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Opportunistic infection
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<h2 id="types-of-opportunistic-infections">Types of opportunistic infections</h2> <p class="note">Further information: <a href="/facts/Immunodeficiency/CIEujXmc">Immunodeficiency</a></p> <p>A wide variety of pathogens are involved in opportunistic infection and can cause a similarly wide range in pathologies. A partial list of opportunistic pathogens and their associated presentations includes: </p> <h3>Bacteria</h3> <ul><li><i><a href="/facts/Clostridioides_difficile/lELAUztP">Clostridioides difficile</a></i> (formerly known as <i>Clostridium difficile</i>) is a species of bacteria that is known to cause gastrointestinal infection and is typically associated with the <a href="/facts/Hospital-acquired_infection/sKWTbPTq">hospital setting</a>.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a><a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a></li> <li><i><a href="/facts/Legionella_pneumophila/UrQCVYkg">Legionella pneumophila</a></i> is a bacterium that causes <a href="/facts/Legionnaires%27_disease/0zqx5s0e">Legionnaire's disease</a>, a <a href="/facts/Respiratory_tract_infection/lLKXWrJf">respiratory infection</a>.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a><a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a></li> <li><i><a href="/facts/Mycobacterium_avium_complex/jFfvXTSI">Mycobacterium avium complex</a></i> (MAC) is a group of two bacteria, <i>M. avium</i> and <i>M. intracellulare</i>, that typically co-infect, leading to a lung infection called <a href="/facts/Mycobacterium_avium-intracellulare_infection/CkcalmdE">mycobacterium avium-intracellulare infection</a>.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a></li> <li><i><a href="/facts/Mycobacterium_tuberculosis/cbRjnhIQ">Mycobacterium tuberculosis</a></i> is a species of bacteria that causes <a href="/facts/Tuberculosis/ggPyovAl">tuberculosis</a>, a respiratory infection.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a></li> <li><i><a href="/facts/Pseudomonas_aeruginosa/HBhyIxAn">Pseudomonas aeruginosa</a></i> is a bacterium that can cause respiratory infections. It is frequently associated with <a href="/facts/Cystic_fibrosis/tlNK5BAH">cystic fibrosis</a> and hospital-acquired infections.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a></li> <li><i><a href="/facts/Salmonella/2SkCRybG">Salmonella</a></i> is a <a href="/facts/Genus/m8EFjSms">genus</a> of bacteria, known to cause gastrointestinal infections.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a></li> <li><i><a href="/facts/Staphylococcus_aureus/9yDVBMsc">Staphylococcus aureus</a></i> is a bacterium known to cause skin infections and <a href="/facts/Sepsis/n52bkffJ">sepsis</a>, among other pathologies. Notably, <i>S. aureus</i> has evolved several <a href="/facts/Drug_resistance/cgLruXm6">drug-resistant</a> strains, including <a href="/facts/Methicillin-resistant_Staphylococcus_aureus/4DGUo2co">MRSA</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a></li> <li><i><a href="/facts/Streptococcus_pneumoniae/B5XxK27j">Streptococcus pneumoniae</a></i> is a bacterium that causes respiratory infections.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a></li> <li><i><a href="/facts/Streptococcus_pyogenes/qrkSpDz1">Streptococcus pyogenes</a></i> (also known as group A <i>Streptococcus</i>) is a bacterium that can cause a variety of pathologies, including <a href="/facts/Impetigo/hDuv14qE">impetigo</a> and <a href="/facts/Streptococcal_pharyngitis/bp4ATM2j">strep throat</a>, as well as other, more serious, illnesses.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a></li></ul> <h3>Fungi</h3> <ul><li><i><a href="/facts/Aspergillus/pKhecLTW">Aspergillus</a></i> is a fungus, commonly associated with respiratory infection.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a><a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a></li> <li><i><a href="/facts/Candida_albicans/7o27aEFS">Candida albicans</a></i> is a species of fungus that is associated with <a href="/facts/Oral_candidiasis/joetTDM8">oral thrush</a> and gastrointestinal infection.