OPPORTUNISTIC INFECTIONS

By: VAISHNAVI PRABHAKAR 2ND YEAR M.B.B.S T.M.C

An opportunistic infection is an infection caused by pathogens that usually do not cause disease in a healthy immune system. A compromised immune system, however, presents an opportunity for the pathogens to infect.

An infection that is normally mild in a healthy individual, but which takes advantage of an ill person's weakened immune system to move into the body, grow, spread, and cause serious illness. - Gale Encyclopedia of Medicine An infection by a microorganism that normally does not cause disease but becomes pathogenic when the body's immune system is impaired and unable to fight off infection, as in AIDS and certain other diseases. - The American Heritage Medical Dictionary

IMMUNODEFICIENCY (OR) IMMUNOSUPPRESSION CAN BE CAUSED BY

1. 2. 3. 4. 5. 6. 7. 8. 9.

Malnutrition Recurrent infections Immunosuppressing agents for organ transplant recipients Chemotherapy for cancer AIDS or HIV infection Genetic predisposition Skin damage Antibiotic treatment Medical procedures

10. Pregnancy

OUTLINE

NEUROLOGICAL

PROTOZOAL

VIRAL

BACTERIAL

MALIGNANCIES OPPORTUNISTIC INFECTION

OTHER CONDITIONS AND COMPLICATIONS

AND MYCOBACTERIAL

FUNGAL

BACTERIAL AND MYCOBACTERIAL

MYCOBACTERIUM AVIUM COMPLEX

FUNGAL
ASPERGILLOSIS

PROTOZOAL
CRYPTOSPORIDIOSIS

VIRAL
CYTOMEGALOVIRUS HEPATITIS HERPES SIMPLEX

CANDIDIASIS COCCIDIODOMYCOSIS CRYPTOCOCCAL MENINGITIS HISTOPLASMOSIS

ISOSPORIASIS

SALMONELLOSIS
SYPHILIS AND NEURO SYPHILIS TUBERCULOSIS BACILLARY ANGIOMATOSIS

MICROSPORIDIOSIS
PNEUMOCYSTIS CARINI PNEUMONIA

HUMAN PAPILOMA VIRUS

MOLLUSCUM CONTAGIOSUM ORAL HAIRY LEUKOPLAKIA
PROGRESSIVE MULTIFOCAL LEUKONCEPHALOPATHY

TOXOPLASMOSIS

NEUROLOGICAL CONDITIONS
AIDS DEMENTIA COMPLEX PERIPHERAL NEUROPATHY

MALIGNANCIES
KAPOSIS SARCOMA

OTHER CONDITIONS
APTHOUS ULCER

SYSTEMIC NON HODGKINS LYMPHOMA PRIMARY CNS LYMPHOMA

MALABSORPTION

BACTERIAL AND MYCOBACTERIAL

1.MYCOBACTERIUM AVIUM COMPLEX
2.SALMONELLOSIS 3.SYPHILIS AND NEURO SYPHILIS 4.TUBERCULOSIS 5.BACILLARY ANGIOMATOSIS

MYCOBACTERIUM AVIUM COMPLEX

1. They penetrate the gastrointestinal mucosa by unknown mechanisms and are phagocytosed by macrophages in the lamina propria. 2. Immune cells cannot kill the organisms, and MAC spreads through the submucosa 3. Lymphatic drainage transports mycobacteria to abdominal lymph nodes, from which the organisms enter the bloodstream. 4. Hematogenous spread can occur to many sites, but spleen, bone marrow, and liver are the most common. 5. Tissue destruction is rare, and most signs and symptoms of MAC disease are due to elaboration of cytokines. 6. MAC is rarely the direct cause of death but increases the risk for superinfection; death may result from malnutrition

SALMONELLOSIS

1. Salmonellosis is an infection with bacteria called Salmonella.

2. Most persons infected with Salmonella develop diarrhea, fever, and

abdominal cramps 12 to 72 hours after infection. 3. The illness usually lasts 4 to 7 days, and most persons recover without

treatment. However, in some persons, the diarrhea may be so severe

that the patient needs to be hospitalized. 4. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. 5. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.

