Table 1: Summary of HIV-associated opportunistic infections identified by NGS*.

- Case 1 – CNS Toxoplasmosis Case 2 – Disseminated MAC Case 3 – TB Lymphadenitis Case 4 – Microsporidiosis
Demographics
Age (years)
Gender
49
M
23
M
56
M
45
M
HIV/AIDS information
CD4+ cell count (cells/μL)
HIV-1 viral load (copies/mL)
4
197,000
9
809,000
25
527,000
339
221,000
Localization of infection CNS Disseminated Disseminated Gastrointestinal
Other microbiology tests ordered - Blood cultures for bacteria, fungi, AFB
- Blood TB T-spot
- Blood antigen for Strongyloides, Cryptococcus, Histoplasma and Toxoplasma
- BAL cultures for bacteria, fungi, AFB, Mycoplasma and Legionella; PCR for Chlamydia pneumoniae
- CSF cultures, PCR for Toxoplasma, JC virus, EBV, TB
- Brain tissue pathology staining for multiple organisms
- Blood cultures for bacteria, fungi, AFB
- Bone marrow biopsy cultures and staining for bacteria, viruses, fungi, AFB
- Blood cultures for bacteria, fungi, AFB
- BAL cultures for bacteria, viruses, fungi, AFB, Mycoplasma and Legionella; PCR for Chlamydia pneumoniae
- Lung tissue cultures and staining for bacteria, viruses, fungi, AFB
- CSF cultures, VDRL and antigens for Cryptococcus and WNV
- Lymph node biopsy tissue cultures and staining for bacteria, fungi, AFB
- CSF cultures, multiple viral PCRs, and AFB stain/culture
- Stool ova and parasites
- GI pathogen PCR panel
Positive microbiology test(s) Blood Toxoplasma IgG; CSF Toxoplasma PCR; Brain tissue Toxoplasma stain Bone marrow biopsy AFB culture; AFB blood culture Lung tissue AFB culture; lymph node tissue x2 AFB stain and culture GI pathogen panel positive Norovirus and Cryptosporidium
NGS result(s) Toxoplasma gondii; Cytomegalovirus; Nocardia farcinica; Enterococcus faecalis and Enterococcus faecium Mycobacterium avium complex Mycobacterium tuberculosis; EBV Enterocytozoon bieneusi

*NGS, next-generation sequencing; CNS, central nervous system; AFB, acid-fast bacilli; TB, tuberculosis (Mycobacterium tuberculosis); BAL, bronchoalveolar lavage; EBV, Epstein-Barr Virus; CSF, cerebrospinal fluid; MAC, Mycobacterium avium complex; WNV, West Nile Virus; GI, gastrointestinal.

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