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Generalized Pruritus and Gradual Loss of Vision as the Presenting Complaints of Acute HIV Infection: Management Challenges during COVID-19 Pandemic. Case Rep Infect Dis 2021; 2021:6436936. [PMID: 34868691 PMCID: PMC8633852 DOI: 10.1155/2021/6436936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although the prevalence of HIV is low in Bangladesh, there is a potential for an increased number of cases. This is because of high cross-border mobility (India and Myanmar) of people and increased injection drug abusers amongst youth in the cities and rural areas, HIV can present in many ways, from asymptomatic to advanced disease, including various atypical (generalized itching) and advanced (loss of vision) manifestations. A high degree of suspicion is required to diagnose HIV in a country like Bangladesh. Early diagnosis and prompt treatment are essential to have a better outcome. Methods Here, we report two thought-provoking cases where patients were suffering from generalized itchy lesions (pruritic papular eruption) throughout the body for a long time and gradual loss of vision in another case. Results Due to lack of suspicion, initially, HIV screening was not done. Both patients visited several health centres, but no diagnosis was made. Moreover, COVID-19 pandemic worsens the situation. Finally, they were diagnosed with HIV; unfortunately, one of them lost her vision due to CMV retinitis and another patient died of other complications. Conclusion Ongoing COVID-19 pandemic put many challenges to ensure optimum care, especially for patients with long-sufferings like HIV. Clinicians have to have a very high degree of suspicion while dealing with patients presented with rare manifestations, particularly in a low endemic clinical setting.
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Chronic itch in African Americans: an unmet need. Arch Dermatol Res 2021; 314:405-415. [PMID: 34129098 DOI: 10.1007/s00403-021-02255-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
Chronic pruritus carries a significant burden of disease and is associated with a negative impact on quality of life. African Americans are disproportionately burdened by chronic pruritic disorders, including but not limited to atopic dermatitis, prurigo nodularis, inflammatory scalp dermatoses, pathologic scarring, and HIV-related dermatoses. Racial differences in skin structure and function may contribute to the pathogenesis of itch in African Americans. Itch perception and response to treatment in African Americans remain understudied and not well understood. As such, there is a large unmet need with regard to the knowledge and management of pruritus in African Americans. This review highlights notable differences in the epidemiology, pathophysiology, genetic predisposition, clinical presentation, and response to treatment for select pruritic skin conditions. By addressing itch as an unmet need in African Americans, we hope to improve patient outcomes and lessen disparities in dermatologic care.
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Mohammed S, Vellaisamy SG, Gopalan K, Sukumaran L, Valan AS. Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study. Indian J Sex Transm Dis AIDS 2020; 40:146-151. [PMID: 31922105 PMCID: PMC6896392 DOI: 10.4103/ijstd.ijstd_69_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Pruritic papular eruption (PPE) remains as one of the most common cutaneous manifestations in HIV-infected patients. Proper knowledge about understanding the risk factors associated with this disease may help to decrease the prevalence of PPE. Objective: The present study was conducted to determine the prevalence of PPE in HIV-infected patients and to correlate between the severity of PPE and individual CD4 count. Materials and Methods: This was a cross-sectional study, conducted in Palakkad Antiretroviral Therapy Centre, Kerala, between March 2017 and April 2017. A total of 100 HIV patients with evidence of multiple itchy skin lesions of 1-month duration were included in the study. Severity of lesion was evaluated using an objective “rash severity scale” for PPE. Data were coded and analyzed. Results: Prevalence of PPE was 11.35% in our study. The mean age of the study population was 41.17 ± 12. Male-to-female ratio was 1:2. In our study, 97% of the patients were giving history of mosquito bite. Most of the patients (40%) had moderate type of PPE. In our study, majority (86%) had a CD4 count of more than 200, and the incidence of PPE was more frequently seen in patients with CD4 count more than 200 cells which was statistically significant. Conclusion: PPEs are unique dermatosis, which is having a devastating impact on the quality of life, stigmatizing them in their communities. Thus, recognizing those lesions helps in allowing better treatment of this distressing condition.
