AIDS Flashcards
oropharyngeal disease in AIDS
- oral Candidiasis - oral thrush, most common GI complication in HIV-infected patients
- oral hairy leukoplakia - EBV and HPV
common causes of esophagitis in AIDS
- Candida albicans
- HSV
- CMV
characteristics of candidal esophagitis
- endoscopically typified by whitish-yellow plaques
- cytologic brushings
- diagnosis of candidal esophagitis in setting of HIV infection confirms progression to AIDS
- yeast and/or pseudohyphae
- most frequent occurring fungal infections in patients with HIV infection
diagnosis of candidal esophagitis
- esophagoscopy preferable to barium study
- cytologic brushings superior to biopsies due to superficial, relatively noninvasive nature of candidal infections
treatment of Candidal esophagitis
- clotrimazole
- nystatin
- ketoconazole
- fluconazole
- amphotericin B
ketoconazole
- requires gastric acid secretion for absorption
fluconazole
- superior to ketoconazole
- DOC in Candidal esophagitis
amphotericin B
- used in patients unable to swallow, those who fail therapy with other antifungal agents, and those with dissemination
HSV esophagitis
- intense retrosternal pain and odynophagia
- less common cause of esophagitis than Candida
- vesicles lead to “volcano ulcerations”
cytologic findings of HSV esophagitis
- multinucleated giant cells along with ballooning degeneration
- ground glass nuclei
- Cowdry type A eosinophilic intranuclear inclusion bodies with epithelial cells
complications of HSV esophagitis
- bacterial or fungal superinfection, especially with Candida
HSV esophagitis diagnosis
- endoscopy superior to radiology
- cytology: intranuclear inclusion bodies
- radiology: progressive circular or diamond shaped halos representing surrounding edematous mucosa
treatment of HSV esophagitis
- acyclovir for 10-14 days
- vidarabine and foscarnet for resistant strains
CMV esophagitis
- almost exclusively in IC patients
- most common life-threatening opportunistic viral infection in patients with AIDS
- most causes of CMV esophagitis arise from reactivation of latent virus
- a lot more pain than seen with Candida or HSV
diagnosis of CMV esophagitis
- endoscopy required for diagnosis
- biopsy is superior to cytologic brushings or culture
- basophilic intranuclear inclusion bodies (owls eye inclusions)
treatment of CMV esophagitis
- ganciclovir
- foscarnet for resistant strains
ganciclovir toxicity
- toxicity includes leukopenia and thrombocytopenia
- zidovudine (AZT) should be discontinued or dose decreased due to potential for severe leukopenia
foscarnet toxicity
- renal failure and hypocalcemia
most common digestive organ to be involved with Kaposi’s sarcoma
- stomach
AIDS gastropathy
- diminished gastric acid secretion in association with antiparietal cell antibodies and gastric atrophy
diarrhea and AIDS
- most common and often most morbid GI manifestation of AIDS
- gays are more likely to have diarrhea
- AIDS patients with diarrhea have more weight loss and a greater degree of immunosuppression (decreased CD4, T helper cells)
cryptosporidia
- can cause diarrhea in both immunocompetent and IC people
- large volume stools and lack of inflammation suggests a secretory or toxin-mediated process
- IC hosts include AIDS, hypogammaglobulinemia, leukemia
- CD4 counts are frequently < 100 and usually < 50 cells/mm3
- malabsorption and lactose intolerance are common
crypto symptoms
- watery diarrhea
- N/V
- crampy abdominal pain
- flatulence
- weight loss
- LACK OF FEVER- LACK OF IMMUNE RESPONSE
crypto diagnosis
- stains acid fast
- biopsy
crypto treatment
- ART tx in AIDS patients to improve immune function
isoporiasis
- clinical illness indistniguishable from crypto
- eosinophilia is common
treatment of isosopora
- TMP-SMX
microsporidia
- ubiquitous, spore forming, obligate intracellular parasite
- likely to infect the jejunum
- found in gays who travel to tropical regions
- CD4 counts typically < 50 cells/mm3
- malabsorption is common
- septata intestinalis: has the ability to disseminate, found in kidney and liver
symptoms of microsporidia
- multiple, watery BMs
- abdominal pain
- flatulence
- progressive weight loss
- LACK OF FEVER
two infections that do not have fever
- crytpo and microsporidia
treatment of microsporidia
- improve CD4 counts and immunologic response
- albendazole may be effective against septata intestinalis
mycobacterium avium complex (MAC)
- typically indicates a systemic infection
- small intestinal more common than colonic
- may produce malabsorption
- gut lesion in histology resembles Whipples (differentiate using acid-fast staining)
diagnosis of MAC
- acid fast organisms in the blood, stool and duodenal fluid
- differentiation from TB requires culture
neoplastic disease in AIDs
- Kaposi’s sarcoma
- found in gingiva, palate, stomach, and intestine
hepatic MAI/AIDS
- most specific hepatic disease in AIDS
- marked increase in ALP and milder increases in transaminases
pathologic lesion found in hepatic MAI/AIDS
- poorly formed granulomas contained acid-fast bacilli within foamy histiocytes
diagnosis of hepatic MAI/AIDS
- biopsy of liver
hepatic CMV/AIDS
- second most common intrahepatic infection in AIDS
- hepatomegaly is usually present
- mildly elevated ALP and transaminases
- intracytoplasmic inclusions, mononuclear cell infiltrate, and focal hepatic necrosis seen in biopsy
biliary pelioisis hepatitis
- fever, ab pain, LYTIC BONE LESIONS
- liver biopsy: sinusoidal dilatation, blood filled
- Rochalimaea hensela and Rochalimaea quintana
- treated with erythromycin or tetracycline
lymphoma and AIDS
- usually of non-Hodgkins type (B cell origin)
- poor response to chemotherapy
symptoms of lymphoma in AIDS
- NIGHT SWEATS
- lymphadenopathy
- RUQ pain
- hepatomegaly
- fever
TB
- more common in IVDAs than in gays
- diagnoses by culture of acid-fast bacilli from liver tissue
- hepatomegaly common and lesions are seen radiographically
viral hepatitis and AIDS
- HCV present in up to 89% of HIV-infected IVDAs
biliary tract disease etiologies
- CMV
- crypto
- microsporidium
- any combo
