Spectrum Of Opportunistic Infections Research Articles

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.

The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia

ABSTRACT Background: Women are disproportionally affected by HIV and are at greater risk of OIs and malignancies. This study investigated the spectrum of OIs and malignancies among women living with HIV (WLHIV) in Ethiopia. Methods: A retrospective longitudinal study was conducted among 3,817 WLHIV on Antiretroviral Treatment (ART) from 2007 to 2019 in Ethiopia. Data on OIs, malignancies, and clinical characteristics were retrieved from medical records. Prevalence, incidence, and mortality rates were measured over 13 years of follow-up. The Kaplan-Meier survival curve and multivariable Cox-proportional hazard regression were used to estimate incidence and identify predictors of OIs and malignancies, respectively. Result: The pooled prevalence of OIs or malignancies was 47%. OIs accounted for 39% and malignancies were 23.3%. The incidence of OIs and malignancies were 19.4 (95%CI:9.2-29.5) and 11.5 (95%CI:2.2-20.8) per 100 person-years of observation, respectively. Incidence of candidiasis was 14.1 per 100 person-years followed by Lymphoma (11.9), Cervical Cancer (11.5), and TB (10.9). The risk of OIs was higher in patients with baseline CD4 count ≤500 cells/mm3 [AHR (95%CI): 2.0 (1.8-2.3)] and VL>1000 copies/ml [AHR (95%CI): 1.5 (1.1-1.9)]. Overall, 24.6% died, and of them, 62.2% had a history of OIs or malignancies. The risk of death was higher among WLHIV with a history of Toxoplasmosis, TB and PCP. Conclusion: OIs and malignancies was recently increasing and two-thirds of all deaths were associated with these co-morbidities. The high rates of OIs and malignancies were attributed to poor treatment outcomes. The finding calls to enhance the diagnosis and treatment of these co-morbidities. Abbreviations AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University

Helicobacter pylori infection rates in dyspeptic Serbian HIV-infected patients compared to HIV-negative controls.

Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in people living with HIV (PLHIV). To evaluate the Helicobacter pylori infection prevalence rate trends in HIV co-infected individuals in comparison to the HIV-negative population, we compared histopathological findings of H. pylori positive gastritis (gastritis topography and histopathology) between 303 PLHIV and 2642 HIV-negative patients who underwent esophagogastroduodenoscopy (EGD) between 1993 and 2014 due to dyspeptic symptoms. The prevalence of H. pylori infection was significantly higher in HIV-negative controls than in PLHIV (50.2% vs. 28.1%). A significantly positive linear trend of H. pylori co-infection in PLHIV was revealed in the observed period (b = 0.030, SE = 0.011, p = 0.013), while this trend was significantly negative in HIV-negative patients (b = - 0.027, SE = 0.003, p < 0.001). Patients with HIV/H. pylori co-infection had significantly higher CD4+ T cell counts and more often had undetectable HIV viremia, due to successful anti-retroviral therapy (ART). Stomach histopathological findings differed between HIV co-infected and H. pylori mono-infected patients. Our findings confirm that the ART has changed the progression of HIV infection, leading to a significant increase in the prevalence of H. pylori infection in dyspeptic PLHIV over time. Our data also suggests that a functional immune system may be needed for H. pylori-induced human gastric mucosa inflammation.

Mortality and survival benefits in people living with human immunodeficiency virus initiated newly with Antiretroviral therapy irrespective of CD4 count

Background: HIV is a global pandemic with estimated 37.9 million people living with HIV(PLHIV) worldwide in which 23.3 million (62%) PLHIV take antiretroviral therapy (ART). In 2018 UNAIDS estimated 7,70,000 people died from AIDS related illness globally. India has around 21,40,000 PLHIV and 69,110 AIDS-related deaths in 2017 according to NACO report. This study aims to know the mortality and survival benefits in PLHIV newly initiated on ART as per test and treat policy.Methods: A prospective observational cohort study was conducted from June 2017 to June 2018, involving 100 ART-naïve PLHIV attending this ART Centre at Hospitals attached to BMCRI, Bangalore, India. Survival analysis was done by Kaplan Meier estimates. Spectrum of opportunistic infections and their role in cause of mortality was studied.Results: The overall survival rate was 92% at 6 months and 91% at one year after ART initiation. The mortality rate at the end of one year was 9%, out of which Pulmonary Tuberculosis is the most common cause of mortality. There was a significant increase in the CD4 count during follow up, the mean increase in the CD4 T-cell count at the end of 6 months and 12 months was 157 cells and 286 cells per cubic millimeter respectively above the baseline value.Conclusions: In this study early initiation of ART is found to be beneficial in clinical and immunological recovery with increase in CD4 counts and reduction in opportunistic infections in PLHIV. Pulmonary Tuberculosis remains the grave risk factor for mortality among PLHIV/AIDS patients on ART.

