HIV-infectious Disease & Cancer

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 …

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The diagnosis relies on a KOH preparation test from skin scrapings or swabs from pustules.

Topical ketoconazole and miconazole can be used initially but systemic fluconazole or itraconazole may be used if topical therapy fails.  

Cryptococcus neoformans is the most common invasive fungal infection in PLWHIV. Cutaneous disease due to Cryptococcus is not seen in immunocompetent people. Cryptococcosis in PLWHIV is an AIDS-defining illness. (15) 

Approximately   10-20%   of   patients   with   HIV   infection   and cryptococcal infection have cutaneous lesions, which is a marker of disseminated infection. (95) These   lesions   can   have varying   morphologies   including: erythematous papules, nodules, pustules, ulcers, herpetiform vesicles, indurated plaques or subcutaneous swelling.  

Skin biopsy is often required to confirm cutaneous cryptoccocal infection. The diagnosis of cutaneous cryptococcal infection requires investigation for systemic disease. 

Cutaneous cryptococcosis without evidence of systemic involvement can be treated with oral fluconazole. If extracutaneous disease is found then the recommended treatment is intravenous amphotericin and flucytosine for at least 2 weeks, followed by oral fluconazole for at least 8 weeks. (21)  

Scabies  Transmission of Sarcoptes scabiei, the causative mite for scabies, occurs by direct skin-to-skin contact with a person who has the infection or via fomites. The likelihood of transmission is higher when the parasite burden in the affected patient is bigger. Transmission via inanimate objects, such as shared clothing, is rare, but may occur in …

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Classic scabies presents as papulovesicular lesions. The distribution varies, favouring the wrists, interdigital web spaces, elbows, axillae, breasts and genitals. Predominantly night-time pruritus is usually present. Excoriation may lead to bacterial superinfection including impetigo, cellulitis and, in some cases, fatal sepsis. (98) In PLWHIV, both the classic form and generalised, crusted (Norwegian) scabies can occur. …

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The diagnosis is usually clinical and may be assisted by dermoscopy. (100) Definitive diagnosis of scabies is by microscopic examination of skin scrapings in potassium hydroxide 10% solution, demonstrating mites, ova or faeces. The skin is scraped with a sterile blade and the skin sample is placed in mineral oil for transport.