Chang CC, Harrison TS, Bicanic TA, Chayakulkeeree M, Sorrell TC, Warris A, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis. 2024;24(8):e495-e512. HIV. PoGftPaToOIiAaAw. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with …
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the CNS caused by reactivation of John Cunningham virus (JCV). This rare condition is associated with advanced immunosuppression almost exclusively – malignancy, HIV, organ transplantation, and immunomodulatory agents. Clinical features The demyelination involves white matter and can involve grey matter. In classical PML, the signs and …
Cryptococcal disease (cryptococcosis) is caused by Cryptococcus neoformans – Cryptococcus gattii complex, a ubiquitous environmental yeast that is endemic in many countries including Australia. While cryptococcosis can affect many organs, cryptococcal meningoencephalitis is the most frequently recognised, and most severe form with mortality rates, ranging from 24%-47% at 10 weeks.(5-8). Clinical presentation Patients typically present …
Christina C. Chang Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne VIC Introduction People with HIV (PWH) presenting with central nervous system (CNS) manifestations require careful assessment as the differentials are broad. Key factors in the history and examination to narrow down the diagnostic possibilities include a sudden vs. insidious onset; an acute …
HIV-related opportunistic infections (OI) in the central nervous system (CNS) Read More »
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.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of SCAR. The incidence is higher in patients with HIV infection than in the general population due to higher rates of polypharmacy and underlying immune dysregulation. (149, 150) There have been well documented case reports of Stevens- Johnson syndrome and TEN in …
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) Read More »
Patients with SJS/TEN may present with a prodrome of fever, stinging eyes, painful swallowing, followed by development of dusky macules which progress to erosions and bullae. Epidermal detachment is common, which may lead to massive fluid loss and electrolyte imbalance. Any mucosal surface may be affected including the eyes, aerodigestive tract and genitalia. SJS is …
A skin biopsy is usually obtained for definitive diagnosis given the morbidity and mortality associated with this condition. Severity scoring such as with the SCORTEN criteria may be helpful for prognostication. (153)
Stevens-Johnson syndrome has an attributable mortality of 5% and TEN an overall mortality of 30%. (153) If SJS/TEN is considered, patients should be transferred to a tertiary centre, and ideally one with an HDU/ICU or Burns Unit. Discontinuation of the offending drug is essential. Drugs initiated in the last 1 to 3 weeks before illness …
Pityriasis rubra pilaris (PRP) refers to a group of rare inflammatory skin disorders with clinical and histological similarities to plaque psoriasis. (130) There are six clinical subtypes, with Type VI, discussed herein, being proposed in 1995 as a unique HIV-associated dermatosis. (131) Due to its rarity and potential for misclassification as psoriasis, data on the …
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