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INFECTIOUS DISEASE

DIAGNOSIS

■ CXR

■ Classically: Diffuse interstitial infiltrates

■ Other: Focal consolidation, cavitary lesion, or normal

■ LDH and A-a gradient frequently elevated

TREATMENT

■ TMP-SMX (sulfa allergy =clindamycin +primaquine)

■ Prednisone if A-a gradient >35 or PaO 2 <70 mm Hg

MYCOBACTERIUMTB

■ 50–200 times higher incidence in HIV+patients

■ False-negative PPDs common due to immunosuppression

SYMPTOMS/EXAM

■ Fever

■ Cough

■ Hemoptysis

■ Night sweats

■ Weight loss/anorexia

DIAGNOSIS

■ CXR

■ Classically: Upper lobe infiltrates and cavitary lesions

■ CD4<200: Negative or have almost any finding

Neurologic Complications

See Table 8.4 for head CT findings.

TABLE 8.4. Head CT and CSF Findings in HIV

DISEASE HEADCT CSF DEFINITIVEDIAGNOSIS

HIV encephalopathy Atrophy Normal Diagnosis of exclusion

C. neoformans Normal ↑Opening pressure (66%), +Cryptococcal antigen

↑Monos,+India ink (70%)

T. gondii Multiple ring-enhancing ↑Opening pressure, ↑monos Brain biopsy

lesions (subcortex or basal

ganglia)

CNS lymphoma Solitary ring-enhancing ↑Protein Monoclonal malignant

lesions (periventricular) lymphocyteson CSF cytology

Progressive multifocal Nonenhancing white Normal or ↑protein PCR of JC virus

leukoencephalopathy matter lesion(s)

Mycobacterial Intracranial/spinal cord Frequently normal Brain biopsy, normally

meningitis (#1 M. abscesses

avium intracellulare)

HIV+patients with CD4 counts

<200 can have active (highly

contagious) TB with a normal

CXR.