Prevalence Of Opportunistic Infections Research Articles

A RARE COMPLICATION: ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) INDUCED BY SEVERE PNEUMOCYSTIS CARINII PNEUMONIA (PCP)

Introduction: Pneumocystis pneumonia (PCP) represents a prevalent opportunistic infection among individuals with HIV, posing a significant risk of mortality. The occurrence of acute respiratory distress syndrome (ARDS) as a consequence of PCP further accentuates the gravity and intricacy of this pulmonary infection. Objective: This case report aims to discuss the management of the rare complication of ARDS induced by severe PCP in a 36-year-old man with HIV. Case Presentation: A 36-year-old male teacher, presented with worsening dyspnea, intermittent fever, and a productive cough persisting for two weeks, along with weight loss and fatigue. Initial diagnostic impressions included pulmonary tuberculosis with pneumonia. Treatment involved oxygen therapy, fluid administration, and medication. Laboratory tests showed leukocytosis, elevated blood glucose, and abnormal liver function. Subsequent investigations confirmed HIV infection. Chest X-ray revealed severe bilateral pneumonia and possible ARDS, leading to transfer to the Intensive Care Coronary Unit for further management. Discussion: The diagnosis of severe Pneumocystis jirovecii pneumonia (PCP) underscores the importance of recognizing PCP as a significant clinical concern, especially in HIV patients. Diagnostic challenges, such as late HIV diagnosis, highlight the need for timely screening and intervention. Management involved a multidisciplinary approach, including pulmonologists and cardiologists. Despite treatment adjustments, some patients experience clinical deterioration, necessitating careful management strategies like antiretroviral (ARV) therapy and respiratory support. This case underscores the complexity of managing PCP-related ARDS and the crucial role of timely intervention and comprehensive care. Conclusion: Severe PCP led to ARDS in an HIV-infected patient due to inflammation and lung damage, exacerbated by the immunocompromised state. Timely diagnosis and treatment are crucial to prevent complications and improve outcomes in such cases.

Pathophysiological microenvironments in oral candidiasis.

Oral candidiasis (OC), a prevalent opportunistic infection of the oral mucosa, presents a considerable health challenge, particularly in individuals with compromised immune responses, advanced age, and local predisposing conditions. A considerable part of the population carries Candida in the oral cavity, but only few develop OC. Therefore, the pathogenesis of OC may depend on factors other than the attributes of the fungus, such as host factors and other predisposing factors. Mucosal trauma and inflammation compromise epithelial integrity, fostering a conducive environment for fungal invasion. Molecular insights into the immunocompromised state reveal dysregulation in innate and adaptive immunity, creating a permissive environment for Candida proliferation. Detailed examination of Candida species (spp.) and their virulence factors uncovers a nuanced understanding beyond traditional C. albicans focus, which embrace diverse Candida spp. and their strategies, influencing adhesion, invasion, immune evasion, and biofilm formation. Understanding the pathophysiological microenvironments in OC is crucial for the development of targeted therapeutic interventions. This review aims to unravel the diverse pathophysiological microenvironments influencing OC development focusing on microbial, host, and predisposing factors, and considers Candida resistance to antifungal therapy. The comprehensive approach offers a refined perspective on OC, seeking briefly to identify potential therapeutic targets for future effective management.

Opportunistic Infections in Individuals Living with HIV/AIDS: What is the Situation Found in a Specialized Care Service Located in Northeastern Brazil?