Spectrum of opportunistic infections in relation to CD4 counts in HIV/AIDS patients admitted in the department of general medicine of a tertiary care hospital

Background: HIV/AIDS was first recognized in USA in 1981 when centre for disease control (CDC) reported unexplained occurrence of Pneumocystis carinii pneumonia in 5 healthy homosexuals. Soon it was recognized in drug abusers and blood transfusion recipients. The present study has been taken up with an aim to know the incidence of various opportunistic infections in HIV positive patients and to correlate different opportunistic infections (OIs) with the CD4+cellcount.Methods: Sample of 132 cases admitted in Gandhi hospital during the study period were taken. CD4+ counting of blood samples was done by Flow cytometry as per manufacturer’s instructions (FACS Calibur, Becton- Dickinson, Immunocytometry system). Correlation of CD4 cell counts was done with the respective opportunistic infections.Results: TB (50%) is the most frequent OI followed by candidiasis (49%), pneumocystis (16%) and others. The mean CD4 cell count in TB was 110.80/mL and in candidiasis 97.84/mL. Low values were observed in CMV (27/mL) and in toxoplasmosis (61.66/mL).Conclusions: In most of the patient’s respiratory system was the most common system involved by OIs and had CD4 T cell count below 200/mL. Early diagnosis and prompt treatment of opportunistic infections is important. This study helps the clinicians in proper guidance to come up before development of severe immunodeficiency to prevent serious and fatal outcome.

Spectrum of opportunistic infections in relation to CD4 count in HIV-2 patients

Spectrum of opportunistic infections in relation to CD4 count in HIV-2 patients

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.

Spectrum of opportunistic infections with correlation to CD4 counts in newly diagnosed HIV seropositive cases

Background: A rise in HIV/AIDS is observed in resource poor countries like India despite successful implementation of control programmes. Most of these deaths recorded in cases of AIDS are because of opportunistic infections [OI] and other malignancies. The reason may be attributed to the effective destruction or decrease in CD4 cells which play a pivotal role in immune system. OI cause substantial morbidity and hospitalization, economical loss to the society and shorten the survival time of HIV patient. The objective of this study was to evaluate the different type of infections and identify the frequent pathogens affecting the HIV patients who are attending a tertiary care hospital in India. The clinical profile of these patients was studied and proportion of CD4 counts with respect to their type of infection and pathogen is also evaluated.Methods: A prospective cross sectional study was conducted for one year period. Clinical samples were collected from all the newly diagnosed cases of HIV and performed various staining techniques and cultured on appropriate culture media. All the isolates were identified as per standard guidelines. Serological evaluation for IgM antibodies for toxoplasma was done by ELISA. CD4 counts were estimated by FACS.Results: Tuberculosis was the commonest (67%) OI in HIV cases, followed by candidiasis (61.5%), respiratory tract infections (50%), gastro intestinal tract infections (44%) and meningitis (38%) in our study. The mean CD4 cell counts in the study was 267.11cells/µl. The commonest fungal pathogen was C.albicans and Cryptosporidium parvum the parasitic pathogen. The mean CD4 cell counts were lesser in parasitic infections when compared to bacterial and fungal infections. Six cases of P.jiroveci pneumonia were identified in our study. Mortality was recorded among the HIV cases with CD4 cell counts &lt;50 cells/ µl.Conclusions: Early diagnosis and prompt treatment of OIs contributes to increased life expectancy among infected patients, delaying the progression to AIDS. This study helps the clinicians in proper guidance to come up with right diagnosis and early response to manage the patients in resource poor countries like India.

