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Lymphadenopathy in HIV

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141. Fungal meningitis

, coordination and gait disturbances, and urinary incontinence) behavioural or personality change reduced visual acuity and papilloedema nausea or vomiting fever reduced conscious level cranial nerve palsies seizures weight loss mouth ulcers focal neurological signs lymphadenopathy, hepatosplenomegaly dyspnoea papular umbilicated skin lesions retinal defects nasal or palatal eschar HIV infection corticosteroid use underlying chronic disease (e.g., malignancy, organ failure, autoimmune disease, organ (...) to the increasing number of patients immunosuppressed by pharmacological agents and HIV infection. Cryptococcal, histoplasmal, coccidioidal, and candidal meningitis will be discussed specifically in this monograph. Kravitz GR, Davies SF, Eckman MR, et al. Chronic blastomycotic meningitis. Am J Med. 1981 Sep;71(3):501-5. Harley WB, Lomis M, Haas DW. Marked polymorphonuclear pleocytosis due to blastomycotic meningitis: a case report and review. Clin

2018 BMJ Best Practice

142. 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

2018 BMJ Best Practice

143. Mycobacterium avium-intracellulare

Mycobacterium avium-intracellulare Mycobacterium avium-intracellulare - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Mycobacterium avium-intracellulare Last reviewed: February 2019 Last updated: January 2018 Summary Variable presenting features including chronic cough, weight loss, and fevers. Increased incidence in patients with underlying lung disease, heavy smoking, and excessive alcohol consumption. HIV-infected (...) patients with CD4 cell count <50 cells/microlitre also at increased risk of infection. Diagnosis of pulmonary disease in non-HIV-infected individuals requires repeated isolation of the organism from respiratory secretions, in addition to compatible symptoms and radiographic presentation. Combination treatment with at least 2 drugs is essential. Definition Mycobacterium avium-intracellulare (MAI), also known as mycobacterium avium complex (MAC), consists of 2 mycobacterium species, M avium and M

2018 BMJ Best Practice

144. Gingivitis

removal of dental plaque by tooth brushing and cleaning between the teeth. Necrotising ulcerative gingivitis (NUG) is a more serious condition that is mainly found in developing countries associated with people with severe malnutrition or HIV/AIDS with low CD4 T-cell counts. Definition Gingivitis is inflammation of the gingiva. The vast majority of cases are related to bacteria-induced inflammation caused by the dental plaque (bacterial biofilm) that forms daily on the teeth. Necrotising ulcerative (...) and Conditions can provide the medical reader with comprehensive information on the wide range of local and systemic diseases affecting the gingiva. Holmstrup P. Non-plaque-induced gingival lesions. Ann Periodontol. 1999 Dec;4(1):20-31. History and exam presence of risk factors bleeding on tooth brushing dental plaque halitosis redness, swelling, and puffy gingiva cervical lymphadenopathy fever malaise pain poor oral hygiene tobacco diabetes

2018 BMJ Best Practice

145. Diagnosis and management of gonorrhoea and syphilis

: An Crepel (BCFI/CBIP), Agnes Cuyas (NGC), Nicolas Fairon (KCE), Virginie Maes (Sciensano), Romain Mahieu (Direction de la Santé, COCOM), Carole Schirvel (Cellule de surveillance des maladies infectieuses, AVIQ), Jørgen Skov Jensen (IUSTI), Irm Vinck (KCE) Reported interests: Membership of a stakeholder group on which the results of this report could have an impact: Nicole Dekker (Guideline first line for Chlamydia and HIV) Holder of intellectual property (patent, product developer, copyrights (...) , trademarks, etc.): Christiana Nöstlinger (Advice for HIV screening for the first line – Steekkaart), Sandra Van den Eynde (Products of Sensoa, e.g. Praat over seks – methodiek) Fees or other compensation for writing a publication or participating in its development: Sarah Swannet (Guideline on HIV for first line), Heleen Van Mieghem (Guideline on the care for the patient living with HIV for first line) A grant, fees or funds for a member of staff or another form of compensation for the execution

2019 Belgian Health Care Knowledge Centre

146. Syphilis in pregnancy

Queensland Clinical Guidelines: Syphilis in pregnancy. Flowchart version: F18.44-2-V1-R23 At risk baby · Mother had syphilis requiring treatment in this pregnancy (irrespective of adequacy of treatment) AND/OR · Baby with clinical suspicion of syphilis: o Rash o Hepatomegaly o Rhinitis o Lymphadenopathy o Other signs/symptoms Communication · Document need for follow-up · Advise local services of follow-up needs Follow-up · Clinical assessment at each opportunity · Serology at 3 and 6 months of age o (...) Abbreviations CSF Cerebrospinal fluid FHR Fetal heart rate GP General Practitioner HIV Human immunodeficiency virus IgM Immunoglobulin M IV Intravenous JHR Jarisch Herxheimer Reaction PCR Polymerase Chain Reaction POC Point of care QSSS Queensland Syphilis Surveillance Service SOP Standard operating procedure STI Sexually transmitted infection USS Ultrasound VDRL Venereal Diseases Research Laboratory Definition of terms Adequate treatment In a pregnant woman, treatment may be considered adequate if a stage