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Affiliation(s)
- Shoubin Mohammed
- Department of Skin and STD, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - Seethalakshmi Ganga Vellaisamy
- Department of Skin and STD, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | - Kannan Gopalan
- Department of Skin and STD, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
| | | | - A S Valan
- Science Health Allied Research and Education India Foundation, Hyderabad, Telangana, India
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Chopra D, Kumari S, Kundal RK, Bahl RK, Aggarwal S, Singh H, Bansal S. A study of clinicopathological correlation of pruritic papular eruptions in HIV patients. Indian J Sex Transm Dis AIDS 2018; 39:44-49. [PMID: 30187026 PMCID: PMC6111639 DOI: 10.4103/ijstd.ijstd_10_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Pruritic papular eruption (PPE) is a chronic eruption of papular and pruritic lesions of unknown etiology, symmetrically distributed over trunk and extremities. These are common cutaneous manifestations in HIV patients. It is an important cause of HIV-related morbidity. PPE can be the first marker of HIV. Their etiology, histopathological findings, and associated factors vary from region to region. There are no clear data available on the etiology, exact spectrum of the condition, histopathological findings, or treatment of PPE. Aims: The study is aimed at documenting the etiology, CD4 count, and its histopathological correlation in HIV-infected patients. Settings and Design: An observational study conducted in Government Medical College, Patiala. Subjects and Methods: Two-year data regarding history, HIV status, cluster of differentiation 4 (CD4) cell count, and skin biopsy of clinically suspected PPE patients with known HIV status were analyzed. Statistical Analysis Used: All the results were then statistically analyzed. Categorical data were analyzed by Chi-square test, and one-way Spearman's rho test was used for multiple group comparison. Results: Data of 50 eligible patients were analyzed. The majority of the patients were female (between 21 and 50 years of age). The most common histopathological patterns were of papular urticaria, scabies, and drug reaction, and the others less common PPE were polymorphic light eruption and eosinophilic folliculitis. Patients with papular urticaria (32%) had significantly lower mean CD4 counts (157 cells/mm3), while in scabies, the mean CD4 count (376 cells/mm3) was higher. Conclusions: We conclude that histopathology helps in specifying the pattern of PPE and its etiology. It can be a marker of advanced HIV infection. Thus, correlation between the histopathology, clinical diagnosis, and CD4 counts helps to know the disease process.
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Affiliation(s)
- Dimple Chopra
- Department of Skin and VD, Rajindra Hospital, GMC, Patiala, Punjab, India
| | - Sarvjit Kumari
- Department of Skin and VD, Rajindra Hospital, GMC, Patiala, Punjab, India
| | | | - Rakesh Kumar Bahl
- Department of Skin and VD, Rajindra Hospital, GMC, Patiala, Punjab, India
| | - Shivali Aggarwal
- Department of Skin and VD, Rajindra Hospital, GMC, Patiala, Punjab, India
| | - Harpal Singh
- Department of Pathology, Rajindra Hospital, GMC, Patiala, Punjab, India
| | - Shalini Bansal
- Department of Skin and VD, Rajindra Hospital, GMC, Patiala, Punjab, India
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Chua SL, Amerson EH, Leslie KS, McCalmont TH, Leboit PE, Martin JN, Bangsberg D, Maurer TA. Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era. Br J Dermatol 2015; 170:832-9. [PMID: 24641299 DOI: 10.1111/bjd.12721] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. OBJECTIVES To determine factors associated with PPE in HIV-infected persons receiving ART. METHODS A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. RESULTS Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL(-1) (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8(+) T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). CONCLUSIONS Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions.
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Affiliation(s)
- S L Chua
- Department of Dermatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, U.K
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Wernham AG, Vydianath B, Chua SL. Thalidomide-A novel therapeutic approach for pruritic papular eruption of HIV. JAAD Case Rep 2015; 1:109-11. [PMID: 27051700 PMCID: PMC4808702 DOI: 10.1016/j.jdcr.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aaron Giles Wernham
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Bindu Vydianath
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ser Ling Chua
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Increased number of peripheral CD8+ T cells but not eosinophils is associated with late-onset skin reactions caused by bendamustine. Int J Hematol 2015; 102:53-8. [PMID: 25833722 DOI: 10.1007/s12185-015-1791-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/17/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Bendamustine is a chemotherapeutic drug that has recently come to be used frequently in the treatment of indolent B cell lymphomas. Skin toxicity is recognized as one of its characteristic side effects, but detailed information on such reactions has not yet been obtained. To clarify the clinical features of skin toxicity associated with bendamustine, we retrospectively analyzed skin reactions that developed in patients treated with bendamustine and rituximab (BR). Of 34 patients treated with 3-6 cycles of BR, 11 developed late-onset, persistent skin eruptions. These patients demonstrated increases in CD8(+) T cell number and CD8(+):CD4(+) cell ratio at the end of chemotherapy. In contrast, peripheral eosinophil count was not associated with such adverse events, whereas eosinophil infiltration was frequently observed in the skin. Patients with skin reactions tended to have higher seropositivity of hepatitis B core antibody, and multiplex viral screening PCR of the frozen sera demonstrated cytomegalovirus-DNA in some of the eruption-positive patients. It is speculated that inappropriate activation of CD8(+) T cells by latently infected pathogens may be one of the triggers of late-onset skin reactions caused by bendamustine.
