HIV: infections + other disorders Flashcards
(26 cards)
infections encountered in patients with CD4 count 200-500
oral thrush - candida albicans
shingles - herpes zoster
hairy leukoplakia - EBV
kaposi sarcoma - HHV-8
infections encountered in patients with CD4 count 100-200
cryptosporidiosis
cerebral toxoplasmosis
progressive multifocal leukoencaphalopathy
pneumocystis jirovecii pneumonia
HIV dementia
infections encountered in patients with CD4 count 50-100
aspergillosis
oesophageal candidiasis
cyptococcal meningitis
primary CNS lymphoma - 2nd to EBV
infections encountered in patients with CD4 count <50
cytomegalovirus retinitis
mycobacterium avium-intracellulare infection
which protease inhibitor can precipitate renal issues
indinavir
–> cna precipitate intratubular crystal obstruction
HIV associated nephropathy (HIVAN) management
antiretroviral therapy (ART)
- if already on (should be) - check adherence
HIV associated nephropathy (HIVAN) features
nephrotic syndrome - massive proteinuria
normal or large kidneys
focal segmental glomerulosclerosis
elevated urea + creatinine
normotension
oesophageal candidiasis in patients with HIV
CD4 count <100
sx = dysphagia, odynophagia
tx = fluconazole + itraconazole
focal neurological lesions that can occur from HIV
toxoplasmosis
- 50% of cerebral lesions in those with HIV
primary CNS lymphoma
- assoc with EBV
TB - much less common
toxoplasmosis presentation, investigaiton + management
sx = headache, confusion, drowsiness
Ix = CT - ring enhancing lesions
mx = sulfadiazine + pyrimethamine
primary CNS lymphoma, investigation + management
assoc with EBV
Ix = CT - mulltiple enhancing lesions
tx = steroids, chemo, surgery if low grade
differentiating between toxoplasmosis + lymphoma in HIV patients
toxoplasmosis
- multiple lesions
- ring or nodular enhancement
- thallium SPECT NEGative
lymphoma
- single lesion
- solid (homogenous) enhancement
- thallium SPECT POSitive
generalised neurological disease in HIV patients
encephalitis - from CMV or HIV, rare ish in HIV
cryptococcus - commonest fungal infection of CNS
progressive multifocal leukoencephalopathy (PML) - widespread demyelination
AIDS dementia complex
cryptococcus presentation + investigation
px = headache, fever, malaise, N+V, seizures, focal neuro deficit
CSF - high protein, low glucose, india ink test positive
CT = meningeal enhancement, cerebral oedema
Progressive multifocal leukoencephalopathy (PML)
widespread demyelination
- due to infection of oligodendrocytes by JC virus
px - behavioural changes, speech, motor, visual impairment
MRI - high signal demyelinating white matter lesiona
AIDS dementia complex
caused by HIV itself
sx = behavioural changes, motor impairement
CT = cortical + subcortical atrophy
commonest opportunistic infection in AIDS
pneumocystis jiroveci
who should receive Pneumocystis jiroveci prophylaxis
all patients with CD4 count <200
Pneumocystis jiroveci investigations
CXR = bilateral interstitial pulmonary infiltrates or lobar consolidation
exercise induced desaturation !!!!!!
sputum fails to show PCP, bronchoalveolar lavage often needed
- **silver stain **show characteristic cysts
management of Pneumocystis jiroveci
co-trimoxazole
severe cases = IV pentamdine
steroids in hypoxic
Kaposis sarcoma cause
caused by HHV-8 (human herpes virus 8)
Kaposis sarcoma presentation
purple papules or plaques on the skin or mucosa (eg in GI/resp tract)
skin lesions may ulcerate
resp involvement may cause haemoptysis + pleural effusion
Kaposis sarcoma management
radiotherapy + resection
commonest infective cause of diarrhoea in HIV patients
cryptosporidium
- intracellular protozoa
- ziehl neelsen stain = red cysts
- mx = supportive
