A study of clinical spectrum of opportunistic infections in HIV infected children and its correlation with CD4 count and anti-retroviral therapy

Background: To determine the clinical spectrum and prevalence of opportunistic infections (OIs) in HIV infected children and correlate the occurrence of opportunistic infections with their CD4 count and Anti-retroviral treatment (ART).Methods: A total of 100 HIV infected children diagnosed with opportunistic infections were included in the study. Demographic details, clinical examination and relevant investigations were done for all the children. Clinical spectrum of OIs and HIV staging was recorded. CD4 counts were done at baseline and were repeated at 6 monthly intervals.Results: Mean age of the patients was 7.08±3.48 years (ranging from 6 months to 15 years) at enrollment with male to female ratio of 1.2:1. Fever (91%) was a common presenting symptom followed by weight loss (74%), cough (37%), abdominal pain (29%) and breathlessness (16%). CD4 count was significantly associated with presence of opportunistic infection in the study group. Tuberculosis - pulmonary (32%) and extra-pulmonary (29%) was the most common oppurtunistic infections, followed by oral thrush (13%), Herpes zoster (10%), Molluscum Contagiosum (9%), Pneumocystis jiroveci pneumonia (3%), Parvovirus infection (3%) and Pruritic Papular Eruptions (2%). 70% children were on ART as per clinical and immunological staging of HIV.Conclusions: Low CD4 count is significantly associated with severe opportunistic infections, therefore drop in CD4 count should serve as an alarming signal for the treating physician. High index of suspicion is required to detect opportunistic infections and therefore CD4 counts should be done more frequently to predict occurrence of OIs.

Download Full-text

Hematological abnormalities in HIV infected individuals in correlation to CD4 counts and ART status

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i4.14033 ◽

2016 ◽

Vol 7 (4) ◽

pp. 14-18 ◽

Cited By ~ 1

Author(s):

R Raman Thulasi ◽

D Manimaran ◽

G Hemanathan ◽

Tameem Afroz ◽

Radha Sagar

Keyword(s):

Opportunistic Infections ◽

Hematological Parameters ◽

Cd4 Count ◽

Health Concern ◽

Medical Sciences ◽

Cd4 Counts ◽

Medical Centers ◽

Hematological Abnormalities ◽

Set Up ◽

One Year

Background: HIV is pandemic and remains as a public health concern for many decades. This infection though associated with many opportunistic infections and neoplasms, it is further complicated with marked hematological abnormalities. The aim of this study is to determine the magnitude & severity of hematological abnormalities in HIV infected individuals and also to analyze these abnormalities in correlation with the CD4 counts. We also compared these hematological abnormalities in patients on ART and those not on ART.Materials and Methods: The study was conducted for a period of one year, on 120 HIV positive cases including both patients on ART & not on ART. Controls with similar age and sex distribution was set up. The blood samples were collected and processed in an automated cell counter. The parameters were tabulated and analyzed with respect to CD4 count & ART status.Results: Among the total of 120 HIV cases, 77% had anemia, 21% had leucopenia and 5% had thrombocytopenia. The magnitude and severity of anemia, leucopenia, thrombocytopenia and other parameters was found to be more in patients not on ART, when compared to patients on ART. Similarly, the magnitude and severity of most of hematological abnormalities were inversely proportional to the CD4 count in non-ART cases but not with cases on ART.Conclusion: The basic hematological parameters can be used as a prospective screening test to assess the severity and progression of HIV infection when CD4 count is not available. These parameters can also be used to assess the response to anti-retroviral treatment. Therefore, these basic hematological investigations readily available at all medical centers are of great use while treating HIV infected patients.Asian Journal of Medical Sciences Vol.7(4) 2016 14-18

Download Full-text

Co-infection by Cryptococcus neoformans fungaemia and Non tuberculous Mycobacterium together with Pneumocystis jiroveci pneumonia in a patient with newly diagnosed HIV infection

10.22541/au.161415032.29795885/v1 ◽

2021 ◽

Author(s):

