Written and compiled by Brent Dorian Carpenter
HIV-positive and AIDS-afflicted persons have become accustomed to dire warnings about opportunistic infections. The CDC has compiled a list of what it calls 22 classic AIDS-defining ailments that fall within four categories: viral, bacterial, fungal and protozoal. Many are familiar, such as pneumocystic pneumonia, Hepatitis-C and Kaposi’s sarcoma. Others are exquisitely more exotic, such as toxoplasmic encephalitis.
However, there have been several other hot “bugs” in the news recently that pose unusual and challenging threats to the HIV-positive community. With compromised immune systems, HIV-positive persons are disproportionately at risk from these ailments, and treatment options often vary from those available to the general population.
The following information is intended to highlight 10 of these entities and bring this vital information together in one place, a sort of one-stop shopping guide to help the layperson analyze what they are, discover what consequences they pose, and determine what treatment options, if any, are available.
Smallpox (Variola major)
Smallpox outbreaks occurred from time to time for thousands of years, and were one of the deadliest killers in human history. It was used in bio-warfare against Native Americans (gifts of smallpox-infested blankets) in the 19th century. get dates The disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.
The United States and Russia maintained frozen samples of the disease in laboratories for research purposes, and it is feared that rogue nations may have obtained some. As the war with Iraq and the threat of bio-terrorism looms large, an outbreak of this deadly disease is possible across the nation and on the front lines of battle. Thousands of health care workers and first responders are being vaccinated.
Transmission: Contagious. Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Smallpox can be spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of smallpox.
Symptoms: Exposure to the virus is followed by an incubation period during which people do not have any symptoms. This incubation period averages 7 to 17 days. During this time, people are not contagious. The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually in the range of 101 to 104 degrees Fahrenheit.
Consequences of contraction: One type of smallpox has a fatality rate of 30%; the other type is usually fatal.
Treatment & Prevention: There is no specific treatment for smallpox disease, and the only prevention is vaccination. HIV-positive and other immune-compromised persons are discouraged from being vaccinated. In the event of an outbreak, stay indoors and isolated.
Long-term ramifications: By the end of the second week after the rash appears, most of the sores have scabbed over. The scabs begin to fall off, leaving marks on the skin that eventually become pitted scars. Most scabs will have fallen off three weeks after the rash appears. The person is contagious until all of the scabs have fallen off.
Anthrax (Bacillus anthracis)
History: Shortly following the attacks of September 11, the nation was rocked with anthrax hysteria after samples were mailed to individuals is several states. Although only three deaths occurred in the attack, the U.S. Postal Service began irradiating mail to sterilize it.
Transmission: Not contagious. Anthrax is acutely infectious and is caused by a spore-forming bacterium. Anthrax most commonly occurs in hoofed mammals and can also infect humans. Human anthrax has three major clinical forms: cutaneous, inhalation, and gastrointestinal.
Symptoms: Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock.
The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever, followed by abdominal pain, vomiting of blood, and severe diarrhea.
Consequences of contraction:
Inhalation anthrax is often fatal. If left untreated, anthrax in all forms can lead to death.
Treatments & Prevention
Early antibiotic treatment of anthrax is essential. Delay lessens chances for survival. Anthrax usually is susceptible to penicillin, doxycycline, and fluoroquinolones. Many HIV-positive patients currently being treated with the antibiotic Cipro for other infections are also protected. An anthrax vaccine also can prevent infection, however it is not recommended for the general public and is not available.
Long-term ramifications: Uncertain. However, according to recent news reports, several surviving inhalation anthrax victims of the October 2001 attack continue to suffer severe, permanent, disabling ailments.
West Nile Virus (West Nile meningoencephalitis)
History: Appearing seemingly out of nowhere in recent years, West Nile flavivirus is a flu-like bug commonly found in Africa, West Asia, and the Middle East. Several hundred deaths have occurred in the United States, including two confirmed cases with HIV- co-infected patients in Michigan. Following coast-to-coast hysteria, the CDC reports that most deaths occurred in persons with compromised immune systems, such as the elderly, HIV-positive individuals, and chemotherapy patients.
Transmission: Not contagious. West Nile virus is spread by the bite of an infected mosquito, and can infect people, horses, many types of birds, and some other animals. There is no evidence to suggest that West Nile virus can be spread from person to person or from animal to person.