Introduction: Opportunistic infections are not uncommon in individuals living with the Human Immunodeficiency Virus (HIV), being one of the main causes of morbidity and mortality associated with Acquired Immunodeficiency Syndrome (AIDS). Aim: to conduct a survey on the prevalence of opportunistic infections in individuals living with HIV/AIDS assisted by a Specialized Care Service (SCS). Design: For this purpose, an epidemiological, analytical, and retrospective study was conducted, in which data collection was performed from patient records. The association of variables such as sex, age, education, income, treatment, viral load, CD4+ T lymphocytes, and opportunistic infection was verified through Fisher's exact test to identify possible factors associated with infections. Results: From 2014 to 2020, 214 cases were reported, of which 65 had some opportunistic infection, the most frequent being: oral candidiasis (58.46%); cytomegalovirus (16.92%); pulmonary tuberculosis (12.31%); and herpes zoster (10.77%). A higher frequency was observed in males (73.85%); age between 20 and 59 years (44.61%); income below one minimum wage (50%); and incomplete elementary education (37.04%). There was no statistical significance (p<0.05) among the associated variables in the study. Implications: It can be concluded that oral candidiasis remains one of the main coinfections in individuals living with HIV/AIDS. Additionally, these results may contribute to the development of prevention strategies, reducing the number of cases of opportunistic infections, and improving the survival of individuals living with HIV/AIDS.

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections.

Prevalence Of Opportunistic Infections Among People Living With HIV In Osogbo, Osun State

This study aims to identify common opportunistic infections and their prevalence among people living with HIV in Osogbo, Osun state, who are receiving treatments for the HIV virus, which has spread widely. A mixed study design was employed, including a hospital-based retrospective study and a Key Informant Interview. The retrospective study involved 280 HIV patients at State Specialists Hospital Asubiaro SSHA Osogbo, Nigeria, and collected socio-demographic, opportunistic infection diagnosis, and viral load test results. The study also included a Key Informant Interview with six health workers in the HIV care unit. Quantitative data was analyzed using descriptive statistics and Chi-square tests, while qualitative data was analyzed using a thematic approach. The study reveals that the majority of People Living with HIV are females (77.1%), with 69% unemployed and 28.6% employed. Most are married (82.5%). In 2020, 58.2% achieved viral suppression, while in 2021, 65.7% and 69% achieved it. Common opportunistic infections include tuberculosis, pruritus, oral candidiasis, and herpes zoster. The prevalence of opportunistic infections decreased from 9.0% to 7.6% between January 2020 and May 2022. The prevalence of opportunistic infections in the study was low, which is due to the high preventive measures employed by the health workers in the hospital. Hence adherence to HAART (Highly Active Antiretroviral Therapy) medications helps to maintain healthy living for People living with HIV

Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa.

The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is still one of the main causes of death in sub-Saharan Africa. Antiretroviral therapies (ARTs) have significantly improved the health conditions of people living with HIV/AIDS (PLWHA). Consequently, a significant drop in morbidity and mortality, along with a reduced incidence of opportunistic infections (OIs), has been observed. However, certain atypical and biological profiles emerge in ART patients post-examination. The objective of this study was to identify the risk factors that contributed to the onset of OIs in HIV patients undergoing ART in Gabon. Epidemiological and biological data were obtained from medical records (2017 to 2019) found at the outpatient treatment centre (CTA) of Franceville in Gabon. Samples for blood count, CD4, and viral load analysis at CIRMF were collected from PLWHA suffering from other pathogen-induced conditions. A survey was carried out and data were analysed using Rstudio 4.0.2 and Excel 2007 software. Biological and socio-demographic characteristics were examined concerning OIs through both a univariate analysis via Fisher's exact tests or chi2 (χ2), and a multivariate analysis via logistic regression. Out of the 300 participants initially selected, 223 were included in the study, including 154 (69.05%) women and 69 (30.95%) men. The mean age was 40 (38.6; 41.85), with individuals ranging from 2 to 77 years old. The study cohort was classified into five age groups (2 to 12, 20 to 29, 30 to 39, 40 to 49, and 50 to 77 years old), among which the groups aged 30 to 39 and 40 to 49 emerged as the largest, comprising 68 (30.5%) and 75 (33.6%) participants, respectively. It was noted that 57.9% of PLWHA had developed OIs and three subgroups were distinguished, with parasitic, viral, and bacterial infections present in 18%, 39.7%, and 55.4% of cases, respectively. There was a correlation between being male and having a low CD4 T-cell count and the onset of OIs. The study revealed a high overall prevalence of OIs, and extending the study to other regions of Gabon would yield a better understanding of the risk factors associated with the onset of these infections.