SYPHILIS AND NEURO SYPHILIS

1. Syphilis is a bacterial infection (Treponema pallidum) that is most often spread by sexual contact.

2. The infection usually causes disease over a course of several years.

3. In the early stages, syphilis causes disease of the genitals, mucous membranes and skin.

4. If it is not treated, syphilis can lead to serious problems, such as heart

problems, neurological problems (neurosyphilis), blindness,

dementia, and death. 5. Syphilis different stages. 6. Primary syphilis, Secondary syphilis, Latent syphilis, Tertiary syphilis, neurosyphilis

1.

PRIMARY SYPHILIS A painless sore called chancre. Develops within two to six weeks Usually Develops On The Penis, Vulva, Vagina Or Anus 2. SECONDARY SYPHILIS Outbreak of small, pox-like lesionsusually brownish-pink in colorseem like a non-itchy rash when clustered together. Can appear anywhere on the body, but a rash and lesions on the palms and soles of the feet are classic symptoms of secondary syphilis. Can Occur Months To Years After Primary Syphilis, And Can Last Two Years Or More. 3. TERTIARY SYPHILIS Bacteria can spread and damage internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. This can lead to a variety of serious health problems, including stroke, paralysis, aneurysms, and heart disease.

NEUROSYPHILIS
occurs when T. pallidum infects the brain or spinal cord . Infection can occur during any syphilis stage and can cause serious neurological damage, including paralysis, numbness, gradual blindness and deafness. Neurosyphilis can be serious enough to cause permanent disability or death. Studies have found that HIV-positive people infected with T. pallidum are more likely to develop neurosyphilis, even during the early stages of infection.

TUBERCULOSIS

Caused by mycobacteria, mainly mycobacterium tuberculosis. Usually attacks LUNGS. Can also affect CNS, lymphatic system, circulatory system, genitourinary system, gastrointestinal system, bones, joints and even the skin. The classic symptoms of tuberculosis are a chronic cough wit blood- tinged sputum, fever, night sweats and weight loss. Diagnosis relies on chest x-rays, tuberculin skin test, examination of microbiological culture of body fluids.

BACILLARY ANGIOMATOSIS
1. Caused By Either Bartonella Henselae Or Bartonella Quintana. 2. Bartonella henselae is most often transmitted through a cat scratch or bite,] though ticks and fleas may also act as a vector. 3. 4. Bartonella quintana is usually transmitted by lice. BA is characterized by the proliferation of blood vessels, resulting in them forming tumour-like masses in the skin and other organs.

5.

Cutaneous BA is characterised by the presence of

lesions on or under the skin. (lesion-several forms).

FUNGAL
1.ASPERGILLOSIS 2.CANDIDIASIS 3.COCCIDIODOMYCOSIS 4.CRYPTOCOCCAL MENINGITIS 5.HISTOPLASMOSIS

ASPERGILLOSIS
1. Aspergillosis is the name given to a wide variety of diseases caused by fungi of the genus Aspergillus. 2. The most common forms are allergic bronchopulmonary aspergillosisallergic bronchopulmonary aspergillosis, pulmonary aspergilloma and invasive aspergillosis. 3. Most humans inhale Aspergillus spores every day, 4. most common cause is aspergillus fumiaatus Aspergillus fumigatus. 5. May cause repeated coughing up of blood and occasionally

severe, even fatal, bleeding.

6. Rapidly invasive infection - lungs (causes cough, fever, chest pain, and difficulty breathing).

7. Aspergillosis affecting the deeper tissues

makes a person very ill. 8. Symptoms include fever, chills, shock, delirium, and blood clots. 9. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties. Death can occur quickly.

10. Aspergillosis of the ear canal causes itching

and occasionally pain. Fluid draining overnight from the ear may leave a stain on the pillow. Aspergillosis of the sinuses causes a feeling of congestion and sometimes pain or discharge.

CANDIDIASIS
1. Candidiasis, commonly called yeast infection or thrush, is a fungal infection (mycosis) of any of the candida species, of which candida albicans is the most common.

2. Candidiasis encompasses infections that range from superficial,

such as oral thrush and vaginitis, to systemic and potentially lifethreatening diseases. 3. Most candidial infections are treatable and result in minimal

complications such as redness, itching and discomfort, though

complication may be severe or fatal if left untreated in certain populations. 4. In immunocompetent persons, candidiasis is usually a very localized infection of the skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the

gastrintestinal tract, the urinary blader, or the genitalia.