Symptoms: Most people who become infected with West Nile virus will have either mild or no symptoms. Symptoms of severe infection include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. It is estimated that only 1 in 150 persons infected with the West Nile virus will develop a more severe form of disease.
Consequences of contraction: On rare occasions, West Nile virus infection can result in severe and sometimes fatal illnesses.
Treatments & Prevention: There is no specific treatment for West Nile virus infection. In more severe cases, intensive supportive therapy is indicated, often involving hospitalization, intravenous fluids, ventilator support, and prevention of secondary infections (pneumonia, urinary tract, etc.). Prevention is emphasized: the use of mosquito repellent and clothing that covers exposed surfaces of the body. Stay indoors at dawn and dusk (peak mosquito biting times).
Long-term ramifications: West Nile fever typically lasts only a few days and does not appear to cause any long-term health effects. In severe cases, neurological effects may be permanent.
Norwalk Virus (Norovirus caliciviridae)
History: The so-called cruise-ship virus struck several ocean liners during this winter, sickening hundreds. Rarely fatal, noroviruses are a group of related, single-stranded RNA viruses that cause acute gastroenteritis in humans.
Transmission: Very contagious. Noroviruses are found in the stool or vomit of infected people. Infection can occur by eating food or drinking liquids that are contaminated with norovirus; touching surfaces or objects contaminated with norovirus, and then placing hands in the mouth; having direct contact with another person who is infected and showing symptoms; or sharing foods or eating utensils with someone who is ill.
Symptoms: Nausea, vomiting, diarrhea, and some stomach cramping. Sometimes people additionally have a low-grade fever, chills, headache, muscle aches, and tiredness.
Consequences of contraction: The illness is usually brief, with symptoms lasting only about 1 or 2 days. There is no evidence to suggest that an infected person can become a long-term carrier of norovirus.
Treatment & Prevention: Currently, there is no antiviral medication that works against norovirus and there is no vaccine to prevent infection. Prevention steps include frequently washing your hands, especially after toilet visits and changing diapers. Carefully wash fruits and vegetables, and steam oysters before eating them. Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using a bleach-based household cleaner. Immediately remove and wash clothing or linens that may be contaminated. Flush or discard any vomit and/or stool in the toilet immediately.
Infected persons should not prepare food while they have symptoms and for 3 days after recovery. Food that may have been contaminated by an ill person should be disposed of properly.
Long-term ramifications: None.
Cryptosporidiosis (Cryptosporidium parvum)
History: Cryptosporidiosis, or Crypto, is a diarrheal disease caused by a microscopic parasite.
It can live in the intestine of humans and animals and is passed in infected stool. The parasite is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it very resistant to chlorine disinfection. During the past two decades, Crypto has become recognized as one of the most common causes of waterborne disease in humans in the United States.
An outbreak in Milwaukee in the late 1990s left several dead, thousands sickened and the entire city unable to trust its water supply when cow manure backed up into the water treatment system.
Transmission: Very contagious. Millions of Crypto can be released in a bowel movement from an infected human or animal. You can become infected after accidentally swallowing the parasite. Crypto may be found in soil, food, water, or surfaces that have been contaminated with the feces from infected humans or animals. Crypto is not spread by contact with blood.
Symptoms: Diarrhea, loose or watery stool, stomach cramps, upset stomach, and a slight fever.
Some people have no symptoms. Symptoms generally begin 2-10 days after being infected.
Consequences of contraction: If you have a severely weakened immune system, you are at risk for more serious disease. Your symptoms may be more severe and could lead to serious or life-threatening illness.
Treatment & Prevention
There is no effective treatment. Most people with a healthy immune system will recover on their own. If you have diarrhea, drink plenty of fluids to prevent dehydration. Anti-diarrheal medicine may help slow down diarrhea, but consult with your health care provider before taking it.
Prevention methods include washing and/or peeling all raw vegetables and fruits before eating. Use uncontaminated water to wash all food that is to be eaten raw. Avoid eating uncooked foods, using ice or drinking untreated water when traveling in countries with minimal water treatment and sanitation systems.