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a></li> <li><i><a href="/facts/Coccidioides_immitis/eVX5xq7N">Coccidioides immitis</a></i> is a fungus known for causing <a href="/facts/Coccidioidomycosis/WBBD9nMk">coccidioidomycosis</a>, more commonly known as Valley Fever.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a></li> <li><i><a href="/facts/Cryptococcus_neoformans/QdwgHGn1">Cryptococcus neoformans</a></i> is a fungus that causes <a href="/facts/Cryptococcosis/H8gpKmPA">cryptococcosis</a>, which can lead to pulmonary infection as well as nervous system infections, like <a href="/facts/Meningitis/4m4STzJB">meningitis</a>.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a><a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a></li> <li><i><a href="/facts/Histoplasma_capsulatum/lVjdYpM7">Histoplasma capsulatum</a></i> is a species of fungus known to cause <a href="/facts/Histoplasmosis/FfMdb5m8">histoplasmosis</a>, which can present with an array of symptoms, but often involves respiratory infection.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a></li> <li><i><a href="/facts/Pseudogymnoascus_destructans/qE5ss9rG">Pseudogymnoascus destructans</a></i> (formerly known as <i>Geomyces destructans</i>) is a fungus that causes <a href="/facts/White-nose_syndrome/1TCkDeFl">white-nose syndrome</a> in <a href="/facts/Bat/CJudzNt1">bats</a>.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a></li> <li><i><a href="/facts/Microsporidia/z01Q4Xfl">Microsporidia</a></i> is a group of fungi that infect species across the <a href="/facts/Animal/4b8J33nd">animal kingdom</a>, one species of which can cause <a href="/facts/Microsporidiosis/DucLCQMC">microsporidiosis</a> in immunocompromised human hosts.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a></li> <li><i><a href="/facts/Pneumocystis_jirovecii/lzPGB7an">Pneumocystis jirovecii</a></i> (formerly known as <i>Pneumocystis carinii</i>) is a fungus that causes <a href="/facts/Pneumocystis_pneumonia/hrFCRv8b">pneumocystis pneumonia</a>, a respiratory infection.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a></li></ul> <h3>Parasites</h3> <ul><li><i><a href="/facts/Cryptosporidium/HLSpRu7I">Cryptosporidium</a></i> is a <a href="/facts/Protozoa/JczTf25H">protozoan</a> that infects the <a href="/facts/Gastrointestinal_tract/nK2zwqBS">gastrointestinal tract</a>.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a></li> <li><i><a href="/facts/Toxoplasma_gondii/LzFxHk0j">Toxoplasma gondii</a></i> is a protozoan, known for causing <a href="/facts/Toxoplasmosis/6wTKf6SG">toxoplasmosis</a>.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a><a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a></li></ul> <h3>Viruses</h3> <ul><li><i><a href="/facts/Cytomegalovirus/gtxdYP8S">Cytomegalovirus</a></i> is a family of opportunistic viruses, most frequently associated with respiratory infection.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a><a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a></li> <li><i><a href="/facts/Human_polyomavirus_2/yLy0271h">Human polyomavirus 2</a></i> (also known as JC virus) is known to cause <a href="/facts/Progressive_multifocal_leukoencephalopathy/wl3Kbcsl">progressive multifocal leukoencephalopathy</a> (PML).<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a><a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a></li> <li><i><a href="/facts/Kaposi%27s_sarcoma-associated_herpesvirus/uP1fKRnI">Human herpesvirus 8</a></i> (also known as Kaposi sarcoma-associated herpesvirus) is a virus associated with <a href="/facts/Kaposi%27s_sarcoma/0IFdzpbH">Kaposi sarcoma</a>, a type of cancer.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a></li></ul> <h2 id="causes">Causes</h2> <p><a href="/facts/Immunodeficiency/CIEujXmc">Immunodeficiency</a> or <a href="/facts/Immunosuppression/22GHUHkr">immunosuppression</a> are characterized by the absence of or disruption in components of the immune system, leading to lower-than-normal levels of immune function and immunity against pathogens.