Parasitic pulmonary infections in HIV-infected patients
- Patricia A Tietjen, MD
Patricia A Tietjen, MD
- Professor of Clinical Medicine
- New York Medical College
Prior to the era of potent antiretroviral therapy, parasitic pulmonary infections were more commonly seen than they are today. However, the clinician still needs to be aware of presenting symptoms and signs of these uncommon infections, which may still be diagnosed in the immunosuppressed patient with untreated or drug-resistant HIV infection.
This topic will address pulmonary infections related to Toxoplasma gondii, Strongyloides stercoralis, Cryptosporidium, and Microsporidium.
T. gondii is a ubiquitous intracellular protozoan. Although T. gondii can infect a wide range of vertebrates, feral and domestic cats are the definitive hosts. The organism undergoes its complete life cycle in the cat, resulting in the production of oocytes, which are passed with the feces into soil. Oocytes may remain infective for over one year. If ingested, Toxoplasma can invade tissue and reproduce. The two routes of transmission to humans are:
●Ingestion of food or beverages contaminated with sporulated oocytes.
●Transmission from mother to fetus.
- Pomeroy C, Filice GA. Pulmonary toxoplasmosis: a review. Clin Infect Dis 1992; 14:863.
- Mariuz P, Bosler EM, Luft BJ. Toxoplasmosis in individuals with AIDS. Infect Dis Clin North Am 1994; 8:365.
- Holliman RE. Serological study of the prevalence of toxoplasmosis in asymptomatic patients infected with human immunodeficiency virus. Epidemiol Infect 1990; 105:415.
- Evans TG, Schwartzman JD. Pulmonary toxoplasmosis. Semin Respir Infect 1991; 6:51.
- Derouin F, Sarfati C, Beauvais B, et al. Prevalence of pulmonary toxoplasmosis in HIV-infected patients. AIDS 1990; 4:1036.
- Bonilla CA, Rosa UW. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome: diagnosis by bronchoalveolar lavage. South Med J 1994; 87:659.
- Pugin J, Vanhems P, Hirschel B, et al. Extreme elevations of serum lactic dehydrogenase differentiating pulmonary toxoplasmosis from Pneumocystis pneumonia. N Engl J Med 1992; 326:1226.
- Oksenhendler E, Cadranel J, Sarfati C, et al. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome. Am J Med 1990; 88:18N.
- Maguire GP, Tatz J, Giosa R, Ahmed T. Diagnosis of pulmonary toxoplasmosis by bronchoalveolar lavage. N Y State J Med 1986; 86:204.
- Derouin F, Sarfati C, Beauvais B, et al. Laboratory diagnosis of pulmonary toxoplasmosis in patients with acquired immunodeficiency syndrome. J Clin Microbiol 1989; 27:1661.
- Burg JL, Grover CM, Pouletty P, Boothroyd JC. Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol 1989; 27:1787.
- McCabe RE, Oster S. Current recommendations and future prospects in the treatment of toxoplasmosis. Drugs 1989; 38:973.
- Dannemann B, McCutchan JA, Israelski D, et al. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. The California Collaborative Treatment Group. Ann Intern Med 1992; 116:33.
- Lane HC, Laughon BE, Falloon J, et al. NIH conference. Recent advances in the management of AIDS-related opportunistic infections. Ann Intern Med 1994; 120:945.
- Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin Infect Dis 1992; 15:211.
- Benson CA, Kaplan JE, Masur H, et al. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. Clin Infect Dis 2005; 40:S131.
- USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary. MMWR Recomm Rep 1995; 44:1.
- Furrer H, Opravil M, Bernasconi E, et al. Stopping primary prophylaxis in HIV-1-infected patients at high risk of toxoplasma encephalitis. Swiss HIV Cohort Study. Lancet 2000; 355:2217.
- Mussini C, Pezzotti P, Govoni A, et al. Discontinuation of primary prophylaxis for Pneumocystis carinii pneumonia and toxoplasmic encephalitis in human immunodeficiency virus type I-infected patients: the changes in opportunistic prophylaxis study. J Infect Dis 2000; 181:1635.
- Celedon JC, Mathur-Wagh U, Fox J, et al. Systemic strongyloidiasis in patients infected with the human immunodeficiency virus. A report of 3 cases and review of the literature. Medicine (Baltimore) 1994; 73:256.
- Satoh M, Kiyuna S, Shiroma Y, et al. Predictive markers for development of strongyloidiasis in patients infected with both Strongyloides stercoralis and HTLV-1. Clin Exp Immunol 2003; 133:391.
- Lessnau KD, Can S, Talavera W. Disseminated Strongyloides stercoralis in human immunodeficiency virus-infected patients. Treatment failure and a review of the literature. Chest 1993; 104:119.
- Maayan S, Wormser GP, Widerhorn J, et al. Strongyloides stercoralis hyperinfection in a patient with the acquired immune deficiency syndrome. Am J Med 1987; 83:945.
- Davidson RA, Fletcher RH, Chapman LE. Risk factors for strongyloidiasis. A case-control study. Arch Intern Med 1984; 144:321.
- Nucci M, Portugal R, Pulcheri W, et al. Strongyloidiasis in patients with hematologic malignancies. Clin Infect Dis 1995; 21:675.
- Igra-Siegman Y, Kapila R, Sen P, et al. Syndrome of hyperinfection with Strongyloides stercoralis. Rev Infect Dis 1981; 3:397.
- Igual-Adell R, Oltra-Alcaraz C, Soler-Company E, et al. Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis. Expert Opin Pharmacother 2004; 5:2615.
- Torres JR, Isturiz R, Murillo J, et al. Efficacy of ivermectin in the treatment of strongyloidiasis complicating AIDS. Clin Infect Dis 1993; 17:900.
- Mannheimer SB, Soave R. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am 1994; 8:483.
- Forgacs P, Tarshis A, Ma P, et al. Intestinal and bronchial cryptosporidiosis in an immunodeficient homosexual man. Ann Intern Med 1983; 99:793.
- Weber R, Kuster H, Visvesvara GS, et al. Disseminated microsporidiosis due to Encephalitozoon hellem: pulmonary colonization, microhematuria, and mild conjunctivitis in a patient with AIDS. Clin Infect Dis 1993; 17:415.