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Fulltext Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries

del Amo J, Moreno S, Bucher HC, Furrer H, Logan R, Sterne J, et al.

Clin Infect Dis, 2012 May;54(9):1364-72.
PMID: 22460971 DOI: 10.1093/cid/cis203

BACKGROUND: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries.
METHODS: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting.
RESULTS: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL.
CONCLUSIONS: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.

Matched MeSH terms: AIDS-Related Opportunistic Infections/microbiology; AIDS-Related Opportunistic Infections/epidemiology*
Fulltext Immunological profiles of immune restoration disease presenting as mycobacterial lymphadenitis and cryptococcal meningitis

Tan DB, Yong YK, Tan HY, Kamarulzaman A, Tan LH, Lim A, et al.

HIV Med, 2008 May;9(5):307-16.
PMID: 18400078 DOI: 10.1111/j.1468-1293.2008.00565.x

A proportion of HIV patients beginning antiretroviral therapy (ART) develop immune restoration disease (IRD). Immunological characteristics of IRD were investigated in a cohort of HIV patients beginning therapy in Kuala Lumpur, Malaysia.

Matched MeSH terms: AIDS-Related Opportunistic Infections/diagnosis*; AIDS-Related Opportunistic Infections/immunology
Fulltext Pneumocystis carinii (jirovecii) pneumonia (PCP): the most common opportunistic infection observed in HIV/AIDS cases at the University Malaya Medical Centre, Kuala Lumpur, Malaysia

Jamaiah I, Rohela M, Tok EL, Tan CL, Tan WH, Teo WS, et al.

Southeast Asian J. Trop. Med. Public Health, 2012 Jul;43(4):825-31.
PMID: 23077803

This retrospective study was conducted among 59 HIV/AIDS patients with opportunistic infections admitted to the University Malaya Medical Centre between 2000 and 2009. Fifty-five point nine percent of cases were Chinese, 25.4% were Malays, 11.9% were Indians and 6.8% were of unknown ethnic origin. The male:female ratio was 2.9:1 (44 males and 15 females). The highest prevalence (38.9%) occurred in the 30-39 year old age group. Men comprised 47.7% and women 53.3%; the majority of both were married. The majority of cases were Malaysians (89.8%) and the rest (10.2%) were immigrants. Most of the patients (18.6%) were non-laborers, followed by laborers (11.9%), the unemployed (5.1%) and housewives (3.4%). The most common risk factor was unprotected sexual activity (20.3%). The two most common HIV/AIDS related opportunistic infections were Pneumocystis carinii (jirovecii) pneumonia (PCP) (62.7%) and toxoplasmosis (28.8%). Seventy-two point nine percent of patients had a CD4 count <200 cells/microl and 5.1% had a CD4 count >500 cells/microl. Eleven point nine percent of cases died during study period. A low CD4 count had a greater association with opportunistic infections. Most of the patients presented with fever (44.1%), cough (42.4%) and shortness of breath (28.8%). Detection of the etiologic pathogens aids clinicians in choosing appropriate management strategies.

Matched MeSH terms: AIDS-Related Opportunistic Infections/epidemiology*
Detection of Cryptosporidium parvum in HIV-infected patients in Malaysia using a molecular approach

Zaidah AR, Chan YY, Asma HS, Abdullah S, Nurhaslindawati AR, Salleh M, et al.

Southeast Asian J. Trop. Med. Public Health, 2008 May;39(3):511-6.
PMID: 18564692

This cross-sectional study determined the prevalence of cryptosporidiosis in HIV-infected patients using polymerase chain reaction (PCR). Stool specimens were collected from HIV infected patients who were admitted to Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia, for various indications from December 2004 to December 2005. A modified acid-fast stain was performed on the direct stool smears, then the stool specimens were further tested using nested PCR targeting the 18S rRNA gene of Cryptosporidium parvum, with a built-in internal control (IC). Out of 59 samples, 11 were positives. Nested PCR identified a total of nine samples (16%) compared to microscopy, which identified only three samples. All PCR negative results showed IC amplicons, suggesting that these samples were true negatives and were not due to inhibition of PCR. This study highlights the importance of molecular diagnosis in determining the true prevalence and epidemiology of C. parvum.