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Liautaud B, Vignier N, Miossec C, Plumelle Y, Kone M, Delta D, Ravel C, Cabié A, Desbois N. First case of visceral leishmaniasis caused by Leishmania martiniquensis. Am J Trop Med Hyg 2014; 92:317-9. [PMID: 25404076 DOI: 10.4269/ajtmh.14-0205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report the first case of visceral leishmaniasis (VL) caused by Leishmania martiniquensis in the Caribbean, which until now, was known only to cause cutaneous leishmaniasis. The disease presented with fatigue, anemia, and hepatosplenomegaly in a 61-year-old man with human immunodeficiency virus (HIV) infection who was receiving antiretroviral therapy. Diagnosis was made by bone marrow biopsy. VL is life-threatening, and its emergence in the Caribbean is of concern.
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Affiliation(s)
- Bernard Liautaud
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Nicolas Vignier
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Charline Miossec
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Yves Plumelle
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Moumini Kone
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Delphine Delta
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Christophe Ravel
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - André Cabié
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
| | - Nicole Desbois
- Department of Tropical and Infectious Disease, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Department of Tropical and Infectious Disease, University Hospital of Avicenne, Bobigny, France; Parasitology and Mycology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Laboratory, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; Hematology Unit, University Hospital of Fort-de-France, Fort-de-France, Martinique, French West Indies; University Hospital of Montpellier, Unité Mixte de Recherche 5290, French National Reference Center for Leishmaniasis, Montpellier, France; Faculté des Antilles et de la Guyane, Institut National de la Santé et de la Recherche Medicale CIC1424 and EA4537, Martinique, French West Indies
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Naswa S, Khambhati R, Marfatia YS. Pruritic papular eruptions as presenting illness of HIV. Indian J Sex Transm Dis AIDS 2011; 32:118-20. [PMID: 22021976 DOI: 10.4103/0253-7184.85420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucocutaneous manifestations can be the first markers of HIV. We are reporting the case of an adolescent girl who presented with chronic, recurrent, intensely pruritic papular lichenified eruptions over extremities, face and trunk, which were exudative and crusted at places. She had delayed milestones with growth failure and no pubertal features. She did not have any risk factors to be suspected for HIV. The lesions were refractory to treatment, so she was tested for HIV and she came out to be HIV positive. This case reports pruritic papular eruptions as presenting illness of HIV.
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Affiliation(s)
- Smriti Naswa
- Department of Skin VD, Government Medical College and SSG Hospital, Vadodara, India
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10
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Magand F, Nacher M, Cazorla C, Cambazard F, Marie DS, Couppié P. Predictive values of prurigo nodularis and herpes zoster for HIV infection and immunosuppression requiring HAART in French Guiana. Trans R Soc Trop Med Hyg 2011; 105:401-4. [DOI: 10.1016/j.trstmh.2011.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022] Open
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Budavari JM, Grayson W. Papular follicular eruptions in human immunodeficiency virus-positive patients in South Africa. Int J Dermatol 2007; 46:706-10. [PMID: 17614798 DOI: 10.1111/j.1365-4632.2007.03141.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Papular and follicular eruptions, such as papulopruritic eruption, eosinophilic folliculitis, and infective folliculitis, are relatively common disorders in patients infected with the human immunodeficiency virus (HIV). These conditions may show considerable clinical overlap. OBJECTIVE To assess the relative proportion of pruritic papular cutaneous eruptions in South Africans with HIV-associated dermatoses, and to correlate the clinical and histologic features of these lesions. METHODS The clinical and histologic features of papular follicular eruptions were correlated in 40 consecutive black HIV-positive patients who underwent skin biopsy. RESULTS The clinical features were similar in all patients and consisted of widespread papules and pustules involving the face, limbs, and trunk. The most common histologic finding was acute suppurative folliculitis, seen in 27 patients (67.5%). In most cases, no cause was found for the suppuration. Papulopruritic eruption of HIV was diagnosed in six patients (15%), HIV-associated eosinophilic folliculitis in four (10%), Pityrosporum folliculitis in two (5%), and acne in one (2.5%). Concordance between the initial clinical diagnosis and the final histopathologic diagnosis was achieved in only 27.5% of cases. CONCLUSION Skin biopsy remains an important adjunct to the correct diagnosis and classification of papular and follicular eruptions in HIV-positive patients.
