Infection In Aids Upload

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 [email protected]@yahoo.co.in