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TM: HIV Clinical Presentations + OIs (iii) (Skin manifestations (HSV…
TM: HIV Clinical Presentations + OIs (iii)
Focal CNS disease
cerebral toxoplasmosis
toxoplasma gondii
headache in 50-70%
altered mental status in 70%
focal signs in 60%
seizures in 30%
usually CD4 < 100
serum IgG +ve
ring lesions + midline shift
Dx
CT suggestive
MRI better
PCR on CSF
stereotactic brain biopsy
Tx
pyrimethamine + sulfadizine + folinic acid OR co-trimoxazole OR azithromycin, dapsone, clindamycin
over 86% response rate to tx
lives in cats (faecel oocysts)
dangerous in pregnancy: can infect foetus via blood stream + cause blindness + brain damage
v unusual in healthy people
primary CNS lymphoma
mass effect, afebrile, alert, global mental dysfunction in 60%, seizures in 15%
responds to palliative radiotherapy, aggressive chemo, HAART
EBV in genome
PML
Dx: T2 weighted MRI - multiple fluffy hypodense non-contrast enhancing lesions in subcortical white matter
pontine + right cerebellar demyelination
high-intensity abnormalities isolated in the white matter (on T1 weighted images they appear as low density abnormalties)
JC virus
DNA polyomavirus
infects oligodendrocytes + causes demyelination
ubiquitous (70% of adults infected)
most sufferers decline + die in 4-6 months
HAART (could cause more inflamm) + cidofovir may help some
approx 1/3 improve after tx
disorder of speech, vision, movement
later rapid dementia, disability, blindness, coma
enlarged nuclei with peripheral condensation of chromatin + central "glassy appearance - viral inclusions
viral encephalitis
pathological dx: brain inflamm
meningism with focal/generalised brain dysfunction, seizures, focal neuro defects, diminished level of consciousness, psych changes, coma, altered mental status
caused by CMV, HSV, Varicella-zoster, TB, nocardia, histoplasmosis, neurosyphilis, listeria, aspergillus
CMV tx
gancyclovir (acts on viral DNAP)
valgancyclovir (oral prodrug)
foscarnet (inhibits DNAP)
cidofovir (inhibits DNAP)
fomivirsen (binds nRNA)
brain abscess
TB
nocardia
bacterial
aspergillus
Skin manifestations
usually dry scaly skin (ichthyosis)
seborrheic dermatitis in 20-80%
dermatophytosis (e.g. tinea wapitis)
dry skin syndrome
HIV associated pruritus
eosinophilic folliculitis
fungal infections - candida, cryptococcus
varicella zoster
HSV
small tingling vesicles become large painful ulcers
Tx: acyclovir IV, valacyclovir PO, ganciclovir PO
psoriasis
asteatotic eczema
dry scaly itchy cracked skin
Norwegian scabies
Molluscum contagiosum
2-5 mm pink papule with central umbilication
prurigo nodules
tx: fewer washes, no soap, moisturisers, antihistamines (H1 blockers), topical menthol, steroid cream, UVB rays, PsoralenUVA
Kaposi's sarc
round irregular pink/red/violaceous macules/papules
palpable, firm, non tender
symmetric linear lesions
later become confluent
large masses all over mouth, GIT, lungs, eyelid, face
caused by HHV8 + Kaposi's sarc herpes virus V