Opportunistic infection

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Opportunistic infection
Chest X-ray in influenza and Haemophilus influenzae - annotated.jpg
Chest X-ray of a patient who first had influenza and then developed Haemophilus influenzae pneumonia, presumably opportunistic
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg

An opportunistic infection is an infection caused by pathogens (bacteria, fungi, parasites or viruses) that take advantage of an opportunity not normally available. These opportunities can stem from a variety of sources, such as a weakened immune system (as can occur in acquired immunodeficiency syndrome or when being treated with immunosuppressive drugs, as in cancer treatment), [1] an altered microbiome (such as a disruption in gut microbiota), or breached integumentary barriers (as in penetrating trauma). Many of these pathogens do not necessarily cause disease in a healthy host that has a non-compromised immune system, and can, in some cases, act as commensals until the balance of the immune system is disrupted. [2] [3] Opportunistic infections can also be attributed to pathogens which cause mild illness in healthy individuals but lead to more serious illness when given the opportunity to take advantage of an immunocompromised host. [4]

Contents

Types of opportunistic infections

A wide variety of pathogens are involved in opportunistic infection and can cause a similarly wide range in pathologies. A partial list of opportunistic pathogens and their associated presentations includes:

Bacteria

Fungi

Parasites

Viruses

Causes

Immunodeficiency or immunosuppression are characterized by the absence of or disruption in components of the immune system, leading to lower-than-normal levels of immune function and immunity against pathogens. [1] They can be caused by a variety of factors, including:

The lack of or the disruption of normal vaginal microbiota allows the proliferation of opportunistic microorganisms and will cause the opportunistic infection bacterial vaginosis. [38] [39] [40] [41]

Opportunistic Infection and HIV/AIDS

HIV is a virus that targets T cells of the immune system and, as a result, HIV infection can lead to progressively worsening immunodeficiency, a condition ideal for the development of opportunistic infection. [42] [43] Because of this, respiratory and central nervous system opportunistic infections, including tuberculosis and meningitis, respectively, are associated with later-stage HIV infection, as are numerous other infectious pathologies. [44] [45] Kaposi’s sarcoma, a virally-associated cancer, has higher incidence rates in HIV-positive patients than in the general population. [46] As immune function declines and HIV-infection progresses to AIDS, individuals are at an increased risk of opportunistic infections that their immune systems are no longer capable of responding properly to. Because of this, opportunistic infections are a leading cause of HIV/AIDS-related deaths. [47]

Prevention

Since opportunistic infections can cause severe disease, much emphasis is placed on measures to prevent infection. Such a strategy usually includes restoration of the immune system as soon as possible, avoiding exposures to infectious agents, and using antimicrobial medications ("prophylactic medications") directed against specific infections. [48]

Restoration of immune system

Avoidance of infectious exposure

The following may be avoided as a preventative measure to reduce risk of infection:

Prophylactic medications

Individuals at higher risk are often prescribed prophylactic medication to prevent an infection from occurring. A person's risk level for developing an opportunistic infection is approximated using the person's CD4 T-cell count and other indications. The table below provides information regarding the treatment management of common opportunistic infections. [54] [55] [56]

Opportunistic infectionsIndication(s) for prophylactic medicationsPreferred agent(s)When to discontinue agent(s)Secondary prophylactic/maintenance agent(s)
Mycobacterium tuberculosis Upon diagnosis of HIV, any positive screening test, or prior medical history of Mycobacterium tuberculosis.These current agents' doses/frequency will discontinue after two months. Depending on clinical presentation, maintenance agents will continue for at least four more months.
  • Rifampicin, isoniazid, and pyridoxine
Pneumocystis jiroveci CD4 count is less than 200 cells/mm3 or less than 14%. The person has documented medical history of recurrent oropharyngeal candidiasis.This current agent doses/frequency will discontinue after 21 days. Secondary prophylactic agent dose/frequency will continue until the CD4 count is above 200 cells/mm3 and the HIV viral load is undetectable for at least three months while taking antiretroviral therapy.
  • Trimethoprim-sulfamethoxazole
Toxoplasma gondii CD4 count is less than 100 cells/mm3 or less than 14%, and the person has a positive serology for Toxoplasma gondii.
  • Trimethoprim-sulfamethoxazole
This agent will discontinue after six weeks. Secondary prophylactic medications will continue until the CD4 count is above 200 cells/mm3 and HIV viral load is undetectable for at least six months while taking antiretroviral therapy.
Mycobacterium avium complex disease CD4 count is less than 50 cells/mm3 and has a detectable viral load while taking antiretroviral therapy.
  • Clarithromycin and ethambutol
  • Rifabutin may be added depending on clinical presentation.
These agent(s) will discontinue after 12 months only if the person does not have any symptoms that will be concerning for persistent Mycobacterium avium complex disease and their CD4 count is above 100 cells/mm3, and while their HIV viral load is undetectable for at least six months while taking antiretroviral therapy.N/A

