Opportunistic infection
| Opportunistic infection | |
|---|---|
 | |
| Chest X-ray of a patient who first had influenza and then developed Haemophilus influenzae pneumonia, presumably opportunistic | |
| Specialty | Infectious diseases  |
An opportunistic infection is an infection that occurs more commonly in individuals with an immunodeficiency disorder and acts more severe on those with a weakened immune system. These types of infections are considered serious and can be caused by a variety of pathogens including viruses, bacteria, fungi, and parasites.[1] Under normal conditions, such as in humans with uncompromised immune systems, an opportunistic infection would be less likely to cause significant harm and would typically result in a mild infection or no effect at all. These opportunistic infections can stem from a variety of sources, such as a weakened immune system (caused by Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome), when being treated with immunosuppressive drugs (as in cancer treatment),[2] when a microbiome is altered (such as a disruption in gut microbiota), or when integumentary barriers are breached (as in penetrating trauma). Opportunistic infections can contribute to antibiotic resistance in an individual making these infections more severe. Some pathogens that cause these infections possess intrinsic resistance (natural resistance) to many antibiotics while others acquire resistance over time through mutations or HGT.[3] Many of these pathogens, such as the bacterium Clostridioides difficile (C. diff), can be present in hosts with uncompromised immune systems without generating any symptoms, and can, in some cases, act as commensals until the balance of the immune system is disrupted.[4][5][6][7] With C. diff and many other pathogens, the use or misuse of antibiotics can cause the disruption of normal microbiota and lead to an opportunistic infection caused by antibiotic resistant pathogens.[8] In some cases, opportunistic infections can be labeled as nosocomial infections due to individuals contracting them within a healthcare/hospital setting.[9] In terms of history, there is not one individual that can be attributed for discovering opportunistic infections. Over time and through medical advancement, there have been many scientists that have contributed to the study and treatment options for patients affected by these infections.[10][11]
Types of opportunistic infections
[edit]Opportunistic infections can be caused by a wide variety of different types of pathogens. These infections can be caused by viral, bacterial, fungal, as well as parasitic pathogens.[12]
A partial list of opportunistic pathogens and their associated effects are as follows:
Bacteria
[edit]- Clostridioides difficile (formerly known as Clostridium difficile) is a bacteria that is known to cause gastrointestinal infection and diarrhea. It is typically associated with being the most common hospital acquired infection.[13][14]
- Legionella pneumophila is a bacterium that causes Legionnaire's disease, a respiratory infection.[15][16]
- Mycobacterium avium complex (MAC) is a group of two bacteria, M. avium and M. intracellulare, that typically co-infect, leading to a lung infection called mycobacterium avium-intracellulare infection.[17][18]
- Mycobacterium tuberculosis is a species of bacteria that causes tuberculosis, a respiratory infection.[19]
- Pseudomonas aeruginosa is a bacterium that can cause respiratory infections. It is frequently associated with nosocomial infections and cystic fibrosis which can lead to organ dysfunctions and shortened life expectancy.[20][21]
- Salmonella is a genus of bacteria that is known to cause gastrointestinal infections causing an inflammatory response accompanied with fever and diarrhea.[22][23]
- Staphylococcus aureus is a bacterium known to cause skin infections and sepsis, among other pathologies. Notably, S. aureus has evolved several drug-resistant strains, including MRSA.[24][25]
- Streptococcus pneumoniae is a bacterium that causes respiratory infections as well as meningitis and bacteremia.[26][27]
- Streptococcus pyogenes (also known as group A Streptococcus) is a bacterium that can cause a variety of conditions, including impetigo and strep throat, as well as other illnesses.[28][29]
Fungi
[edit]- Aspergillus is a fungus, commonly associated with respiratory infection.[30][31]
- Candida albicans is a species of fungus that is a part of the normal human microbiome. It acts as a commensal unless there is a change in concentrations. It can be associated with various conditions such as oral thrush and gastrointestinal infection.[32][33][34]
- Coccidioides immitis is a fungus known for causing coccidioidomycosis, more commonly known as Valley Fever.[35]
- Cryptococcus neoformans is a fungus that causes cryptococcosis, which can lead to pulmonary infection as well as nervous system infections, like meningitis.[36][37]
- Histoplasma capsulatum is a species of fungus known to cause histoplasmosis, which can present itself with an array of symptoms, but often involves respiratory infection.[38][39]
- Pseudogymnoascus destructans (formerly known as Geomyces destructans) is a fungus that causes white-nose syndrome in bats.[40]
- Microsporidia is a group of fungi that infect species across the animal kingdom, one species of which can cause microsporidiosis in immunocompromised human hosts.[41]
- Pneumocystis jirovecii (formerly known as Pneumocystis carinii) is a fungus that causes pneumocystis pneumonia, a respiratory infection.[42]
Parasites
