AIDS defining Opportunistic infections and Neoplasms

Opertunistic Infections In AIDS:
Parasitic Fungal Neoplasm
Cryptosporidiosis (most common in India)or Isosporidiosis (enteritis)Pnemocystosis (pneumonia or disseminated)Toxoplasmosis (pneumonia or CNS infection)Strongyloides stercoralis(common) Candidiasis (esophageal, tracheal, or pulmonary)Cryptococcosis (CNS infection) Coccidioidomycosis (disseminated)Histoplasmosis (disseminated)Pneumocystis cariniiPenicillium marneffeiAspergillosis (rare) kaposi sarcoma(Multifocal tumor of vascular origin)( HHV - 8 )Non Hodgkin lymphoma Primary lymphoma of brain Invasive cancer of uterine cervixImmunoblastic lymphoma (most common lymphoma)Primary Effusion Lymphoma (PEL)Plasmacvtic lymphoma of the oral cavityBurkitt's lymphoma(EB virus)


Parasitic Fungal Neoplasm
Cryptosporidiosis (most common in India)or Isosporidiosis (enteritis)Pnemocystosis (pneumonia or disseminated)Toxoplasmosis (pneumonia or CNS infection)Strongyloides stercoralis(common) Candidiasis (esophageal, tracheal, or pulmonary)Cryptococcosis (CNS infection) Coccidioidomycosis (disseminated)Histoplasmosis (disseminated)Pneumocystis cariniiPenicillium marneffeiAspergillosis (rare) kaposi sarcoma(Multifocal tumor of vascular origin)( HHV - 8 )Non Hodgkin lymphoma Primary lymphoma of brain Invasive cancer of uterine cervixImmunoblastic lymphoma (most common lymphoma)Primary Effusion Lymphoma (PEL)Plasmacvtic lymphoma of the oral cavityBurkitt's lymphoma(EB virus)
CNS & AIDS Neurons are not infected by HI
  • HIV encephalitis with microgtial nodules
  • Prominent in the subcortical white matter, diencephalon, and brainstem
  • HIV isolates from the brain are almost exclusively M-tropic
  • Toxoplasmosis Most common space occupying lesion in HIV infected
  1. CT scan - multiple contrast-enhancing lesions, tend to be peripheral, predilection for the basal ganglia
  2. Single lesions are atypical of toxoplasmosis
  3. Progressive multifocal leucoencephalopathy - non enhancing white matter lesions without mass effect
Opportunistic infections causing diarrhoea in AIDS:
  • Mycobacterium species
  • Viruses :cytomegalovirus, adenovirus, and herpes simplex
  • Protozoa :Cryptosporidium(2nd mostcommon,shows acid fast oocyst), Isospora belli(most common,shows acid fast oocyst), Microsporida, and Blastocystis hominis may also play a role
  •  Agents transmitted venereally per rectum (e.g., Neisseria gonorrhoeae, Treponema pallidum, Chlamydia) may contribute to proctocolitis.
Other Opertunistic Infection In AIDS
  • In AIDS, lymphadenopathy is most often due to Non specific enlargement of lymph node
Kaposi Sarcoma
  •  It is common in patients with AIDS; indeed, its presence is used as a criterion for diagnosing AIDS.
  • There are four types of Kaposi sarcoma:
  1. The classic type/chronic KS/ European KS affects elderly men of Mediterranean and Middle European descent and in men in Sub-Saharan Africa. It presents with multiple red to purple skin plaques or nodules, usually in the distal lower extremities; these slowly increase in size and number and spread more proximally.It is rare and unassociated with HIV infection. It most often arises in middle-aged to elderly men of Mediterranean or Jewis descent (less than 10% are women), particularly if they come from a rural environment. They have a higher than expected rate of diabetes mellitus
  2. HIV-associated/epidemic Kaposi sarcoma mainly affects men who have sex with men.
  3. Endemic/ African/ Lymphadenopathic Kaposi sarcoma arises in some parts of Africa in children and young adults. It is not associated with HIV. Skin lesion are sparse.
  4. Iatrogenic/transplant associated Kaposi sarcoma is due to drug treatment causing immune suppression in the setting of solid organ transplantation
. Sialadenitis In AIDS:
  • The causes of HIV-SGD is unknown
  • Infection with human immunodeficiency virus (HIV) may be associated with nontender, bilateral enlargement of the major salivary glands or symptoms of dry mouth known as HIV-associated salivary gland disease (HIV-SGD). Labial salivary gland (LSG) biopsy can be done.
  • HIV-SGD patient show a number of similarities to and differences from patient with Sjogren's syndrome (SS). The similarities include the oral and salivary features, histopathology and possibly changes in other orgAns. The differences include the lower salivary gland T4/ T8 ratio and the absence of autoantibodies in serum
Exam Question
  • Diarrhoea in AIDS can be caused by Mycobacterium species ; Viruses :cytomegalovirus, adenovirus, and herpes simplex; Protozoa :Cryptosporidium, Isospora belli, Microsporida, and Blastocystis hominis; Neisseria gonorrhoeae, Treponema pallidum, Chlamydia
  • Fungal infections associated with AIDS patient are Penicillium mameffei,Candida, Cryptococcosis, Coccidioidomycosis, Histoplasmosis ,Pneumocystis carinii
  • Strongyloides stercoralis is the Commonest helminthic infection in AIDS
  • Kaposi sarcoma is the Multifocal tumor of vascular origin
  • Most common opportunistic infection in AIDS in India is Cryptosporidium
  • Cryptosporidium is the most common causative agent in diarrhea in AIDS patients
  • Kaposi sarcoma, Non Hodgkin lymphoma,Primary lymphoma of brain, Invasive cancer of uterine cervix ,Immunoblastic lymphoma ,Burkitt's lymphoma are the malignancies in AIDS Protozoa commonly causing diarrhea in HIV patients and have acid fast oocyst are isospora belli.
  • In AIDS, lymphadenopathy is most often due to Non specific enlargement of lymph node
  • Kaposi sarcoma is the commonest malignancy in AIDS patients
  • Immunoblastic Lymphoma is the Most common variant of Lymphoma seen in HIV Patients
  • Primary Effusion Lymphoma (PEL) is a rare variant of Immunoblastic Lymphomas seen primarily in HIV infected patients.
  • There are four types of Kaposi sarcoma
  • Skin lesion in Kaposi sarcoma are sparse in African type
  • Aspergillosis is the rarest opportunistic fungal infection seen in AIDS patient
  • Most common parasitic infection in AIDS Strongyloides stercoralis
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