TYPES OF CANDIDIASIS
THRUSH
Mouth infection caused by Candida Albicans

ESOPHAGITIS
Thrush spreads to esophagus

CUTANEOUS C ANDIDIASIS
yeast infections that affect the skin; most common diaper rash, hands exposed to moisture, groins areas and buttocks exposed to moisture, and has also been known to grow in the underneath the skin folds of large breasted women

DEEP CANDIDIASIS
A yeast infection that contaminates the bloodstream and then is capable of spreading throughout the body; this type of infections is potentially very deadly.

COCCIDIODOMYCOSIS

1. Coccidioidomycosis (also known as valley fever,

San Joaquin Valley fever, California valley fever,

and desert fever) is a fungal disease caused by coccidioides immitis or C. posadasiiC.posadasi . 2. It is endemic in certain parts of Arizona, California, Nevada, New Mexico, Texas, Utah and northwestern Mexico. 3. The disease is usually mild, with flu like symptoms and rashes.

CRYPTOCOCCAL MENINGITIS
1. Cryptococcal meningitis the brain and spinal cord), caused by the fungus Cryptococcus neoformans. 2. Cryptococcus neoformans is found in soil around the world.

Cryptococcal meningitis most often affects people with

compromised immune systems. Risk factors include AIDS, lymphoma and diabetes. It occurs in 5 out of 1 million people.

3. Symptoms
Headache Fever Nausea and vomiting Stiff neck Sensitivity to light (photophobia) Change in mental status
DISTENTION OF PERIVASCULAR SPACES WHICH IMPARTS A SWISS CHEESE APPEARANCE TO THE BRAIN.

Hallucinations

HISTOPLASMOSIS
1. Histoplasmosis - Histoplasma capsulatum
fungus. 2. Also known as Ohio River Valley fever. 3. The infection enters the body through the lungs. 4. Histoplasma fungus grows as a mold in the soil, and infection results from breathing in airborne particles. 5. symptoms manifests within 3 to 17 days after exposure;

6. Most affected individuals have clinically silent

manifestations and show no apparent ill effects.

HISTOPLASMOSIS
1. The acute phase of histoplasmosis -non-specific
respiratory symptoms, often cough or flu-like. Chest xray findings are normal in 4070% of cases. 2. Chronic histoplasmosis disseminated cases can resemble affects

tuberculosis;

histoplasmosis

multiple organ systems and is fatal unless treated. 3. Severe infections can cause hepatosplenomegaly,

lymphadenopathy, and adrenal enlargement. Lesions

have a tendency to calcify as they heal. 4. Ocular histoplasmosis damages the retina of the eyes. Scar tissue is left on the retina which can experience leakage, resulting in a loss of vision not unlike macular degeneration.

PROTOZOAL
1. 2. 3. 4. CRYPTOSPORIDIOSIS ISOSPORIASIS MICROSPORIDIOSIS PNEUMOCYSTIS

5.
6.

CARINI PNEUMONIA
TOXOPLASMOSIS

CRYPTOSPORIDIOSIS
1. Cryptosporidiosis is a parasitic disease caused by
cryptosporidium. 2. It affects the intestines of mammals and is typically an acute short-term infection.

3.

It is spread through the fecal-oral route; the main symptom is

self-limiting diarrhea in people with intact immune systems.

4.

In immunocompromised individuals, such as AIDS patients, the symptoms are particularly severe and often fatal.

5. As well as watery diarrhea, there is often stomach pains or

cramps and a low fever. 6. Some individuals are asymptomatic but can pass on the infection to others. Even after symptoms have finally subsided

an individual is still infective for some weeks.

7. Severe diseases, including pancreatitis can occur.

ISOSPORIASIS
1. Isosporiasis is a human intestinal disease caused by the parasite
Isospora belli. 2. Infection causes acute, non-bloody diarrhea with crampy abdominal pain, which can last for weeks and result in malabsorption and weight loss. 3. In immunodepressed patients, and in infants and children, the diarrhea can be severe. Eosinophilia may be present (differently from other protozoan infections). 4. They are resistant and remain viable in the environment for months. 5. Ingestion of mature I belli oocysts leads to invasion of the epithelial cells of the distal duodenum and proximal jejunum, with resulting cell

damage.
6. Symptoms of isosporiasis suggest a toxin-mediated mechanism, but no toxin has been identified.

