosporidia spp
Microsporidal infections occurs along Microsporidal infections occurs along with Cryptosporial infectionswith Cryptosporial infections
Different species cause opportunistic Different species cause opportunistic infection in Immunosuppresed and infection in Immunosuppresed and AIDS patientsAIDS patients
1 Encephalitozoon helium1 Encephalitozoon helium
2 Virraforma cornae2 Virraforma cornae
In intestine - Enterocytozoon beeneusiIn intestine - Enterocytozoon beeneusi
IsosporaIsospora
Present with Present with gastrointestinal gastrointestinal Manifestations Manifestations clinicallyclinically
Found in Intestinal Found in Intestinal tracttract
Fresh specimens of Fresh specimens of stool specimens stool specimens examined for examined for OocystsOocysts
GiardiasisGiardiasis Caused by Giardia Caused by Giardia
intestinalisintestinalis May produce May produce
Infections in Infections in Immunosupressed Immunosupressed
Manifest with Manifest with diarrhea and diarrhea and malabsorption malabsorption syndromesyndrome
Examination of stool Examination of stool will reveal Cysts and will reveal Cysts and Trophozoites.Trophozoites.
Life cycle of Giardiasis Life cycle of Giardiasis InfectionInfection
Strongyloidosis - AIDSStrongyloidosis - AIDS Caused by Caused by
Strongyloides Strongyloides stercoralisstercoralis
In AIDS / In AIDS / Immunosuppresed Immunosuppresed Filariform larva may Filariform larva may penetrate gut directly penetrate gut directly in large numbers and in large numbers and produce produce overwhelming overwhelming infection with fatal infection with fatal outcomeoutcome
Life cycle of Life cycle of StrongyloidosisStrongyloidosis
Entamoeba Histolytica Entamoeba Histolytica
Amoebiasis is common Amoebiasis is common in many geographic in many geographic locationslocations
Rarely attributed in the Rarely attributed in the developing world as developing world as AIDS defining illnessAIDS defining illness
Microscopic Microscopic examination for examination for Trophozoites will Trophozoites will confrim the active confrim the active infectioninfection
Life cycle of Entamoeba Life cycle of Entamoeba HistolyticumHistolyticum
Entamoeba histolyticaEntamoeba histolytica
Endemic in many Endemic in many developing countries,developing countries,
Poor hygiene and in Poor hygiene and in sanitary conditions sanitary conditions predispose to infectionpredispose to infection
Examination of fresh Examination of fresh specimens are highly specimens are highly essentialessential
Differentiate Differentiate E.histolytica from E.histolytica from Entamoeba coli.Entamoeba coli.
Lesihmania donovaniLesihmania donovani
Infections are Infections are prevalent in Tropical prevalent in Tropical Africa, South America, Africa, South America, MediterraneanMediterranean
Produce Non specific Produce Non specific manifestationsmanifestations
Demonstration of Demonstration of Amastigotes in Bone Amastigotes in Bone marrow biopsy and marrow biopsy and splenic aspirates splenic aspirates confirms diagnosis.confirms diagnosis.
Life cycle of Lesihmania Life cycle of Lesihmania donovanidonovani
Viral Infections in Viral Infections in AIDSAIDS
Viruses infecting AIDSViruses infecting AIDSPatientsPatients
CytomegalovirusesCytomegaloviruses Herpes simplexHerpes simplex Varicella zosterVaricella zoster Human papilloma virusHuman papilloma virus Papovavirus / Papilloma virus.Papovavirus / Papilloma virus. Hepatitis B and C may be associated.Hepatitis B and C may be associated.
CytomegalovirusCytomegalovirus
CMV Retinitis most common cause CMV Retinitis most common cause of Retinal infections in AIDSof Retinal infections in AIDS
Also causes Also causes
Pneumonia Pneumonia
Disseminated diseaseDisseminated disease
GastroenteritisGastroenteritis
Isolation of CMV virusesIsolation of CMV viruses
Throat washingThroat washing UrineUrine
grown on grown on Human fibroblasts Human fibroblasts
shows shows Cytomegalic Cytomegalic changes andchanges and
Intranuclear Intranuclear inclusions.inclusions.
SerologySerology
Most useful investigation in resource Most useful investigation in resource poor settingspoor settings
Ig G estimation will inform only past Ig G estimation will inform only past infectionsinfections
Ig M estimation will reveal current Ig M estimation will reveal current predisposition with CMV infectionpredisposition with CMV infection
Serological assays are not reliable in Serological assays are not reliable in highly Immunosuppresed patients.highly Immunosuppresed patients.