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> They can be caused by a variety of factors, including: </p> <ul><li><a href="/facts/Malnutrition/KasQy5MR">Malnutrition</a></li> <li><a href="/facts/Fatigue_(medical)/C2oo4Hvg">Fatigue</a></li> <li>Recurrent <a href="/facts/Infection/182XrncP">infections</a></li> <li><a href="/facts/Immunosuppressive_drug/ctlB3Hda">Immunosuppressing agents</a> for <a href="/facts/Organ_transplant/1jNvVJn6">organ transplant</a> recipients</li> <li>Advanced <a href="/facts/HIV/ulY2rgzu">HIV</a> infection</li> <li><a href="/facts/Chemotherapy/fWTLbaUT">Chemotherapy</a> for <a href="/facts/Cancer/PVW6n1D0">cancer</a></li> <li><a href="/facts/Genetics/bu8wne0A">Genetic</a> predisposition</li> <li><a href="/facts/Skin/4havlLzG">Skin</a> damage</li> <li><a href="/facts/Antibiotic/sF1kIfxg">Antibiotic</a> treatment leading to disruption of the physiological <a href="/facts/Microbiome/lVjQnvpm">microbiome</a>, thus allowing some microorganisms to outcompete others and become <a href="/facts/Pathogenic/axMXtV1M">pathogenic</a> (e.g. disruption of <a href="/facts/Intestinal_flora/Xy1IWzSP">intestinal microbiota</a> may lead to <i><a href="/facts/Clostridium_difficile_colitis/kYFGjVKf">Clostridium difficile</a></i> infection)</li> <li>Medical procedures</li> <li>Pregnancy <p class="note">Further information: <a href="/facts/Susceptibility_and_severity_of_infections_in_pregnancy/FeLIIm7t">Susceptibility and severity of infections in pregnancy</a></p></li> <li><a href="/facts/Ageing/AxL4qCW4">Aging</a></li> <li><a href="/facts/Leukopenia/LB1Avvby">Leukopenia</a> (i.e. <a href="/facts/Neutropenia/qasEurVu">neutropenia</a> and <a href="/facts/Lymphocytopenia/sGQwg8ez">lymphocytopenia</a>)</li> <li>Burns</li></ul> <p>The lack of or the disruption of <a href="/facts/List_of_microbiota_species_of_the_lower_reproductive_tract_of_women/Vmph4v5H">normal vaginal microbiota</a> allows the proliferation of <a href="/facts/List_of_bacterial_vaginosis_microbiota/4oVj7tF6">opportunistic microorganisms</a> and will cause the opportunistic infection <a href="/facts/Bacterial_vaginosis/Tmvw2bMR">bacterial vaginosis</a>.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a><a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> </p> <h2 id="opportunistic-infection-and-hivaids">Opportunistic Infection and HIV/AIDS</h2> <p>HIV is a virus that targets <a href="/facts/T_cell/5z6PQ9UN">T cells</a> of the <a href="/facts/Immune_system/HRCTf1pb">immune system</a> and, as a result, HIV infection can lead to progressively worsening immunodeficiency, a condition ideal for the development of opportunistic infection.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> Because of this, respiratory and central nervous system opportunistic infections, including tuberculosis and meningitis, respectively, are associated with later-stage HIV infection, as are numerous other infectious pathologies.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a><a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> Kaposi's sarcoma, a virally-associated cancer, has higher incidence rates in HIV-positive patients than in the general population.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> As immune function declines and HIV-infection progresses to AIDS, individuals are at an increased risk of opportunistic infections that their immune systems are no longer capable of responding properly to. Because of this, opportunistic infections are a leading cause of HIV/AIDS-related deaths.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> </p> <h2 id="prevention">Prevention</h2> <p>Since opportunistic infections can cause severe disease, much emphasis is placed on measures to prevent infection. Such a strategy usually includes restoration of the immune system as soon as possible, avoiding exposures to infectious agents, and using antimicrobial medications ("prophylactic medications") directed against specific infections.