MICROSPORIDIOSIS
1. Microspridiosis is an opportunistic intestinal infection that causes diarrhea and wasting in immunocompromised individuals. 2. In HIV infected individuals, microsporidiosis generally occurs when CD4+ T cell counts fall below 100. 3. At least 14 microsporidian species have been recognized as human pathogens, spread across eight genera: 4. The primary causes are Enterocytozoon bieneusi and Encephalitozoon intestinalis.

PNEUMOCYSTIS
1. Pneumocystis pneumonia (PCP) is a form of pneumonia caused by the yeast-like fungus, Pneumocystis jirovecii. 2. Symptoms of PCP include fever, non-productive cough, shortness of breath (especially on exertion), weight loss and night sweats. There is usually not a large amount of sputum with PCP unless the patient has an additional bacterial infection. The fungus can invade other visceral organs, such as the liver, spleen and kidney, but only in a minority of cases. 3. The risk increases when CD4 positive cell levels are less than 200 cells/l. 4. The disease attacks the interstitial, fibrous tissue of the lungs, with marked thickening of the alveolar septa and alveoli and leading to significant hypoxia which can be fatal. 5. Oxygen is less able to diffuse into the blood, leading to hypoxia. Hypoxia, along with high arterial carbon dioxide (CO2) levels, stimulates ventilation, thereby causing dyspnea.

TOXOPLASMOSIS
1. Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. 2. primary host is the felid (cat) family. 3. During the first few weeks, the infection typically causes a mild flu-like illness or no illness. 4. The parasite can cause encephalitis (inflammation of the brain) and neurologic diseases and can affect the heart, liver, and eyes (chorioretinitis). 5. Infection has two stages: Acute toxoplasmosis During acute toxoplasmosis, symptoms are often influenza like: swollen lymph nodes, or muscle aches and pains that last for a month or more. Latent toxoplasmosis in the latent phase only bradyzoites are present, forming cysts in nervous and muscle tissue.

VIRAL
1. 2. 3. 4. 5. 6. 7. 8. CYTOMEGALOVIRUS HEPATITIS HERPES SIMPLEX HUMAN PAPILOMA VIRUS MOLLUSCUM CONTAGIOSUM ORAL HAIRY LEUKOPLAKIA PROGRESSIVE MULTIFOCAL LEUKONCEPHALOPATHY

CYTOMEGALOVIRUS
1. In humans it is commonly known as HCMV or Human Herpesvirus 5 (HHV-5). 2. HCMV infections are frequently associated with salivary glands, though they may be found throughout the body. 3. Some of them develop an infectious mononucleosis/glandular fever-like syndrome, with prolonged fever, and a mild hepatitis. A sore throat is common. 4. Initial HCMV infection, which often is asymptomatic is followed by a prolonged, in apparent infection during which the virus resides in cells without causing detectable damage or clinical illness. 5. Infectious CMV may be shed in the bodily fluids of any infected person, and can be found in urine, saliva, blood, tears, semen, and breast milk. 6. CMV infection can be demonstrated microscopically by the detection of intranuclear inclusion bodies. The inclusion bodies stain dark pink by H&E staining, and are called "Owl's Eye" inclusion bodies. 7. Lyrically replicating virus disrupts the cytoskeleton, causing massive cell enlargement, which is the source of the virus' name.

CYTOMEGALOVIRUS

HEPATITIS
1. Hepatitis (plural hepatitides) implies injury to the liver characterized by
the presence of inflammatory cells in the tissue of the organ. 2. The condition can be self-limiting, healing on its own, or can progress to scarring of the liver. 3. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. 4. A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide. Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process. 5. It may run a subclinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs

liver functions that include, among other things, removal of harmful

substances, regulation of blood composition, and production of bile to help digestion.

 Symptoms Acute Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice (33%) and tender hepatomegaly (10%). There can be occasional lymphadenopathy (5%) or splenomegaly (5%). Chronic Majority of patients will remain asymptomatic or mildly symptomatic, abnormal blood tests being the only manifestation. Features may be related to the extent of liver damage or the cause of hepatitis. Many experience return of symptoms related to acute hepatitis. Jaundice can be a late feature and may indicate extensive damage. Other features include abdominal fullness from enlarged liver or spleen, low grade fever and fluid retention (ascites). Extensive damage and scarring of liver (i.e., cirrhosis) leads to weight loss, easy bruising and bleeding tendencies. Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.

