Geographic Opportunistic Infections
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1 Epidemiology of HIV Associated Opportunistic Infections in the United States Siriluck Anunnatsiri, MD Division of Infectious Diseases and Tropical Medicine Department of Medicine, Khon Kaen University Clin Infect Dis 2000;30:S5 14 Geographic Opportunistic Infections Diseases Coccidioidomycosis Penicilliosis Leishmaniasis Geographic distribution San Joaquin Valley in California, Arizona, southern regions of Utah, Nevada, New Mexico, western Texas Southeast Asia, southern China Mediterranean region, southern Asia, Africa, South America
2 Top 5 Common OIs in Thai HIV-Infected Patients National data Tuberculosis (30%) PCP (20%) Cryptococcosis (13%) Esophageal candidiasis (5%) Recurrent pneumonia (3%) A tertiary care center, Bangkok Tuberculosis (58%) PCP (18%) Cryptococcosis (8%) CMV retinitis (4%) MAC infection (2%) P. marneffei infection: common in the northern Thailand Bureau of Epidemiology, Department of Disease Control Ministry of Public Health, J Infect 2007; 55: Common HIV-related OIs in ASEAN countries HIV-related OIs in Lao PDR OIs Countries Cambodia 1 Malaysia 2 Philippine 3 Singapore 4 TB PCP Cryptococcosis CMV Eso. candidiasis Toxoplasmosis Cryptosporidiosis MAC Isosporiasis, histoplasmosis, salmonellosis Penicilliosis, histoplasmosis PML, histoplasmosis 1. SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 2007; 38: 62-8; 2. SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 2004; 35 (S2): 26-32; 3. Salvana EM, et al. Abstract in ID Week 2012.; 4. BMC Infectious Diseases 2004, 4:47 UNESCO Bangkok 2007
3 HIV-TB coinfection Phnom Penh, Cambodia * MDR-TB: new case 3.7% previously treated 28.9% *Glob Health Action 2015; 8: Nontuberculous Mycobacterial Disease in Patients with HIV in Cambodia, Thailand, and Vietnam Prevalence of NTM disease = 2% (19 of 1,060) Bacterial infection: Problem of drug resistance Bacteremia in Cambodia, ,833 adults; Community-acquired 86% ESBL-producing E. coli (48%); Klebsiella spp. (44), Enterobacter spp. (46%) Salmonella S. Typhi S. Choleraesuis -Multi-drug resistant 75% 92% -Nalidixic acid resistant 90% 33% -Azithromycin resistant 5% 71% PLOS ONE 2013; 8: e59775; PLOS Neglect Trop Dis 2012; 6: e1933. Am J Respir Crit Care Med 2012; 185,:
4 Opportunistic infections Nocardiosis Rhodococcosis A 43-yr-old female, Loa Prolonged fever for 1 mo Right cervical lymphadenopathy Oral thrush +ve Hepatosplenomegaly Lab: Anti-HIV positive Anemia Cholestatic hepatitis CXR: normal Major invasive fungal infection in HIVinfected patients Pneumocystosis Histoplasmosis Opportunistic enteric protozoa in HIVinfected patients Cystoisosporiasis Cryptococcosis Penicilliosis Microsporidiosis Enteric protozoa Cyclosporiasis Cryptosporidiosis Clin Infect Dis 2013;56(6):861 9
5 Nonenteric protozoa in HIV-infected patients Toxoplasmosis Leishmaniasis?? Southern Thailand: Leishmania siamensis Potential vector: Sergentomyia gemmea Western Malaysia: presence of sandfly Acanthamoeba infection Skin infection, rhinosinusitis, encephalitis BMC Microbiol 2013; 13: 60; BMC Infectious 2013; 13: 333; J Neuroimaging 2015; 25: ; J Clin Microbiol 2012; 50: ; Laryngoscope 2002; 112: Malaria and HIV Helminthic infection Strongyloidiasis Parasitemia; Higher density of parasitemia Clinical malaria Risk of severe malaria in nonimmune patient Risk of Rx failure Malaria HIV HIV viral load MTCT of HIV Neurocysticercosis Lymphatic filariasis Schistosomiasis Am J Trop Med Hyg 2007; 77(1):
6 Lymphatic filariasis 2 villages of Mae Chan sub-district, Umphang district, Tak province at Thai-Myanmar border, Thailand ISRN Tropical Medicine 2013 ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY (2003) 21: Viral infection in HIV-infected patients CMV JC virus Herpes: Herpes simplex, Varicellar-zoster Herpes simplex 8 Viral hepatitis EBV Schistosoma mekongi WHO; Emerg Infect Dis 2009; 15:
7 Summary The most frequent causes of AIDS-defining illnesses in ASEAN countries are similar to those reported in the Thailand. Awareness of some emerging and problematic pathogens is necessary when caring patients from neighboring countries
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Overall response rate: 701/1265 (55.4%) physicians responded from 3/4/09 to 3/30/09.
Infectious Diseases Society of America Emerging Infections Network 4/2/09 Report for Query: Travel and Tropical Medicine Overall response rate: 701/1265 (55.4%) physicians responded from 3/4/09 to 3/30/09.