Eihab Subahi ◽

safwan aljafar ◽

haidar barjas ◽

Mohamed Abdelrazek ◽

Fatima Rasoul

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Cryptococcus Neoformans ◽

Opportunistic Infections ◽

Newly Diagnosed ◽

Aids Patients ◽

Pneumocystis Jiroveci ◽

Pneumocystis Jiroveci Pneumonia ◽

Immunodeficiency Virus

Opportunistic infections are common in human immunodeficiency virus (HIV)-infected patients. Co-infections with Cryptococcus neoformans together with Mycobacterium and Pneumocystis jiroveci pneumonia (PCP) are rare, and typically occur in immunocompromised individuals, particularly AIDS patients.

Download Full-text

Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4997 ◽

2015 ◽

Vol 9 (01) ◽

pp. 060-069 ◽

Cited By ~ 8

Author(s):

Nermin Kamal Saeed ◽

Eman Farid ◽

Afaf E Jamsheer

Keyword(s):

Bacterial Infections ◽

Opportunistic Infections ◽

Arab World ◽

Cd4 Count ◽

Hiv Positive ◽

Pneumocystis Jirovecii Pneumonia ◽

Cd4 Counts ◽

Significant Difference ◽

Streptococcus Milleri ◽

Mycobacteria Other Than Tuberculosis

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians’ awareness to improve care of HIV-infected patients.

Download Full-text

A Clinical Profile and Co-morbidities of Pemphigus Vulgaris Patients: A Study of 35 Cases

KYAMC Journal ◽

10.3329/kyamcj.v10i2.42789 ◽

2019 ◽

Vol 10 (2) ◽

pp. 106-109

Author(s):

Md Abdur Razzaque ◽

Zulfikar Ali ◽

Kazi Shihab Uddin ◽

Md Imtiajul Islam ◽

Sajib Kumar Nath

Keyword(s):

Pemphigus Vulgaris ◽

Skin Lesions ◽

Cutaneous Lesions ◽

Female Ratio ◽

Medical College ◽

Autoimmune Blistering Disease ◽

Blistering Disease ◽

High Index Of Suspicion ◽

Male To Female ◽

Sixth Decade

Background: Pemphigus vulgaris (PV), an autoimmune blistering disease involving the skin and mucosa. PV frequently begins with oral lesions and progresses to skin lesions. Autoimmune bullous skin disorders are associated with IgG or IgA auto- antibodies against distinct adhesion molecules of the epidermis and dermal epidermal basement membrane zone, respectively. These auto- antibodies lead to a loss of skin adhesion which shows up clinically as the formation of blisters or erosions. Objectives: To characterize the clinical parameters and co-morbidities of PV patients from a single tertiary medical centre in Bangladesh. Material and Methods: This observational study was done including 35 PV patients attending in the department of Dermatology and Venereology, Khwaja Yunus Ali Medical College Khawja Eunus Ali Medical College from 2010 to 2014. Thirty patients of pemphigus diagnosed clinically confirmed and treated over a 4-year period (2010-2014). Results: Majority of the patients 45.7% belongs to age group 41-50 years. Mean age 47.12±11.13. The male to female ratio in our study sample was 1:1.5. The youngest patient was 17 years old and the oldest 68. For both genders, the risk of onset peaked during the fifth and sixth decade of life. Out of 35 patients, 15(42.9%) was presented with mucosal lesions only, while 13 patients 37.1% had mucocutaneous lesions and 7 patients 20% had only cutaneous lesions. The most common comorbidies were hypertension 20.0%, osteoporosis 17.1%, and diabetes 8.6%, thyroid disease 8.6%, psoriasis 5.7%, rheumatoid arthritis 2.7%, rheumatic fever 2.9%, autoimmune hepatitis 2.9%, and myasthenia gravis 2.9%. Conclusion: The associated comorbidities of PV emphasize the need for dermatologists to keep a high index of suspicion and actively evaluate patients to determine their presence. KYAMC Journal Vol. 10, No.-2, July 2019, Page 106-109

Download Full-text

Assessment of Bronchiectasis in HIV Patients among an Urban Population

Case Reports in Pulmonology ◽

10.1155/2020/8903809 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Veena Dronamraju ◽

Navneet Singh ◽

Justin Poon ◽

Sachi Shah ◽

Joseph Gorga ◽

...