2019 Queensland Health

147. 34m with fever, headache and myalgias

checking for HIV, both as a primary driver of this, but to inform his immune status is important. Finally, I think finishing with the category of atypical or specifically spirochete or rickettsial organisms, this is definitely important given what we found in the social history. So thinking about, disseminated syphilis is a possibility, perhaps scrub typhus. As far as I know, in New York murine typhus really isn’t as a problem, but here in Houston where I practice that would definitely be on the table (...) to be very systematic and comprehensive in how she approached the case. Consider pausing and writing down what additional workup you would order at this point, before we reveal what happened next. ♫ Fade into medium music pause ♫ Shira Ultimately, blood and urine cultures remained without growth. HIV antibody testing and viral load were both negative. HAV, HBV, and HEV serologies were non-revealing. Serologies for EBV and CMV revealed negative IgM’s with positive IgG’s consistent with prior exposure

2019 Clinical Correlations

148. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

Antibiotics in Community- acquired LRTI in Europe HIV human immunodeficiency virus HRQOL health-related quality of life ICD International Classification of Diseases IVDR EU Regulation 2017/746 on In Vitro Diagnostic Devices ( the IVDR) LRTI lower respiratory tract infection LTC long-term care OOH out-of-hours OR odds ratio MeSH medical subject headings NPV negative predictive value NNT number needed to test POC point-of-care POCT point-of-care testing PPV positive predictive value RADT rapid antigen

2019 EUnetHTA

149. Penile Cancer

of HPV and this may account for the worldwide variation in incidence [ ]. About one third of cases are attributed to HPV-related carcinogenesis [ ]. Penile cancer is not linked to HIV or AIDS. Figure 1: Annual incidence rate (world standardised) by European region/country* *Adapted from [ ]. 3.3. Risk factors and prevention Several risk factors for penile cancer have been identified (Table 2) [ ] (LE: 2a). Table 1: Recognised aetiological and epidemiological risk factors for penile cancer Risk

2019 European Association of Urology

151. Diagnosis and Treatment of Early Stage Testicular Cancer

, cardiac, and skeletal muscle and can be elevated from cancerous (e.g., kidney, lymphoma, GI, breast) or non-cancerous conditions (e.g., heart failure, anemia, HIV). Of the five isoenzymes of LDH, LDH-1 is the most frequently elevated isoenzyme in GCT. The magnitude of LDH elevation correlates with bulk of disease. As a non-specific marker, its main GCT use is in the prognostic assessment at diagnosis. Treatment decisions based solely on LDH elevation in the setting of normal AFP and hCG should

2019 American Urological Association

152. BSG consensus guidelines on the management of inflammatory bowel disease in adults

Assessment Tool; FBC: full blood count; HBI: Harvey Bradshaw Index; Hb: haemoglobin; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; HPV: human papilloma virus; HR: hazard ratio; HSTC: haematopoietic stem cell transplantation; HSV: herpes simplex virus; IBD: inflammatory bowel disease; IBD-U: inflammatory bowel disease unclassified; IBS: irritable bowel syndrome; IGRA: interferon gamma release assays; IL: interleukin; i.m.: intramuscular; IPAA: ileoanal pouch

2019 British Society of Gastroenterology

153. Varicella Zoster Virus glycoprotein E antigen (Shingrix) - Herpes Zoster

GMT Geometric Mean Titre GSK GlaxoSmithKline HCP Host Cell Protein HCT Haematopoietic stem Cell Transplant HI Haemagglutinin Inhibition HIV Human Immunodeficiency Virus HP Hydrogen Peroxide HZ Herpes Zoster HZO HZ Ophthalmicus Assessment report EMA/88588/2018 Page 5/170 HZ/su The herpes zoster subunit candidate vaccine (50 µg gE/AS01 B ), also called gE/AS01 B candidate vaccine IC Immunocompromised ICH International Conference on Harmonization IDMC Independent Data Monitoring Committee IFN (...) 70 years having a four times increased risk of PHN than those younger than 60 years. Besides increase in age, immunosuppression from any cause, including hematologic malignancies, HIV and immunosuppressive medications, is an important risk factor for herpes zoster, increasing the risk of HZ by at least 10-fold. An increased risk of HZ has been reported in infants whose mothers had had varicella in pregnancy. Prompt antiviral therapy, if available, is recommended for herpes zoster in healthy

