Search

Aspergillosis is widely regarded as an opportunistic infection of concern chiefly to physicians treating patients with terminal disease. Pulmonary aspergillosis is being recognized with increasing frequency as a cause of suppuration and hemorrhage. Twelve such cases and one of Aspergillus meningitis have been treated with 5-fluorocytosine. This oral medication has proved highly effective in many patients, with eradication of infection in several. In patients with underlying chronic pulmonary damage, drug resistance has developed, and relapse or reinfection has been frequent.

Aspergillosis is an opportunistic infection. It usually involves the lungs, but rarely involves the skin. An example of cutaneous involvement is presented. AspergiUosis as a cause of granulomatous lesions in debilitated patients is discussed.

Fifteen cyanotic patients with extreme pulmonic stenosis showed radiologic changes of apical pleural capping and parenchymal pseudofibrosis simulating chronic granulomatous chest disease. Repeated skin tests and sputum examination were negative except for one patient who developed terminal opportunistic infection with Aspergillus. The changes are ascribed to two major vascular complications of extreme pulmonic stenosis: (1) apical capping caused primarily by a plexus of transpleural collateral vessels and pleuritis following multiple small bleeds from these vessels; (2) parenchymal lesions caused both by varicosities of transpleural, bronchial and other collateral vessels and by thromboses in small pulmonary arteries. The syndrome occurred in patients with persistent cyanosis and polycythemia due to pulmonic stenosis who survived for 15 or more years. In some, apical pseudofibrotic changes were accompanied by recurrent small hemoptyses. If results of appropriate skin testing and sputum examination prove negative for granulomatous disease, the diagnosis of “pseudo-” pseudofibrosis of the cyanotic” should be considered in patients with the triad of cyanosis, reduced pulmonary blood flow and chronic apical pulmonary changes.

SUMMARY.— A patient is described with generalized mycosis fungoides who became severely demented. Autopsy showed that the dementia was due to progressive multifocal leukoencephalopathy. The presumed pathogenesis of this rare disorder of the nervous system was demonstrated by electron microscopical examination of necropsy samples of brain, which showed intranuclear viral filaments and rounded particles. This bizarre viral invasion of the brain is thought to be an opportunistic infection due to impairment of immune defences by the generalized reticulosis and the chemotherapy received by the patient.

A 42-year-old patient is reported in whom Mycobacterium kansasii pulmonary infection preceded the development of arthritis secondary to hematogenous spread. Contributing factors included systemic lupus erythematosus and corticosteroid therapy. Further, we present evidence that in M. kansasii infections, pulmonary lesions may precede extrapulmonary disease; hematogenous spread of infection likely represents the route through which joint disease evolves; previous damage to the joint whether from intrinsic disease as in rheumatoid arthritis, or extrinsic disease as in trauma, may be necessary for the development of infectious arthritis; and lastly, dissemination often represents opportunistic infection in patients who are immunologically compromised.

Background: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. Objective: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. Results: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). Conclusion: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV. Key words: HIV, AIDS, Opportunistic infection, Tuberculosis doi: 10.3126/kumj.v6i3.1708 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 335-339

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. More than 2 billion people are infected with TB bacilli worldwide. It is a leading public health problem particularly in the developing countries. The HIV epidemic has increased the global tuberculosis burden. TB is the commonest opportunistic infection and leading cause of mortality of People living with HIV (PLHA). Tuberculosis is a major public health problem in Nepal. The objective of the study is to determine prevalence of Pulmonary Tuberculosis among HIV positives attending HIV clinics in Eastern Nepal, and to assess the socio-demographic factors associated with TB and HIV/AIDS. Methodology: Cross-sectional prospective study was carried out among HIV positive attending different VCT and HIV clinics from Sunsari Morang and Jhapa district of Eastern Nepal. Face to face interview was performed and sputum sample were collected using convenience sampling technique. Data was collected from PLHA on related information on Socio-demographic profi le, risk taking behavior with the help of pretested semi-structured questionnaire. Univariate and bivariate analysis were performed using SPSS 15.0. Chi-squire test was performed to establish statistical signifi cance between dependent and independent variables. Results: Out of total 242 PLHA, 75.2% were males and 24.8% females; around half of them (48.8%) were in the age group of (30-39) yrs, 23% in (25-29) yrs, and 15.7% in (20-24) years. Prevalence of pulmonary tuberculosis was found to be 27.3% (n=66). PTB was high among IDU’s (48.6%), followed by clients of CSWs (21%), housewife (13.6%), highway truck drivers (10.6%) and CSWs (6%). Conclusion: Prevalence of PTB is very high among PLHA attending VCT & HIV clinics of Eastern Nepal. This study reveals that PTB is signifi cantly associated with increasing age, risk taking behavior and place of residence. There is urgent need of active case fi nding as well as periodic screening among people living with HIV/AIDS of this region to address HIV-associated TB morbidity and mortality. DOI: http://dx.doi.org/10.3126/saarctb.v8i1.5885 SAARCTB 2011; 8(1): 1-8

