Health HIV & eye -CMV Retinitis

Fungal infection- Prevention & treatment

2009-05-10T04:13:00.000-07:00

Consult a dermatologist. Fungal infection on skin are resistant to Rx & tend to become chronic. A lot of itching will be there. The patient gets tired as infection tends to recur. If its a fungal infection, you can go for
1. Tab. ketoconazole (nizral)1 tab twice a day for a day & then once a day for 3 weeks
2. Tab fluconazole (forcan)150 mg in a dose as mentioned above
Before taking any of these tablets, make sure that you don't have a major liver problem. Both the drugs are hepatotoxic. If you have history of jaundice 2-3 times, its better to do liver function tests ( SGPT,SGOT). These are enzyme levels which may be high if you have any liver disease.
. Griseofulvin is generally preferred for fungal infection of nail bed. Its available in tablet form.
Many antifungal creams are available like -
clotrimazole, fluconazole, ketoconazole ( trade name- forcan, nizral).
. Good hygiene is extremely important & remember not to share towel with anybody. Keep skin dry.
. Fungal infection on skin are more common in groin, underarms, below the breasts in lactating women, etc. This is because of excessive sweating in these areas. Area below the breasts in lactating women, remains wet due to oozing milk. So it should be kept dry.
make it sure that you don't have dandruff. If you have it, try shampoo- Nizral, scalpe, selsun. Remember not to share comb with anybody.
If the dermatologist diagnoses it as psoriasis, pemphigus vulgaris, then Rx is different.

Molluscum contagiosum- An eye infection

2009-05-05T10:12:00.000-07:00

Molluscum contagiosum is a highly infectious viral disease seen on eyelids. it is seen as a small, umbilicated nodule.
Its common in HIV infected cases

Tuberculosis- Lung Disease

2009-03-07T00:16:00.000-08:00

Tuberculosis is an infectious disease which is especially common in India. Almost every Indian gets exposed to mycobacterium tuberculosis, an organism that causes tuberculosis. Almost every Indian gets exposed to tuberculosis mycobacteria during his / her lifetime.

Why tuberculosis is getting so much importance again?

This is because of increasing number of HIV +ve people. AIDS patients have compromised immunity. So they get manifest tuberculosis more easily than people who have good immunity. In AIDS patients, TB manifestations will be more severe. Resistant strains of organism cause infection

Which people are likely to be immunocompromised?

People who have following diseases are likely to be immunocompromised.

1. HIV, AIDS

2. Cancer

3. Patients on oral or intravenous steroids. These include

a. Patients who have undergone organ transplant surgery,

b. Patients who have immune mediated diseases like systemic lupus erythematosus, polyarteritis nodosa, rheumatoid arthritis, pemphigus

4. Intravenous drug abusers - This is due to risk of getting HIV infection.

Which organs can get affected in tuberculosis?

Tuberculosis can affect many organs. The most common are –

1. Lungs

2. Lymph nodes

3. Gastrointestinal tract

4. Genitourinary system

Tuberculosis of skin

Skin tuberculosis is a form of extrapulmonary TB (TB infection of other organs and tissues) and it can cause cosmetically disfiguring lesions.

Tuberculous chancre

Direct infection of the skin or mucous membranes from mycobacteria results in chancre.

Various forms of Skin tuberculosis

A. TB verrucosa cutis

–

1. This occurs after direct inoculation of TB into the skin in someone who has been previously infected with mycobacteria.

2. Seen as a purplish or brownish-red warty growth

3. Lesions most often occur on the knees, elbows, hands, feet and buttocks

4. Lesions may persist for years but can clear up even without treatment

B. Scrofuloderma

1. Lesions result from direct extension of underlying TB infection of lymph nodes, bone or joints

2. Firm, painless lesions that ulcerate with a granular base

3. May heal even without treatment but this takes years and leaves cosmetically unsightly scars

C. Miliary TB

1. Infection (usually in the lungs) spreads to other organs and tissues via the bloodstream.

2. Skin lesions are small (millet-sized) red spots that develop into ulcers and abscesses

3. More likely to occur in immunocompromised patients, e.g. HIV, AIDS, cancer

4. Prognosis is poor (many patients die even if diagnosed and treated)

D. Lupus vulgaris

1. Persistent and progressive form of cutaneous TB

2. Small sharply defined reddish-brown lesions with a gelatinous consistency (called apple jelly nodules)

3. Lesions persist for years, leading to disfigurement and sometimes skin cancer.

Treatment of cutaneous TB will be covered in next resource

HAART Rx

Highly Active Anti-Retroviral Treatment

HIV

2008-11-16T09:11:00.000-08:00

The initial asymptomatic period is called as "window period" .This is important as all tests will be -ve but patient can transmit disease to others

Opportunistic infections

are really a cause of concern & multidrug resistant tuberculosis(MDR TB) is creating a lot of problems

Various Opportunistic infections are

1. TB- Pulmonary & extrapulmonary

2. Fungal infections of skin

3. Skin infections

Main objectives of Rx at present are- to keep patient alive & free of opportunistic infections as far as possible.The patient should have very good nutrition.

Cost of Rx is very high.Many drugs are to be taken in combination.This is called as "HAART-Highly Active Anti-Retroviral Therapy" .With this therapy, it is now possible to have a longer life

There is still no effective vaccine to prevent HIV.Scientists are doing research for developing antiHIV- vaccine

HIV is rapidly spreading & is very common in
1 Africa
2 developing countries like- India
3 In India- It is seen commonly in Maharashtra,Manipur,Mizoram,etc
Its common in cities like Mumbai

Diagnosis Of CMV Retinitis

Its based on clinical findings & high degree of suspicion. Supportive measures are FFA ( Fundus fluorescein angiography).

