1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Time for another interesting learning case.
Written by @krutiyagnikdo and @johnhannamd
Written by @krutiyagnikdo and @johnhannamd
2/ Which of the following is most likely to reveal the diagnosis?
3/ DDx for cutaneous manifestations in HIV patients is broad: bacterial (typical and unusual like bacillary angiomatosis), seborrheic dermatitis, viral (HSV, VZV, CMV, molluscum contagiosum), HIV exanthem, STI (syphilis), endemic fungi, drug reaction, neoplasm, TB/NTM, scabies...
4/ Great article about cutaneous manifestations in HIV
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
5/ In our patient his Histo urine Ag was >20, and path of neck lesion showed yeast with narrow based budding in the dermis consistent with histoplasmosis.
His right thigh skin lesion path was consistent with molluscum contagiosum.
His right thigh skin lesion path was consistent with molluscum contagiosum.
7/ Histoplasmosis can range from mild pulm disease to disseminated disease in immunocompromised patients with AIDS. Cough and dyspnea are common along with systemic symptoms.
Pancytopenia along with elevated LFTs, ferritin, and LDH is frequently seen.
pubmed.ncbi.nlm.nih.gov
Pancytopenia along with elevated LFTs, ferritin, and LDH is frequently seen.
pubmed.ncbi.nlm.nih.gov
8/ Since most patients with AIDS have disseminated disease, the most sensitive and specific test is detection of Histo antigen.
The sensitivity of antigen in disseminated disease is higher in immunocompromised patients and with more severe illness.
pubmed.ncbi.nlm.nih.gov
The sensitivity of antigen in disseminated disease is higher in immunocompromised patients and with more severe illness.
pubmed.ncbi.nlm.nih.gov
9/ Antigen detection is most commonly sent on urine and serum; can also send from cerebrospinal and BAL fluid.
Antigen levels decline in response to treatment.
Culture remains the gold standard but can take weeks.
Antigen levels decline in response to treatment.
Culture remains the gold standard but can take weeks.
10/ Since patients with HIV and histoplasmosis often are very immunocompromised, they may be concurrently infected with another OI. Always have a high index of suspicion for this!
Rapid treatment is indicated due to high mortality with disseminated disease.
Rapid treatment is indicated due to high mortality with disseminated disease.
11/ Severe immunosuppression, disseminated disease, clinical instability- are considered to have severe disease. Tx requires amphotericin B.
Patients with mild symptoms and a single focus of disease (other than CNS) are considered mild to moderate. Tx is itraconazole.
Patients with mild symptoms and a single focus of disease (other than CNS) are considered mild to moderate. Tx is itraconazole.
12/ To prevent relapse, suppressive therapy is indicated in patients who are immunosuppressed.
Maintenance therapy are tx with itraconazole.
Itraconazole was also found to be superior for histoplasmosis (less mortality) compared to fluconazole.
pubmed.ncbi.nlm.nih.gov
Maintenance therapy are tx with itraconazole.
Itraconazole was also found to be superior for histoplasmosis (less mortality) compared to fluconazole.
pubmed.ncbi.nlm.nih.gov
Loading suggestions...