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Clinical manifestations in HIVinfection

Clinical manifestations in HIVinfection. 新光醫院 黃建賢. AIDS. These early signs and symptoms may be oral, dermatological, lymphatic or systemic with genital/anal or other manifestations. Signs and symptoms. Signs and symptoms include :

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Clinical manifestations in HIVinfection

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  1. Clinical manifestations in HIVinfection 新光醫院 黃建賢

  2. AIDS • These early signs and symptoms may beoral, dermatological, lymphatic or systemic with genital/anal or other manifestations.

  3. Signs and symptoms • Signs and symptoms include : • herpes zoster, thrush, recurrent vaginal candidiasis, cervical dysplasia, cervical cancer, persistent generalized lymphadenopathy (PGL), anemia, thrombocytopenia, fevers, night sweats, weight loss and minor infections.

  4. 台灣地區感染人類免疫缺乏病毒者依檢體來源統計表台灣地區感染人類免疫缺乏病毒者依檢體來源統計表 民國73年~91年 檢體來源 檢體件數 感染者數 陽性率(十萬分之一) 發病數 陽性率(十萬分之一) 本署指定醫院 2,388,838 2965 124.92 990 41.71 捐血中心篩檢 19,388,969 419 2.16 53 0.27 役男體檢 2,326,026 97 4.17 15 0.64 監所收容人員篩檢 769,431 98 12.74 17 2.21 其他 2,681,624 856 32.46 206 7.81 篩檢件數 27,554,888 4435 16.13 1281 4.66

  5. Oral Candidiasis

  6. PCP

  7. Syphilis

  8. Meningitis • Name: 許X • Age: 35 Y/O. Sex: male. • C.C: Headache for 1 week. • P.E.: no meningeal sign. • PHx: • HIV (+) one month ago. • Sexual exposure at Thailand 3 years ago.

  9. Meningitis • Lab: • WBC: 3400. N/L: 74/15. Hgb: 9.8. • Brain CT: negative. • CSF: Protein: 126. Sugar: 42. Lactate: 20.2. • Indian ink: many cryptococcus. • Cryptococcal Ag: >1024. • Culture: Cryptococcus.  • Dx: Cryptococcal meningitis. • Tx:AmpB 50 mg qd

  10. CMV retinitis • Name: 張X X • Age: 54 Y/O Sex: female • C. C.: • Blurred vision for 3 months. • PHx: • AIDS diagnosed 8 months ago. • Hx of oral candidiasis, HSV infection with oral ulcer, PCP pneumonia, Herpes-Zoster infection in recent one year.

  11. CMV retinitis • Lab data: • WBC: 4200. Hgb: 8.3. N/L: 86/4. • Urine virus culture: CMV. • Dx: AIDS with CMV retinitis. • Tx: • Ganciclovir 250 mg iv q12h for 3 weeks. • Fever subsided and visual acuity improved one week later.

  12. PCP • Name: 劉X X • Age: 25 Y/O. Sex: male • C.C.: • Dry cough for 2 + months. • Fever & SOB for 13 days. • PHx: • Stay at USA form 1978 - 1988.

  13. PCP • Lab: • WBC: 11600. Hgb: 12.4. Plat: 440,000. • HIV (+) ( ELISA & Western blot ). • CD4: 50. • ABG: FiO2 90%. PaO2 : 51.6. • Toluidine blue stain : positive for PCP. • Dx: AIDS with PCP • Tx: AZT + Bactrium. • 1 year later : C/O chest pain. • UGI endoscopy: esophageal candiasis.

  14. PCP • Name: 甘X X • Age: 62 Y/O. Sex: male • C.C.: • cough & SOB for 2months. • P.E: • oral candidiasis. • Chest: bil basal rales. • PHx: Bisexual for many years.

  15. PCP • Lab data: • WBC:21900. N/L: 88/12. • ABG: PaO2 : 64.3. ( FiO2 : 30 %). • HIV (+). • Ga scan: diffuse Ga uptake in both lung. • Bronchoscopy: PCP.

  16. Anemia in HIV infection and AIDS • multifactorial. • Mild anemia can occur during primary infection • normocytic andnormochromic with no specific diagnostic features. • may be associated neutropenia, thrombocytopenia, and atypical lymphocytes • early lymphopenia is followed by lymphocytosis.

  17. Anemia • By the time of diagnosis, anemia is often present • 3.2% to 36.9% • Anemia in HIV : predictive of shorter survival • Anemia in HIV : opportunistic infections • Sullivan PS; Blood 1998, 91:301-308. • Spino C J; Acquir Immune Defic Syndr Hum Retrovirol 1997, 15: 346-355. • Hoots WK; J Acquir Immune Defic Syndr Hum Retrovirol 1998, 18: 349-357. • Moore RD; J Acquir Immune Defic Syndr Hum Retrovirol 1998, 19: 29-33.

  18. Causes of anemia • HIV infection of hematopoietic stem cells and bone marrow stromal cells • opportunistic infection • Autoimmune hemolytic anemia • Drug toxicity • Direct or indirect effect of HIV-related lymphoma • Unknown mechanisms; thrombotic microangiopathy including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura

  19. Anemia in HIV infection • 蔡X X • C.C.: cough for 1 month • CXR: Atypical lung infection • P.H.: sexual exposure Tailand 7 year • Lab.: • WBC: 6900 B6S83L6M4AL1 • PLT194000 • Hb 8 Ht 24.2 MCV 92.2

  20. Molluscum contagiosum • 蔡X X • C.C.: chronic skin lesions 1 year • Follow up at OPD 14 times • STS-RPR and TPHA positive at outer Lab. • P.H.: Herpes zoster • P.E.: oral candidiasis • Biopsy by Dermatologist: • Molluscum contagiosum

  21. Peri-anal abscess • 王X X • Fever one week • LAB • WBC 21500 B2S83L9M5 • PLT 17800 Hb 15 • Dx.: F.U.O. at ER • P.H.: repeat proctatitis

  22. Rectal ulcer • 孫X X • Fever and frequent stool • Lab: • WBC2700 B5S20L46M20 • P.H.: • Sexual exposure at Tailand • Sigmoidscope: • Rectal ulcer r/o AIDS, r/o CMV

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