Lecture 30: AIDS and Headache Flashcards
Is meningitis a concern in a patient with a headache for ten days?
Yes, it could potentially be chronic meningitis. Although this would be atypical.
What are some possible causes of prolonged headaches in a patient with HIV?
- Brain abscess due to toxoplasma gondii
- Cryptococcus neoformans, a cause of meningitis in immunocompromised patiuents.
What are common causes of dysphagia in AIDS patients?
Candida albicans colonies in the throat and pharynx
What are two very common AIDS diagnoses?
- Candida albicans oesophagitis
- Cryptococcus neoformans meningitis
Relate AIDs diagnoses in relation to declining CD4 count:
CD4 decline
Early stage diagnosis: Tuberculosis, herpes, oral candidiasis
Middle stage diagnosis: Pneumocystis pneumonia, oesophogeal candidiasis
Later stage: Toxoplasm, crytptococcal meningitis, kaposis sarcoma
Last stage: CMV disease, MAIC disease
What are other causes of lymphopenia (similar to AIDS):
- Immunosuppression to prevent rejection of an organ transplant
- Chemo of lymphatic malignancy
What are the two fungal disease in AIDS?
Oral and oesophogeal mucosal disease due to candida albicans
Meningitis due to cryptococcus neoformans (gradual onset, chronic)
How can fungal infections be divided?
Common, minor, skin and mucosal infections
and
Rare, serious, deep tissue infections
What is the excessively simple classification of fungi:
Divided into:
Yeasts
Moulds
Write some notes on yeasts:
- Round or oval, reproduce by budding
- Candida albicans and other candida
- Cryptococcus neoformans
Write some notes on moulds:
- Tubular hyphae, reproduce by spores
- Dermatophytes
- Aspergillus species
Write some notes on candida albicans:
Commensal of mouth, gut, vagina.
Overgrowth related to antibacterial therapy, immune suppression, hormonal effects, foreign bodies
Causes:
- Oral or vaginal ‘thrush’
- Cutaneous or nail candidiasis
- Urinary catheter bladder infections
- Rare systemic infection
Describe the diagnosis of candida albican:
It is seen as black yeasts with psuedo-hypae on gram stain
It grows well on blood agar
Describe the treatment of candidiasis:
Usually topical, sometimes oral.
- Nystatin suspension or pastilles
- Amphotericin B pastilles
- Azole pessaries or cream
Azoles commonly
Describe how C. Neoformans causes disease:
Pulmonary infection
- Due to inhalation of fungus from environment
- Totally controlled in people with normal immune
- Usually asymptomatic
Spread via blood to CSF
- Only in people with severe immunodeficiency
Meningitis in immunodeficient people
- i.e AIDS, high dose prolonged corticosteroids therapy etc
Chronic lymphocytic meningitis
- Slow deterioration in mental state with head ache and fever
How is cryptococcus meningitis diagnosed?
Usually: 10-100 WBCs in CSF lymphocyte not PMN predominance protein raised, glucose low
Encapsulated yeasts seen with india ink stain. C. Neoformans grown on agar
Cryptococcal antigen +ive in CSF and serum
Whats the treatment for cryptococcal meningitis?
IV amphotericin B
IV or Oral Fluconazole
Approx six weeks total therapy
What are some dermtophytes?
Tinea, capitis etc
What are the treatments for dermatophytes?
For skin: A topical azole
i.e clotrimazole, econazole etc
For nails: An oral agents
i.e Terbinafine for 3-4 months or itraconazole for 3-4 months
Whats the mould/infection of deeper tissues?
Aspergillus fumigatus
- Spore bearing branching mould in rotting vegetation
- Rare cause of disease in neutropenic patients, can also cause allergic bronchopulmonary aspergillosis
What are the concerns of amphotericin B:
Risk of infusion related anaphylaxis, neprohtoxicity with K loss.
Disrupts cytoplasmic membrane
What are the causes of fever and headache and impaired thinking?
Meningitis (All microbes)
Brain abscess (Bacteria)
Encephalitis (Virus)
Whats the risk of examining the CSF?
Do CT/MRI before lumbar puncture to prevent pressure drop/brain shift due to pressure gradient.
