Immunodeficiency states

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AIDS: opportunistic infections

Gram-negative organisms (isolated in 5-20% of shunt infections, particularly in infants) Other pathogens: Pseudomonas spp., Streptococcus spp., Propionibacterium acnes, Coryne-bacterium diphtheriae, Candida

Streptococcus pneumoniae (65 %). Pneumococ-cus is the predominant organism, presumably due to its common presence in the upper airway Other streptococci (10%) Haemophilus influenzae (9%) Neisseria meningitidis (5 %) Staphylococcus aureus (5 %) Enteric Gram-negative bacilli (4%) Staphylococcus epidermidis (2 %) Listeria monocytogenes

Streptococcus pneumoniae (56%) Aerobic Gram-negative bacilli (26%): Enterobacter aerogenes, Serratia marcescens, Escheri-chia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella species Haemophilus influenzae (8%) Streptococcus species (6%) Neisseria meningitidis (2 %) Staphylococcus aureus (2 %)

Aerobic Gram-negative bacilli (46%): Escheri-chia coli, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa Anaerobes (13%): Gram-positive (peptostrepto-cocci, Clostridia, etc.); Bacteroides fragilis; Gram-negative, other than B. fragilis Streptococcus species (13%) Staphylococcus epidermidis (7 %) Staphylococcus aureus (7 %) Haemophilus parainfluenzae (7 %) Diphtheroids (5%)

Toxoplasma gondii. This is among the most common of the neurological complications in patients with HIV infection. Cerebral toxoplasmosis is seen in 28-40% of AIDS patients

* Hirschmann JV. Bacterial meningitis following closed head injury. In: Sande MA, Smith AL, Root RT, editors. Bacterial meningitis. New York: Churchill Livingstone, 1985. AIDS: acquired immune deficiency syndrome; CNS: central nervous system; CSF: cerebrospinal fluid. Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license.

Predisposing condition Pathogenic organism

AIDS: type of cell deficiency - T-cell deficiency

- B-cell deficiency

- Neutropenia

Cryptococcus neoformans. Cryptococcal meningitis is commonly associated with AIDS, with an estimated incidence of 2 -11 % Coccidioides immitis

Candida albicans. Although 40-60% of AIDS patients develop oropharyngeal or esophageal candidiasis, it rarely affects the brain in patients with AIDS

Listeria monocytogenes. A surprisingly low incidence of cerebral infection is seen, compared to the very high frequency of the organism in patients with other causes of cell-mediated immune deficiency

Mycobacterium tuberculosis and Mycobacterium avium-intracellulare. Involvement of the CNS is not as common as might be expected from the frequency of mycobacterial infection Treponema pallidum. Syphilis takes a more aggressive course in HIV-seropositive persons, and neurosyphilis is seen with increased frequency in the HIV-positive population Histoplasma capsulatum Nocardia asteroides Streptococcus pneumoniae Gram-negative bacilli


Listeria monocytogenes Cryptococcus neoformans Histoplasma capsulatum Streptococcus pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Staphylococcus epidermis Streptococcus fecalis

Other causes of cell-mediated immune deficiency

- Bacteria • Listeria monocytogenes. This is the most com mon cause of bacterial meningitis in patients with cell-mediated deficiency, despite its rarity in AIDS patients. In renal transplant patients, meningitis appears in 75 % of infected cases • Nocardia asteroides. The CNS is involved in approximately one-third of nocardial infections, which are more common in immunocom-promised patients

Predisposing condition

Pathogenic organism

• Mycobacterium tuberculosis

- Fungi

• Cryptococcus neoformans

• Coccidiodes immitis

• Histoplasma capsulatum

- Parasites

• Toxoplasma gondii. One of the most common

CNS complications occurring in patients with


• Strongyloides stercoralis. CNS complications

(meningitis, cerebritis, abscess, diffuse microin-

farcts) are rare

Defects of humoral

Immunoglobulin deficiency or splenectomy


• Streptococcus pneumoniae

• Haemophilus influenzae

• Neisseria meningitidis

Defects in neutrophils

Neutropenia or abnormalities in neutrophil func-


- Bacteria

• Pseudomonas aeruginosa

• Other Gram-negative bacilli

• Staphylococcus aureus

- Fungi

• Candida albicans

• Aspergillus fumigatus

• Mucorales

Medical conditions

- Diabetes mellitus

• Streptococcus pneumoniae

• Gram-negative bacilli


• Cryptococcus neoformans

• Mucorales

- Alcoholism

• Streptococcus pneumoniae

• Listeria monocytogenes

- Pneumonia or upper res

• Streptococcus pneumoniae

piratory tract infection

• Neisseria meningitidis

• Haemophilus influenzae

• Viruses

- Leukemia

• Gram-negative bacilli

• Staphylococcus aureus

- Lymphoma

• Listeria monocytogenes

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