Spectrum of opportunistic infections in HIV infected children in North India

Introduction: Human Immunodeficiency Virus adversely affects the immune system of the body, making a person vulnerable to variety of infections. Usually benign micro organisms become virulent and cause serious illnesses. Such opportunistic infections are very common in HIV infected children. If they are not diagnosed and treated in time they may prove fatal. The pattern of opportunistic infections are changing with time and place. To study the newer pattern of opportunistic infection in HIV infected children, this study was undertaken. Methods: 140 children of both sexes between age 18 months to 15 years, diagnosed HIV positive as per NACO HIV testing guidelines, were included in this study. They were examined, investigated and classified into clinical and immunological staging as per WHO classification. They were investigated for opportunistic infections. Result: Different kinds of skin involvement including scabies, papular pruritic eruptions, seborrhoic dermatitis, pyoderma, herpes zoster, molluscum contagiosum, fungal infections were noted in 47% children. Oropharyngeal candidiasis was also common. Recurrent respiratory tract infection, recurrent diarrhea, urinary tract infection, CSOM, parotid involvement was seen in majority of children. Over all, bacterial infection was seen in 36.4% children, followed by fungal infection in 18.5%, viral infection in 14.3% and tubercular infection in 10% respectively. Several studies have reported tuberculosis as the most common opportunistic infection in HIV infected children, but contrary to this, tuberculosis was the fourth commonest opportunistic infection in our study. Recurrent bacterial infections were the commonest one. Pneumocystis Carinii Pneumonia (PCP), the hallmark of AIDS defining illness in developed world, is not so common in our set up. We found only one probable case of PCP in our study.

Spectrum of Opportunistic Infections and Risk Factors for In-Hospital Mortality of Admitted AIDS Patients in Shanghai.

To investigate the frequency and the spectrum of major opportunistic infections (OIs), evaluate the major clinical factors associated with each specific OI, and identify the risk factors for in-hospital death among HIV patients in East China.A retrospective cohort study was made including all the HIV-infected patients who were admitted for the first time to the Shanghai Public Health Clinical Center during June 1, 2013 to June 1, 2015. The demographic and clinical data were collected. Comparison of continuous variables was analyzed by one-way ANOVA and rank sum test. Person χ test and Fisher exact test were applied to analyze the categorical variables. A Cox proportional hazards regression model was used to determine the risk for the occurrence of in-hospital death.In total, 920 patients were enrolled with age of 41.59 ± 13.36 years and 91% male. Median CD4 was 34 (IQR, 13-94) cells/μL. Among these patients, 94.7% acquired OIs while the rest developed malignancies. Pneumocystis pneumonia and bacterial coinfection (42.1%) was found to be the most common OIs, followed by tuberculosis (31.4%), CMV (20.9%), Cryptococcosis (9.0%), and MAC infection (5.2%). Of the above 5 major OIs, CMV-infected patients had the lowest median CD4 cell count 22.50 (IQR, 7.50-82.00) while the patients with tuberculosis infection had the highest count 61.00 (IQR, 27.00-176.00). In-hospital death rate was 4.2 per 100 person-years among these patients. Of note, admitted patients with 2 types of OIs (2.20, 95% CI 1.39-3.48) and those patients who were 40-year old or older (1.75, 95% CI 1.10-2.78) had a higher risk of such death.Pneumocystis pneumonia and tuberculosis were still the leading causes for the admission of HIV-infected patients in East China, and these patients tended to have very low CD4 cell counts. It is believed that expanding the HIV screening test and pushing the infected ones get ART earlier is required for generating a more successful HIV management strategy.

Spectrum of Systemic Yeast Infections in Leukemia Patients in Cameroon and Sensitivity of Isolates to Griseofulvin, Ketoconazole and Organic Extracts of Four Medicinal Plants

Clinical management of leukemia patients with hydroxyurea - based chemotherapy drugs and radiotherapy often does not yield very quick therapeutic benefits in patients, especially in tropical resource limited countries. Evidence based supportive and palliative care plan is critical in the clinical management of leukemia patients, which clinicians and oncologists in Africa often do not adequately implement during in-patient management in hospitals for a number of reasons including cost and knowledge. The spectrum of opportunistic infections in leukemia conditions is not well known and considered during management plans. In this study, we report the spectrum of systemic yeast infections amongst leukemia patients attending Phytobiotechnology Research Foundation clinic in Cameroon from June 2012 to June 2015 for the presence of various opportunistic systemic mycoses. All the patients in this study were already receiving hydroxyurea therapy for more than one year at the hospitals in Cameroon. The screening and testing were done through visual observation, KOH microscopy, in addition to culture tests on potato and malt extract agars. Twenty patients screened, were found with systemic yeast infections. Culture of urine, mouth swabs, vaginal fluids and blood yielded a 80% isolates of Candida albicans, and 20% Non Albicans Candida (NAC) including Cryptococcus species isolated from oral swab only. The results generally show that systemic yeasts are prevalent in leukemia patients and its co morbidity may possibly complicate effective chemotherapy treatment. The anti-yeast activity of Persea americana, magnifera indica, Moringa oleifera, and Allium sativum was significant with zones of inhibitions exhibited by Moringa oleifera and Allium sativum showing a better ant yeast activities than with ketoconazole and griseofulvin. The results also suggested the need to exploit alternative botanicals in the comanagement of leukemia as well as its attending opportunistic infections is a critical step toward generating a better treatment for leukemia.