Keyword(s):

Case Series ◽

Cd4 Count ◽

Wall Thickening ◽

Hiv Patients ◽

Pneumocystis Jiroveci ◽

Computed Tomographic ◽

Pneumocystis Jiroveci Pneumonia ◽

History Of ◽

Urban Institutions

Bronchiectasis is characterized by permanent destruction of the airways that presents with productive cough, as well as bronchial wall thickening and luminal dilatation on computed tomographic (CT) scan of the chest; it is associated with high mortality. Accumulating data suggests higher rates of bronchiectasis among the HIV-positive population. This case series involves 14 patients with bronchiectasis and HIV followed at two major urban institutions from 1999 to 2018. Demographics, clinical presentation, microbiology, radiographic imaging, and outcomes were collected and compiled. Mean age was 42 years (range 12-77 years). 36% had a CD4 count greater than 500 cells/mm3, 28% had a CD4 count between 200 and 500 cells/mm3, and 36% had AIDS. 43% were treated for Pneumocystis jiroveci pneumonia (PJP) and 50% for Mycobacterium avium complex (MAC) infection. 21% had COPD, 7% had asthma, and 7% had a history of pulmonary aspergillosis. Two patients were followed up by pulmonary services after diagnosis of bronchiectasis on CT. The timeline of the follow-up in these cases was within months and after three years respectively. It is posited that the prevalence of bronchiectasis in HIV patients may be underestimated. Improving recognition and management of bronchiectasis could help diminish rehospitalization rates.

Download Full-text

Drug Metabolism and Disposition Genes in Israeli HIV Patients: MDR1 and CYP3A4 Polymorphisms May Affect Susceptibility to HIV but Not the Course of the Disease.

Blood ◽

10.1182/blood.v106.11.1434.1434 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1434-1434

Author(s):

Meirav Kedmi ◽

Sara Bar Cohen ◽

Michelle Hauzi ◽

Shlomo Maayan ◽

Deborah Rund

Keyword(s):