Matched MeSH terms: AIDS-Related Opportunistic Infections/parasitology*
Hypersensitivity reactions to high-dose co-trimoxazole in HIV-infected Malaysian and Scottish patients

Pakianathan MR, Kamarulzaman A, Ismail R, McMillan A, Scott GR

AIDS, 1999 Sep 10;13(13):1787-8.
PMID: 10509585
Matched MeSH terms: AIDS-Related Opportunistic Infections/drug therapy
A case of T-cell acute lymphoblastic leukemia after treatment of acute promyelocytic leukemia

Bee PC, Gan GG, Sangkar JV, Teh A, Goh KY

Int J Hematol, 2004 May;79(4):358-60.
PMID: 15218965

We diagnosed T-cell acute lymphoblastic leukemia (T-ALL) with multiple cytogenetic abnormalities in a 17-year-old girl a year after she had received a diagnosis of acute promyelocytic leukemia (APML). After the diagnosis of APML in June 2001, the patient was treated with idarubicin and all-trans-retinoic acid. In September 1999, her younger sister also received a diagnosis of APML and to date has remained well. T-ALL after remission of APML is very rare, and only 1 such case has been reported. Possible causes include therapy-related reasons, genetic susceptibility to leukemia, and environmental exposure.

Matched MeSH terms: Opportunistic Infections/etiology
Fulltext Impact of antiretroviral therapy on opportunistic infections of HIV-infected children in the therapeutic research, education and AIDS training asia pediatric HIV observational database

Prasitsuebsai W, Kariminia A, Puthanakit T, Lumbiganon P, Hansudewechakul R, Siew Moy F, et al.

Pediatr Infect Dis J, 2014 Jul;33(7):747-52.
PMID: 24378942 DOI: 10.1097/INF.0000000000000226

There are limited data on opportunistic infections (OIs) and factors associated with their occurrence after highly active antiretroviral therapy (HAART) in Asian children. The use of HAART in Asia started much later than in developed countries and therefore reported findings may not be fully applicable to the pediatric HIV epidemic in Asia.

Matched MeSH terms: AIDS-Related Opportunistic Infections/epidemiology*
Culture and molecular identification of fungal contaminants in edible bird nests

Chen JX, Wong SF, Lim PK, Mak JW

Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2015;32(12):2138-47.
PMID: 26429550 DOI: 10.1080/19440049.2015.1101494

Widespread food poisoning due to microbial contamination has been a major concern for the food industry, consumers and governing authorities. This study is designed to determine the levels of fungal contamination in edible bird nests (EBNs) using culture and molecular techniques. Raw EBNs were collected from five house farms, and commercial EBNs were purchased from five Chinese traditional medicine shops (companies A-E) in Peninsular Malaysia. The fungal contents in the raw and commercial EBNs, and boiled and unboiled EBNs were determined. Culturable fungi were isolated and identified. In this study, the use of these methods revealed that all EBNs had fungal colony-forming units (CFUs) that exceeded the limit set by Standards and Industrial Research Institute of Malaysia (SIRIM) for yeast and moulds in EBNs. There was a significant difference (p < 0.05) in the number of types of fungi isolated from raw and commercial EBNs, but no significant difference in the reduction of the number of types of fungi after boiling the EBNs (p > 0.05). The types of fungi isolated from the unboiled raw EBNs were mainly soil, plant and environmental fungi, while the types of fungi isolated from the boiled raw EBNs, unboiled and boiled commercial EBNs were mainly environmental fungi. Aspergillus sp., Candida sp., Cladosporium sp., Neurospora sp. and Penicillum sp. were the most common fungi isolated from the unboiled and boiled raw and commercial EBNs. Some of these fungi are mycotoxin producers and cause opportunistic infections in humans. Further studies to determine the mycotoxin levels and methods to prevent or remove these contaminations from EBNs for safe consumption are necessary. The establishment and implementation of stringent regulations for the standards of EBNs should be regularly updated and monitored to improve the quality of the EBNs and consumer safety.