Avoid drinking untreated water during community-wide outbreaks of disease caused by contaminated drinking water. Avoid swallowing recreational water during swimming. Avoid fecal exposure during sex.
Long-term ramifications: For persons with AIDS, anti-retroviral therapy that improves immune status will also decrease or eliminate symptoms of Crypto. However, Crypto is usually not cured and may come back if the immune status worsens. See your health care provider to discuss anti-retroviral therapy used to improve immune status.
Staphyloccocus (Staphylococcus aureus)
History: Staphylococcus aureus, or staph, is commonly carried on the skin or in the nose of healthy people and occasionally can cause an infection. Staph is one of the most common causes of skin infections in the United States. Most of these infections are minor (such as pimples and boils) and most can be treated without antibiotics.
However, staph infections are notorious during hospital stays and can also cause intravenous catheter site infections and surgical wound infections, and pneumonia. Over the past 50 years, treatment of these infections has become more difficult because staph bacteria have become resistance to various antibiotics. These resistant strains are called methicillin-resistant Staphylococcus aureus, or MRSA.
Transmission: Contagious. Staph bacteria and MRSA can spread among people having close contact with infected people. MRSA is almost always spread by direct physical contact, and not through the air. Spread may also occur through indirect contact, by touching objects (towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or staph bacteria.
Symptoms: Redness or burning on the sensation on the skin near wounds, accompanied by high temperature and fever.
Consequences of contraction: Staph bacteria can cause different kinds of illness, including skin infections, bone infections, pneumonia, life-threatening bloodstream infections, and others.
Resistant strains can cause death. HIV-positive patients tend to be hospitalized more often than the general population, and since hospitals are notorious for staph bacteria, special precautions should be observed.
Treatment & Prevention
Most staph bacteria and MRSA are susceptible to several antibiotics. Furthermore, most staph skin infections can be treated without antibiotics by draining the sore.
However, if antibiotics are prescribed, patients should complete the full course and call their doctors if the infection does not get better. Prevention methods include practicing good hygiene by washing hands thoroughly with soap and water. Keep cuts and abrasions clean and covered with a proper bandage until healed. Avoid contact with other people’s wounds or material contaminated from wounds.
Long-term ramifications: Organ damage, skin disfigurement, long-term hospitalization or death from resistant strains.
Syphilis (Treponema pallidum)
History: Long associated with the notorious Tuskegee Experiments conducted on African Americans by the U.S. government from the 1930s until 1972, a recent explosion of the sexually transmitted disease, which the CDC thought was on the verge of eradication, has sent health care workers scrambling to squash the epidemic. Co-infection with HIV is rising at alarming rates and can lead to serious complications of an otherwise easily treatable disease.
Transmission: Not contagious. Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.
Symptoms: It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases. The time between infection and the first symptom can range from 10-90 days. The primary stage is usually marked by the appearance of one or more sores called a chancre, which appears at the spot where syphilis entered the body. The chancre is usually firm, round, small, and painless, and lasts 3-6 weeks, eventually healing on its own. If adequate treatment is not administered, the infection progresses to the secondary stage. The second stage starts when one or more areas of the skin break into a rash that usually does not itch. The rash often appears as rough, red or reddish brown spots both on the palms of the hands and on the bottoms of the feet. The rash may also appear on other parts of the body with different characteristics. Sometimes the rashes are so faint that they are not noticed. Even without treatment, rashes clear up on their own. Second-stage symptoms can also include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and tiredness.
Consequences of contraction: A person can easily pass the disease to sex partners when primary or secondary stage signs or symptoms are present. Genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increase in the risk of acquiring HIV infection when syphilis is present.
Treatment & Prevention: A single dose of penicillin will cure a person who has had syphilis for less than a year. Penicillin will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. Abstain from sexual contact with infected partners until their syphilis sores are completely healed. It should be noted that condoms do not provide complete protection because syphilis sores can sometimes occur on areas not covered by a condom.
Long-term ramifications: The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. Without treatment, the infected person still has syphilis even though there are no signs or symptoms. It remains in the body, and it may begin to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include inability to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. This damage may cause death.
History: Infection rates are rapidly rising amongst HIV-positive persons. Globally, more than one-third of all HIV patients are co-infected. The number in the U.S. is about one-quarter. Tattooing has become one of the fastest-growing means of transmission.
