A. Bacterial infections  

 
1. Salmonella  

 

  
      Source: 

   

Eggs, poultry, water  

 
      Clinical presentation: Diarrhoea (?bloody) and vomiting
Fever
Septicaemic shock
Typhoid fever

 

      Diagnosis: 

 

 Stool and blood cultures  
      Treatment:                     

Isolate
Fluid replacement
Anti-diarrhoeals:                                            
Ciprofloxacin 500mg b.d. for 2 weeks or amoxycillin 500mg tds; trimethoprim 200mg bd.)
      Complications:  

Septicaemia
Osteomyelitis
Intestinal perforation  

     

      Infectious risk to others:

  

High

      Prevention:  

Hand washing
Good food preparation, storage and handling
Boil drinking water
Recurrence less likely if 3 month treatment given  
   if septicaemic

 
2. Tuberculosis  

 

  
       Source:                               

Airborne cough droplets from others
In UK about 1/3 reactivation of previous infections  

 
      Clinical presentation:   Cough (? Blood), fever, night sweats, weight loss, fatigue,  hepatosplenomegaly     

             
      Diagnosis:                                 Microscopy and culture of sputum, blood or CSF

  
      Other investigations:       CD4 count <100/ml
Anaemia
Raised alkaline phoshpatase
Drug resistance testing not useful  

 

      Treatment: 

According to local protocols: same as in HIV-ve patients 
UK:   Rifampicin
Isoniazid             For 3 months
Pyrimethamine  
Then 2 drugs for4 months  
Longer Rx if:   extrapulmonary
Drug resistance present  

 
      Complications:                extrapulmonary spread
High risk for emergence of multi-drug resistant (MDR) strains                                                      
TB drugs may reduce effectiveness of HAART  

 
      Infectious risk to others:  same as in HIV-ve patients
HIV +ve patients at very highrisk of acquiring TB from  others
Isolate all patients with TB in sputum until sputum clear  

 
      Prevention:      

Screen contacts: Tuberculin test and CXR
Role of long term isoniazid in prevention uncertain

 
 3. Mycobacterium avium-intracellulare (MAI)  

 
      Source:         

Widespread  

 
      Clinical presentation:    

 

 Fever, fatigue, anaemia, diarrhoea, weight loss  
      Diagnosis:                          

Blood culture, bone marrow biopsy  

 
      Other investigations:      

CD4 count <100/ml
Anaemia
Raised alkaline phoshpatase
Drug resistance testing not useful  

 
      Treatment:                     

Rifabutin 300mg o.d.
Clarithromycin 500 mg bd.
Ethambutol 15/mg/kg o.d.
Continued life long or until CD4 count recovers >100/ml  on HAART

 
      Complications:          

Prognosis poor in absence of HAART  

 
      Infectious risk to others:     None

 
      Prevention:  

Controversial but may be considered for patients with CD4<50/ml:
Azithromycin 1250mg once weekly or
Rifabutin 300mg o.d or
Clarithromycin 500mg bd.

 
But:  Expensive
Survival advantage only shown for rifabutin
High risk of selection of resistant organisms
Not universally accepted in Europe