Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Complications of Human Immunodeficiency Virus Type 1 375

Signs & Symptoms

Fungi

■PCP: fever, dry cough, dysphagia, high LDH, severe hypoxia

■Candida: pseudomembranous thrush – white, creamy plaques on

inflamed base, buccal mucosa, tongue, gums, palate; scrapes off eas-

ily; erythematous thrush – spotty or confluent red patches; hyper-

plastic thrush – white lesions that do not wipes off and respond

to azole therapy. Oral pain, taste perversion, odynophagia with

esophagitis in late-stage disease – dysphagia, odynophagia, thrush,

diffuse esophageal pain; also recurrent vulvovaginitis esp. when CD4

<100/mm^3

■Cryptococcus: meningitis – fever, headache, alert, nausea and vom-

iting, malaise, less common are visual changes, stiff neck, cranial

nerve deficits, seizures, no focal neurologic deficits; other – nodules

or ulcerative skin lesions, may resemble molluscum, is rare compli-

cation of disseminated C. neoformans

■Histoplasma capsulatum: fever, wasting, adenopathy, skin or

mucosal lesion, pancytopenia, diarrhea, meningitis, sepsis-like

symptoms, pulmonary infiltrations or cavitations, abnormal LFTs

■Cocciodes immitus: diffuse pulmonary infiltrations or cavitations,

hilar adenopathy; extrapulmonary disease include skin lesions

(maculopapular, keratotic and verrucous ulcers, and subcutaneous

abscesses), joint and bone involvement, and meningitis

■Penicillium marneffei: fever, pneumonitis, skin and mucosal lesions

(nodules, pustules, and papules)

■Aspergillus: invasive pulmonary disease with lung consolida-

tion and cavitation, hypoxemia; tracheobronchitis with cough,

fever, dyspnea; acute or chronic invasive sinusitis; invasive fun-

gal dermatitis; also, cerebral aspergillosis, post-traumatic kerati-

tis, aspergilloma (fungus ball), allergic sinusitis, allergic bron-

chopulmonary aspergillosis (ABPA), and dissemination to other

sites

Parasites

■Toxoplasma gondii: encephalitis (fever, reduced alertness,

headache, focal neurologic deficits, seizures), retinitis and adenitis

■Cryptosporidia: enteritis, watery diarrhea, no fecal leukocytes,

fever uncommon, malabsorption, wasting, large stool volume with

abdominal pain

■Isospora: enteritis, watery diarrhea, no fecal leukocytes, no fever,

wasting, malabsorption