Religious and traditional beliefs and practices as predictors of mental and physical health outcomes and the role of religious affiliation in health outcomes and risk taking

BackgroundWhile many studies from sub-Saharan countries, including Zimbabwe, allude to the important role of religion and tradition for young people living with HIV (YPLHIV), most of these studies tend to be descriptive and lack advanced statistical analysis. This study aims to close this gap.MethodsData for this study was collected between July and October 2021 from 804 YPLHIV (aged 14–24) in Zimbabwe. The questionnaire included questions regarding participants’ conceptions of HIV, their health seeking and risk-taking behaviour, current HIV viral load results, the prevalence of opportunistic infections, their mental health status, and demographic characteristics. The analysis was done using multilevel mixed-effects logistic regression.ResultsWe found that Traditional religious affiliation was linked to overall lower viral load (OR: 0.34; CI: 0.12–0.96; P: 0.042), Apostolic to more (OR: 1.52; CI: 1-2.3; P: 0.049) and Pentecostal to less (OR: 0.53; CI: 0.32–0.95; P: 0.033) treatment failure. Additionally, conceptions about HIV without spiritual or religious connotation, such as ‘seeing HIV as result of a weak body’ was associated with lower risk of treatment failure (OR: 0.6; CI: 0.4-1.0; P: 0.063), higher chances for undetectable viral load (OR: 1.4; CI: 1–2; P: 0.061), and overall lower viral load (OR: 0.7; CI: 0.5-1; P: 0.067). Moralizing concepts of HIV, like ‘seeing HIV as a result of sin in the family’, was linked to higher risk of opportunistic infections (OR:1.8; CI:1.1-3; P: 0.018), and higher risk of treatment failure (OR: 1.7; CI: 0.7–1.1; P: 0.066). Religious objections toward certain forms of therapy, like toward cervical cancer screening, was linked to higher risk of mental problems (OR: 2.2; CI: 1.35–3.68; P: 0.002) and higher risk of opportunistic infections (OR:1.6; CI:1.1–2.1; P: 0.008). Religious affiliations significantly influenced conceptions of HIV, health seeking behaviour, and risk taking.ConclusionTo our knowledge, this study is the first to provide evidence about the statistically significant associations between religious and traditional beliefs and practices and current health outcomes and health risk factors of YPLHIV in Zimbabwe. It is also the first to identify empirically the role of religious affiliations as predictors of current viral load results. This new knowledge can inform contextualized approaches to support YPLHIV in Zimbabwe.

Advances and Challenges in Cytomegalovirus Detection Methods for Liver Transplant Donors

Cytomegalovirus (CMV) infection is a highly prevalent opportunistic infection among liver transplant recipients. When the liver donor is infected with CMV, there is a risk of transmission to the recipient, leading to CMV infection. To improve the postoperative outcome of liver transplantation, it is crucial to shift the focus of CMV detection to the donor and achieve early diagnosis, as well as implement effective preventative and therapeutic measures. However, the commonly used CMV detection methods in the past had limitations that prevented their early and accurate diagnosis in liver transplant donors. This review focuses on the latest advancements in CMV detection methods that can potentially be applied to liver transplant donors. The objective is to compare and evaluate their clinical utility, thereby providing guidance and support for rapid and accurate diagnosis of CMV infection in the clinic. The clustered regularly interspaced short palindromic repeats-associated proteins (CRISPR–Cas) system-based assay emerges as a promising method for detecting the virus, offering great prospects for early and expedient CMV infection diagnosis in clinical settings.

Evaluation of the Effects of Photodynamic Therapy With Methylene Blue on Different Candida Species In Vitro.

