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Lymphadenopathy in HIV

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121. A Study of the Pharmacokinetics and Antiviral Activity of Dolutegravir in the Central Nervous System in HIV-1 Infected ART-naive Subjects

B or Class C condition was assessed from Baseline though the date the last participant completed Week 96 + the follow-up visit (if applicable). Category (CAT) A: one or more of the following conditions (CON), without any CON listed in Categories B and C: asymptomatic HIV infection, persistent generalized lymphadenopathy, acute (primary) HIV infection with accompanying illness or history of acute HIV infection. CAT B: symptomatic CON that are attributed to HIV infection or are indicative (...) A Study of the Pharmacokinetics and Antiviral Activity of Dolutegravir in the Central Nervous System in HIV-1 Infected ART-naive Subjects A Study of the Pharmacokinetics and Antiviral Activity of Dolutegravir in the Central Nervous System in HIV-1 Infected ART-naive Subjects - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study

2011 Clinical Trials

122. An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV. (PubMed)

An Algorithm for Tuberculosis Screening and Diagnosis in People with HIV. Tuberculosis screening is recommended for people with human immunodeficiency virus (HIV) infection to facilitate early diagnosis and safe initiation of antiretroviral therapy and isoniazid preventive therapy. No internationally accepted, evidence-based guideline addresses the optimal means of conducting such screening, although screening for chronic cough is common.We consecutively enrolled people with HIV infection from (...) eight outpatient clinics in Cambodia, Thailand, and Vietnam. For each patient, three samples of sputum and one each of urine, stool, blood, and lymph-node aspirate (for patients with lymphadenopathy) were obtained for mycobacterial culture. We compared the characteristics of patients who received a diagnosis of tuberculosis (on the basis of having one or more specimens that were culture-positive) with those of patients who did not have tuberculosis to derive an algorithm for screening

2010 NEJM

123. Human Immunodeficiency Virus (HIV) Infection

by their mechanism of replication via reverse transcription to produce DNA copies that integrate in the host cell genome. Several retroviruses, including 2 types of HIV and 2 types of human T-lymphotropic virus (HTLV—see ), cause serious disorders in people. HTLV Infections Infection with human T-lymphotropic virus (HTLV) 1 or 2 can cause T-cell leukemias and lymphomas, lymphadenopathy, hepatosplenomegaly, skin lesions, and immunocompromise. Some HTLV-infected patients develop infections similar to those (...) , arthralgias, generalized lymphadenopathy, and septic meningitis. After the first symptoms disappear, most patients, even without treatment, have no symptoms or only a few mild, intermittent, nonspecific symptoms for a highly variable time period (2 to 15 yr). Symptoms during this relatively asymptomatic period may result from HIV directly or from opportunistic infections. The following are most common: Lymphadenopathy White plaques due to oral candidiasis Herpes zoster Diarrhea Fatigue Fever

2013 Merck Manual (19th Edition)

124. Cytomegalovirus infection

Cytomegalovirus infection Cytomegalovirus infection - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cytomegalovirus infection Last reviewed: February 2019 Last updated: January 2019 Summary In people with normal immune systems, CMV infection is often asymptomatic or manifests as infectious mononucleosis-like syndrome (fever, lymphadenopathy, and atypical lymphocytosis). In immunocompromised people (patients with AIDS (...) Manuel would like to thank Dr Sandra Asner from the University Hospital of Lausanne, Switzerland for her careful review of congenital CMV in this topic. They would also like to gratefully acknowledge Dr Raymund R. Razonable and Dr Atul Humar, the previous contributors to this topic. Peer reviewers Assistant Professor Department of Family Medicine University of Maryland School of Medicine MD Disclosures GHT declares that he has no competing interests. Clinical Director HIV and Sexual Health Chelsea

2019 BMJ Best Practice

125. Immune thrombocytopenia

/pubmed/19395674?tool=bestpractice.com The focus of this topic is primary ITP. History and exam presence of risk factors bleeding absence of systemic symptoms absence of medicines that cause thrombocytopenia absent splenomegaly or hepatomegaly absent lymphadenopathy women of childbearing age age <10 or >65 years Diagnostic investigations FBC and peripheral blood smear HIV serology Helicobacter pylori breath test or stool antigen test hepatitis C serology thyroid function tests quantitative

2019 BMJ Best Practice

126. Overview of sexually transmitted infections

, and perihepatic abscesses. High rates of antimicrobial resistance have been reported, and antibiotic treatment should be guided by local and national guidelines. A common sexually transmitted infection caused by a spirochetal bacterium. Clinical presentation is often asymptomatic but can manifest in a number of ways. Diagnosis is usually straightforward after clinical exam and serological testing; treatment is with penicillin. Untreated syphilis facilitates HIV transmission and causes considerable morbidity (...) ulcer with fluctuant lymphadenitis (bubo formation). Chancroid is an important cofactor in HIV transmission, and HIV status must be assessed. Most cases resolve with antibiotic therapy, and recurrence is rare. An acute ascending polymicrobial infection of the female upper genital tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis . Dayan L. Pelvic inflammatory disease. Aust Fam Physician. 2006 Nov;35(11):858-62. http://www.ncbi.nlm.nih.gov/pubmed/17099803?tool