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> </p> <h3>Restoration of immune system</h3> <ul><li>In patients with HIV, starting <a href="/facts/Management_of_HIV/AIDS/q6KaJl8d">antiretroviral therapy</a> is especially important for restoration of the immune system and reducing the incidence rate of opportunistic infections<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a><a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a></li> <li>In patients undergoing chemotherapy, completion of and recovery from treatment is the primary method for immune system restoration. In a select subset of high risk patients, <a href="/facts/Granulocyte_colony-stimulating_factor/aPbo9muU">granulocyte colony stimulating factors</a> (G-CSF) can be used to aid immune system recovery.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a><a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a></li></ul> <h3>Avoidance of infectious exposure</h3> <p>The following may be avoided as a preventative measure to reduce the risk of infection: </p> <ul><li>Eating undercooked meat or eggs, unpasteurized dairy products or juices.</li> <li>Potential sources of tuberculosis (high-risk healthcare facilities, regions with high rates of tuberculosis, patients with known tuberculosis).</li> <li>Any oral exposure to feces.<a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a></li> <li>Contact with farm animals, especially those with diarrhea: source of <i><a href="/facts/Toxoplasma_gondii/LzFxHk0j">Toxoplasma gondii</a></i>, <i><a href="/facts/Cryptosporidium_parvum/8YSMIJYp">Cryptosporidium parvum</a>.</i></li> <li>Cat feces (e.g. cat litter): source of <i><a href="/facts/Toxoplasma_gondii/LzFxHk0j">Toxoplasma gondii</a></i>, <a href="/facts/Bartonella/LHnJXkPm"><i>Bartonella</i> spp</a>.</li> <li>Soil/dust in areas where there is known <a href="/facts/Histoplasmosis/FfMdb5m8">histoplasmosis</a>, <a href="/facts/Coccidioidomycosis/WBBD9nMk">coccidioidomycosis</a>.</li> <li>Reptiles, chicks, and ducklings are a common source of <i><a href="/facts/Salmonella/2SkCRybG">Salmonella</a></i>.</li> <li>Unprotected sexual intercourse with individuals with known <a href="/facts/Sexually_transmitted_infection/IYL1rxdI">sexually transmitted infections</a>.</li></ul> <h3>Prophylactic medications</h3> <p>Individuals at higher risk are often prescribed prophylactic medication to prevent an infection from occurring. A person's risk level for developing an opportunistic infection is approximated using the person's <a href="/facts/CD4/l3krxz97">CD4 T-cell count</a> and other indications. The table below provides information regarding the treatment management of common opportunistic infections.<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a><a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a> </p> <table><tbody><tr><th>Opportunistic infections</th><th>Indication(s) for prophylactic medications</th><th>Preferred agent(s)</th><th>When to discontinue agent(s)</th><th>Secondary prophylactic/maintenance agent(s)</th></tr><tr><td><a href="/facts/Mycobacterium_tuberculosis/cbRjnhIQ">Mycobacterium tuberculosis</a></td><td>Upon diagnosis of HIV, any positive screening test, or prior medical history of Mycobacterium tuberculosis.</td><td><ul><li><a href="/facts/Rifampicin/9naa8C5l">Rifampicin</a></li><li><a href="/facts/Isoniazid/kaFX7E6u">Isoniazid</a></li><li><a href="/facts/Pyridoxine/sRTLFpv1">Pyridoxine</a></li><li><a href="/facts/Pyrazinamide/TYlkeztA">Pyrazinamide</a></li><li><a href="/facts/Ethambutol/BT67zIyK">Ethambutol</a></li></ul></td><td>These current agents' doses/frequency will discontinue after two months. Depending on clinical presentation, maintenance agents will continue for at least four more months.</td><td><ul><li>Rifampicin, isoniazid, and pyridoxine</li></ul></td></tr><tr><td><a href="/facts/Pneumocystis_jirovecii/lzPGB7an">Pneumocystis jiroveci</a></td><td><a href="/facts/CD4/l3krxz97">CD4 count</a> is less than 200 cells/mm3 or less than 14%. The person has documented medical history of recurrent <a href="/facts/Oral_candidiasis/joetTDM8">oropharyngeal candidiasis</a>.