Introduction: Oral candidiasis is the most prevalent opportunistic infection of the oral cavity. The most common cause of this infection is Candida albicans. Considering the side effects of conventional antifungal therapies, this study aimed to evaluate the efficacy of photodynamic therapy with new methylene blue (a photosensitizer) in inhibiting the growth of C. albicans, C. tropicalis, C. glabrata, and C. krusei in vitro. Methods: In this experimental study, 200 samples of standard suspension (0.5 McFarland) were prepared from C. albicans, C. tropicalis, C. glabrata, and C. krusei (50 samples from each species). The samples of each species were divided into five groups (n=10), including photodynamic therapy with a photosensitizer, with or without laser irradiation, nystatin treatment, laser therapy, and control. Next, cultivation of samples was performed on Sabouraud dextrose agar, and the colony-forming units were determined after 24 hours of incubation at 37 °C. Data were analyzed in SPSS version 22 by means of the Kruskal-Wallis test (P<0.05). Results: The most sensitive and resistant species to nystatin therapy were C. glabrata and C. krusei, respectively. On the other hand, C. krusei was the most sensitive species to photodynamic therapy, and C. glabrata was the most resistant type to this treatment. The highest therapeutic effectiveness was attributed to nystatin therapy, although photodynamic therapy was also effective. Laser therapy was recognized as the least effective method. Conclusion: Photodynamic therapy with new methylene blue, as a suitable adjunct therapy, can be effective in the management of candidiasis. It may also be a potential novel treatment for immunocompromised patients with oral candidiasis.

Distribution pattern and prevalence of opportunistic infections and their possible reciprocal effects among HIV patients, Burayu health centers, Ethiopia.

Opportunistic infections are a major public health problems in immuno-compromised individuals, particularly in HIV patients, and form a lethal combination, each speeding the progress of the other. The aim of this study was to assess the pattern and prevalence of opportunistic infections and their reciprocal effects among HIV patients attending the Burayu Health Centers. A health institution-based retrospective cross-sectional study was conducted on 1,448 HIV patients. All patients diagnosed with HIV and HIV-opportunistic co-infections with complete data were included. Logistic regression analysis was used to quantify the association of HIV-opportunistic co-infections and various socio-demographic and clinical variables. A total of 1,448 HIV- positive patients were reviewed and 572 (39.5%) were found to have opportunistic infections. The trend of HIV co-infection showed gradually decreased. Majority of HIV patients were found at a CD4+ count < 200cells/mm3.The rate of opportunistic infections increased with decreasing CD4 T-cell count. HIV-infected patients with a CD4+ cell count of < 200 cells/mm3 were found to be 44 times more likely to develop opportunistic infections. HIV-opportunistic co-infection was significantly associated with sex, marital status, ART drug adherence, residence, and educational status of the patients. The odds of co-infections in patients who were urban dwellers were 2 times higher than in those who lived in rural areas. Similarly, patients who were single were 3 times more likely to be infected with coinfections. Maleness was found to be protective from coinfection and it showed a reduction of 64%. Opportunistic co-infections are more prevalent in HIV-infected patients with a CD4+ cell count of < 200 cells/mm3, poor drug adherence, and also associated with the occupation. So, regular examination and appropriate medication can reduce the prevalence of opportunistic co-infections.

Reappraisal of Idiopathic CD4 Lymphocytopenia at 30 Years

BackgroundIdiopathic CD4 lymphocytopenia (ICL) is a clinical syndrome that is defined by CD4 lymphopenia of less than 300 cells per cubic millimeter in the absence of any primary or acquired cause of immunodeficiency. Some 30 years after its original identification, ICL has remained a disease of obscure cause, with limited evidence with respect to its prognosis or management, despite diagnostic and therapeutic innovations.MethodsWe evaluated the clinical, genetic, immunologic, and prognostic characteristics of 108 patients who were enrolled during an 11-year period. We performed whole-exome and targeted gene sequencing to identify genetic causes of lymphopenia. We also performed longitudinal linear mixed-model analyses of T-cell count trajectories and evaluated predictors of clinical events, the response to immunization against coronavirus disease 2019 (Covid-19), and mortality.ResultsAfter the exclusion of patients with genetic and acquired causes of CD4 lymphopenia, the study population included 91 patients with ICL during 374 person-years of follow-up. The median CD4+ T-cell count among the patients was 80 cells per cubic millimeter. The most prevalent opportunistic infections were diseases related to human papillomavirus (in 29%), cryptococcosis (in 24%), molluscum contagiosum (in 9%), and nontuberculous mycobacterial diseases (in 5%). A reduced CD4 count (<100 cells per cubic millimeter), as compared with a CD4 count of 101 to 300 cells, was associated with a higher risk of opportunistic infection (odds ratio, 5.3; 95% confidence interval [CI], 2.8 to 10.7) and invasive cancer (odds ratio, 2.1; 95% CI, 1.1 to 4.3) and a lower risk of autoimmunity (odds ratio, 0.5; 95% CI, 0.2 to 0.9). The risk of death was similar to that in the age- and sex-adjusted general population, but the prevalence of cancer was higher.ConclusionsAmong the study patients, ICL continued to be associated with increased susceptibility to viral, encapsulated fungal, and mycobacterial diseases, as well as with a reduced response to novel antigens and an increased risk of cancer. (Funded by the National Institute of Allergy and Infectious Diseases and the National Cancer Institute; ClinicalTrials.gov number, NCT00867269.)

