Other infections

Other infections commonly seen in HIV+ patients

Updated: 08/17/2025

© Jun Wang, MD, PhD

 

Mycobacterium avium complex

  • Nontuberculous mycobacteria, M. avium or M. intracellulare
  • More common when CD4+ cell < 50/mcl
  • Associated with shortened survival
  • Incidence decreased due to ART
  • Likely transmitted by inhalation or ingestion
  • Localized lymphadenitis: signs of inflammation, associated with immune reconstitution
  • Disseminated infection

o   Presentation: fever, night sweat, diarrhea, etc

o   Lab: anemia, elevated LDH and alkaline phosphatase, low CD4 count, etc

Toxoplasmosis

  • Caused by protozoan parasite toxoplasma gondii
  • Most common CNS infection in AIDS
  • Transmitted by ingestion of infectious oocysts from soil or cat litter, or undercooked meat from infected animal
  • Clinical manifestation likely associated with reactivation, esp when CD4+ cell < 100/mcl
  • Clinical presentations include encephalitis (TE), pneumonitis, chorioretinitis, and other systems, including GI tract, heart, etc
  • Radiological findings: multiple ring-enhanced brain lesions by MRI (TE)
  • Diagnosis (TE) based on compatible clinical syndrome (headache and other neurological manifestations), low CD4 count, positive T. Gondii IgG, image studies, histological exams and/or PCR
  • Treatment: anti-toxoplasma agents (TMP-SMX, etc), ART

Cryptococcosis

  • Caused by cryptococcus neoformans
  • Most commonly meningitis
  • May have skin papules like molluscum contagiosum
  • Transmitted through inhalation
  • ART naïve or resistant patients
  • Most common in patients with CD4+ cells<100/mcl
  • Indolent for 1-2 weeks, followed by presentations of meningitis
  • Most commonly fever, malaise, and headache 
  • Stiff neck, photophobia, and vomiting may present in a small portion of patients
  • Suspicious if fever, headache and CD4+ cell<100/mcl
  • Pathology findings: Round yeast with thick capsule in CSF or other infected sites, highlighted by stains (India ink, mucicarmine, etc)
  • Diagnosis: CSF culture, cytological evaluation, cryptococcal PCR, and serology studies
  • Treatment: Antifungal, ART

Others

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