During the decade 1960–1969, Nocardia asteroides was isolated from sputum, abscesses or exudates in twenty-two patients at Memorial Hospital. These patients could be divided into two groups. Group I consisted of thirteen patients with underlying neoplasms receiving radiation or chemotherapy in whom unequivocal evidence of nocardial infection developed. Clinical manifestations included bronchopneumonia, lobar pneumonia, necrotizing pneumonia with single or multiple abscesses, and brain, hepatic or scrotal abscesses. Ten patients had either leukemia or lymphoma. The simultaneous presence of tumor and nocardial infection in the lung was noted in five cases. Sputums or exudates from the patients in group I were positive for organisms simultaneously in both culture and smear in only a third of examinations; this stresses the need for multiple bacteriologic examinations when the diagnosis of nocardiosis is suspected. Although the underlying disease was usually progressively fatal, an excellent response to sulfonamides with resolution of pulmonary disease was noted in several patients who were maintained on anticancer therapy. Group II was composed of nine patients with predominantly respiratory symptoms and fever. Multiple positive cultures were obtained in many of these patients, but all lacked objective pulmonary findings and symptoms usually resolved without treatment. Such cases may represent milder nocardial infections of the upper respiratory tract although a saprophytic role for nocardia cannot be ruled out. These observations indicate that nocardiosis is a significant and often fatal opportunistic infection in patients being treated for cancer, but further studies are needed to define the clinical and epidemiologic spectrum of this disease in man.

Background: Opportunistic intestinal infections cause a significant morbidity and mortality among the HIV infected people. The present study was undertaken to find the prevalence of intestinal opportunistic parasitic infections among the HIV infected populace in eastern Nepal and to correlate the occurrence with the CD4 T cell counts. Materials and Methods: Stool from 122 HIV infected people were examined microscopically for the presence of parasitic ova/cyst. CD4 T cell enumeration was done using FACS Count (Becton Dickinson). Stool from 100 age matched HIV negative controls were also examined. Results: A male preponderance in the parasite positivity was seen. Twenty five of symptomatic and 2.8% of asymptomatic harboured one or more intestinal parasites.12.3% of the study population had intestinal parasitoses with 7.3% being infected with opportunistic parasites. The mean CD4 count of the subjects was 307 while those with parasitoses were 204. A statistically significant difference was seen between the CD4 counts of symptomatic and asymptomatic patients. Conclusion: Coccidian parasites are frequent opportunistic intestinal parasites infecting HIV infected patients. A lowered CD4 count predisposes to acquisition of these agents. Regular monitoring of CD4 counts and screening for these opportunistic agents in the HIV infected will help reduce the mortality and morbidity associated with infections by these agents. Keywords: HIV; Opportunistic infection; CD4 count; AIDS DOI: http://dx.doi.org/10.3126/jpn.v1i2.5405 JPN 2011; 1(2): 118-121

Background : An estimated 2.47 million (2.0-3.1 million) people were living with HIV/AIDS in India by the end of 2006. Among those HIV infected individuals, TB was the commonest opportunistic infection and leading cause of mortality. HIV infection makes a person susceptible to both pulmonary and extra pulmonary forms of TB. Various studies have documented the occurrence of TB from 46 to 65 percent. However, provision of HIV screening services for Tuberculosis out patient attendees is limited at present. Aims : To study feasibility of counseling for HIV screening and document the prevalence of HIV among TB out patient attendees. Methods : This prospective explorative study included persons who sought TB screening at TB unit, Madurai from Jan 2003- Feb 2004. An interview schedule was developed to obtain information on socio-demographic profi le, risk behavior profi le and test results. Information collected includes socio-demographic profile, risk behavior profi le and reaction to test results. Univariata and bivariate analyses were performed using Epi-info 6.04 (CDC, Atlanta, GA, July 1996). Chi-square test, student "t" test and one way ANOVA tests were performed to establish statistical signifi cance between dependent and independent variables Results : This study has found 57.66% chest symptomatic attending TB out patient ward were HIV positive. An analysis of risk profile versus positive results showed that 47(n=75) and 48(n=90) who admitted and denied high-risk behavior respectively, found to be positive to HIV screening test. Conclusion : The researchers suggest that HIV counseling and testing services can be offered to all chest symptomatic attending TB out patient ward. This structural change will make HIV screening more effective and benefi cial to patient community by ensuring early detection HIV infection. DOI: 10.3126/saarctb.v6i1.3060 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (1) 16-24

SummaryA recent decrease in the frequency and severity of infections caused by P. aeruginosa, which had become the prototype of severe opportunistic infection, can be attributed, in part at least, to the development of new potent antipseudomonal antibiotics.However, prevention of this type of infection by the promotion of a high standard of nursing care and maybe also by the use of antipseudomonal vaccines remains the most important approach to the control of the infections caused by P. aeruginosa in the susceptible patients.