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Affiliation(s)
- Judith M Budavari
- Division of Dermatology, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
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13
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Abstract
HIV patients develop a variety of infectious and non-infectious diseases of the skin and mucous membranes. Some of these serve as indicator diseases for a weakening immune system. While none of the dermatological complications is pathognomonic, conditions such as oral hairy leukoplakia, herpes zoster, thrush, and eosinophilic folliculitis should make physicians consider the possibility of underlying HIV disease. Moreover, one has to consider HIV if these skin diseases take an atypical or severe course, or if they do not respond properly to appropriate medication. Frequent and rare dermatoses occurring in HIV infection are discussed.
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Affiliation(s)
- U R Hengge
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf, Germany.
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14
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Abstract
Despite the development of laboratory methods, dermatological symptoms are a basic index of the presence and physical course of HIV infection. HIV infection usually undergoes a long latent period, proceeds to a period of immunodeficiency-related symptoms, and ends in an advanced immunodeficiency state characterized by opportunistic infections and neoplasms. Occasionally, dermatological manifestations can be the first signs of asymptomatic disease, indices of advanced immunodeficiency, or symptoms of opportunistic infections or neoplasms. The variety of symptoms and signs for the skin during the course of HIV infection is a consequence of the progressing immunodeficiency and therefore indicates the underlying disorder. The use of these manifestations is a challenge for clinical praxis.
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Affiliation(s)
- Dimitris Rigopoulos
- Department of Dermatology, University of Athens, A. Sygros Hospital, Athens, Greece
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Kumarasamy N, Solomon S, Madhivanan P, Ravikumar B, Thyagarajan SP, Yesudian P. Dermatologic manifestations among human immunodeficiency virus patients in south India. Int J Dermatol 2000; 39:192-5. [PMID: 10759958 DOI: 10.1046/j.1365-4362.2000.00945.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) may be associated with a large number of dermatologic manifestations, which may at times constitute the presenting symptoms. These skin lesions are well delineated in the Western literature, but there is a paucity of information from the southern part of the Indian subcontinent. Objective We evaluated 833 persons with HIV to determine the types of dermatologic lesions present. RESULTS The various lesions observed were oral candidiasis (45.0%), multidermatomal herpes zoster (11.2%), dermatophytosis of the skin (8.0%), herpes genitalis (7.7%), papular pruritic dermatitis (7.7%), staphylococcal infection of the skin (2.9%), oral hairy leukoplakia (2.3%), molluscum contagiosum (1.3%), genital warts (1.2%), and scabies (0.5%). Alopecia, intractable itching, dry skin, Addisonian pigmentation, and Kaposi's sarcoma were also noted. A correlation between the dermatologic manifestations and CD4 cell counts was found. CONCLUSION Although the pattern of cutaneous lesions was comparable with that from the West, there is a strikingly lower incidence of Kaposi's sarcoma.