Spectrum of opportunistic infections among HIV seropositive patients in Delhi region-a study by Delhi state AIDS control society

Abstract Background: HIV infection leads to AIDS and opportunistic infections are major cause of morbidity and mortality of such patients which considerably affect the health and quality of life of people infected with

A rare case of early‐onset neonatal sepsis

Introduction: Capnocytophaga sputigena is a capnophilic Gram‐negative bacillus normally residing intra‐orally in humans, and may be associated with opportunistic infections in the immunocompromised. A case of early‐onset neonatal sepsis is described, which has only rarely been reported as a cause of premature birth and neonatal septicaemia. Case presentation: This case report focuses on the rare presentation of a microbe, Capnocytophaga sputigena, causing pre‐term labour, early neonatal septicaemia and maternal chorioamnionitis. To the best of our knowledge, it is the first case report of such a presentation in New Zealand. This case helps to demonstrate the contrast between the stormy clinical course in the newborn and the silent asymptomatic presentations in the mother. Conclusion: Capnocytophaga spp. normally reside in the human oral cavity and have been associated with the pathogenesis of periodontal disease. They have also been reported in wounds in humans inflicted by animal bites, and in a wide spectrum of opportunistic infections in the immunocompromised. Only rarely have Capnocytophaga spp. been attributed as a cause associated with pre‐term birth, early neonatal septicaemia or chorioamnionitis.

Clinico-Immunological Profile of Children Infected with HIV Through Vertical Transmission, in Southern India.

Karnataka, being "High Prevalent State" of southern India, the HIV infection among antenatal women has crossed 1%. There are very few reports available with CD4 count and stage wise clinical spectrum among children. The clinical spectrum among HIV infected infants and children vary in different areas of the world. Hence it is important to know the spectrum of opportunistic infections and their respective CD4 count among HIV infected children of our locality. The opportunistic infections among 31 paediatric seropositive patients were evaluated. These all patients were classified as per CDC guide lines into stage I, stage II, and stage III based on CD4 counts of > 1000cells/μl, 500-999 cells/μl,<500cells/μl respectively. The opportunistic infections were diagnosed by standard laboratory investigations. Clinical spectrum presented by each stage children was documented. Children in stage I were 5(16.1%),stage II 14(45.1%) and stage III 12(38.7%). Oral candidiasis (29%) was the commonest, followed by recurrent respiratory tract infection (25.8%), tubercular lymphadenitis (16.1%) and chronic diarrhoea (12.9%). The present study showed the children with higher CD4 count had few infections and children with lower CD4 count presented with multiple opportunistic infections. This study also showed vertical transmission as the sole mode of transmission.

Recent trends in the spectrum of opportunistic infections in human immunodeficiency virus infected individuals on antiretroviral therapy in South India.

Background:Opportunistic infections (OI) are the major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. The pattern of OIs differs widely, hence it is necessary to correlate spectrum of OIs and CD4 counts among HIV infected individuals in specific localities.Materials and Methods:The present study describes the clinical and laboratory profiles of different OIs among 55 HIV seropositive patients. CD4 count was estimated and antiretroviral therapy (ART) was started in 27 patients as per National Acquired Immunodeficiency Syndrome Control Organization guidelines. These 27 patients were classified into stage 1, stage 2 and stage 3 based on CD4 counts of >500 cells/μl, 200-499 cells/μl and <200 cells/μl respectively. The OIs presented by respective groups were documented.Results:Pulmonary tuberculosis was found to be the most common OI constituting 43.6% of all cases followed by candidiasis (30.9%), cryptosporidial diarrhea (21.8%), herpes zoster (16.3%), cryptococcal meningitis (3.63%), Pneumocystis jirovecii pneumonia (1.81%), and other miscellaneous infections (23.6%). Only 1 patient was found in stage I while 13 patients each were grouped in stage II or stage III. The mean CD4 count in our study population who were on ART was 230 ± 150 cells/µl.Conclusion:The pattern of OIs among our study group did not differ significantly from patients not receiving ART. The effect of ART on CD4 count differs from patient to patient based on the degree of depletion of CD4 count before the initiation of ART, drug adherence, concomitant OIs and their treatment.

P3.330 Prevalence and Immunological Correlates of Opportunistic Infections Among HIV Patients Attending at ART Clinic of University of Gondar Hospital

IntroductionHuman immunodeficiency virus (HIV) pandemic is among the greatest health crises ever faced by humanity. Morbidity and mortality in HIV disease is due to immunosuppression leading to life-threatening opportunistic infections...

