The diagnosis of mpox requires confirmation by nucleic acid amplification testing (NAAT) using a sterile dry swab collected from lesional fluid or crust. Skin biopsy for NAAT and histopathological analysis can be helpful in patients without vesicles or crusts available to swab. (83)
Mpox, previously termed monkeypox, is an orthopoxvirus infection predominantely spread through sexual contact. In 2022 a global outbreak led to its declaration as a Public Health Emergency of International Concern by the WHO, with over 78,000 cases across 100 countries. (76) This outbreak disproportionately affected PLWHIV, who comprised approximately 40% of diagnosed cases. (77) To …
Dermatophyte infections Dermatophytosis is most commonly due to Trichophyton rubrum, Trychophytum mentagrophytes or Microsporum canis. Patients living with HIV are not at increased risk of dermatophytosis, including those with advanced infection or low CD4+ counts. (88) Clinical presentation Cutaneous dermatophyte infection may affect the inguinal areas (tinea cruris), scalp (tinea capitis), body (tinea corporis) or nails …
Culture of the fungal skin or nail scraping may be required if the speciation of the fungus is required for directed antifungal treatment. Erroneous treatment with topical steroids may reduce available scale for scraping (tinea incognito) and biopsy for tissue culture may be required.
Management of dermatophytoses does not differ for PLWHIV. Superficial disease can be initially treated topically. In children and adults (including pregnant women), localised tinea infections may be treated with topical terbinafine or miconazole. However, if this fails or if there is widespread, nail or dermal disease, systemic antifungal therapy is recommended. Duration of treatment depends …
Clinical presentation Oral candidiasis is the most common presentation of candida infection, presenting as white, exudative, plaques on the tongue, and oral mucosa. It can also present as the erythematous/atrophic erythematous form without white plaques which is often missed. (92) Other presentations include angular cheilitis with erythema and white scale, and chronic hyperplastic candidiasis with …
The diagnosis of candidiasis is usually made clinically. Samples for microscopic examination and cultures are usually required when fungal resistance is suspected.
Intraoral therapies such as nystatin or amphotericin lozenges are often used initially for oral candidiasis, topical clotrimazole for cutaneous candidiasis, and clotrimazole or miconazole pessaries for VVC. (92, 93) Systemic antifungal therapy may be required in refractory cases or in immunocompromised patients; fluconazole is the agent of choice at a dose of 150 mg single …
Malassezia has seven different subspecies that cause or contribute to a spectrum of conditions, with M. symbodialis, M. globosa and M. furfur the most common species isolated. These are commensal organisms on normal skin, however show greater diversity and immunoreactivity in patients with HIV leading to greater likelihood of associated cutaneous manifestations. (95) Clinical presentation Malassezia can present in the …
The diagnosis relies on a KOH preparation test from skin scrapings or swabs from pustules.
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