Published: 2018-06-25

Scenario of mycobacterial and fungal infection in HIV seropositive patients and their co-relation with CD4 count in Western Uttar Pradesh

Richa Pandey, Amit Singh, Dharmendra Prasad Singh, Rajesh Kumar Verma, Manoj Kumar, Deepak Kumar


Background: HIV infection is defined by sero-conversion and the detection of HIV-specific antibodies. Emergence and pandemic spread of acquired immunodeficiency syndrome is due to the exposure to human immunodeficiency virus (HIV). A decrease in CD4 count is at least partially responsible for the profound immunodeficiency that leads to various OIs in HIV- infected persons. When the CD4 count falls below 200cells/µL, there is irreversible breakdown of immune defence mechanism and patient become prey to a variety of human opportunistic pathogens.HIV positive patients must receive infections screening and access medical care before onset of advanced immunosuppression.

Methods: In this study, total 230 HIV positive patients were selected during 18 months of study period. CD4 counts were estimated of all HIV positive cases. Positive HIV patients were investigated further to detect mycobacterial and fungal opportunistic infections. They were subjected to routine microscopy such as KOH mount, India ink, Gram’s staining for suspected fungal infection and ZN staining method for suspected mycobacterial infection. For fungal infection, samples were inoculated in two Sabouraud Dextrose Agar followed by different biochemical test and LPCB mount; for mycobacterial infection, samples were cultured on LJ medium followed by biochemical test.

Results: In our study, maximum patients presented with complain of fever (90.43%), weight loss (73.91%) followed by loss of appetite (35.65%), breathlessness (33.91%), coughing (28.69%) and chest pain (22.17%). Overall prevalence of OIs (Mycobacterium and fungal) was 93 (40.43%) among 230 HIV positive patients. Among OIs 63(27.39%) patients were detected as having Mycobacterial infection and 41(17.82%) as had opportunistic fungal infections. Maximum OIs were related to patients with CD4 count 0-200 cells/µL followed by 201-400 Cells/µL. Most common OIs, among mycobacterial and opportunistic fungal infection were M. tuberculosis (50 isolates) and Candida spp. (26 isolates) respectively.

Conclusions: This study provides important information about the risks of OIs at lower CD4 counts among HIV positive patients. These results highlight the need for early screening of HIV infected patients for opportunistic infections. There is also need to increase awareness in healthcare providers in order to improve decisions regarding prophylaxis for prevention of OIs and appropriate therapeutic intervention.


CD4 counts, HIV, OIs, LPCB mount, ZN staining

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Clerici M, Shearer GM. Correlates of protection in HIV infection and the progression of HIV infection to AIDS. Immunology letters: Elsevier. 1999;51(1-2):69-73.

National AIDS Control Organization. Fact sheet: India HIV estimation 2015. Available from: htps:// 5 May 2018.

Arora DR, Arora B. HIV and other Retroviruses. Textbook of Microbiology. 2nd edition. New Delhi. CBS Publishers and distributors;2009:605-623.

Ramesh K, Gandhi S and Rao V. Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study. Int J App Basic Med Res. 2015;5(2):119-23.

Mayer HB, Wanke CA. Diagnostic Strategies in HIV-infected patients with diarrhoea. AIDS. 1994;8(12):1639-48.

Dabla V, Gupta AK, Singh I. Spectrum of opportunistic infections among HIV seropositive patients in Delhi region-a study by Delhi state AIDS control society. J Med Disorder. 2015;3(1):1-5.

Agarwal SG, Powar RM, Tankhiwale S, Rukadikar A. study of opportunistic infections in HIV-AIDS Patients and their co-relation with CD4+ cell count. Int J Curr Microbiol App Sci. 2015;4(6):848-61.

Chavan VR, Chaudhary V, Ahir P, Mehta R, Mavani PS, Kerkar C, et al. Current scenario of opportunistic and co-infections in HIV-infected individuals at a tertiary care hospital in Mumbai. Indian J Med Microbiol. 2015;33(1):78-83.

Kaur R, Dhakad MS, Goyal R, Bhalla P, Dewan R. Spectrum of opportunistic fungal infections in HIV/AIDS patients in tertiary care hospital in India. Canadian J Infec Dis Med Microbiol. 2016;2016.

Srirangaraj S, Venkatesha D. Opportunistic infections in relation to antiretroviral status among AIDS patients from south India. Indian J Med Microbiol. 2011;29(4):395-00.

Raviglione MC, Snider DE Jr, Kochi A. Glob al epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA. 1995;273(3):220‑06.

Jain S, Singh AK, Singh RP, Bajaj JK, Damle AS. Spectrum of opportunistic fungal infections in hiv-infected patients and their correlation with CD4+ counts in Western India. Indian J Med Microbiol Infec Dis. 2014;2(1):19-22.