DOP17 HIV infection is associated with a less aggressive phenotype of inflammatory bowel disease. A multicenter study based on the ENEIDA registry.

Abstract Background The coexistence of immune-mediated diseases and non-pharmacological immunosuppression states are rare and might determine the natural history of the disease and therapeutic decisions of the physician. IBD guidelines recommend screening for human immunodeficiency virus (HIV) before starting immunosuppressive treatment, but data on the impact of HIV infection on IBD and its management in the era of biological drugs are scarce. Therefore, our aim was to describe IBD phenotype, immunosuppressive requirements, and prevalence of opportunistic infections (OI) in patients with IBD and coexistent HIV infection. Methods Case-control, retrospective, multicenter study including all IBD patients with available HIV serology on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU). IBD patients with positive HIV serology were selected (HIV+) and compared to HIV seronegative IBD patients (controls), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD). Demographic, clinical IBD characteristics, therapeutic requirements, OI and IBD complications were registered. Results Eighty-eight HIV+ IBD patients and 264 controls were included. In the whole cohort, 81% were men, 56.8% had ulcerative colitis (UC), 36.4% Crohns’ disease (CD) and 6.8% IBD unclassified. Median age at IBD diagnosis was 38 years (IQR 30-47), median age at HIV infection diagnosis was 36 years (IQR 30-42), 46.3% being were firstly diagnosed of IBD. Among UC patients, HIV+ had a lower proportion of extensive disease (24.5% vs 44.8%; P=0.002), and a higher proportion of proctitis (38.8% vs. 16.6%; P=0.002) than controls, without differences on disease proximal progression (7.7% vs 7.9%). Among CD patients, HIV+ presented a higher proportion of colonic involvement than controls (40.6% vs 12,6%, P=0.002) and lower penetrating behavior (10.7% vs 25%; ns). HIV+ had a lower proportion of extraintestinal manifestations (10.7% vs 25.4%; P=0.005). Although it was not statistically significant, a trend towards a lower proportion of hospitalizations (25.6% vs 35.3%) and IBD complications (6.3% vs. 9.2%) in HIV+ was observed. Regarding IBD therapeutic requirements, immunosuppressant (40.5% vs 58.7%; P=0.003) and biological drugs (28.3% vs 42.8%; P=0.020) were used less frequently among HIV+ than among controls. Conversely, HIV+ had a higher rate of OI (38.3% vs 17.8%; P&amp;lt;0.001) and malignancies (12.5% vs 8.3%, ns) than controls. Conclusion The coexistence of IBD and HIV infection seems to be associated with a less aggressive IBD phenotype and a lower use of immunosuppressants and biologicals but with a remarkable rate of OI.

Candida profile in HIV-Positive children needs a Dynamic clinical appraisal: A microbiological Study