HERPES SIMPLEX
1. Herpes simplex is a viral disease caused by Herpes simplex
viruses; both herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). 2. categorized based on the site of infection. 3. Oral herpes, the visible symptoms of which are colloquially called cold sores, infects the face and mouth. Oral herpes is the most common form of infection. 4. Infection of the genitals, commonly known as herpes, is the second most common form of herpes. 5. Other disorders such as herpetic whitlow, herpes gladiatorum,

ocular herpes (keratitis), cerebral herpes infection encephalitis,

Mollaret's meningitis, neonatal herpes, and possibly Bell's palsy are all caused by herpes simplex viruses.

HERPES SIMPLEX

Herpes viruses cycle between periods of active diseasepresenting as blisters containing infectious virus particlesthat last 221 days, followed by a remission period, during which the sores disappear. Genital herpes, however, is often asymptomatic, though viral shedding may still occur. After initial infection, the viruses move to sensory nerves, where they reside as life-long, latent viruses. Causes of recurrence are uncertain, though some potential triggers have been identified. Over time episodes of active disease reduce in frequency. Herpes simplex is most easily transmitted by direct contact with a lesion or the body fluid of an infected individual. Transmission may also occur through skin-to-skin contact during periods of asymptomatic shedding. Barrier protection methods are the most reliable, but not failsafe, method of preventing transmission of herpes. Oral herpes is easily diagnosed if the patient presents with visible sores or ulcers. Early stages of orofacial herpes and genital herpes are harder to diagnose; laboratory testing is usually required. Prevalence of HSV infections varies throughout the world. Poor hygiene, overcrowding, lower socioeconomic status, and birth in an undeveloped country have been identified as risk factors associated with increased HSV-1 childhood infection. Additional studies have identified other risk factors for both types of HSV. There is currently no cure for herpes; no vaccine is currently available to prevent or eliminate herpes, although vaccines of varying effectiveness are currently in phase III trials. Also, treatments are available to reduce viral reproduction and shedding, prevent the virus from entering the skin, and alleviate the severity of symptomatic episodes.

HUMAN PAPILLOMA VIRUS

1. A human papillomavirus (HPV) is a papillomavirus that infects the skin and mucous membranes of humans. 2. Approximately 130 HPV types have been identified. Some HPV types can cause warts (verrucae) or some types of cancer, while others have no symptoms. 3. About 30-40 HPV types are typically transmitted through sexual contact and infect the anogenital region. 4. Some sexually transmitted HPV types may cause genital warts. 5. Persistent infection with "high-risk" HPV types different from the ones that cause warts may progress to precancerous lesions and invasive cancer. HPV infection is a cause of nearly all cases of cervical cancer. However most infections with these types do not cause disease. 6. A cervical Pap smear is used to detect cellular abnormalities. This allows targeted surgical removal of condylomatous and/or potentially precancerous lesions prior to the development of invasive cervical cancer. 7. HPV vaccines, Gardasil and Cervarix, which prevent infection with some of the sexually transmitted HPV types that cause the most disease may lead to further decreases in the incidence of HPVinduced cancers.

HUMAN PAPILLOMA VIRUS

MOLLUSCUM
1. Molluscum contagiosum virus (MCV) is a viral infection of the skin or occasionally of the mucous membranes. MC has no animal reservoir, infecting only humans, as did smallpox. 2. There are four types of MCV, MCV 1 to 4; 3. 4. MCV-1 is the most prevalent MCV-2 is seen usually in adults and often sexually transmitted.

5. The infection is most common in children aged 1 to 10 years old.

6.

MC can affect any area of the skin but is most common on the body,
arms, and legs.

7. spreads through direct contact or shared items such as clothing or towels. 8. In adults, molluscum infections are often sexually transmitted and usually affect the genitals, lower abdomen, buttocks, and inner thighs. In rare cases, infections are also found on the lips, mouth, and eyelids.

ORAL HAIRY LEUKOPLAKIA

1. Hairy leukoplakia is a white patch on the side of the tongue with a corrugated or hairy appearance. 2. Hairy leukoplakia is seen in severe defects of immunity, particularly in HIV infection. The cause of this condition is an opportunistic infection by the Epstein-Barr virus. Oral hairy leukoplakia is not

associated with any malignant potential.

3. The condition does not cause any other symptoms and does not require any treatment. If treatment is required, acyclovir is used.

CONCLUSION

Healthy way of living

and a happy mind

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