0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
372 Complications of Human Immunodeficiency Virus Type 1■Coccidiodes immitus: endemic to Southwestern U.S. and Latin Amer-
ica; HIV+persons living in or visiting endemic areas should avoid
activities associated with increased risk (e.g., extensive exposure to
disturbed native soil, for example, at building excavation sites or
during dust storms)
■Penicillium marneffei: primarily seen in S.E. Asia; associated with the
bamboo rat; probably acquired via inhalation of aerosolized conidia
■Aspergillus: ubiquitous fungus found mainly on decomposing veg-
etable matter esp. around human habitations esp. in cellars, potted
plants, and pepper and spices
Parasites
■Toxoplasma gondii: worldwide distribution; found in raw or under-
cooked meat, particularly undercooked pork, lamb, or venison; also
from in soil contaminated with animal feces; and cat feces; can be
congenitally acquired if mother infected during pregnancy
■Cryptosporidium parvum: probable ubiquitous animal pathogen
with human as incidental hosts. Modes of transmission include
direct contact with infected adults, diaper-aged children, and
infected animals; drinking contaminated water; coming into contact
with contaminated water during recreational activities; and eating
contaminated food.
■Isospora belli: more common in southeastern United States and the
Caribbean; occurs in <0.2% AIDS cases in the U.S.
■Microsporidia: general attention to hand washing and other per-
sonal hygiene measures are recommended to decrease risk of infec-
tion; Enterocytozoon bieniusi and Septata intestinalis are main
pathogens
■Giardia lamblia: transmission by oral ingestion of cysts – e.g., food-
borne, contaminated water (esp. cold surface water), person-to-
person (esp. children in daycare centers, male homosexuals and
institutionalized individuals)
■Other Parasites: Leishmania – widespread; spread by sandflies;
Strongyloides stercoralis – widely distributed in tropical and south-
ern USA; found in soil and institutionalized individuals
Bacteria
■Mycobacterium tuberculosis: almost all transmission due to inhala-
tion of infectious droplets from infected individuals produce by
coughing, sneezing or talking; close contact and a highly infectious
(smear positive) source increases likelihood of transmission; higher
exposure risk include volunteer work or employment in health-care
facilities, correctional institutions, and shelters for the homeless, as