Introduction: Candidiasis is the most prevalent opportunistic infection in Acquired Immuno deficiency Syndrome (AIDS). The prolonged and/or recurrent treatment of Candidiasis that results in alteration of profile of Candida species necessitates customizing the antifungal therapy regimen. This study aimed to identify the profile of candidal species in HIV-positive children and adults. Further the colonization of these species was assessed for their antimicrobial sensitivity. Materials and methods: Ten ml saliva was collected from HIV-positive children (n=30) and adults (n=40) and 100μL was cultured on CHROMagarTM followed by identification, counting of species after 48 hours, and antimicrobial sensitivity using the automated VITEK®2 antimicrobial susceptibility testing system. Results: More numbers of HIV-positive children than adults exhibited Candida colonization. The predominant species identified was C. albicans either alone or in combination with C. glabrata, C. tropicalis or C. krusei. An increased proportion of C. glabrata was seen in children whereas the adults showed increase in colonization by C. tropicalis. Assessment of antibiotic resistance showed C. krusei and C. glabrata to be resistant to fluconazole and partly resistant towards Amphotericin B. Conclusion: Higher colonization observed in children may be attributed to the relatively less developed immunity and higher viral load. Multidrug treatment regimens may have caused the changing profile of species from C. albicans to non-albicans. Resistance to fluconazole is attributed to a difference in affinity of the target enzyme and active efflux of fluconazole by the organisms.

Plasma Fat Status is Associated with the Prevalence of Opportunistic Infections and may Predict Disease Progression in HIV/AIDS

Objective: To establish the association between plasma fat status and the prevalence of opportunistic infections in HIV/AIDS patients. Design and Methods: A Cross Sectional and Quantitative study involving 174 adult HIV/AIDS patients recruited over a period of 18 months at a University Teaching Hospital in Ndola, Zambia. Participants were subjected to clinical assessments with anthropometry, CD4+ count, viral load and plasma fat measurements at baseline and repeated on a follow-up visit. The Wilcoxon rank sum test for continuous variables and the Chi square test for categorical variables were applied to compare the study population by gender. The main research question was addressed by establishing the association between Plasma fat and Opportunistic infections, adjusted for potential confounders using the multiple linear regression model. Results: The plasma fat status revealed a higher median total cholesterol of [3.86(3.02,4.62) mmol/l], median triglyceride [1.19(0.87,1.51) mmol/l] and LDL-c [2.31(1.58,2.90) mmol/l] for females than that for the males [3.53(3.06,4.61) mmol/l], [0.96(0.71,1.60) mmol/l] and [1.86(1.36,2.80) mmol/l] individually. In contrast, median HDL-c concentration were higher in the male [1.4(1.21,1.55) mmol/l] than the female gender [1.33(1.13,1.51) mmol/l]. The results per clinical status revealed relatively more males [17(27%)] than females [15(15.2%)], p=0.06 presenting with opportunistic infections. Results in both the overall and by gender regression analyses suggested a consistent inverse interaction involving most of the plasma fat types and BMI with opportunistic infections. Conclusion: Plasma fat status was not significantly predictive of the prevalence of opportunistic infections. However, the consistent inverse association reported between plasma fat and opportunistic infections, may suggest a potential role of plasma fat in immune mechanisms or viral suppression and corresponding clinical outcomes.

Opportunistic Infections and Associated Factors among HIV-Infected Adult Persons on Antiretroviral Therapy at Ruhengeri Referral Hospital, Rwanda: A cross-sectional study

Background &#x0D; Human Immunodeficiency Virus (HIV) is among the highest health crises that humanity ever confronted and it causes progressive weakening of the immune system leading to opportunistic infections (OIs) or malignancies during the natural course of the disease.&#x0D; This study aimed at assessing the prevalence and factors associated with the occurrence of OIs among adult PLWHIV on antiretroviral therapy (ART) at Ruhengeri referral hospital.&#x0D; Methodology&#x0D; A cross-sectional study was performed by reviewing records of HIV-positive adult (≥ 15 years) on ART enrolled at Ruhengeri referral hospital from 1st January 2007 to 31st December 2017. Opportunistic infections were reported based on clinical diagnosis and the prevalence of OIs was determined.&#x0D; Results &#x0D; The study reviewed records from 423 PLWHIV. Thirty-nine (9.2%) PLWHIV had been diagnosed with OIs; and frequent OIs were tuberculosis (20%), oral candidiasis, pneumonia and STI (15.6% each). The independent risk factors for developing OIs were being jobless (AOR = 5.03, 95% CI = 2.13, 32.99), spending more than five years on ART (AOR = 4.34, 95% CI = 1.12-16.78) and starting ART at WHO clinical stage III (AOR = 4.88, 95% CI = 1.65-16.78).&#x0D; Conclusion&#x0D; There is a need to strengthen the management of opportunistic infections despite the use of ART at Ruhengeri referral hospital.&#x0D; Rwanda J Med Health Sci 2022;5(3):323-331

A comparative study on the production of extracellular hydrolytic enzymes of C. albicans and non-albicans Candida species isolated from HIV+/AIDS patients and healthy individuals.