Hiv Infection ◽

Ethnic Group ◽

Ethnic Groups ◽

Mononuclear Cells ◽

Opportunistic Infections ◽

Statistical Significance ◽

Cd4 Count ◽

Multidrug Resistance Gene ◽

Cd4 Counts ◽

Over Time

Abstract Background: Some studies have suggested a relationship between different alleles of the multidrug resistance gene MDR1, and the course of HIV in treated or untreated patients (pts). It is controvertial whether polymorphisms alter the susceptibility to HIV infectivity. We therefore studied the C3435T polymorphism in MDR1, which may influence HIV. The normal allele has been associated with higher MDR1 activity than the polymorphic allele (Hitzl, 2001). We also studied the A to G polymorphism in the NFSE element of the promoter of the CYP3A4 gene, which metabolizes many important drugs. Methods: 96 pts, of either Ethiopian (57) or Caucasian (39) ethnicity, and 276 controls of these ethnic groups were studied using PCR based techniques. MDR1 activity was analyzed on peripheral blood mononuclear cells of 65 pts using rhodamine extrusion. CD4 counts, clinical course and opportunistic infections were recorded at the Hadassah Hospital AIDS Center where all pts are followed. Our pts are highly compliant with medical therapy and followup. Statistical significance was determined using the Cochrane-Armitage Trends test. Results: We found that the C allele of MDR1 C3435T was highly associated with being an HIV patient (p<0.0001) as compared to controls. The reverse was true for the T allele. This association was found for all patients and also separately for each ethnic group. To analyze if this polymorphism affects the course of HIV, we compared CD4 counts in the patients of both ethnic groups according to genotypes. CD4 counts did not differ according to MDR1 C3435T genotype. Furthermore, C3435T genotypes did not affect the change in CD4 count over time in treated pts. CD4 counts rose following antiretroviral therapy in all pts. Twenty-eight of the pts were positive for HIV infection but were not yet treated. In untreated pts, the TT patients had more severe CD4 deficiency over time compared to CC pts. Our sample size is small, but this concurs with the findings of Lee who found that increased MDR1 activity correlated with decreased viral production (Lee, CG, FASEB J, 2000). Rhodamine extrusion did not vary according to MDR1 C3435T genotype. Opportunistic infections were rare and unaffected by genotype. For the CYP3A4 promoter polymorphism, we found a significantly increased probability of being infected with HIV (p<0.0001) with the presence of the C allele, both in heterozygotes and in homozygotes. There were significantly fewer T alleles among the controls as compared to HIV pts. However when analyzed by ethnic group, this association was only found to be significant for Ethiopians and not for Caucasians (Ethiopians: p< 0.0232 compared to p=0.44). There were no differences found in CD4 count, in treated or untreated patients, or in opportunistic infections according to CYP3A4 genotype. Conclusions: We conclude that for Israeli patients (Ethiopians and Caucasians), susceptibility to HIV infection may be altered according to MDR1 genotype. The C allele was highly associated with infection with HIV for both ethnic groups, as compared to normal controls. For Ethiopians, the CYP3A4 genotype may influence the predisposition to HIV infection (the C allele being associated with being a patient as compared to controls). However, the course of the disease and unsorted lymphocyte MDR1 activity were not influenced by the polymorphisms which we studied.

Download Full-text

A Case Report of Mycobacterium Avium Complex Peritonitis in an AIDS Patient

Case Reports in Infectious Diseases ◽

10.1155/2013/590478 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2 ◽

Cited By ~ 2

Author(s):

Yihenew Negatu ◽

Eyasu Mekonen

Keyword(s):

Mycobacterium Avium ◽

Highly Active Antiretroviral Therapy ◽

Mycobacterium Avium Complex ◽

Cd4 Count ◽

Mesenteric Lymph Nodes ◽

Pneumocystis Jiroveci ◽

Pneumocystis Jiroveci Pneumonia ◽

Highly Active ◽

Abdominal Symptoms ◽

Mesenteric Lymph

Peritonitis due to Mycobacterium avium complex (MAC) infection is uncommon. The risk for MAC in AIDS patients is greatest in those with severely depressed CD4 count. The organs most commonly involved in disseminated MAC infection include spleen, mesenteric lymph nodes, liver, and intestines. The involvement of peritoneum by MAC infection is rare. This is a case of MAC peritonitis in a 26-year-old female AIDS patient who is noncompliant to highly active antiretroviral therapy (HAART). This patient presented with abdominal pain and distension, anorexia, diarrhea, and cough. She was treated with rifabutin, clarithromycin, and ethambutol along with atovaquone for Pneumocystis jiroveci pneumonia prophylaxis and so the patient’s condition improved. MAC peritonitis should be considered in a patient presenting with nonspecific abdominal symptoms in the setting of AIDS and low CD4 count.

Download Full-text

African Australians living with HIV: a case series from Victoria

Sexual Health ◽

10.1071/sh09120 ◽

2010 ◽

Vol 7 (2) ◽

pp. 142 ◽

Cited By ~ 4

Author(s):

Chris N. Lemoh ◽

Samia Baho ◽

Jeffrey Grierson ◽

Margaret Hellard ◽

Alan Street ◽

...

Keyword(s):

Delayed Diagnosis ◽

Case Series ◽

Cd4 Count ◽

Horn Of Africa ◽

Hiv Diagnosis ◽

Pneumocystis Jiroveci ◽

Pneumocystis Jiroveci Pneumonia ◽

Hiv Prevention Strategies ◽

Industrialised Countries ◽

Living With Hiv

Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.