Analysis of the features of the course of HIV/AIDS in the Chernivtsi region

The research presents data about the clinical features and the spectrum of opportunistic infections in HIVinfected persons of the Chernivtsi region. An active involvement of the population into the epidemic process, a rapid clinical manifestation of asymptomatic HIV infection through the development of opportunistic infections are observed in the region. In most clinical cases a high rate of lesions of the skin, mucous membranes, the lymphatic, respiratory and central nervous systems was observed. A high percentage of co-infection of viral hepatites and HIV was fixed.

Re: Spectrum of AIDS Defining Opportunistic Infections in a Series of 77 Hospitalised HIV-Infected Omani Patients

Sir, The recent report on the spectrum of AIDS-defining opportunistic infections (OIs) in HIV-infected patients is very interesting.1 Balkhair et al. concluded that “a wide spectrum of OIs are seen in hospitalised HIV-infected patients in Oman.”1 Indeed, OIs are common in HIV and can be seen elsewhere around the world. The concern with the present cohort study is the diagnostic approach. Certainly, to identify the clinical spectrum, good, systematic and highly accurate tests must be implemented. Some OIs require special tests for detection. Focusing on the present report, an interesting point is the low prevalence of intestinal OIs. This might be due to these types of OIs having been overlooked. In our experience, several intestinal parasites including OIs are common and must be screened for in HIV-infected patients.2–3

Idiopathic CD4 Lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases

Idiopathic CD4 lymphocytopenia (ICL) was first defined in 1992 by the US Centers for Disease Control and Prevention (CDC) as the repeated presence of a CD4+ T lymphocyte count of fewer than 300 cells per cubic millimeter or of less than 20% of total T cells with no evidence of human immunodeficiency virus (HIV) infection and no condition that might cause depressed CD4 counts. Most of our knowledge about ICL comes from scattered case reports. The aim of this study was to collect comprehensive data from the previously published cases to understand the characteristics of this rare condition. We searched the PubMed database and Science Direct for case reports since 1989 for Idiopathic CD4 lymphocytopenia cases. We found 258 cases diagnosed with ICL in 143 published papers. We collected data about age, sex, pathogens, site of infections, CD4 count, CD8 count, CD4:CD8 ratio, presence of HIV risk factors, malignancies, autoimmune diseases and whether the patients survived or died. The mean age at diagnosis of first opportunistic infection (or ICL if no opportunistic infection reported) was 40.7 ± 19.2 years (standard deviation), with a range of 1 to 85. One-sixty (62%) patients were males, 91 (35.2%) were females, and 7 (2.7%) patients were not identified whether males or females. Risk factors for HIV were documented in 36 (13.9%) patients. The mean initial CD4 count was 142.6 ± 103.9/mm3 (standard deviation). The mean initial CD8 count was 295 ± 273.6/mm3 (standard deviation). The mean initial CD4:CD8 ratio was 0.6 ± 0.7 (standard deviation). The mean lowest CD4 count was 115.4 ± 87.1/mm3 (standard deviation). The majority of patients 226 (87.6%) had at least one infection. Cryptococcal infections were the most prevalent infections in ICL patients (26.6%), followed by mycobacterial infections (17%), candidal infections (16.2%), and VZV infections (13.1%). Malignancies were reported in 47 (18.1%) patients. Autoimmune diseases were reported in 37 (14.2%) patients.

Assessment of secondary immunodeficiency – the role of laboratory testing

Clinical immunology is in a historically significant phase of escalation of targeted immunotherapeutics that will continue to transform the management of immune mediated diseases. Each of these novel agents manipulates the immune system in different ways with adverse events including a spectrum of opportunistic infections, malignancies and paradoxical inflammatory reactions. A key clinical challenge for prescribers at the bedside is the selection and titration of the most suitable agents for maximum benefit and minimum toxicity. In this context, it is worth reviewing what has been achieved to date in measuring the functional immune reserve in an individual patient. At the simplest level immunodeficiency can be characterised by the susceptibility to infection. This approach presents two problems. First, infections are a universal experience of otherwise healthy individuals, and second, the prevention of episodes of infection is a key clinical ambition. Conventional immunopathology tests may provide data to help identify which patients are at greatest risk of immunosuppression complications, but when critically appraised, fall short of what is required in practice. This paper will review current laboratory approaches to assessing secondary immunodeficiency and will highlight the need for immunopathology laboratories to adapt to the new therapeutic opportunities.