5. HERPIS SIMPLEX:clinical features
Deep seated
(hemorrhagic) vesicles
Chronic ulcerative
mucocutaneous lesion
Exophytic lesion
Ulcerated tumor like
lesion
6. • Diagnosis:
– Direct fluorescent
Ab staining
– Polymerase chain
reaction
– Electron
microscopy
Rx
• Oral acyclovir 200-800 mg
five times daily
• I.V. acyclovir 5mg/kg/dose
three times daily
• I.V. trisodium
phosphonoformate
(Foscarnet) 40mg/kg/dose
two-three times daily or
cidofovir (ACV resistant
mutant)
7. Varicella-Zoster virus
Varicella:
Clinical
features (Monomorphism)
# hemorrhagic infarcted vesiclesinfection
# clear vesicles
Herpes zoster:
Clinical
features
# groups of vesicles in dermatomal distribution
# ecthymatous crusted punch out ulcer
8. • 8-13% of HIV- infected patients had previous
history of herpes zoster
• incidence is more than normal population 7
times
• common in young adult (<60 years)
12. STAPHYLOCOCUS
• Bullous impetigo.
• Ecthyma.
• Folliculitis:
a. Folliculitis due to S. aureus.
b. Often the follicular lesions of the trunk
are intensely pruritic and may be mistaken for
scabies. About 50 % of HIV-infection persons
with scabies have coexistent S. aureus
folliculitis.
14. Treatment of pyogenic disease
(Staphylococcus aureus)
• Semisynthetic penicillin
– dicloxacillin,cloxacillin,oxacillin
• First-generation cephalosporin
• *Rifampicin 450-600 mg/d for 5-10 days
or topical mupirocin ointment
15. Molluscum contagiosum
• Molluscum contagiosum is manifesting as
flesh-colored hemispheric papules. A faint
whitish core usually is visible at the centre of
each papule, some of which may be slightly
umbilicated. This eruption is seen commonly
in immunocompetent young children (ages 3 to
8 years), whose lesions are scattered widely
over the face, arms, and trunk.
• In adults, this mild infection is usually sexually
transmitted and occurs in the pubic area
.
18. Rx
• Molluscum
Seen frequently in young women not on ART
1st line therapy is ART
Liquid nitrogen only temporary
Curretage of large molluscum
19. SYPHILIS
• Coetaneous presentation of primary and
secondary syphilis in HIV-infected persons are
usually similar to those in now-HIV-infected
persons. HIV may delay development of
serological evidence of Treponema pallidum,
resulting in negative tests. In the HIV- infected
person, a negative serological test may not be
adequate to rule out rule out secondary
syphilis.
30. Treatment of drug eruption
• Mild form:
– offending drug may be stopped
– topical corticosteroid
– antihistamine
31. Treatment of drug eruption
• Severe form:
– offending drug must be stopped
– short course high dose systemic corticosteroid
– antihistamine
– antibiotic if necessary
37. KS may effect any portion of the coetaneous
surface. Initially, it appears as red-to brown flat
macules. Papules, nodules, and tumors may also
be present or develop later. Numbering from one
to hundreds, they range in size from several
millimeters to over 10 cm and may be
widespread, grouped, or zosteriform. KS may
affect mucosal surfaces and internal organs.
Visceral involvement occurs in 71% of patients
with advanced HIV disease and KS, most often
affecting the gastrointestinal tract (50%), lymph
nodes (50%), and lungs (37%).
38. • Clinical features:
– common at nose,eyelids & pinna
– skin lesions may be numerous & disseminated
– bleeding ulcers
– symptom & sign of respiratory & gastrointestinal
tract
• Diagnosis:
– histopathology & immunopathology
45. Interestening manifestation of
extrapulmonary tuberculosis
• Systemic examination: no abnormalities.
• Local examination: there was an ill-defined swelling in left
inguinal region measuring 10 x 8 cm, with single opening
discharging pus. On palpation swelling was nontender, local
temperature was not raised. Similar swelling was also present
in opposite region. There was edema of penis with difficulty in
retracting the prepuce.
• Haemoglobin: 7.1 gm%.
• Peripheral smear: microcytic hypochromic anaemia.
• Renal and liver functions: normal.
• CD4 cell count :96 /µl.
• AFB positive in the pus from inguinal swelling.
• Final Diagnosis: PLHA with tuberculous inguinal
lymphadenopathy
46. Mycobacterium tuberculosis
• Clinical features:
– Neck mass (necrotic enlarged lymph node)
– Folliculitis-like lesion
– Necrotic papules
• Diagnosis:
– Acid fast staining of pus,skin,lymph node
– skin biopsy
– Culture & sensitivity test
47. Treatment of M. tuberculosis
Standard short course regimen:
– 2HRZE/4HR for 6 months
48. Photodermatitis
HIV makes pts sensitive to the
sun
Pts with CD4 under 200 on
photosensitizing drugs
Either ART allows pts to go off
photosensitizing drugs or
immune reconstitution decreases
reaction
Tx: sunscreen, tx
the dermatitis with potent
topical steroids and lubricants,
doxepin 25 mg qhs (as
antihistamine)
49. INFECTIOUS MONOCLEOSIS
• EBV is transmitted via intimate contact with body secretions, primarily
oropharyngeal secretions. EBV infects the B cells in the oropharyngeal
epithelium. The organism may also be shed from the uterine cervix,
implicating the role of genital transmission in some cases. On rare
occasion, EBV is spread via blood transfusion.
• Circulating B cells spread the infection throughout the entire reticular
endothelial system (liver, spleen, and peripheral lymph nodes).
EBV infection of B lymphocytes results in a humoral and cellular response
to the virus.
• Early signs include fever, lymphadenopathy, pharyngitis, rash, and/or
periorbital edema. Relative bradycardia has been described in
some patients with EBV mononucleosis, but it is not a constant finding.
• Later physical findings include hepatomegaly, palatal petechiae, jaundice,
uvular edema, splenomegaly, and, rarely (1-2%), findings associated with
splenic rupture.
