The aim of this study was to examine the relationships among diarrhea, CD4+ cell counts and opportunistic protozoa in HIV-infected patients in North India. In a retrospective study, blood and stool samples of 200 HIV-infected patients from March 2001 until 2003, submitted to the AIDS division of National Institute of Communicable Diseases (NICD), were analyzed. Each patient was examined for opportunistic protozoa, HIV-1 status and CD4+ cell counts, and screened for diarrheal symptoms. The rate of diarrhea was 38% in the stool examination. In HIV-infected patients in the groups CD4+ > 500 cells/microL, 200 cells/microL < CD4+ < 500 cells/muL and in the AIDS patients CD4+ < 200 cells/microL, diarrhea was 14.7, 29.8 and 56.1%, respectively. It is clear that the diarrhea in the AIDS patients was significant compared with the two former groups (P < 0.0005). In the AIDS patients CD4+ < 200 cells/microL with diarrhea, Cryptosporidium infection was, at 56.5%, the highest and statistically significant compared with the other parasites (P = 0.037). Microsporidium was detected in 30.4% of the AIDS patients. Diarrhea was common and most strongly associated in patients with low CD4+ cell counts. The data stress the importance of opportunistic protozoa in the HIV-infected patients, and that opportunistic protozoa should be expected in HIV-infected patients with low CD4+ and diarrhea.

Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th 2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P < 0.001 for PT versus non-PT in both subgroups). Median survival duration (months) in the PT versus non-PT categories of ARI was 47 (95% CI as 42,48) versus 95 (95% CI as 90,100) in subgroup I and 71 (95% CI as 65,76) versus 107 (95% CI as 102,112) in subgroup II (P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated im-

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PURPOSE:The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital.MATERIALS AND METHODS:The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed.RESULTS:Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis.CONCLUSIONS:The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.