HIV Complications II Flashcards
Signs and symptoms of HIV x Candidiasis infeciton for:
- oral infection
- oesophageal infection
Oral:
* Asymptomatic
* Taste perversion
* Oral discomfort
* Pharyngeal discomfort on swallowing
* Creamy white plaques which may be stripped off from surface of tissue (in contrast to OHL)
* Erythematous patches
* Angular chelitis
Oesophageal infection:
* Dysphagia
* Retrosternal pain on swallowing (odynophagia)
* Nausea
* Creamy white plaques on endoscopy
Most common fungal infection of CNS associated with HIV is? [1]
WHich is the most common opportunistic infection in AIDS? [1]
Cryptococcus - CNS involvement
PCP - overall most common
Describe the treatment for oral / oesphogeal candida infection from HIV:
Topical tx [2]
Systemic tx [3]
Topical antifungals:
* Topical Nystatin / Amphoterecin lozenges
* Micanazole gel
Systemic antifungals (severe disease)
* Fluconazole 50-100mg/day
* If resistant e.g. long term use of Fluconazole or CD4< 50:
* Itraconazole
* IV Amphoteracin
A patient with HIV suffers a pathology which is suspected to have arisen from inhaling a pathogen from bird faeces. What is the name of the pathogen? [1]
Cryptococcus Neoformans (CN)
Cryptococcus Neoformans (CN) can impact which body systems? [3]
Describe the symptoms associated with each system being affected [+]
Skin:
- Umbilicated papules and ulceration
Lungs:
- Cough
- SOB
- Fever
Meninges & Brain:
- Asymptomatic (10%)
- Headache (most common symptom)
- Fever
- Mental change
Describe how would investigate and diagnose pulmonary cryptococcal infection (associated with HIV)
Chest X-Ray:
* Consolidation +/- cavitation,
* Interstitial infiltrates
* Effusions
Diagnosis:
- Bronchoalveolar lavage
Describe how would investigate and diagnose cryptococcal meningitis (associated with HIV)
DIAGNOSIS :
Serum:
- Crytococcal Antigens (CrAg)
CSF:
- High pressure; low glucose
- Indian ink test positive
- CRAG
- culture +/- lymphocytes
- low glucose; high protein; high pressure
CT:
- meningeal enhancement
- cerebral oedema
A patient is dx with cryptococcal infection. They have a stain perfomed which confirms the dx.
What is the type of stain used? [1]
Indian Ink
Describe the treatment for cryptococcal infection in HIV ptx:
Drugs [3]
Length [1]
IV Amphotericin
+/- Flucytoscine if severe
Then oral Fluconazole
Treat for 6 weeks minimum the repeat LP after this 6 weeks
Which medication can be given for CN prophylaxis in HIV patients? [1]
PROPHYLAXIS: Fluconazole 200-400mg/ day.
When should patients receive PCP prophylaxis? [1]
CD4 count < 200/mm³ should receive PCP prophylaxis
Describe the clinical manifestation of PCP x HIV infection [+]
Features
* Pyrexia
* +/- Chest signs
* O2 desaturation on exertion
* dyspnoea
* dry cough
* fever
* very few chest signs
Describe how you dx PCP x HIV
Chest X-Ray:
* May be normal
* Bilateral infiltrates (bat wings)
* Atypical appearance - effusions, consolidation, cavitation
* Upper lobes only (Pentamidine nebuliser prophylaxis)
Bronchoalveolar lavage:
* Silver staining
* immunofluorescence
* PCR
How do you treat PCP x HIV? [3]
If PCP pO2 < 10kpa? [2] (very severe infection)
TREATMENT:
* Co-trimoxazole 120mg/Kg in 3 divided doses/day
* IV Pentamidine
* Clindamycin and Primaquine
Severe infection:
* IV Methylprednisolone 40mg qds (5 -10 days)
* Oral Prednisolone 40mg bd
What do you give for PCP prophylaxis for PLWHIV? [3]
PROPHYLAXIS:
* Co-trimoxazole 960mg x 3 / week
* Nebulised Pentamidine
* Dapsone
Describe the clinical presentation of HIV x toxoplasma gondii (TG)
Fever
Confusion
Headache
Drowsiness
Focal neurological signs: Fits
Describe the dx and mx of HIV x TG
DIAGNOSIS:
CT/ MRI:
* Ring enhancing lesions
* Classically multiple (but may be single lesions)
* Confirm diagnosis by response to treatment - repeat scan after 3-weeks.
Which infective organism is most likely in this PLWHIV? [1]
Cerebral toxoplasmosis
- demonstrates multiple small peripherally enhancing nodules located predominantly in the basal ganglia as well as the central portions of the cerebellar hemispheres. Only a small amount of surrounding oedema is present.
Describe the treatment for TG HIV [2]
TREATMENT:
Sulphadiazine (or Dapsone or Clindamycin) AND Pyramethamine
Change to oral when improved (total 6 weeks of treatment)
Prophylaxis for HIV x TG? [2]
Dapsone + Pyramethamine
HIV x brisk diarrhoeal illness = ? [1]
Cryptosporidium parvum
Dx of HIV x Cryptosporidium parvum? [2]
Tx? [1]
DIAGNOSIS:
Ziehl-Neelson staining of stool - may need up to 10
Rectal biopsy
TREATMENT:
* Difficult to eradicate if CD4 < 200, ART
* Paromomycin
Dx of Microsporidium species X HIV? [1]
Tx? [3]
Microsporidium species:
- immunofluorescent staining of stool
TREATMENT
* ART
* Albendazole
* High dose Erythromycin
Dx of Isospora belli x HIV? [1]
Tx [1]
DIAGNOSIS:
* Stool analysis
TREATMENT:
* Co-trimoxazole
Dx of Aspergillus fumigatus x HIV? [1]
Tx [2]
Symptoms:
Cough, fever, dyspnoea
DIAGNOSIS:
Chest X-Ray - may see cavitation Bronchoscopy
TREATMENT:
* Amphoteracin B
* Itraconazole
Dx of HIV x Histoplasma capsulatum (Histoplasmosis) [4]
- Chest X-Ray: diffuse infiltrates
- Pancytopenia
- Fungal blood cultures
- Biopsies of affected tissue
S&S of HIV x Histoplasma capsulatum (Histoplasmosis) [4]
SYMPTOMS:
* Fever
* Constitutional symptoms
* Respiratory disease.
SIGNS:
* Hepato-splenomegaly, enlarged lymph nodes, chest signs 10% rash (resembles folliculitis or molluscum)
* Neurological signs
Tx for HIV x Histoplasma capsulatum OR Penicillium marneffei (Histoplasmosis) [2]
TREATMENT:
Itraconazole, Amphoteracin B
Describe the difference in presentation in toxoplasmosis vs lymphoma presentation in people living with HIV [3]
Toxoplasmosis:
* Multiple lesions
* Ring or nodular enhancement
* Thallium SPECT negative
Lymphoma:
* Single lesion
* Solid (homogenous) enhancement
* Thallium SPECT positive