</td><td><ul><li><a href="/facts/Trimethoprim/sulfamethoxazole/dcYzn4mR">Trimethoprim-sulfamethoxazole</a></li></ul></td><td>This current agent doses/frequency will discontinue after 21 days. Secondary prophylactic agent dose/frequency will continue until the CD4 count is above 200 cells/mm3 and the HIV viral load is undetectable for at least three months while taking <a href="/facts/Antiretroviral_therapy/q6KaJl8d">antiretroviral therapy</a>.</td><td><ul><li>Trimethoprim-sulfamethoxazole</li></ul></td></tr><tr><td><a href="/facts/Toxoplasma_gondii/LzFxHk0j">Toxoplasma gondii</a></td><td>CD4 count is less than 100 cells/mm3 or less than 14%, and the person has a positive serology for Toxoplasma gondii.</td><td><ul><li>Trimethoprim-sulfamethoxazole</li></ul></td><td>This agent will discontinue after six weeks. Secondary prophylactic medications will continue until the CD4 count is above 200 cells/mm3 and HIV viral load is undetectable for at least six months while taking antiretroviral therapy.</td><td><ul><li><a href="/facts/Sulfadiazine/PlU6PBEP">Sulfadiazine</a>, <a href="/facts/Pyrimethamine/PobyDnmn">pyrimethamine</a>, and <a href="/facts/Folinic_acid/SPubEUDE">folinic acid</a></li></ul></td></tr><tr><td><a href="/facts/Mycobacterium_avium-intracellulare_infection/CkcalmdE">Mycobacterium avium complex disease</a></td><td>CD4 count is less than 50 cells/mm3 and has a detectable viral load while taking antiretroviral therapy.</td><td><ul><li><a href="/facts/Clarithromycin/LoeUP4Ih">Clarithromycin</a> and ethambutol</li><li>Rifabutin may be added depending on clinical presentation.</li></ul></td><td>These agent(s) will discontinue after 12 months only if the person does not have any symptoms that will be concerning for persistent Mycobacterium avium complex disease and their CD4 count is above 100 cells/mm3, and while their HIV viral load is undetectable for at least six months while taking antiretroviral therapy.</td><td>N/A</td></tr></tbody></table> <p>Alternative agents can be used instead of the preferred agents. These alternative agents may be used due to allergies, availability, or clinical presentation. The alternative agents are listed in the table below.<a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a><a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a><a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a> </p> <table><tbody><tr><th>Opportunistic infections</th><th>Alternative agent(s)</th></tr><tr><td><a href="/facts/Mycobacterium_tuberculosis/cbRjnhIQ">Mycobacterium tuberculosis</a></td><td><ul><li><a href="/facts/Rifabutin/snlV34I8">Rifabutin</a></li></ul></td></tr><tr><td><a href="/facts/Pneumocystis_jirovecii/lzPGB7an">Pneumocystis jiroveci</a></td><td><ul><li><a href="/facts/Dapsone/0d1BGd1n">Dapsone</a></li><li><a href="/facts/Atovaquone/wJXYl7Xd">Atovaquone</a></li><li><a href="/facts/Pentamidine/xz00bxxS">Pentamidine</a></li></ul></td></tr><tr><td><a href="/facts/Toxoplasma_gondii/LzFxHk0j">Toxoplasma gondii</a></td><td><ul><li>Dapsone, pyrimethamine, and folinic acid</li><li>Atovaquone, pyrimethamine, and folinic acid</li></ul></td></tr><tr><td><a href="/facts/Mycobacterium_avium-intracellulare_infection/CkcalmdE">Mycobacterium avium complex disease</a></td><td><ul><li><a href="/facts/Azithromycin/8CAbVtsz">Azithromycin</a> and ethambutol</li></ul></td></tr></tbody></table> <h2 id="treatment">Treatment</h2> <p>Treatment depends on the type of opportunistic infection, but usually involves different <a href="/facts/Antibiotic/sF1kIfxg">antibiotics</a>. </p> <h2 id="veterinary-treatment">Veterinary treatment</h2> <p>Opportunistic infections caused by <a href="/facts/Feline_leukemia_virus/dVAoftwC">feline leukemia virus</a> and <a href="/facts/Feline_immunodeficiency_virus/dYKMBf1V">feline immunodeficiency virus</a> <a href="/facts/Retroviral/GWAx3C3o">retroviral</a> infections can be treated with <a href="/facts/Lymphocyte_T-cell_immunomodulator/qt3MPmxo">lymphocyte T-cell immunomodulator</a>. </p> Wikimedia Commons has media related to Opportunistic infections. <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Justiz Vaillant AA, Qurie A (2021). 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