Oropharyngeal candidiasis is the most prevalent opportunistic fungal infection in patients with human immunodeficiency virus (HIV) as well as other immunodeficiency disorders, which is caused by various Candida species, mostly Candida albicans. Studies have shown that Candida isolates differ in their pathogenicity. These variations are attributed to virulence factors, host characteristics, and the target tissue. This study aimed to determine and compare the secretion of hydrolytic enzymes in C. albicans and non-albicans Candida species isolated from HIV+/AIDS patients and healthy individuals. Samples were taken from 201 patients with HIV and 118 healthy individuals. The samples were identified by macroscopic, phenotypic, and molecular methods, and virulence factors were subsequently measured. Statistical differences in enzymatic activity of various Candida isolates were calculated (P<0.0001). In total, 95 samples (47.20%) from patients and 46 samples (38.90%) from healthy individuals were positive for the growth of different Candida species. There were 39 (41.10%) and 36 (78.30%) C. albicans in patients and healthy individuals, respectively, as well as 56 (58.90%) and 10 (21.70%) non-albicans species in patients and healthy subjects, respectively. All the enzymes produced by Candida species enzymes were at low, medium, and high levels. Hemolysin activity in Candida species isolated from patients was significantly higher, compared to healthy individuals. Moreover, the activity of all C. albicans enzymes in patients was significantly higher than other Candida species. The C. albicans isolated from HIV-positive individuals secreted higher amounts of exoenzymes, and can cause oropharyngeal candidiasis and become a source of candidiasis for the host.

Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

BACKGROUND: Due to the reduced immune response following chemotherapy, cytomegalovirus (CMV) retinitis is the most prevalent opportunistic intraocular infection in HIV-infected adults. It can also affect children with acute lymphoblastic leukemia (ALL). CASE PRESENTATION: We describe an 11.5-year-old female who is undergoing maintenance chemotherapy for B-lineage ALL. She had vision loss in her right eye and began to have hazy vision in her left eye. Bilateral active retinitis lesions were discovered during the retinal examination. The diagnosis of bilateral CMVR was made based on clinical symptoms, retinal examination findings, and a blood sample for CMV DNA detection using the polymerase chain reaction (PCR) technique. She was given ganciclovir intravenously and intravitreally, followed by oral valganciclovir prophylaxis. Patients who received a solid organ or hematopoietic stem cell transplant were infected with CMVR, although patients with ALL who received less immunosuppressive chemotherapy were also affected (maintenance phase therapy). Intravenous and intravitreal ganciclovir injections are effective treatments, the patient had significant clinical improvement. CMV retinitis is frequent in children with ALL who are in the maintenance phase of the treatment. CONCLUSION: The importance of early detection and treatment cannot be overstated. CMV retinitis: Key prognostic variables. CMV retinitis should be considered as cause of blurred vision in patients with ALL.

Black Fungus Development in SARS-COVID-19 Patients

Mucormycosis refers to a fungal infection resulting from fungus that belong to the order Mucorales and was first described in 1885 by Paltauf. Being the third most prevalent opportunistic fungal infection after candidiasis and aspergillosis, it causes significant endothelial damage by invading the vascular wall. Multiorgan failure and sepsis develop owing to its spread toward the brain.

