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14 : Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond

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Abstract:

In the context of emerging infectious diseases, opportunistic infections (OIs) have assumed importance because of immunocompromised populations that are either new or have increased over the past two decades. Such populations may be immunocompromised as the result of a pathologic process that occurs in human immunodeficiency virus (HIV) infection, or because of medical treatments that induce immunosuppression, such as radiation or chemotherapy for cancer or immunosuppressive therapy for organ transplantation. The challenges posed by Ols in HIV-infected persons are numerous and go beyond simple measurements of incidence of disease and costs of medical care. They are perhaps best illustrated by a discussion of two Ols that present a different array of challenges- pneumonia (PCP) and cryptosporidiosis. A variety of other conditions are associated with immunosuppression and increased susceptibility to OIs. Vaccinations pose challenges in terms of efficacy in inununocompromised persons and possible stimulation of HIV replication and acceleration of HIV disease. OIs pose significant challenges as emerging infectious diseases in increasing populations of immunocompromised persons, including persons receiving bone marrow or solid organ transplants, and the elderly.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 1

Incidence of opportunistic infections in HIV-infected persons following their first CD4+ T-lymphocyte count of <200 cells/ μl. Data are from the CDC's Adult and Adolescent Spectrum of Disease Project, averaged for the period 1992 to 1996.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 2

Reasons for development of PCP among 9,079 persons with PCP enrolled in the CDC ASD Project through July 1997.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 3

Alignment of TRAP-C2 sequences from isolates. Source: reference .

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 4

Number of reported bone marrow transplants, United States, 1989 to 1995. Data are from the Statistical Center of the International Bone Marrow Transplant Registry and the Autologous Blood and Marrow Transplant Registry.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 5

Timetable of infection following allogeneic bone marrow transplantation. The figure indicates disease in the absence of opportunistic infection chemoprophylaxis, which can reduce the incidence of herpes simplex virus (HSV) and cytomegalovirus (CMV) disease, candidiasis, and pneumonia.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 6

Number of solid organ transplants performed in the United States. 1988–1995. Data for kidney, liver, and heart transplants are shown; those for pancreas and lung (which are also increasing but totaled fewer than 2000 in 1995) are omitted. Data are from the United Network for Organ Sharing.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Figure 7

Percentage of persons in the United States who are elderly. 1950 to 1995. Data are from the U.S. Bureau of the Census.

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
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Tables

Generic image for table
Table 1

Prevalence of AIDS indicator conditions among adults and adolescents reported with an AIDS illness, United States, 1996

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 2

Occurrence of mutant DHPS gene in from persons with breakthrough PCP

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 3

Modes of transmission of cryptosporidiosis

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 4

Outbreaks of cryptosporidiosis in tbe United States (drinking water)

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 5

Challenges posed by opportunistic infections in HIV-infected persons

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 6

Non-HIV-infected populations with impaired immunity

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14
Generic image for table
Table 7

Opportunistic infections in the elderly

Citation: Kaplan J, Hanson D, Jones J, Beard C, Juranek D, Dykewicz C. 1998. Opportunistic Infections (OIs) as Emerging Infectious Diseases: Challenges Posed by OIs in the 1990s and Beyond, p 257-272. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch14

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