Fundus fluorescein angiography

- This is is a simple test in which a dye is injected in vein which passes through eye circulation & serial retinal photographs are taken.

Treatment For CMV Retinitis

1. Local Treatment

1. Intravitreal Ganciclovir -

This is an antiviral drug which prevents progression of disease. The drug has to be injected inside the eye- in the vitreous cavity in operation theatre.

Advantages of Local Rx

1. It avoids side effects of oral or intravenous drugs

Disadvantages of Local Rx

1. Risk of endophthalmitis.

Endophthalmitis is a very serious eye infection which can lead to vision loss.

How much is the risk ?

Endophthalmitis can occur in 1 out of 1000- 5000 injection cases ( This is according to recent research reports). So one need not worry much.

2. Short Term Effects of Intravitreal Ganciclovir.

This is one more problem & the drug injection has to be repeated after 2-3 months or in some cases later. This depends on following factors

a. Eye's response to the 1st injection
b. General improvement in patient's immunity which is judged by CD4/CD8 counts. Immunity means body's ability to fight against diseases. It depends upon various factors like -
Nutrition
Vaccination, etc.

How to prevent HIV

2008-11-16T03:20:00.000-08:00

One should take all precautions to prevent this disease.

1 Avoid unprotected intercourse with commercial sex workers.Use of condoms is recommended

2 Make it sure that all blood products have been checked for HIV before transfusion

3 Licencing & screening of commercial sex workers by Govt will be very helpful

4 Start sex education in schools after std 8th

5 Use disposable needles, blades.Proper sterilization of instruments in hospitals before surgery

6 Avoid sharing of needles in case of intravenous drug abusers
7 Blood should be screened before transfusion

HIV is not transmitted by following things

1 Shaking hands with an infected person

2 Sharing food with an infected person
Tears contain HIV virus in small amounts. Whether it transmits HIV or no is not yet clear & research is going on

2008-11-12T23:21:00.001-08:00

First we should educate Indian society about HIV & AIDS.We should tell about various modes of transmission.People should understand that sex is not the only way of transmission .

Though it is difficult to implement this immediately,it may be possible after a few years.As a doctor,I have seen many innocent youngsters getting this infection from partner without any mistake on their part.
It can be done as a routine screening test for students during last year of college graduation.But there are some problems.HIV can remain undetected during initial few months - up to 6 months or more-.This is called as "window period".So even if the test done during last year of graduation comes as negative that is not a guarantee that a person doesn't have infection.Another thing- Tridot test is a good screening test but not confirmatory.ELISA is also not confirmatory.All literature which is available,suggeste that it should be confirmed by "Western Blot" test
The attitude of society - how society thinks about a HIV +ve person should be changed.
Though some people have mentioned that it is not possible to make it mandatory before marriage,I strongly support making it compulsory before marriage.After all,its a matter of 2 families,2 lives & in future the children born to such couple will also get this infection.So in this scenario,we should use our brain & not heart or emotions.Without bothering what others will feel,"Premarital HIV screening should be made mandatory.This will be an important step in moving towards a healthy nation.
HIV counselling is available in all good hospitals nowadays.So after counselling & with consent ,test should be done.We should think of longterm effects on family members if someone gets HIV.HIV treatment is very costly & causes a lot of financial stress on other family members as a person with HIV most of the times remains sick due to opportunistic infections & will not be able to work very efficiently.
"Prevention is always better than cure".This is the basic rule of medical science.We should not forget this.Rather than repenting & crying later , we should try to concentrate on prevention.Preventive medicine is getting importance in all diseases like heart diseases,etc
Rather than spending time in matching "Janam-kundalis" ,both families should go for such tests.This is the need of the time especially when health authorities have warned regarding the speed of HIV spread in India.
Because of co-education,call centres, girls & boys are coming closer.This relationship may progress into sexual relationship.Pub culture is also there.So HIV is spreading. Use of condoms should be promoted. Various types of condoms are available which don't interfere with sexual pleasure ( lubricated condoms, scented condoms, ultrathin condoms)

Cytomegalovirus (CMV) retinitis

2008-10-30T08:12:00.000-07:00

Cytomegalovirus (CMV) retinitis is the most common cause of blindness in patients with acquired immunodeficiency syndrome (AIDS).
It is seen commonly when CD4 cells count falls below 50/cmmm.
Retinal vascular inflammation and attenuation are components of the retinitis.
Hazy vitreous, optic nerve pallor and retinal pigmentary changes,cellophane maculopathy, cystoid macular edema, Significant anterior and posterior vitreous cells,optic nerve head neovascularization has been reported in a patient with inactive CMV retinitis and immune recovery vitritis, without evidence of capillary nonperfusion on angiography. A case of optic disk neovascularization after branch retinal vein occlusion and branch retinal artery occlusion in association with HIV and CMV retinitis was also reported
Optic disk neovascularization was reported in a patient with inactive CMV retinitis without capillary nonperfusion and with immune recovery vitritis.
As the CMV retinitis resolves, atrophy of the retinal vasculature develops. Retinitis resolves with anti-CMV therapy.
CMV retinitis is a common cause of rhegmatogenous retinal detachment ( RD ).In this, a few breaks form in thinned out retina & leads to RD.
Other viruses which infect HIV cases are-
. Herpes simplex & zoster
. Molluscum contagiosum