Infections in the immunosuppressed

Infections in the immunosuppressed key points:

Which patients…!????

• HIV-positive.

• Post-transplantation (stem cell/solid organ).

Which organisms?

• HIV—depends on CD4 count (but commonly CMV, toxoplasmosis , syphilis, TB , microsporidia )

CD4 count (cells/mm3)

250–500 ……. VZV and TB

150–250 ……….lymphoma and Kaposi’s sarcoma

50–150 …………Pneumocystosis ,toxoplasmosis Microsporidiosis ,VZV retinitis

<50 …………CMV retinitis

• Post-transplantation : commonly CMV or fungi.

• Therapeutic immunosuppression for systemic disease: commonly CMV and toxoplasmosis and occasionally fungi.

Infections in the immunosuppressed powerpoint presentation :

Tb in the immunosuppressed

1.  TB In The Immunosuppressed Slam 201002414
2. Normal Chest X-ray
3. . Introduction  TB is the most common opportunistic infection  By producing a progressive decline in cell-mediated immunity,  HIV alters the pathogenesis of TB,  greatly increasing the risk of disease from TB in HIV-co-infected individuals  and leading to more frequent extra-pulmonary involvement,  atypical radiographic manifestations,  and paucibacillary disease, which can impede timely diagnosis
4.  In HIV-infected patients with LTBI, active TB develops in about 5 to 10%/yr, whereas in people who are not immunocompromised, it develops in about the same percentage over a lifetime  a chest x-ray may show a nonspecific pneumonia or even be normal.  Smear-negative TB is more common when HIV coinfection is present.  Because smear-negative TB is common, HIV-TB coinfection is often considered a paucibacillary disease state.
5. Immunity
6. Impact of HIV Infection on the Pathogenesis of Tuberculosis  Defective macrophages function in response to TB infection  HIV impairs the host’s ability to contain new TB infection  etc
7.  The presentation of TB also is affected by the extent of HIV-related immunosuppression.  In patients with CD4 counts of >350 cells/µL, the clinical and radiographic presentation is similar to that of patients without HIV infection.  However, as immunosuppression advances, the radiographic presentation becomes less typical and extra-pulmonary and disseminated disease become more common…
8. Radiographic Findings  Upper-lobe infiltrates and cavities are the typical findings in reactivation TB, whereas intra-thoracic lymphadenopathy and lower-lobe disease are seen in primary TB.  In HIV-infected persons with higher CD4 counts (ie, >200 cells/µL), the radiographic pattern tends to be one of reactivation disease with upper-lobe infiltrates with or without cavities.  In HIV-infected persons who have a greater degree of immunosuppression (ie, CD4 count <200 cells/µL), a pattern of primary disease with intra-thoracic lymphadenopathy and lower-lobe infiltrates is seen.  As chest radiographs may appear normal in up to 21% of those with culture- positive TB and CD4 counts of <50 cells/µL,(51) a high index of suspicion must be maintained in evaluating an HIV-infected patient with symptoms suggestive of TB
9. Without Pleural Effusion
10. .With Pleural Effusion
11. CD4 Count Significance  In AIDS patients, a mycobacterial illness that develops while the CD4 count is ≥ 200/μL is almost always TB. By contrast, depending on the probability of TB exposure, a mycobacterial infection that develops while the CD4 count is < 50/μL is usually due to M. avium complex
12.  MAC
13. Milliary TB IMMUNOCOMPETENT IMMUNOSUPPRESSED

Infections in the immunosuppressed Videos:

Infections in Immunocompromised Patients

Infections in the immunosuppressed