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Affiliation(s)
- N Kumarasamy
- YRG Center for AIDS Research and Education, and University of Madras, Madras, India
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Galhardo MC, Perez M, Morgado MG, Almeida S, De Azevedo LM, Georg I, Ferreira H, Sarno EN. Search for evidence of a Th2 profile in HIV+ patients. Int J Dermatol 2000; 39:109-15. [PMID: 10692059 DOI: 10.1046/j.1365-4362.2000.00858.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypersensitivity dermatoses are common in human immunodeficiency virus-positive (HIV+) patients, particularly as the disease progresses. Studies have shown that a switch to T-helper 2 (Th2) might represent a turning point in HIV. This study investigated whether increases in the number of skin mast cells, immunoglobulin E (IgE) serum levels, and eosinophilia, involved in the Th2 response in allergic disease, might also be present in HIV+ patients. If so, these alterations might explain one of the mechanisms of skin hypersensitivity in these patients. METHODS Forty-five skin biopsies from the normal skin of the upper arm of HIV+ patients and 15 controls were included in the study. HIV+ individuals were classified into three equal categories according to their immunologic status: Category I (< 200/microL), Category II (200-499/microL), and Category III (> 500/microL). Anti-tryptase antibody was employed in tissue sections to show mast cells; IgE serum levels and eosinophils in peripheral blood count were investigated; delayed-type hypersensitivity (DTH) skin tests (candidin, trichophytin, and PPD 2U) were evaluated. RESULTS Normal cutaneous mast cell and eosinophil counts were the same in all categories and in the control group, but increased IgE levels (P < 0. 01) and DTH skin test anergy (P < 0.006) were observed among acquired immunodeficiency syndrome (AIDS) patients. CONCLUSIONS The density of skin mast cells in HIV infection was not modified in the course of the disease. Mast cells do not seem to be primarily responsible for triggering hypersensitivity dermatoses among AIDS patients, although data in support of the Th2 response, as seen in increased IgE serum levels and DTH anergy, are present.
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Affiliation(s)
- M C Galhardo
- Centro de Pesquisa-Evandro Chagas, Laboratório de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
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Boonchai W, Laohasrisakul R, Manonukul J, Kulthanan K. Pruritic papular eruption in HIV seropositive patients: a cutaneous marker for immunosuppression. Int J Dermatol 1999; 38:348-50. [PMID: 10369543 DOI: 10.1046/j.1365-4362.1999.00694.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous reports have shown the correlation between certain skin disorders and immune status in human immunodeficiency virus (HIV) infected patients. Pruritic papular eruption (PPE) is the most common cutaneous manifestation in HIV infected patients. The purpose of this study is to define the relationship between the presentation of PPE and the immune status in HIV infection, as measured by the T-cell subset, and to establish the usefulness of this common eruption as a predictor of CD4 count. METHOD In this cross-sectional study, 20 HIV-positive patients with characteristics of PPE were studied. Clinical data, skin biopsy, and immune status, evaluated by measuring CD4, CD8, and CD4/CD8, were investigated. RESULTS Seventy-five per cent of patients already had antecedent skin disorders, so PPE is not a leading symptom in HIV infected patients; 81.25% of PPE patients had an advanced degree of immunosuppression with a CD4 count below 100/mm3 and 75% below 50/mm3. CONCLUSIONS PPE can be regarded as a cutaneous marker of advanced HIV infection.
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Affiliation(s)
- W Boonchai
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Muñoz-Pérez MA, Rodriguez-Pichardo A, Camacho F, Colmenero MA. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. Br J Dermatol 1998; 139:33-9. [PMID: 9764146 DOI: 10.1046/j.1365-2133.1998.02310.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several prospective studies on dermatological findings in human immunodeficiency virus (HIV) type 1 infected patients have been published, mostly in populations in which the predominant risk factor for HIV infection is homosexuality. We attempted to identify cutaneous diseases associated with HIV-1 infection and to assess disease progression in a cohort of Spanish patients in whom the predominant cause of HIV infection was intravenous drug abuse. We prospectively examined 1161 HIV-1-positive patients for 38 months. Seventy-four per cent of patients were intravenous drug abusers, whereas heterosexual contact was the only risk factor in 14% and homosexuality in 9%. Centers for Disease Control stage II disease predominated (51%), whereas stage IV disease was less frequent (39%). The mean CD4 count was 353/mm3. We took patients' past and present medical history and performed a complete physical examination as well as taking photographs and carrying out the necessary diagnostic procedures. CD4 counts/mm3 were measured at each visit. A diagnosis of cutaneous disease was made in 799 patients (69%). Oral candidiasis and seborrhoeic dermatitis were the most common skin disorders, followed by xerosis, drug eruptions, dermatophytosis and the papular eruption of acquired immunodeficiency syndrome. Condyloma acuminatum, herpes zoster and herpes simplex were the most frequent viral infections. Conditions that have a statistically significant association with advanced stage and low CD4 levels include drug eruptions, xerosis, light reactions, diffuse alopecia, herpes simplex, oral candidiasis, psoriasis, oral hairy leucoplakia, molluscum contagiosum, Kaposi's sarcoma, furuncles, candidal intertrigo, folliculitis and ungual infection, as well as onychomycosis and tinea pedis or manuum. Dermatoses commonly associated with homosexuality, such as Kaposi's sarcoma and oral hairy leucoplakia, were rare in our patients.
