Opportunistic Infections: Introduction

Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. Risk factors for infection include conditions or agents that may lead to an immunocompromised state, disruption of the normal flora, and/or disturbance of the mucosal barrier. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). The diagnosis is made by identifying Candida on KOH preparation, cultures, or tissue biopsy. Treatment depends on the extent and site of infection, and includes topical or systemic antifungal medications

Pneumocystis jiroveci is a yeast-like fungus causing pneumocystis pneumonia (PCP) in immunocompromised patients. Pneumocystis pneumonia is spread through airborne transmission and classically affects patients with AIDS, functioning as an AIDS-defining illness. Patients may present with insidious onset of fever, chills, dry cough, chest pain, and shortness of breath. The diagnosis is supported by an increased β-D-glucan level and diffuse, bilateral infiltrates on chest imaging in the immunocompromised patient. A definitive diagnosis can be given with microscopy of induced sputum or specimens from bronchoalveolar lavage (BAL). Management involves antimicrobial therapy with a trimethoprim-sulfamethoxazole combination, and supportive care. Addressing the etiology of immunodeficiency is paramount. Prophylaxis is often required to prevent infection or reinfection.

Cryptococcosis is an opportunistic, fungal infection caused by the Cryptococcus species. The principal pathogens in humans are C. neoformans (primary) and C. gattii. Cryptococcus neoformans is typically found in pigeon droppings and acquired by inhaling dust from contaminated soil. The majority of affected patients are immunocompromised. Patients with AIDS, chronic steroid use, and organ transplant are particularly affected. The primary virulence factor is an antiphagocytic capsule, consisting of repeating capsular polysaccharide antigens. The infection typically affects the lungs and presents as a primary lesion or pneumonia. Dissemination can occur to involve the brain and meninges, skin, bones, and visceral organs. Treatment for cryptococcal meningitis is usually amphotericin B and flucytosine, followed by fluconazole. Cryptococcosis is an AIDS-defining illness and typically associated with CD4 count < 100 cells/μL.

Aspergillosis is an opportunistic fungal infection caused by Aspergillus species, which are common spore-forming molds found in our environment. As Aspergillus species are opportunistic, they cause disease primarily in patients who are immunocompromised. The organs that are most commonly involved are the lungs and sinuses. Invasive aspergillosis can spread hematogenously and may involve the brain, heart, and skin. Symptoms may vary depending on the organ involved, but pulmonary symptoms may include shortness of breath, wheezing, cough, and hemoptysis. The diagnosis is made based on imaging studies, fungal cultures, and analysis of serologic or respiratory samples. Management depends on the presentation but can include antifungal therapy and surgical resection in severe disease.