English

Abstract

Respiratory infections are the major cause of morbidity and mortality in persons with HIV infection. About 70% of HIV/AIDS patients with infection experience a pulmonary opportunistic infection in life time. The nature of pulmonary infection of HIV reflects the level of immunodeficiency. Though increasing number of AIDS cases are being reported from central India, the data on spectrum of opportunistic infections of respiratory tract in HIV seropositive patients from developing countries as well as from the region is scanty. The present study was undertaken to determine the incidence of various fungal pathogens of lower respiratory tract in HIV seropositive patients. A total of 108 HIV seropositive cases presenting with the signs and symptoms of involvement of lower respiratory tract were studied. KOH mount examination revealed fungal elements in 40 samples. Toluidine blue staining and Giemsa staining techniques were used in the present study for the demonstration of Pneumocystis carinii in the sputum. In our series, no specimen revealed forms suggestive of Pneumocystis carinii. Yeast cells belonging to Candida spp were isolated from 20 cases, 16 isolates belonged to candida albicns & 2 each of candida gullermondii & candida tropicalis, Moulds were recovered from 2 sputum specimens. Both belonged to Aspergillus species, considering morphology on SDA and microscopic morphology in Lactophenol cotton blue (LCB) mount, one species was identified as Asp. flavus and other was Asp. niger. Although reports of the HIV epidemic emerged from the developed and industrialized countries initially, now focus is shifting fast to South-East Asia in which India contributes the major bulk of cases and at present is in an advanced stage of the epidemic in some states of the country (NACO 2000d). The first case of AIDS in India was detected in 1986, since then HIV infections have been reported in almost all states and union territories (WHO 2003a). Respiratory infections are the major cause of morbidity and mortality in persons with HIV infection. It is clear that with the progression of HIV infection, the function of pulmonary immunocompetent cells declines. There is severe reduction in concentration of pulmonary CD4 cells and impaired cytolytic activity (Murray and Mills 1990a). About 70% of HIV/AIDS patients with infection experience a pulmonary opportunistic infection in life time (Millar 1996). The nature of pulmonary infection of HIV reflects the level of immunodeficiency (Barlett and Gallant 2004). Infections with Candida species and Cryptococcus neoformans have been recognized as important complications of HIV infection since the early years of the AIDS epidemic. Shortly thereafter, disseminated fungal infections were included among the indicator diseases diagnostic of AIDS, if they occurred in a patient with laboratory evidence of HIV infection. (Murray and Mills 1990b). Aspergillus species have been isolated from a large number of patients with HIV disease or identified at postmortem examination of patients with AIDS (Niedt and Schinella 1985).