Matched MeSH terms: Opportunistic Infections
Fulltext A case report of severe Ascariasis infection in systemic lupus erythematosus patient

Tan J. Y. S., R. Surendran, Mohd Noh Malehah, Shaila Kabir, Chong Y. Y. Eleen

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):53-53.
MyJurnal

Introduction: Ascariasis is a parasitic infection, which commonly affects immunocompromised patients. Most pa-tients remained asymptomatic during the early larval migration stage and respond well with conventional anti-hel-minthic drugs. Previous literature had reported symptomatic Ascaris infection mimicking bacterial pneumonia and the typical eosinophilia found in Loeffler syndrome was absent in patients on corticosteroids. Thus, a high index of suspicion for ascariasis is needed for immunosuppressed patients presented with infection. We present here a case of severe ascariasis infection in a systemic lupus erythematosus patient. Case description: A 16-year-old boy presented with fever, generalized maculopapular rash associated with neutropenia and thrombocytopenia. He was treated initially as Dengue Fever initially. However his symptoms did not resolve at even day 14 of admission. On further assessment, we were convinced he has SLE based upon presence of malar rash, oral ulcers, urinary protein-uria, persistent leucopenia, thrombocytopenia with low complements and ANA positive. He was promptly started on IV hydrocortisone. He showed a good progress in the first few days. On day 5 of admission, he coughed out a round worm which later identified as Ascarisis lumbricoides. He was started on Albendazole. Unfortunately he developed hemoptysis and respiratory compromisation where he required intubation. Post intubation he went into cardiac arrest, which required CPR. Following that event, his condition further deteriorated with multi organ failure. He succumbed to his illness three days later. Conclusion: Immunocompromised patients are prone to opportunistic infections including parasitic infections. we present here a case of ascariasis in an SLE patient who unfortunately succumbed to the illness. Due to the variable clinical symptoms that mimic other infections, screening for parasitic infections needs to be considered especially if the patients do not respond to antibiotics and routine treatments.

Matched MeSH terms: Opportunistic Infections
Fulltext The correlation of Acanthamoeba from the ventilation system with other environmental parameters in commercial buildings as possible indicator for indoor air quality

Ooi SS, Mak JW, Chen DK, Ambu S

Ind Health, 2017 Feb 07;55(1):35-45.
PMID: 27476379 DOI: 10.2486/indhealth.2015-0218

The free-living protozoan Acanthamoeba is an opportunistic pathogen that is ubiquitous in our environment. However, its role in affecting indoor air quality and ill-health of indoor occupants is relatively unknown. The present study investigated the presence of Acanthamoeba from the ventilation system and its correlation with other indoor air quality parameters, used in the industry code of practice and its potential as an indicator for indoor air quality. Indoor air quality assessments were carried out in nine commercial buildings with approval from the building management, and the parameters assessed were as recommended by the Department of Occupational Safety and Health. The presence of Acanthamoeba was determined through dust swabs from the ventilation system and indoor furniture. Logistic regression was performed to study the correlation between assessed parameters and occupants' complaints. A total of 107 sampling points were assessed and 40.2% of the supplying air diffuser and blowing fan and 15% of the furniture were positive for cysts. There was a significant correlation between Acanthamoeba detected from the ventilation system with ambient total fungus count (r=0.327; p=0.01) and respirable particulates (r=0.276; p=0.01). Occupants' sick building syndrome experience also correlated with the presence of Acanthamoeba in the ventilation system (r=0.361; p=0.01) and those detected on the furniture (r=0.290; p=0.01). Logistic regression showed that there was a five-fold probability of sick building syndrome among occupants when Acanthamoeba was detected in the ventilation system.

Matched MeSH terms: Opportunistic Infections
Spectrum of opportunistic infections related to the central nervous system among AIDS patients in Hospital Kuala Lumpur

Nissapatorn V, Lee C, Khairul Anuar A

JUMMEC, 2000;5:89-92.

