Opportunistic infection
An opportunistic infection is an infection caused by pathogens that take advantage of an opportunity not normally available, such as a host with a weakened immune system, an altered microbiota, or breached integumentary barriers. Many of these pathogens do not cause disease in a healthy host that has a normal immune system. However, a compromised immune system, which is seriously debilitated and has lowered resistance to infection, a penetrating injury, or a lack of competition from normal commensals presents an opportunity for the pathogen to infect.
Types of infections
A partial listing of opportunistic organisms includes:- Aspergillus sp.
- Candida albicans
- Clostridium difficile
- Coccidioides immitis
- Cryptococcus neoformans
- Cryptosporidium
- Cytomegalovirus
- Geomyces destructans
- Histoplasma capsulatum
- Isospora belli
- Polyomavirus JC polyomavirus, the virus that causes Progressive multifocal leukoencephalopathy.
- Kaposi's Sarcoma caused by Human herpesvirus 8 , also called Kaposi's sarcoma-associated herpesvirus
- Legionnaires' Disease
- Microsporidium
- Mycobacterium avium complex
- Mycobacterium tuberculosis
- Pneumocystis jirovecii, previously known as Pneumocystis carinii f. hominis
- Pseudomonas aeruginosa
- Salmonella
- Staphylococcus aureus
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Toxoplasma gondii
Causes
- Malnutrition
- Fatigue
- Recurrent infections
- Immunosuppressing agents for organ transplant recipients
- Advanced HIV infection
- Chemotherapy for cancer
- Genetic predisposition
- Skin damage
- Antibiotic treatment leading to disruption of the physiological microbiome, thus allowing some microorganisms to outcompete others and become pathogenic
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 directed against specific infections.Restoration of immune system
- In patients with HIV, starting antiretroviral therapy is especially important for restoration of the immune system and reducing the incidence rate of opportunistic infections
- 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 can be used to aid immune system recovery.
Avoidance of infectious exposure
- Eating undercooked meat or eggs, unpasteurized dairy products or juices
- Potential sources of tuberculosis
- Any oral exposure to feces.
- Contact with farm animals, especially those with diarrhea: source of Toxoplasma gondii, Cryptosporidium parvum
- Cat feces : source of Toxoplasma gondii, Bartonella spp.
- Soil/dust in areas where there is known histoplasmosis, coccidiomycosis
- Reptiles, chicks, and ducklings that are a common source of Salmonella.
- Unprotected sexual intercourse with individuals with known sexually transmitted infections.
Prophylactic medications
Infection | When to Give Prophylaxis | Agent |
Pneumocystis jirovecii | CD4 < 200 cells/mm3 or oropharyngeal candidasis | TMP-SMX |
Toxoplasma gondii | CD4 < 100 cells/mm3 and positive Toxoplasma gondii IgG immunoassay | TMP-SMX |
Mycobacterium avium complex | CD4 < 50 | Azithromycin |