Leukocyte chemotaxis in vitro was studied by a modification of the Boyden technic in 46 thermally injured patients. All patients demonstrated a decrease in leukocyte migration through a Nuclepore filter toward a standard casein-serum chemotactic agent. Leukocyte chemotaxis was inversely correlated with burn size during the first 72 h after injury. After 72 h, leukocyte chemotaxis directly correlated with clinical status and was highly predictive for ultimate mortality. Since mortality was largely due to infection, these findings suggest that suppression of leukocyte chemotaxis may explain the susceptibility to opportunistic infection in thermally injured patients.

The high incidence of EB virus infections (and possibly of other viruses) in patients with African lymphoma and, to a lesser extent, in patients with lymphosarcoma in the temperate zones, is thought to be due to its being a passenger virus which persists in the human body and, since it is lymphotropic, presents an opportunistic infection of proliferating lymphoid cells. The thesis is put forward that by entering the cell nucleus, the virus renders malignant lymphoid cells more vulnerable to cytotoxic drugs. Hence a deliberate policy of EB virus inoculation before starting chemotherapy might achieve a more rapid response and longer remissions in indigenous lymphomas of the temperate zones, and might possibly render drug-resistant cases once more drug-sensitive.

This is a report of a documented case of empyema caused by Corynebacterium pyogenes , successfully treated with penicillin, in a patient presenting with widespread carcinoma of the breast. Also included are a review of the biochemical and cultural characteristics of the organism and a survey of the world's literature on the subject of human infection caused by this bacterium.

Summary. Active tuberculous infection was present in 4.6% of patients with haematological diseases as compared to 0.2% of other patients admitted over a similar period of time. There was no evidence either in the literature or in these cases that tuberculosis gave rise to an unusual leukaemoid response. It was more likely that the blood disorder (leukaemia, marrow failure or vitamin B12 deficiency) resulted in loss or diminution of the normal immune response and that this permitted reactivation of an old tuberculous lesion or in a new opportunistic infection.

Meningitis caused by L. monocytogenes is discussed from the standpoints of clinical presentation and course, underlying illness, and altered host resistance. The `opportunistic' nature of the infection is emphasized, and case histories of patients with diseases which may specifically alter host resistance in such a fashion as to render the patient susceptible to this organism, or who are receiving drugs which may have the same result, are presented. The critical role of host macrophages, and the alteration of this role by Hodgkin's disease, leukaemia, and cytotoxic drug therapy are emphasized.

INFECTIONS with organisms of low pathogenicity often complicate the treatment of malignant lymphoma. Bacteria and viruses harmless to healthy persons may be fatal to patients with lowered resistance; certain fungi have become notorious for such "opportunistic infections." 1 If a lowly fungus can be called "opportunistic," surely the opprobrium can be applied to a parasitic worm aggressively invading a weakened host. Infections with Strongyloides stercoralis , seldom serious in otherwise healthy persons, can cause the death of those debilitated from malnutrition or other illness. To our knowledge, strongyloidiasis has not been previously reported in association with malignant diseases of the lymphatic system. Report of Cases Case 1.— A 63-year-old white farmer was admitted to the hospital after eight months of weakness, itching, cough, anorexia, and weight loss. The spleen, liver, and superficial lymph nodes were enlarged. The platelet count was 16,000/cu mm and the white blood cell count (WBC) was 2,450/cu

There have been four reports of systemic sporotrichosis developing in patients after an initial diagnosis of sarcoidosis. We have recently seen a fifth patient who had both diseases. The coexistence of these two uncommon diseases suggests that there is a meaningful relationship between them. This relationship could be interpreted in two ways. An unrecognized infection with Sporotrichum schenckii might have caused the noncaseating epithelioid granulomas which were then erroneously diagnosed as sarcoidosis. Or alternately, opportunistic infection with S schenckii might have occurred in patients with true sarcoidosis. A final choice between these two explanations is impossible at this time, but steroid treatment in three patients and the abnormalities in immune response which are known to occur in sarcoidosis lead us to favor the second explanation.