A relTospective study was conducted in Hospital Kuala Lumpur, May, 2001.49 (12.1%) of 406 AIDS patients were diagnosed as opportunistic infections related to the central nervous system. The sex ratio (M:F) was 7.2. The median age was 34 years. The predominant age group for male as same as female was 25-34 years.The majority of the study subjects were Chinese (79.6%), married (49%), unemployed (42.9%) and heterosexuals (95.9%) as the risk behavior related to HlV infection. The most frequent clinical manifestations was headache (71.4%). At the time of diagnosis, the greater number of patients 39 (79.6%) had CD4 count < 200 celVcumm. Outcome of acute therapy the patients had a complete (85.7%), treatment continued (10.3%), and transfer to other hospital (2.00/0). Toxoplasmic encephalitis (7.6%) and cryptococcosis (3.9%) were the frequent cause of focal intracerebral lesions and meningitis in these patients respectively. Oral candidiasis (32.7%) was the most common among other opportunistic infections in this study. KEYWORDS: AIDS, Opportunistic infections. central nervous system, clinical manifestations, outcome.

Matched MeSH terms: Opportunistic Infections
Talaromyces (Penicillium) species infection in the central nervous system

Chuah CH, Ong YC, Kong BH, Woo YY, Wong PS, Leong KN, et al.

J R Coll Physicians Edinb, 2020 Jun;50(2):138-140.
PMID: 32568283 DOI: 10.4997/JRCPE.2020.211

Talaromycosis typically occurs as an opportunistic infection among immunocompromised individuals. Infection caused by species other than T. marneffei is uncommon. While most reported cases describe infection in the lungs, we report an extremely rare intracranial Talaromyces species infection. This 61-year-old with end-stage renal disease who was unwell for the previous two months, presented with fever and worsening confusion lasting for three days. Lumbar puncture was suggestive of meningitis. Cerebrospinal fluid (CSF) culture was later confirmed to be Penicillium chrysogenum. The patient was co-infected with Group B Streptococcus sepsis. He improved with amphotericin B and ceftriaxone and was discharged with oral itraconazole for four weeks. However, he died of unknown causes two weeks later at home. Talaromyces species infection in the central nervous system is uncommon. This case highlighted a rare but life-threatening fungal meningitis. Among the four reported cases worldwide, none of the patients survived.

Matched MeSH terms: Opportunistic Infections
Fulltext Fatal infections in older patients with inflammatory bowel disease on anti-tumor necrosis factor therapy

Lee WS, Azmi N, Ng RT, Ong SY, Ponnampalavanar SS, Mahadeva S, et al.

Intest Res, 2017 Oct;15(4):524-528.
PMID: 29142521 DOI: 10.5217/ir.2017.15.4.524

Anti-tumor necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD); however, it is associated with an increased risk of infections, particularly in older adults. We reviewed 349 patients with IBD, who were observed over a 12-month period, 74 of whom had received anti-TNF therapy (71 patients were aged <60 years and 3 were aged ≥60 years). All the 3 older patients developed serious infectious complications after receiving anti-TNFs, although all of them were also on concomitant immunosuppressive therapy. One patient developed disseminated tuberculosis, another patient developed cholera diarrhea followed by nosocomial pneumonia, while the third patient developed multiple opportunistic infections (Pneumocystis pneumonia, cryptococcal septicemia and meningitis, Klebsiella septicemia). All 3 patients died within 1 year from the onset of the infection(s). We recommend that anti-TNF, especially when combined with other immunosuppressive therapy, should be used with extreme caution in older adult patients with IBD.

Matched MeSH terms: Opportunistic Infections
Sexually transmitted disease (STD) and acquired immunodeficiency syndrome (AIDS) in South East Asia

Ismail R

Clin Dermatol, 1999 5 20;17(2):127-35; discussion 105-6.
PMID: 10330595 DOI: 10.1016/s0738-081x(99)00005-x
Matched MeSH terms: AIDS-Related Opportunistic Infections/epidemiology

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