Specific DiagnosisSpecific Diagnosis
May need PCR methods from various May need PCR methods from various samples samples
Molecular methods helps in Specific Molecular methods helps in Specific DiagnosisDiagnosis
Establishes the viral Load in actively Establishes the viral Load in actively suffering patients.suffering patients.
Herpes SimplexHerpes Simplex
AIDS patients suffer AIDS patients suffer more often and most more often and most severe Infectionssevere Infections
Herpes simplex 2 are Herpes simplex 2 are identified as most identified as most prominent sexually prominent sexually transmitted infection transmitted infection world wide.world wide.
Produce simple lesions to Produce simple lesions to disabling Diseasedisabling Disease
Herpes simplexHerpes simplex Isolation of virusesIsolation of viruses from throat washingsfrom throat washings Cerebrospinal fluidCerebrospinal fluid StoolStool Serology - Not very specific in establishing Serology - Not very specific in establishing
Diagnosis Diagnosis
Polymerase chain reaction – Sensitive/SpecificPolymerase chain reaction – Sensitive/Specific Most useful establishing the Diagnosis of CNS Most useful establishing the Diagnosis of CNS
infections. infections.
Varicella Zoster VirusVaricella Zoster Virus
Varicella zoster virus Varicella zoster virus causes chicken pox in causes chicken pox in children and youngchildren and young
Latent infection Latent infection persists in ganglionpersists in ganglion
Reactivation of latent Reactivation of latent infection causes infection causes Varicela ZosterVaricela Zoster
AIDS are prone for AIDS are prone for Zoster Zoster manifestations.manifestations.
Herpes ZosterHerpes Zoster
Produces most severe Produces most severe morbiditymorbidity
Disease starts with pain Disease starts with pain on skin or mucous on skin or mucous membrane with membrane with eruptions supplied by eruptions supplied by one or more groups of one or more groups of sensory nerve routessensory nerve routes
Usually diagnosed Usually diagnosed clinicallyclinically
On many occasions On many occasions Herpes zoster leads to Herpes zoster leads to suspicion of AIDSsuspicion of AIDS
Diagnosis of Herpes Diagnosis of Herpes zosterzoster
A clinically diagnosed A clinically diagnosed condition.condition.
Laboratory testing Laboratory testing confirmsconfirms
Virus can be isolated Virus can be isolated from vesicle fluid from vesicle fluid cultured on human cellscultured on human cells
Immuno florescenceImmuno florescence Complement fixation Complement fixation
teststests
Helps in atypical casesHelps in atypical cases
Epstein Barr virus - AIDSEpstein Barr virus - AIDS
Appear with Appear with intermittent intermittent manifestationsmanifestations
Manifest with lesions Manifest with lesions on the lateral border on the lateral border of tongue or mucous of tongue or mucous membranemembrane
Histological Histological examination Under examination Under Electron MicroscopyElectron Microscopy
Human Papilloma virus - Human Papilloma virus - AIDSAIDS
There are >100 There are >100 strains of Papilloma strains of Papilloma virusesviruses
About 30 strains are About 30 strains are transmitted sexuallytransmitted sexually
Can produce cervical Can produce cervical cancer in womencancer in women
Growing Importance Growing Importance in AIDS patients.in AIDS patients.
Diagnosis -Diagnosis - Abnormal pap smear Abnormal pap smear
suggestivesuggestive DNA technologies DNA technologies
are emerging.are emerging.
Papova virus - AIDSPapova virus - AIDS
JC virus a member of the JC virus a member of the groupgroup
Produce multifocal Produce multifocal leucoencephalopathyleucoencephalopathy
Produce neurological and Produce neurological and intellectual impairmentintellectual impairment
Can produce hemiparesisCan produce hemiparesis Definitive diagnosis with Definitive diagnosis with
Histological examination Histological examination for virus with Biopsy for virus with Biopsy specimensspecimens
Other viruses - AIDSOther viruses - AIDS
AIDS patients can be co infected AIDS patients can be co infected with Hepatitis B and Cwith Hepatitis B and C
They share same route of They share same route of transmission as in drug abuse, transmission as in drug abuse, Blood transfusion even sexual Blood transfusion even sexual transmissiontransmission
Hepatitis B infection - Hepatitis B infection - AIDSAIDS
Needs further Needs further evaluation on the evaluation on the progress of progress of InfectionInfection
Infected patients Infected patients become chronic become chronic carrierscarriers
Hepatitis C - AIDSHepatitis C - AIDS
Hepatitis C is Hepatitis C is much more much more dangerous in dangerous in producing chronic producing chronic complications than complications than Hepatitis B Hepatitis B infectioninfection
Molloscum contasiousmMolloscum contasiousm
Lesion have Lesion have propensity for propensity for spreading widely spreading widely over the patients over the patients bodybody
Usually sexually Usually sexually transmittedtransmitted
AIDS patients are AIDS patients are highly prediposed..highly prediposed..