2018 BMJ Best Practice

127. Encephalitis

of America. Clin Infect Dis. 2008 Aug 1;47(3):303-27. https://academic.oup.com/cid/article/47/3/303/313455/The-Management-of-Encephalitis-Clinical-Practice http://www.ncbi.nlm.nih.gov/pubmed/18582201?tool=bestpractice.com History and exam presence of risk factors fever rash altered mental state focal neurological deficit meningismus parotitis lymphadenopathy optic neuritis acute flaccid paralysis movement disorder cough gastrointestinal infection seizures biphasic illness autonomic and hypothalamic (...) blood cultures throat swab nasopharyngeal aspirate sputum culture chest radiography CT brain MRI brain EEG CSF analysis CSF culture CSF serology CSF PCR urine culture stool enteroviral culture IgG and IgM antibodies (blood) PCR (blood) HIV serology/RNA test CSF biomarkers/prion protein assay paraneoplastic antibodies (blood and CSF) whole-body CT whole-body PET scans magnetic resonance spectroscopy next-generation sequencing of CSF brain biopsy Treatment algorithm INITIAL ACUTE ONGOING Contributors

2018 BMJ Best Practice

128. Lymphogranuloma venereum

; presents as painful, unilateral, inguinal or femoral lymphadenopathy (often referred to as 'inguinal syndrome'). Proctocolitis has emerged as a more typical presentation in men who have sex with men (particularly those who are HIV-positive). Chronic inflammation can lead to scarring and fibrosis causing lymphoedema of the genitals, or formation of strictures and fistulae if anorectal involvement. Identification of Chlamydia trachomatis from the swab of a genital ulcer or aspiration of a bubo (...) through contact with mucous membranes or abrasions in the skin of the genital region. History and exam presence of risk factors inguinal lymphadenopathy non-specific symptoms of proctocolitis groove sign of Greenblatt genital elephantiasis, saxophone penis, esthiomene fever, malaise, arthralgias lower abdominal or lower back pain genital or anal ulcer non-specific symptoms of bacteraemic spread erythema nodosum anogenital sinus tracts, strictures, or fistulae other STDs risky sexual behaviour HIV

2018 BMJ Best Practice

129. Chronic fatigue syndrome/Myalgic encephalomyelitis

-exertional malaise (PEM)/exertional exhaustion, unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headaches, and sore throat and tender lymph nodes (without palpable lymphadenopathy), with symptoms lasting at least 6 months. Komaroff AL. Myalgic encephalomyelitis/chronic fatigue syndrome: a real illness. Ann Intern Med. 2015 Jun 16;162(12):871-2. http://annals.org/article.aspx?articleid=2322808 http://www.ncbi.nlm.nih.gov/pubmed/26075760?tool=bestpractice.com The fatigue (...) differential erythrocyte sedimentation rate CRP comprehensive metabolic panel thyroid-stimulating hormone antinuclear antibody (ANA), rheumatoid factor HIV antibody test heads-up tilt-table test if symptomatic orthostatic intolerance serum ferritin HbA1c urine toxicology screen antibody tests for gluten sensitivity/coeliac disease 2-day cardiopulmonary exercise testing Treatment algorithm ONGOING Contributors Authors Professor Division of Rheumatology, Immunology, and Allergy Georgetown University

2018 BMJ Best Practice

130. Myocarditis

[Citation ends]. History and exam presence of risk factors viral syndrome (prior) autoimmune disease infectious disease drugs and toxins age <50 years chest pain dyspnoea orthopnoea fatigue palpitations rales elevated neck veins S3 gallop sinus tachycardia atrial and ventricular arrhythmias syncope S3 and S4 summation gallop pericardial friction rub peripheral hypoperfusion hypotension altered sensorium lymphadenopathy infection (non-HIV) HIV infection smallpox vaccination autoimmune/immune-mediated