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Affiliation(s)
- M A Muñoz-Pérez
- Department of Dermatology, Virgen Macarena Hospital, School of Medicine of Seville, Spain
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Affiliation(s)
- S N Matthews
- Division of Dermatopathology, University of Texas Southwestern Medical Center Dallas, USA
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Jean SS, Reed GW, Verdier RI, Pape JW, Johnson WD, Wright PF. Clinical manifestations of human immunodeficiency virus infection in Haitian children. Pediatr Infect Dis J 1997; 16:600-6. [PMID: 9194111 DOI: 10.1097/00006454-199706000-00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was designed to describe the characteristics of HIV-1 infection in children in Haiti and to assess its impact on morbidity and mortality. BACKGROUND Throughout the developing world the female-to-male ratio of HIV-1 infection approaches 1:1, leading to a tremendous burden of vertically transmitted HIV-1 infection. The frequency of transmission, progression of disease and AIDS-defining clinical illnesses are not as well-described in this setting as in the industrial world. METHODS Children were identified as being HIV-1-seropositive from case findings among family members of individuals presenting for screening at the GHESKIO Centers in Port-au-Prince, Haiti. Children who were seronegative from the same population were also enrolled and both groups were followed at regular intervals. The clinical course and illnesses associated with HIV infection were documented. RESULTS Rapid progression to symptomatic disease and death was seen and a battery of physical findings enabled a clinician over time to assign with high sensitivity and specificity the diagnosis of AIDS to a child. Although many findings are similar, the presentation of HIV-1 infection in Haiti differed in significant ways from observations in the industrial world. In particular signs of malnutrition, failure to thrive and tuberculosis were more common in the Haitian population. CONCLUSION Pediatric HIV-1 infection in Haiti differs significantly from the illness in the industrial world. Early mortality poses a particular difficulty in diagnosing and ascribing mortality to HIV-1 infection.
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Affiliation(s)
- S S Jean
- Cornell University Infectious Diseases Research Unit, Cornell University Medical College, New York, NY, USA
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Affiliation(s)
- M M Bason
- Department of Dermatology, Louisiana State University Medical Center, New Orleans 70112
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Affiliation(s)
- N S Sadick
- Department of Medicine, Cornell University Medical College, New York, New York
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Bañuls J, Ramon D, Aniz E, Jorda E, Torres V. Papular pruritic eruption with human immunodeficiency virus infection. Int J Dermatol 1991; 30:801-3. [PMID: 1757183 DOI: 10.1111/j.1365-4362.1991.tb04791.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Bañuls
- Service of Dermatology, Valencia Clinic Hospital, Spain
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Hevia O, Jimenez-Acosta F, Ceballos PI, Gould EW, Penneys NS. Pruritic papular eruption of the acquired immunodeficiency syndrome: a clinicopathologic study. J Am Acad Dermatol 1991; 24:231-5. [PMID: 2007668 DOI: 10.1016/0190-9622(91)70033-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pruritic papular eruption of the acquired immunodeficiency syndrome is characterized by generalized, pruritic, skin-colored papules and nodules. Chronic lesions are excoriated and hyperpigmented. The eruption and pruritus typically wax and wane and are resistant to oral antihistamine and topical steroid therapy. The characteristic histologic features are (1) superficial and mid dermal perivascular and perifollicular mononuclear cell infiltrate with numerous eosinophils and (2) follicular damage of varying degrees. When compared with control subjects, these patients did not demonstrate any significant difference in laboratory or demographic data.
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Affiliation(s)
- O Hevia
- Department of Dermatology and Cutaneous Surgery, University of Miami
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