Bacterial Bacterial Infections inInfections in
AIDSAIDS
Bacteria - AIDSBacteria - AIDS
Mycobacterium Mycobacterium tuberculosistuberculosis
Salmonella sppSalmonella spp Mycobacterium Mycobacterium
avium intracellulareavium intracellulare Streptococcus Streptococcus
pneumoniapneumonia Staphylococcus Staphylococcus
aureus aureus
Haemophilus Haemophilus InfluenzaeInfluenzae
Moraxella Moraxella catarhaliscatarhalis
Rodococci equiRodococci equi Bartonella Bartonella
quintanaquintana NocardiaNocardia
Mycobacterium Mycobacterium tuberculosistuberculosis
High prevalence of Tuberculosis in AIDSHigh prevalence of Tuberculosis in AIDS High prevalence of AIDS associated with High prevalence of AIDS associated with
Tuberculosis.Tuberculosis. An early disease in AIDS patientsAn early disease in AIDS patients Can occur even at minimal Immuno Can occur even at minimal Immuno
SuppressionSuppression TB in HIV may be reactivation of latent TB - TB in HIV may be reactivation of latent TB -
common in Developing world.common in Developing world. Present with similar picture as in HIV negative Present with similar picture as in HIV negative
patients, as long as CD4 counts are highpatients, as long as CD4 counts are high
TB in Advanced AIDSTB in Advanced AIDS
Present with atypical manifestations, asPresent with atypical manifestations, as Absence of cavitationsAbsence of cavitations Without hilar Without hilar
LymphadenopathyLymphadenopathy But may effect Lymphnodes – present But may effect Lymphnodes – present
with Lymphadenopathywith Lymphadenopathy Involvement of Bone marrow, LiverInvolvement of Bone marrow, Liver Bacteremia a leading clue to diagnosisBacteremia a leading clue to diagnosis
Diagnosis of Diagnosis of TuberculosisTuberculosis
X ray chest - the minimal investigation.X ray chest - the minimal investigation. Sputum microscopy most important Sputum microscopy most important
InvestigationInvestigation In advanced disease Smear positivity In advanced disease Smear positivity
decreases, need culturing for decreases, need culturing for MycobacteriumMycobacterium
Use of Florescent Microscopy is gaining Use of Florescent Microscopy is gaining importance for detection of AFB in HIV importance for detection of AFB in HIV patients.patients.
X – ray Chest remains the X – ray Chest remains the Most important Most important Investigation in Investigation in
TuberculosisTuberculosis
Sputum Microscopy the Sputum Microscopy the most important simple most important simple
investigationinvestigation
Acid fast bacilli detection Acid fast bacilli detection by Florescent Methods are by Florescent Methods are
more sensitivemore sensitive
Atypical mycobacterium - Atypical mycobacterium - AIDSAIDS
Mycobacterium intracellulare occurs in Mycobacterium intracellulare occurs in the late stage of disease ( with gross the late stage of disease ( with gross Immuno Supression )Immuno Supression )
Needs newer methods of diagnosis, asNeeds newer methods of diagnosis, as
Direct examination and blood culture for Direct examination and blood culture for AFBAFB
Examination of Lymphnodes, Bone Marrow, Examination of Lymphnodes, Bone Marrow, and liver give better diagnostic options.and liver give better diagnostic options.
MAI ComplexMAI Complex
Mycobacterium Mycobacterium avium avium intracellulare intracellulare identified as the identified as the most important most important Atypical Atypical mycobacterium mycobacterium infecting AIDS infecting AIDS patientspatients
Other Methods of Diagnosis Other Methods of Diagnosis to Tuberculosisto Tuberculosis
Tuberculin test is less Tuberculin test is less helpful in diagnosis of helpful in diagnosis of Tuberculosis Tuberculosis associated with AIDSassociated with AIDS
Even indurations of Even indurations of > 5 mm to 10 mm > 5 mm to 10 mm
are taken to are taken to consideration as consideration as positivity.positivity.
Other Bacterial Other Bacterial InfectionsInfections
The abnormalities of the B cell function The abnormalities of the B cell function associated with HIV lead to infections with associated with HIV lead to infections with encapsulated bacteria, as reduced production encapsulated bacteria, as reduced production of Ig Gof Ig G22,,,, ,, cannot protect against the cannot protect against the polysaccharide coat of such organisms.polysaccharide coat of such organisms.