Transmission: Not contagious. HCV can be spread through infected blood or body fluids during unprotected sex or needle sharing.
Symptoms: Jaundice, fatigue, nausea, dark urine, abdominal pain and loss of appetite. 80% of patients have none of these signs or symptoms of infection.
Consequences of contraction: Chronic infection occurs in 75-85 % of infected persons. Chronic liver disease occurs in 70%. Alcohol consumption can worsen liver disease. As highly-active antiretroviral therapy (HAART) and prophylaxis of opportunistic infections increase the life span of persons living with HIV, HCV-related liver disease has become a major cause of hospital admissions and deaths among HIV-infected persons.
Treatment & Prevention: There is no vaccine to prevent hepatitis C. However, it is strongly recommended that you should get vaccinated against hepatitis A and B. Interferon and ribavirin are two drugs licensed for the treatment of persons with chronic hepatitis C.
Combination therapy with these can get rid of the virus in up to roughly half of HCV-infected persons. Treatment of HIV-positive persons can be severely complicated by co-infection. Prevention methods include condom use during sex. Do not share personal care items that might have blood on them such as razors or toothbrushes.
Long-term ramifications: Permanent liver damage can occur. Liver transplant may become necessary, which could lead to other complications. Death can result without treatment.
History: A form of cancer usually associated with the cervix has been linked to the presence of HPV. There has been a sharp increase in anal cancer cases amongst gay and bisexual men.
Transmission: Not contagious. Sexually transmitted.
Symptoms: Inflammation and bleeding in the cervix or anus. Presence of genital warts. Symptoms sometimes are undetectable and a pap smear is required for detection.
Consequences of contraction: The virus can lay dormant for years before developing into a more serious problem. Because of the lack of visible symptoms, the virus can be passed to sex partners through unprotected sex.
Treatment & Prevention: Early detection of atypical squamous cells through Pap smears can detect pre-cancerous anomalies before they turn deadly. In more advanced cases, surgery can remove any cancerous growths. Prevention method is condom use during any form of intercourse.
Long-term ramifications: Cervical or anal cancer that could lead to death.
Mad Cow Disease (Bovine Spongiform Encephalopathy)
History: Strong evidence has accumulated for a causal relationship between ongoing outbreaks in Europe of “mad cow disease” and a disease in humans called new variant Creutzfeldt-Jakob disease (vCJD). Both disorders are invariably fatal brain diseases with unusually long incubation periods (measured in years) and are caused by an unconventional transmissible agent. In light of the terror attacks of September 11, there has been recent speculation that the outbreak of Mad Cow disease in England, which resulted in hysteria and the preventative slaughter of millions of cattle, may have been an act of bio-terrorism designed to disrupt the economies of European nations. Although only one human case has been demonstrated in the U.S., that individual lived in England for five years and was determined to have been infected there.
Transmission: Not contagious. Mad cow disease is believed to have resulted from feeding cattle contaminated bone and meat tissue of infected cattle. The disease is transmitted to humans through the consumption of infected meat product. The incubation period for vCJD is unknown because it is a new disease.
Symptoms: Symptoms are prominently psychiatric, with delayed onset of neurologic abnormalities.
Consequences of contraction: There is no known treatment of vCJD and it is invariably fatal.
Treatments & Prevention: The possibility that BSE can spread to humans has focused increased attention on the desirability of national Creutzfeldt-Jakob disease surveillance. To reduce the possible current risk of acquiring vCJD from food, travelers to Europe or other areas with indigenous cases of BSE should consider avoiding beef and beef products altogether. Milk and milk products from cows are not believed to pose any risk for transmitting the BSE agent.
Long-term ramifications: A duration of illness of at least 6 months, followed by death.
The CDC lists 22 opportunistic infections as AIDS-defining illnesses. They are as follows:
Pneumocystic carinii pneumonia (PCP)
Mycobacterium avium complex (MAC)
Salmonellosis (Salmonella poisoning)
Bartonella (formerly Rochalimaea)
Herpes Simplex Virus
Kaposi’s Sarcoma (KS or Human herpesvirus 8)
Human Papillomavirus (HPV)
Special thanks for technical assistance to Jerry Burns, nurse at Detroit Medical Center.