Volume 2 • Issue 2 • 1000113 Virol Mycol ISSN: 2161-0517 VMID, an open access journal Virology & Mycology Khan, Virol Mycol 2013, 2:2 DOI: 10.4172/2161-0517.1000113 Research Article Open Access Profile of Fungal Lower Respiratory Tract Infections and CD4 Counts in HIV Positive Patients Parvez Anwar Khan 1 , Abida Malik 1 , Nazish Fatima 1 , M. Shameem 2 1 Department of Microbiology J.N.M.C.H, Aligarh Muslim University, Aligarh, India 2 Department of tuberculosis and respiratory medicene, J.N.M.C.H, Aligarh Muslim University, Aligarh, India Abstract One hundred and sixty symptomatic confirmed Human Immunodeficiency Virus (HIV)-positive patients, of both sexes with lower respiratory tract infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and antigen detection. *Corresponding author: Parvez Anwar Khan, Department of Microbiology J.N.M.C.H, Aligarh Muslim University, India, E-mail: parvezkhananwar@gmail.com Received February 16, 2013; Accepted June 21, 2013; Published June 24, 2013 Citation: Khan PA, Malik A, Fatima N, Shameem M (2013) Profile of Fungal Lower Respiratory Tract Infections and CD4 Counts in HIV Positive Patients. Virol Mycol 2: 113. doi:10.4172/2161-0517.1000113 Copyright: © 2013 Khan PA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: AIDS; HIV; CD4; Respiratory tract infections; Opportunistic infections Introduction Acquire Immunodeficiency Syndrome (AIDS) caused by the Human Immunodeficiency Virus (HIV) is the most important public health problem of modern times. ough HIV is the causative agent of AIDS, most morbidity and mortality results from opportunistic infections; approximately 80% of these patients are seen to die as a result of such an infection rather than from HIV. Invasive fungal infections are common opportunistic infections associated with significant morbidity and mortality for patients with HIV infection and the risk of invasive fungal infection varies with host immunity as well as environmental exposure [1-3]. e importance of fungal diseases among patients with HIV infection was recognized in the early days of the acquired immunodeficiency syndrome epidemic. Fungal infections were reported in many of the first patients described with a “new acquired cellular immunodeficiency” in 1981 [4]. e spectrum of illness ranges from asymptomatic mucosal candidiasis to overwhelming disseminated infection and life threatening meningitis and fungal pneumonia. While it is difficult to define the impact of the Human Immunodeficiency Virus (HIV) pandemic on the field of infections, an increase in the number and severity of serious fungal infections has been reported. Fungal disease at any anatomic site accounted for over 20% of the AIDS-defining diseases reported to the Centers for Disease Control (CDC). Because most pulmonary fungal diseases have been considered as AIDS defining, this 20% could be an underestimation of their incidence. Necropsy studies in AIDS patients have showed an incidence of fungal infection of 20% to 49% [5,6]. Fungal pneumonia is an infectious process in the lungs caused by 1 or more endemic or opportunistic fungi. Fungal infection occurs following the inhalation of spores, aſter the inhalation of conidia, or by the reactivation of a latent infection. Hematogenous dissemination frequently occurs, especially in an immunocompromised host. e data from India on the etiology and spectrum of fungal infections in HIV/AIDS patients, and the clinical and immunological profile of these patients are scarce. is study was conducted to elucidate the frequency and etiology of various fungal respiratory tract infections in HIV infected patients and its correlation with CD4 cell counts, from north India. In this scenario, knowledge regarding the opportunistic fungal infection will be useful as timely recognition and treatment of Opportunistic Infections (OIs) are the only viable options. Material and Methods Study population and design One hundred and sixty symptomatic confirmed HIV-positive patients, of both sexes having a lower respiratory tract infection were taken as subjects. Patients with confirmed diagnosis of pulmonary tuberculosis and bacterial pneumonia were excluded. Cases were recruited from the outpatient department, wards and the Anti- Retroviral Centre of J.N. Medical College and Hospital from January 2010 to November 2011. All patients were evaluated by a pre-designed protocol covering the patient’s particulars, history, including high- risk behavior, mode of transmission, marital status, partner status, presenting complaints and physical examination. Collection of specimens, microscopy, culture and identification Early morning expectorated or induced sputum, Broncho-alveolar- Lavage fluid (BAL) and percutaneous fine-needle aspirates were collected with complete universal precautions according to the patient’s presentation. Relevant methods were used for diagnosis and isolation, which included a battery of tests as per standard procedures [7,8]. e samples were subjected to direct microscopy using Gram and Giemsa staining, KOH mounts, India ink preparations. Fungal culture was done on Sabouraud dextrose agar, with and without chloramphenicol (16 mg/ml). Specimens were streaked in duplicate; one set of inoculated slants was incubated at 25°C and the other at 37°C, and they were examined every other day for growth up to 4-6 weeks before discarding as negative [9]. Fungal growth was identified by colony morphology, Gram staining, lactophenol cotton blue preparation and Riddle’s slide culture as per standard recommended procedures [10]. Identification & speciation of yeast isolates was done on the basis of germ tube production, morphology on corn meal agar with Tween 80 (Hi-Media), Hi-Crome candida agar (Hi Media), carbohydrate fermentation tests and assimilation tests using yeast nitrogen base agar (Hi Media) as per standard recommended procedures [7-10]. V i r o l o g y & M y c o l o g y ISSN: 2161-0517