HIV patients are predisposed withHIV patients are predisposed with 1 Streptococcus pneumonia1 Streptococcus pneumonia 2 Haemophilus influenzae2 Haemophilus influenzae 3 Moraxella catarrhalis.3 Moraxella catarrhalis.
DiagnosisDiagnosis( Common Bacterial ( Common Bacterial
Infections )Infections ) Routine culture Routine culture
methods are methods are adequate diagnosis.adequate diagnosis.
Many respond to Many respond to routine antibiotic routine antibiotic treatment treatment
But may need long But may need long term treatment to term treatment to control to prevent control to prevent relapses relapses
SalmonellaSalmonella( non Typhoidal )( non Typhoidal )
Can be isolated from Can be isolated from Blood and stool Blood and stool culturescultures
A frequent pathogen A frequent pathogen in HIV infectionin HIV infection
Acquired orally Acquired orally produce disseminated produce disseminated infections.infections.
Any organ can be Any organ can be involvedinvolved
Staphylococcus aureus Staphylococcus aureus Staphylococcal Staphylococcal
infections can infections can produce, Abscess, produce, Abscess, Cellulitis,and Cellulitis,and Folliculitis, and Folliculitis, and FurunclesFuruncles
Routine culture Routine culture methods are adequate methods are adequate to isolate the Bacteriato isolate the Bacteria
But Antibiotic But Antibiotic resistance is concern resistance is concern in treating the in treating the patients.patients.
Bacillary AngiomatosisBacillary Angiomatosis
Bartonella HenselaeBartonella Henselae Bartonella QuintanaBartonella Quintana
Produce raised, reddish Produce raised, reddish
highly vascular skin highly vascular skin lesionslesions
Mimic Kaposi's Mimic Kaposi's SarcomaSarcoma
May manifest as fever May manifest as fever without clues without clues
Bacillary AngiomatosisBacillary Angiomatosis
Bartonella henselae Bartonella henselae manifest as zoonotic manifest as zoonotic infection spread by infection spread by young cats young cats
High level of High level of suscipicion suscipicion necessary for necessary for diagnosis.diagnosis.
Fungi and YeastsFungi and Yeasts
Fungi and Yeasts - AIDSFungi and Yeasts - AIDS
1 Pneumocystis jiroveci ( formerly 1 Pneumocystis jiroveci ( formerly carnii )carnii )
2 Cryptococcus neoformans2 Cryptococcus neoformans 3 Candia spp3 Candia spp 4 Dermatophytes4 Dermatophytes 5 Histoplasma capsulatum5 Histoplasma capsulatum 6 Coccidioides imitis6 Coccidioides imitis
Pneumocystis jiroveciPneumocystis jiroveci
Most common cause of Pneumonia in Most common cause of Pneumonia in AIDS patientsAIDS patients
Difficult to DiagnoseDifficult to Diagnose If the CD4 counts are > 250, If the CD4 counts are > 250,
Pneumocystis is unlikely.Pneumocystis is unlikely. Damage the Alveolar epitheliumDamage the Alveolar epithelium Impedes the gas exchangeImpedes the gas exchange Reduces the Lung complianceReduces the Lung compliance
Chest x-rays can guide in Chest x-rays can guide in DiagnosisDiagnosis
X-ray chest shows X-ray chest shows bilateral bilateral interstitial interstitial infiltrations.infiltrations.
CT scans are more CT scans are more informativeinformative
Microbiological Microbiological DiagnosisDiagnosis
Demonstration of Demonstration of organism in organism in Bronchoalveloar Bronchoalveloar lavages are more lavages are more useful in useful in confirmationconfirmation
Wright – Giemsa Wright – Giemsa stain will help to stain will help to diagnose 50 – 80 % diagnose 50 – 80 % cases from Induced cases from Induced sputumsputum
Cryptococcus neoformans - Cryptococcus neoformans - AIDSAIDS
C. neoformans produces Meningitis C. neoformans produces Meningitis in HIV patients.in HIV patients.
Can manifest with pulmonary Can manifest with pulmonary infectionsinfections
Considered in all cases of AIDS Considered in all cases of AIDS manifesting with neurological manifesting with neurological manifestations suggestive of manifestations suggestive of Meningitis.Meningitis.
Microbiological Microbiological DiagnosisDiagnosis
CSF examination for CSF examination for presence of true yeast presence of true yeast confirms diagnosisconfirms diagnosis
India Ink preparation India Ink preparation of centrifuged of centrifuged samples of CSF helps.samples of CSF helps.