2018 BMJ Best Practice

131. Non-Hodgkin's lymphoma

blurred, such as in acute lymphocytic leukaemia and acute lymphoblastic lymphoma, and chronic lymphocytic leukaemia and small lymphocytic lymphoma, depending on the relative presence of a solid phase (lymphoma) versus circulating phase (leukaemia). History and exam night sweats weight loss fatigue/malaise fever lymphadenopathy splenomegaly hepatomegaly shortness of breath cough abdominal discomfort headache change in mental status dizziness, ataxia chest pain bone pain, back pain (bone involvement (...) ) jaundice pallor purpura skin lesions neurological abnormalities on examination age >50 years male sex immunocompromised host Epstein-Barr virus (EBV) human T-lymphocytotrophic virus-1 (HTLV-1) human herpesvirus-8 Helicobacter pylori coeliac disease HIV organ transplant hepatitis C virus (HCV) Borrelia burgdorferi Sjogren's syndrome rheumatoid arthritis systemic lupus erythematosus (SLE) common variable immunodeficiency Wiskott-Aldrich syndrome ataxia-telangiectasia Chediak-Higashi syndrome

2018 BMJ Best Practice

132. Immune thrombocytopenic purpura

/pubmed/19395674?tool=bestpractice.com The focus of this topic is primary ITP. History and exam presence of risk factors bleeding absence of systemic symptoms absence of medicines that cause thrombocytopenia absent splenomegaly or hepatomegaly absent lymphadenopathy women of childbearing age age <10 or >65 years Diagnostic investigations FBC and peripheral blood smear HIV serology Helicobacter pylori breath test or stool antigen test hepatitis C serology thyroid function tests quantitative

2018 BMJ Best Practice

133. Dermatophyte infections

, vesicles, and maceration vesicles, pustules with or without bullae on the soles fissuring, maceration, and scaling in the interdigital spaces of the fourth and fifth toes chronically scaly, hyperkeratotic plantar skin with erythema of the soles, heels, and sides of the feet folliculitis with nodules thickened nail with subungual hyperkeratosis, onycholysis, and white-yellow to brown discoloration small, white speckled patches on the surface of the nail plate with crumbling nail lymphadenopathy absence (...) of distal pulses black-dot alopecia milky white nail plate area of leukonychia in the proximal nail plate exposure to infected people, animals, or soil exposure to fomites including hat, combs, hairbrushes, and upholstery wrestling chronic topical or oral corticosteroid use HIV diabetes mellitus and other metabolic disorders occlusive clothing hot, humid weather obesity hyperhidrosis frequenting public bathing areas while barefoot deformities of the feet recurrent trauma to the skin atopic dermatitis

2018 BMJ Best Practice

134. Herpes simplex infection

and mild symptoms are common, and most people have unrecognised disease. History and exam presence of risk factors dysuria (in women) lymphadenopathy genital ulcer oral ulcer fever tingling sensation headache/aseptic meningitis HIV infection (risk factor for clinical disease) immunosuppressive medications (risk factor for clinical disease) female sex (risk factor for seropositivity) black race (risk factor for seropositivity) increasing age (risk factor for seropositivity) high-risk sexual behaviour (...) occurs during initial infection with HSV, in which the host lacks an antibody response. Herpes labialis (oral herpes) is infection of the mouth area and lips with HSV-1. If symptomatic, high fever, sore throat, and pharyngeal oedema may occur. Painful ulcers can appear a few days later on the pharyngeal and oral mucosa, and high fever and mouth pain last for several days. Generalised muscle pains and often rigors occur, with cervical lymphadenopathy and sometimes splenomegaly. Recurrent infections

2018 BMJ Best Practice

135. Gonorrhoea infection

pelvic pain in women tenderness and/or swelling of the epididymis mucopurulent or purulent exudate at the endocervix urethral irritation in men dysuria in men tenderness and/or swelling of testis tenderness and/or swelling of prostate anal pruritus mucopurulent discharge from the rectum rectal pain tenesmus rectal bleeding vaginal discharge cervical friability uterine, adnexal, or cervical motion tenderness uterine mass anterior cervical lymphadenopathy conjunctivitis fever skin lesions (papules (...) investigations nucleic acid amplification test (NAAT) culture urinalysis in men Gram stain of urine sediment Gram strain of urethral discharge HIV test syphilis test transvaginal ultrasound pelvic CT/MRI Treatment algorithm ACUTE ONGOING Contributors Authors Assistant Professor Division of Infectious Diseases Department of Medicine UCSD Antiviral Research Center Division of Family Medicine Department of Family and Preventive Medicine UCSD La Jolla Family and Sports Medicine San Diego CA Disclosures SM has

2018 BMJ Best Practice

136. Syphilis infection

manifest in a number of ways. Diagnosis is usually straightforward after clinical examination and serological tests. Treatment is with penicillin. Untreated syphilis facilitates HIV transmission and causes considerable morbidity, such as cardiovascular and neurological disease, as well as a congenital syndrome in the newborn. Syphilis in pregnancy is a major cause of miscarriage, stillbirth, and perinatal morbidity and mortality in some parts of the world. Definition Syphilis is a sexually transmitted (...) of risk factors genital ulcer lymphadenopathy diffuse rash constitutional symptoms fatigue rhinitis (congenital syphilis) hepatosplenomegaly (congenital syphilis) patchy alopecia condylomata lata memory impairment, altered mood, confusion, or dementia visual disturbance Argyll-Robertson pupils loss of sense of vibration, proprioception, and position sense ataxia loss of anal and bladder sphincter control positive Romberg's sign diastolic murmur rubbery nodules with a necrotic centre miscarriage