Alternative agents can be used instead of the preferred agents. These alternative agents may be used due to allergies, availability, or clinical presentation. The alternative agents are listed in the table below. [54] [55] [56]

Opportunistic infectionsAlternative agent(s)
Mycobacterium tuberculosis
Pneumocystis jiroveci
Toxoplasma gondii
  • Dapsone, pyrimethamine, and folinic acid
  • Atovaquone, pyrimethamine, and folinic acid
Mycobacterium avium complex disease

Treatment

Treatment depends on the type of opportunistic infection, but usually involves different antibiotics.[ citation needed ]

Veterinary treatment

Opportunistic infections caused by feline leukemia virus and feline immunodeficiency virus retroviral infections can be treated with lymphocyte T-cell immunomodulator.

Related Research Articles

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A human pathogen is a pathogen that causes disease in humans.

<span class="mw-page-title-main">Infection</span> Invasion of an organisms body by pathogenic agents

An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable disease, is an illness resulting from an infection.

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<span class="mw-page-title-main">Toxoplasmosis</span> Parasitic disease

Toxoplasmosis is a parasitic disease caused by Toxoplasma gondii, an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or months of mild, flu-like illness such as muscle aches and tender lymph nodes. In a small number of people, eye problems may develop. In those with a weak immune system, severe symptoms such as seizures and poor coordination may occur. If a person becomes infected during pregnancy, a condition known as congenital toxoplasmosis may affect the child.

<i>Mycobacterium</i> Genus of bacteria

Mycobacterium is a genus of over 190 species in the phylum Actinomycetota, assigned its own family, Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis and leprosy in humans. The Greek prefix myco- means 'fungus', alluding to this genus' mold-like colony surfaces. Since this genus has cell walls with a waxy lipid-rich outer layer that contains high concentrations of mycolic acid, acid-fast staining is used to emphasize their resistance to acids, compared to other cell types.

<span class="mw-page-title-main">Asymptomatic carrier</span> Organism which has become infected with a pathogen but displays no symptoms

An asymptomatic carrier is a person or other organism that has become infected with a pathogen, but shows no signs or symptoms.

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<i>Mycobacterium avium-intracellulare</i> infection Medical condition

Mycobacterium avium-intracellulare infection (MAI) is an atypical mycobacterial infection, i.e. one with nontuberculous mycobacteria or NTM, caused by Mycobacterium avium complex (MAC), which is made of two Mycobacterium species, M. avium and M. intracellulare. This infection causes respiratory illness in birds, pigs, and humans, especially in immunocompromised people. In the later stages of AIDS, it can be very severe. It usually first presents as a persistent cough. It is typically treated with a series of three antibiotics for a period of at least six months.

<span class="mw-page-title-main">Subclinical infection</span> Nearly or completely asymptomatic infection

A subclinical infection—sometimes called a preinfection or inapparent infection—is an infection by a pathogen that causes few or no signs or symptoms of infection in the host. Subclinical infections can occur in both humans and animals. Depending on the pathogen, which can be a virus or intestinal parasite, the host may be infectious and able to transmit the pathogen without ever developing symptoms; such a host is called an asymptomatic carrier. Many pathogens, including HIV, typhoid fever, and coronaviruses such as COVID-19 spread in their host populations through subclinical infection.

<i>Pneumocystis</i> pneumonia Medical condition

Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus Pneumocystis jirovecii.

<span class="mw-page-title-main">Pathogenic bacteria</span> Disease-causing bacteria

Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of these pathogenic species in humans is estimated to be fewer than a hundred. By contrast, several thousand species are part of the gut flora present in the digestive tract.

<span class="mw-page-title-main">Kaposi's sarcoma</span> Cancer of the skin, integumentary lymph nodes, or other organs

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The co-epidemic of tuberculosis (TB) and human immunodeficiency virus (HIV) is one of the major global health challenges in the present time. The World Health Organization (WHO) reports 9.2 million new cases of TB in 2006 of whom 7.7% were HIV-infected. Tuberculosis is the most common contagious infection in HIV-Immunocompromised patients leading to death. These diseases act in combination as HIV drives a decline in immunity while tuberculosis progresses due to defective immune status. This condition becomes more severe in case of multi-drug (MDRTB) and extensively drug resistant TB (XDRTB), which are difficult to treat and contribute to increased mortality. Tuberculosis can occur at any stage of HIV infection. The risk and severity of tuberculosis increases soon after infection with HIV. A study on gold miners of South Africa revealed that the risk of TB was doubled during the first year after HIV seroconversion. Although tuberculosis can be a relatively early manifestation of HIV infection, it is important to note that the risk of tuberculosis progresses as the CD4 cell count decreases along with the progression of HIV infection. The risk of TB generally remains high in HIV-infected patients, remaining above the background risk of the general population even with effective immune reconstitution and high CD4 cell counts with antiretroviral therapy.

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