Culturing on Fungal Culturing on Fungal medium confirms with medium confirms with Biochemical testsBiochemical tests
Now rapid testing for Now rapid testing for Antigen detection are Antigen detection are available.available.
Candida - AIDSCandida - AIDS
Many AIDS patients present with Oral Many AIDS patients present with Oral Candidosis Candidosis
Esophageal candidosis produces disabling Esophageal candidosis produces disabling complicationcomplication
Vulvovaginal candidosis is problematicVulvovaginal candidosis is problematic Any organ can be infectedAny organ can be infected C.albicans the most prominent pathogen in C.albicans the most prominent pathogen in
AIDSAIDS C.krusei and C.glabrata are other C.krusei and C.glabrata are other
prominent isolates.prominent isolates.
Common lesions in Candida Common lesions in Candida infection.infection.
Diagnosis of Candidal Diagnosis of Candidal infectionsinfections
Microscopical Microscopical examination of examination of various specimensvarious specimens
Culture on Fungal Culture on Fungal mediummedium
Biochemical tests Biochemical tests for identification of for identification of speciesspecies
HistoplasmosisHistoplasmosis
Histoplasma Histoplasma capsulatum capsulatum infections are infections are common in USAcommon in USA
They are present as They are present as soil inhabitants soil inhabitants
Loss of Cell mediated Loss of Cell mediated Immunity Immunity predisposes to predisposes to HistoplasmosisHistoplasmosis
HistoplasmosisHistoplasmosis
Severe disseminated Histoplasmosis develop in Severe disseminated Histoplasmosis develop in AIDS patientsAIDS patients
Fungi can be isolated from Sputum, Urine, and Fungi can be isolated from Sputum, Urine, and Bone marrowBone marrow
Diagnosis - Bone marrow smears stained with Diagnosis - Bone marrow smears stained with Giemsa stain give clues to diagnosis Giemsa stain give clues to diagnosis
Cultured on Sabourauds’ agar.Cultured on Sabourauds’ agar. Serology – presence of antibodies to H antigen Serology – presence of antibodies to H antigen
signifies active Histoplasmosis.signifies active Histoplasmosis. Testing for circulating Antigens more useful in Testing for circulating Antigens more useful in
disseminated Infections.disseminated Infections.
CoccidioidomycosisCoccidioidomycosis
Coccidioides immitis - a dimorphic Coccidioides immitis - a dimorphic fungusfungus
Patients with AIDS can manifest with Patients with AIDS can manifest with disseminated diseases disseminated diseases
Loss of Cell mediated immunity Loss of Cell mediated immunity predisposes to generalized infectionspredisposes to generalized infections
AIDS patients present with rapidly fatal AIDS patients present with rapidly fatal diffuse Reticuloendothelial pneumonitis..diffuse Reticuloendothelial pneumonitis..
C.immitis, is a C.immitis, is a established established pathogenpathogen
C.posadasii was C.posadasii was recently attributed recently attributed to infections in to infections in AIDS patient.AIDS patient.
C.posadasii differs C.posadasii differs from C.immitis on from C.immitis on DNA configurationDNA configuration
Seborrhic DermatitisSeborrhic Dermatitis
Produced by Produced by Malassezia fur furMalassezia fur fur
A common A common infection in Non infection in Non HIV patientsHIV patients
AIDS patients are AIDS patients are highly highly predisposed.predisposed.
Neoplasms in -Neoplasms in -AIDSAIDS
Kaposi's SarcomaKaposi's Sarcoma
Human herpes virus Human herpes virus type 8 predisposes type 8 predisposes Kaposi’s sarcoma in Kaposi’s sarcoma in AIDS patients.AIDS patients.
Lesions are pigmented.Lesions are pigmented. Well circumscribed Well circumscribed
lesionslesions May Involve May Involve
Lymphatics, Lymphatics, Lymphnodes,lungs and Lymphnodes,lungs and Gastrointestinal tractGastrointestinal tract
LymphomasLymphomas
Non Hodgkin's Non Hodgkin's large cell type large cell type
Associated with Associated with Epstein Barr virusEpstein Barr virus
Squamous cell Squamous cell CarcinomaCarcinoma
Associated with Associated with Human papilloma Human papilloma virusvirus
Cervix and Anus Cervix and Anus are involvedare involved
Created for benefit Created for benefit of Medical and of Medical and Paramedical Paramedical Health care Health care workers in workers in
Developing worldDeveloping worldDr.T.V.Rao MDDr.T.V.Rao MD
E mail E mail tvraodoctor2000@yahoo.co.intvraodoctor2000@yahoo.co.in
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