HIV–AIDS
“THE GAY PLAGUE”—– A RETROVIRUS WITH A DOUBLE LAYERED LIPID——BINDS TO GP 120 RECEPTOR OF CD4 CELL
>1.5 MILLION INFECTED IN U.S.
ELISA = SCREENING TEST—–WESTERN BLOT = CONFIRMATION TEST
BLOOD PRODUCTS IN MID MO = 1/225,000
HIV 1 = U.S., EUROPE, CENTRAL AFRICA
HIV 2 = WESTERN AFRICA
LYMPHOTROPHIC–CD4 T HELPER CELL (THE LINK BETWEEN CELL MEDIATED AND HUMORAL IMMUNITY)
STAGE I =ACUTE INFXN = MONO LIKE SYNDROME= NL CD4 COUNT (>1000)
STAGE II = LATENCY (Asx INFXN) CAN BE OVER 10 YEARS= CD4 > 500
STAGE III = PGL (PERSISTENT GENERALIZED LAD)= CD4 = 100-500
STAGE IV = OTHER Dz—SUBGROUPS–CD4 < 200 = AIDS—RELATIVELY QUICK DEATH WITH CD4 < 50
AIDS DEFINING NEOPLASMS = KS, NHL, CERVICAL CA
VIRUS 1) COMPROMISIS IMMUNITY AND 2) IS ITSELF A CARCINOGENIC RETRO LENTIVIRUS
Rx: AZT
ACTIVE PULM TB—-PPD CONSIDERED + IF > 5MM IN HIV PTS
PRIMARY PRESENTATION = PCP PNEUMONIA
PCP AURAL POLYPS —-GOMORI STAIN—REDDICH BROWN AURAL POLYP –Bx CYSTS AND TROPHOZOITES—HELMET SHAPED MICRO ORGANISMS
SEBORRHEIC DERMATITIS WITH SECONDARY STAPH INFXNS– 50% NASAL CARRIERS OF STAPH AUREUS—-Rx = LONG TERM ABX THERAPY AND GOOD HYGEINE
HERPES ZOSTER—-CAN BE BAD—THINK OF HIV TEST FOR ANYONE WITH RECURRENT ZOSTER
POX VIRUS AND MULLUSCUM CONTAGIOSUM VIRUS INFXNS (TYPICALLY INVOLVES THE EYELIDS)—Rx EXCISION
CUTANEOUS CRYPTOCOCCUS—AFFINITY FOR THE FOREHEAD—-CRAIG TEST
BACILLARY ANGIOMATOSIS—-G- BACTERIUM ON WARTHIN STARRY STAIN——LOOKS IDENTICLE TO CAT SCRATCH (BARTONELLA HENSIEI)
PSEUDOMONAL AND S. A SINUSITIS—–HIV PTS HAVE VERY TENACIOUS MUCOUS—-USE A HIGH DOSE MUCOLYTIC
ESOPHAGEAL CANDIDIASIS—-PATHOGNEUMONIC—-AGGRESSIVELY TREAT WITH NYSTATIN, DIFLUCAN AND AMPHO
CRYPTOCOCCAL MENINGITIS—CAN BE ASSOC WITH SSNHL
HIV IS NEUROTROPIC—CAN ITSELF CAUSE A SNHL
REACTIVATED OTOSYPHILIS
EXT OTOMYCOSIS—–CANDIDA ALBICANS
ATYPICAL (DISSEMINATED) TUBERCULOSIS M. INTERCELLARAE
OHL (ORAL HAIRY LEKOPLAKIA) ASSOC. WITH + EBV TITERS–WHITE RAISED LESIONS–LAT TONGUE, Asx, FINE HAIR LIKE KERATIN PROJECTIONS, BALLOON CELLS, PARAKERATOSIS ACANTINOSIS—-POOR PROGNOSTIC INDICATOR
TOXOPLAMOSIS GONDII (CAT = HOST)
PML (PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY)
RECURRENT APTHOUS ULCERS—-SUTTON’S Dz—-CAN BE VERY SYMPTOMATIC (ON THE MOBILE MUCOSA)
WALDEYER’S RING (PRIMARILY NP) HYPERPLASIA
HPV—CAN
CMV–THE MOST COMMON OPPURTINISTIC PATHOGEN
TM PERFS WHICH APPEAR DIFFERENT EACH VISIT
LYMPHOEPITHELIAL CYSTS OF THE PAROTID— —-PRIMARILY B, IN THE TAIL OF THE PAROTID–Rx IS CONSERVATIVE–CT AND FNA FOR Dx, MAY DO SERIAL FNA FOR PALLIATION–CAN OFTEN SCLEROSE WITH TETRACYCLINE
ANGULAR CHELITIS
KS(KAPOSIS SARCOMA)
MACULAR, COLORED(BLUISH, RED-VIOLACEOUS, PURPLE)
HIGH INCIDENCE IN THE HEAD AND NECK—MUCOSAL > CUTANEOUS
MUCOSAL = OC/OP HARD PALATE=MOST COMMON SITE—-SKIN > MUCOSAL (PHOTODYNAMIC THERAPY)—-RADIATION THERAPY HAS OUT OF PROPORTION MUCOSITIS IN HIV PTS
CUTANEOUS = NASAL REGION, POST AURICULAR, SCALP, AND NECK
SLOW GROWING
RELATIVELY Asx
Dx = Bx—-SPINDLE SHAPED CELLS (THINK SARCOMA) WITH RBC’S THROUGHOUT (THINK ANGIOMA)
Rx = CONSERVATIVE—WLE IF POSSIBLE, RT, CHEMO–(INTRALESIONAL VINBLASTINE VS SYSTEMIS VINCRISTINE)
NHL
THE MOST COMMON LYMPHOMA—-SECOND CANCER TO KS
A MONOCLONAL B CELL NEOPLASM
HTLV-1 AND EBV CAN BE PROMOTERS
HIGH INCIDENCE OF EXTRANODAL Dz–PRIMARILY CNS (MUST R/O TOXO, PML, CRYPTOCOCCUS)
Dx = CT SCAN PLUS TOXO TITERS IGM AND IGG (LOOKS LIKE TOXO)–A HYPODENSE RING ENHANCING LESION–MAY WANT TO TREAT EMPIRICALLY FOR TOXO—PYRIMETHAMINE PLUS TRISULFAPYRIMIDINES
Rx OF NHL–VERY INDIVIDUALIZED–LOW DOSE CHEMO
HD (HODKIN’S Dz)–EARLIER AND MORE AGGRESSIVE
SCCA–EARLIER AND MORE AGGRESSIVE–(DIFFICULT TO STAGE REGIONAL Dz DUE TO DIFFUSE LAD)—-LARYNX IS PRIMARY SITE
INTRACRANIAL MASS LESIONS WITH HIV ENCEPHALOPATHY
C—CRYPTOCOCCUS (CRAG TEST = CRYPTOCOCCAL AG TEST)
L—-LYMPHOMA (CNS LYPHOMA)
P—-PROGRESSIVE MULTIFOCAL LEUKOPLAKIA
T—TOXOPLASMOSIS—PRIMARY INTRACRANIAL COMPLICATION—-HYPODENSE RING ENHANCING LESION ORCALCIFICATION ON CT OF THE BRAIN