2018 BMJ Best Practice

137. Overview of sexually transmitted diseases

, and perihepatic abscesses. High rates of antimicrobial resistance have been reported, and antibiotic treatment should be guided by local and national guidelines. A common sexually transmitted infection caused by a spirochetal bacterium. Clinical presentation is often asymptomatic but can manifest in a number of ways. Diagnosis is usually straightforward after clinical exam and serological testing; treatment is with penicillin. Untreated syphilis facilitates HIV transmission and causes considerable morbidity (...) ulcer with fluctuant lymphadenitis (bubo formation). Chancroid is an important cofactor in HIV transmission, and HIV status must be assessed. Most cases resolve with antibiotic therapy, and recurrence is rare. An acute ascending polymicrobial infection of the female upper genital tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis . Dayan L. Pelvic inflammatory disease. Aust Fam Physician. 2006 Nov;35(11):858-62. http://www.ncbi.nlm.nih.gov/pubmed/17099803?tool

2018 BMJ Best Practice

138. Cutaneous T-cell lymphoma

lesions unilesional acral site involvement lymphadenopathy constitutional symptoms palmar-plantar keratoderma alopecia leonine facies onychodystrophy hepatomegaly ectropion bullous, granulomatous, ichthyosiform, and purpuric lesions age >60 years male gender black ethnicity (mycosis fungoides); white ethnicity (Sézary's syndrome) exposure to infectious agents chromosomal abnormality environmental exposure to industrial chemicals, herbicides, pesticides Diagnostic investigations FBC screen for Sézary's (...) cells on blood film skin biopsy polymerase chain reaction (PCR) for T-cell receptor flow cytometry basic metabolic panel LFTs serum LDH human T-cell lymphotropic virus (HTLV)-I serology bone marrow biopsy lymph node biopsy CT scan HIV test FDG-PET scan Treatment algorithm ONGOING Contributors Authors Professor of Targeted Therapy and Oncology University of Manchester Manchester Academic Health Sciences Centre Manchester UK Disclosures TMI declares that he has no competing interests. Consultant

2018 BMJ Best Practice

139. Kaposi's sarcoma

immunosuppression skin lesion oral lesion lymphadenopathy lymphoedema weight loss abdominal pain GI bleeding diarrhoea dyspnoea haemoptysis chest pain fever male sex HIV infection drug abuse immunosuppression therapy transplantation human herpesvirus-8 (HHV-8) infection central African ethnicity (Uganda, Malawi, Zambia, Zimbabwe, Swaziland) Jewish ethnicity Mediterranean ethnicity age <5 years or >50 years Diagnostic investigations HIV test skin/mucosal biopsy lymph node biopsy fecal occult blood CXR CT scan (...) -associated Kaposi's sarcoma. Science. 1994 Dec 16;266(5192):1865-9. http://www.ncbi.nlm.nih.gov/pubmed/7997879?tool=bestpractice.com Lesions frequently involve mucocutaneous sites, but may become more extensive to involve the lymph nodes and visceral organs. Skin lesions evolve from an early patch, to a plaque, and later to ulcerating tumour nodules. History and exam presence of risk factors age >50 years male sex geographic location: sub-Saharan Africa or the Mediterranean HIV infection HHV-8 infection

2018 BMJ Best Practice

140. Chronic fatigue syndrome/Myalgic encephalomyelitis

-exertional malaise (PEM)/exertional exhaustion, unrefreshing sleep, cognitive and autonomic dysfunction, myalgia, arthralgia, headaches, and sore throat and tender lymph nodes (without palpable lymphadenopathy), with symptoms lasting at least 6 months. Komaroff AL. Myalgic encephalomyelitis/chronic fatigue syndrome: a real illness. Ann Intern Med. 2015 Jun 16;162(12):871-2. http://annals.org/article.aspx?articleid=2322808 http://www.ncbi.nlm.nih.gov/pubmed/26075760?tool=bestpractice.com The fatigue (...) differential erythrocyte sedimentation rate CRP comprehensive metabolic panel thyroid-stimulating hormone antinuclear antibody (ANA), rheumatoid factor HIV antibody test heads-up tilt-table test if symptomatic orthostatic intolerance serum ferritin HbA1c urine toxicology screen antibody tests for gluten sensitivity/coeliac disease 2-day cardiopulmonary exercise testing Treatment algorithm ONGOING Contributors Authors Professor Division of Rheumatology, Immunology, and Allergy Georgetown University

2018 BMJ Best Practice

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