Comparison of antifungal activity of probiotics, coconut oil and clotrimazole on candida albicans – An In vitro study

Background: Oral candidiasis is the most prevalent opportunistic infection of oral cavity. Candida albicans causes oral lesions in the vast majority of cases. Antifungal regimens such as azoles and polyenes are commonly used to control candida infections. Virgin coconut oil has been proven to have antifungal, antimicrobial, and antioxidant properties. Probiotic bacteria have been used to modify microflora ecosystems and also have antifungal activity. Aim: To evaluate the antifungal activity of probiotics, coconut oil, and clotrimazole against oral Candida albicans species. Materials and Methods: Coconut oil and probiotics were tested against clotrimazole, a positive control. Candida albicans were isolated and incubated in Rose Bengal Agar at 30° C for 48 h. The growth inhibitory effect of the test materials was evaluated using the direct contact method by adding 25, 50, and 100 μL of the test material as well as control to candida in a sterile tube and incubated at 37° C aerobically for 24 h. Results: The mean zone of inhibition for clotrimazole was 36 mm, whereas for coconut oil it was 13.6 mm, and for probiotics, it was 11.6 mm. Clotrimazole had the highest inhibitory effect at 100 μL concentration. The difference between the groups was statistically significant (P-value 0.002). Conclusion: The antifungal activity of clotrimazole was found to be higher than that of coconut oil and probiotics against C. albicans. Future studies should concentrate on other herbal alternatives which will be as effective as clotrimazole for the management of oral candidiasis.

Цитомегаловирусная и смешанные вирусные инфекции у пациентов с воспалительными заболеваниями кишечника

Актуальность. Вопрос распространенности оппортунистических инфекций у лиц с воспалительными заболеваниями кишечника (ВЗК) остается актуальным. Особое внимание среди оппортунистических инфекций уделяется цитомегаловирусной (ЦМВ) инфекции. Клиническая активность ЦМВ-ассоциированного ВЗК, его длительность и степень тяжести, а также использование стероидов и анти-ФНО-α-агентов были идентифицированы как факторы риска неблагоприятных исходов. В диагностике ЦМВ важно не просто выявить наличие вируса в организме пациента, но и уточнить его этиологическую роль в развитии заболевания. В настоящее время рекомендуется проведение скрининга на ЦМВ у всех пациентов с ВЗК при гормональной резистентности, потере эффекта от поддерживающей терапии и при тяжелых эпизодах заболевания. Цель исследования: оценка частоты выявления изолированной цитомегаловирусной инфекции и смешанных (герпес и парвовирус В19) вирусных инфекций у пациентов с ВЗК и их влияние на активность заболевания. Материалы и методы. Обследовано 189 пациентов с ВЗК, 102 с язвенным колитом и 87 с болезнью Крона, среди них 98 женщин и 91 мужчина. Возраст пациентов составлял от 16 до 63 лет, в среднем (41,4 ± 4,8) года. Кроме стандартного клинико-эндоскопического обследования в соответствии с положениями Европейской организации по изучению болезни Крона и язвенного колита (ЕССО), активность заболевания оценивалась по показателям высокочувствительного С-реактивного белка, гомоцистеина, витамина D в сыворотке крови, альбумина в моче, кальпротектина и лактоферрина в кале. Всем пациентам проведено серологическое исследование крови методом иммуноферментного анализа на специфические антитела к герпесвирусам и IgG-/IgM-антитела к парвовирусу В19, а также определение ДНК вирусов простого герпеса 1, 2, 6-го типов, вируса Эпштейна — Барр, цитомегаловируса, герпеса зостер методом полимеразной цепной реакции. У всех пациентов также определяли уровни цитокинов в крови (фактор некроза опухоли α, интерлейкины 1β, -2, -4, -6, -8, -10, -18). Результаты. У пациентов с ВЗК частота выявления изолированной цитомегаловирусной инфекции составляет, по нашим данным, 19,5 %, а с учетом смешанных поражений — 29,6 %. Клинико-эндоскопическая картина (рефрактерность к базисной терапии, несоответствие между эндоскопической картиной и патоморфологическим заключением), а также данные лабораторных исследований указывают на более тяжелое течение заболевания при наличии цитомегаловирусной инфекции. Выводы. Полученные данные позволяют нам рекомендовать в дополнение к протоколам ЕССО определение наличия оппортунистических инфекций у пациентов с впервые выявленным ВЗК до начала базисной терапии, не дожидаясь развития рефрактерных к лечению форм заболевания.