Download Full-text

Mucormycosis, The Black Fungus alarming Coinfections in Covid-19 Patients

THE JOURNAL OF MICROBIOLOGY AND MOLECULAR GENETICS ◽

10.52700/jmmg.v2i1.20 ◽

2021 ◽

Vol 2 (1) ◽

pp. 15-18

Author(s):

Shahid Nawaz ◽

Maria Saleem

Keyword(s):

Immune System ◽

Opportunistic Infections ◽

Case Reports ◽

Oropharyngeal Candidiasis ◽

Pulmonary Aspergillosis ◽

Pneumocystis Jiroveci ◽

Republic Of China ◽

Pneumocystis Jiroveci Pneumonia ◽

Global Pandemic ◽

Life Threatening

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic causing coronavirus disease 2019 (COVID-19). It was firstly reported in Hubei province in the People’s Republic of China and spread worldwide quickly. The COVID-19 affects every person differently, from mild to life-threatening symptoms (Nawaz, 2020), along with other bacterial or fungal co-infections (CDC., 2021). The COVID-19 affected patients are prone to develop severe opportunistic infections (Salehi et al., 2020). The immune system of SARS-COV-2 infected patients becomes vulnerable to these opportunistic infections if some comorbidities (diabetes, pulmonary disease) or immunocompromised conditions (steroid therapy, hospital stay, and ventilation) are present. The development of infections such as Pneumocystis jiroveci pneumonia, bloodstream candida, pulmonary aspergillosis, and oropharyngeal candidiasis have been reported in SARS-CoV-2 infected patients (Moorthy et al., 2021). A few case reports of rhino-orbital mucormycosis in COVID-19 have been reported (Mehta et al., 2020). One such study was reported by (Sen et al., 2021), in which they presented a series of six cases of COVID-19 disease with rhino-orbital mucormycosis. Only one patient in this series had concurrent COVID-19 and mucormycosis at hospital admission, while five patients developed mucormycosis during treatment for COVID-19. Recent studies in Pakistan have reported an increased number of cases of mucormycosis, also known as “black fungus” in COVID-19 patients (The News., 2021).

Download Full-text

Lemierre’s Syndrome: A Thing of the Past?

10.21203/rs.3.rs-118154/v1 ◽

2020 ◽

Author(s):

Nehal Dhaduk ◽

Sudeepti Vedula ◽

Aparna Govindan ◽

Evelyne Kalyoussef

Keyword(s):

Mortality Rate ◽

Case Reports ◽

Case Series ◽

Lemierre’S Syndrome ◽

Female Ratio ◽

Clinical Presentations ◽

Life Threatening ◽

Lemierre's Syndrome ◽

High Index Of Suspicion ◽

Male To Female

Abstract Introduction: Lemierre’s syndrome (LS), infectious thrombophlebitis of the internal jugular vein, is a rare, life-threatening complication of oropharyngeal infections underrepresented in literature. We reviewed the etiology, clinical characteristics, treatment regiments and prognosis of LS in pediatric patients.Methods: PubMed and MEDLINE were searched from February 10, 2018 to July 28, 2018 for relevant studies. A systematic review was performed using the terms LS and pediatric case. Our criteria included reviews, case reports, and case series with patients under 18 years with a diagnosis of LS. Results: 70 cases of pediatric LS were identified. The male to female ratio was 1:1.7 with an average age of 10.7 years (5 weeks to 17 years). The most common initial clinical presentations were fever (90.0%), sore throat (38.6%), and neck pain or tenderness (35.7%), while the most frequent findings on physical exam were fever (31.4%) and neck involvement (28.6%). F. necrophorum was the predominant organism cultured (62.9%). Septic emboli were seen in 51.4% of cases with the lungs affected in 40 patients. Most commonly used treatments were antibiotics (91.4%) followed by anticoagulation (50.0%) and the overall mortality rate was 8.6%. The average time from initial presentation to diagnosis was 4.9 days. Conclusion: LS is a deadly condition with a staggering mortality rate despite the advent of antibiotic measures. Early identification and a high index of suspicion are necessary to prevent complications associated with LS. Despite its rarity it should remain on the differential for any patient with toxic signs and localized neck findings.

Download Full-text