0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
Complications of Human Immunodeficiency Virus Type 1 381■TB: CT/MRI (Intracerebral lesions in 50-70%). CSF (Normal: 5-10%.
Protein: normal [40%], up to 500 mg/dL. Leukocytes 5–2000 [avg is
60-70% mononuclear cells]. Glucose: 4–40 mg/dL. AFB Smear posi-
tive: 20%). Chest radiographs: active TB in 50%. Tuberculin skin test
positive: 20–30%. Definitive diagnosis: positive culture CSF.Acute Diarrhea
■Salmonella: stool culture, blood culture
■Shigella: Stool culture
■Campylobacter jejuni: stool culture
■Clostridium difficile: endoscopy: polymorphonuclear cells, colitis,
or normal. Stool toxin assay: tissue culture of EIA preferred. CT scan:
colitis with thickened mucosa.
■E. Coli: Adherence to Hep-2 cells.
■Enteric viruses: Major agents; adenovirus, astrovirus, picornavirus,
calicivirus
Chronic diarrhea
■Microsporidia: Special trichrome stain described, biopsy-EM or
Giemsa stain
■Cryptosporidia: AFB smear of stool to show oocyst of 4–6 um
■CMV: Biopsy (intranuclear inclusion bodies, pref w/inflamma-
tion, vasculitis), CT scan-segmental or pancolitis
■MAC: positive blood cultures; biopsy (may show changes like Whip-
ple’s, but w/AFB); CT scan may be supportive; hepatosplenomegaly,
adenopathy, antd thickened small bowel
■Isospora: AFB smear of stool; oocytes of 20–30 um
■Entamoeba histolytica: Stool ova and parasite examination
■Giardia: Stool ova and parasite exam×2 and giardia antigen; rarely
need string test
■Cyclospora: Stool AFB smear resembles cryptosporidia
■Small bowel overgrowth: hydrogen breath test; quantitative culture
of small bowel aspirate
■Strongyloides: larvae in feces or duodenal contents
■Idiopathic: biopsy shows villus atrophy, crypt hyperplasia plus
no identifiable cause despite endoscopy with biopsy and EM for
microsporidiadifferential diagnosis
■Generalized Lymphadenopathy: syphilis, lymphoma, KS, TB; also
MAC and CMV if CD4<100/mm^3