[edit]- Cryptosporidium is a protozoan that causes the condition Cryptosporidiosis. This condition affects the gastrointestinal tract.[43][44]
- Toxoplasma gondii is a protozoan, known for causing toxoplasmosis which is known to lead to impairment of the brain. [45][46][47]
Viruses
[edit]- Cytomegalovirus is considered a member of the human herpesvirus family and is most frequently associated with respiratory infection.[48][49][50]
- Human polyomavirus 2 (also known as JC virus) is known to cause progressive multifocal leukoencephalopathy (PML) which affects the central nervous system.[51][52][53]
- Human herpesvirus 8 (also known as Kaposi sarcoma-associated herpesvirus) is a virus associated with Kaposi sarcoma, a type of skin cancer.[54][55]
Opportunistic Infection and HIV/AIDS
[edit]Human Immunodeficiency Virus is a virus that targets the CD4 cells (a type of white blood cell) within the body's immune system. CD4 counts within a non-affected immune system would range anywhere from 500-1500 cells per cubic millimeter of blood, while an affected immune system would show cell counts below 200.[56] HIV infection can lead to progressively worsening immunodeficiency, a condition ideal for the development of opportunistic infection.[57][58] As HIV worsens over time, the term AIDS, or acquired immunodeficiency syndrome has been used to describe the condition and extensive damage to the immune system as well as the onset and susceptibility to other illnesses. The onset of AIDS leads to respiratory and central nervous system opportunistic infections, including but not limited to pneumonia, tuberculosis and meningitis.[59][60][61] Kaposi's sarcoma, a virally associated cancer, and non-Hodgkin's lymphoma are two types of cancers that are generally defined as AIDS malignancies.[62] 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.[63]
Causes
[edit]Immunodeficiency is characterized by the absence of or the disruption in components of the immune system such as white blood cells (e.g. lymphocytes, phagocytes, etc.). These disruptions cause a decrease in immune function and result in an overall reduction of immunity against pathogens.[64]
They can be caused by a variety of factors, including:
- Pre-existing conditions such as
- Other causes include:
- Undergoing organ transplant with the use of immunosuppressant agents[69]
- Receiving chemotherapy and other immunosuppressant drugs to combat cancer[70]
- Malnutrition[71]
- Genetic predisposition[72]
- Skin damage- cuts, burns, etc. [73]
- Antibiotic treatment or the misuse of antibiotics leading to disruption of the normal microbiome, thus allowing some microorganisms to outcompete others and become pathogenic (e.g. disruption of intestinal microbiota may lead to Clostridium difficile infection)[74]
- Medical procedures such as surgeries, endoscopies, implants, and catheterization [75][76][77][78]
- Pregnancy due to increase susceptibility and hormonal changes[79]
- Aging [80]
- Leukopenia (i.e. neutropenia and lymphocytopenia)[81]
- The lack of or the disruption of normal vaginal microbiota[82][83][84][85]
Prevention
[edit]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.[86]
Restoration of immune system
[edit]- In patients with HIV, starting antiretroviral therapy is especially important for restoration of the immune system and reducing the incidence rate of opportunistic infections[87][88]
- In patients undergoing chemotherapy, completion of and recovery from treatment is the primary method for immune system restoration. In a select subset of high risk patients, granulocyte colony stimulating factors (G-CSF) can be used to aid immune system recovery.[89][90]
Avoidance of infectious exposure
[edit]The following may be avoided as a preventative measure to reduce the risk of infection:
- Eating undercooked meat or eggs, unpasteurized dairy products or juices.
- Potential sources of tuberculosis (high-risk healthcare facilities, regions with high rates of tuberculosis, patients with known tuberculosis).
- Any oral exposure to feces.[91]
- Contact with farm animals, especially those with diarrhea: source of Toxoplasma gondii, Cryptosporidium parvum.
- Cat feces (e.g. cat litter): source of Toxoplasma gondii, Bartonella spp.
- Soil/dust in areas where there is known histoplasmosis, coccidioidomycosis.
- Reptiles, chicks, and ducklings are a common source of Salmonella.
- Unprotected sexual intercourse with individuals with known sexually transmitted infections.
Prophylactic medications
[edit]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.[92][93][94]
| Opportunistic infections | Indication(s) for prophylactic medications | Preferred 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. |
| |
| 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. |
| |
| Toxoplasma gondii | CD4 count is less than 100 cells/mm3 or less than 14%, and the person has a positive serology for Toxoplasma gondii. |
|
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. |
|
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.[92][93][94]
| Opportunistic infections | Alternative agent(s) |
|---|---|
| Mycobacterium tuberculosis | |
| Pneumocystis jiroveci | |
| Toxoplasma gondii |
|
| Mycobacterium avium complex disease |
|
Treatment
[edit]Treatment depends on the type of opportunistic infection, but usually involves different antibiotics.[citation needed]
Veterinary treatment
[edit]Opportunistic infections caused by feline leukemia virus and feline immunodeficiency virus retroviral infections can be treated with lymphocyte T-cell immunomodulator.
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