2018 European Medicines Agency - EPARs

154. Molluscum contagiosum

in the UK immuno-compromised adults (e.g. HIV +ve) Transmitted by skin-to-skin contact; mildly contagious Lesions on the lid margins may shed viral toxins into the conjunctival sac, causing follicular conjunctivitis pannus Predisposing factors Epidemiological studies have shown separate associations with attendance at swimming pools, and with eczema Symptoms Presence of skin lesion(s) Ocular symptoms: redness, watering, photophobia, blurring of vision (all mild) Signs Skin nodule(s) (typically 2-3 mm (...) diam), often with a central depression (‘umbilicated’) No visible inflammation Central core has cheese-like or waxy material which may discharge spontaneously May be single or multiple on the lid(s) and/or elsewhere on the body Ocular signs (usually unilateral) hyperaemic conjunctiva conjunctival follicles pannus (in long-standing cases) watery discharge No lymphadenopathy Differential diagnosis Other lesions of the lids which may be skin-coloured: basal cell carcinoma, neurofibroma, sebaceous

2019 College of Optometrists

156. Myelodysplastic syndrome

% are considered to have AML. MDS can arise primarily without any inciting event or may be related to previous treatment with either chemotherapy or radiation. History and exam older age asymptomatic fatigue exercise intolerance pallor petechiae, purpura bacterial infections presence of risk factors autoimmune disorders splenomegaly hepatomegaly lymphadenopathy age >70 years ionising radiation alkylating agents topoisomerase inhibitors prior haematopoietic stem cell transplantation tobacco benzene aplastic (...) anaemia paroxysmal nocturnal haemoglobinuria (PNH) Down's syndrome (trisomy 21) congenital neutropenia DNA repair deficiency syndromes Diagnostic investigations FBC with differential reticulocyte count red blood cell folate serum B12 levels iron studies HIV testing bone marrow aspiration with iron stain bone marrow core biopsy bone marrow cytogenetic analysis serum erythropoietin HLA typing flow cytometry Treatment algorithm ACUTE ONGOING Contributors Authors Staff Physician VA Nebraska-Western Iowa

2017 BMJ Best Practice

157. MALT lymphoma

, cough salivary gland swelling thyroid swelling breast lump focal neurological deficits lymphadenopathy Helicobacter pylori infection age >60 years autoimmune diseases female sex Chlamydia psittaci infection Campylobacter jejuni infection Borrelia burgdorferi infection hepatitis C virus infection HIV infection Diagnostic investigations FBC blood smear upper GI endoscopy biopsy of affected tissue H pylori serology H pylori stool antigen test LFTs basic metabolic profile bone marrow biopsy (...) immunohistochemistry reverse transcriptase polymerase chain reaction (RT-PCR) or fluorescence in situ hybridisation (FISH) immunoglobulin gene rearrangement studies serum electrophoresis serum LDH serum beta-2 microglobulin staging CT scan endoscopic ultrasound of the stomach double contrast radiography of the GI tract lower GI endoscopy endoscopic otolaryngology CT scan of salivary glands MRI orbit hepatitis C serology hepatitis B serology HIV serology multiple-gated acquisition scan (MUGA) echocardiography

2017 BMJ Best Practice

158. Focal segmental glomerulosclerosis

or greater lymphadenopathy skin rash oral lesions nephrectomy scar male sex black race positive FHx heroin abuse use of known causative medications chronic viral infection solitary kidney pre-existing renal disease kidney transplant acute renal ischaemia obesity Diagnostic investigations serum urea creatinine GFR urinalysis with microscopy urine protein-to-creatinine ratio 24-hour urine collection for protein serum albumin serum lipid profile serum HIV ELISA CD4 count and viral load studies parvovirus (...) Focal segmental glomerulosclerosis Focal segmental glomerulosclerosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Focal segmental glomerulosclerosis Last reviewed: February 2019 Last updated: December 2017 Summary Caused by an injury to podocytes in the renal glomeruli. May be primary (idiopathic) due to an unknown cause or secondary to an underlying condition, such as HIV, obesity, medications, and a maladaptive

2017 BMJ Best Practice

159. Syphilis

formulations are insufficient for syphilis treatment. Treatment should ideally be given at a sexual health service. RECOMMENDED TESTS • Syphilis serology – if clinical suspicion of infectious syphilis specify on laboratory form • HIV serology • Routine STI tests (see Sexual Health Check guideline • In MSM also request hepatitis A and B serology, unless known to be immune • In persons with a history of IDU, incarceration, or who use recreational drugs during sex, request hepatitis (...) C serology TEST IF • MSM (at least annually, but ideally with every sexual health check) • HIV positive (at least annually, but ideally with every sexual health check) • Routine antenatal screen; consider rescreening in later pregnancy if partner change • Routine immigration screen • A sexual contact of a person with syphilis • Routine sexual health check Signs or symptoms of infectious syphilis: • Genital ulcers (see Genital Ulcer Disease summary • MSM with any genital

2017 New Zealand Sexual Health Society

160. Sexually Transmitted Infections

? • There is no available test to determine the HPV status of a person. • Current laboratory assays for HPV DNA detect only particular high risk types (in order to guide clinical management in cervical screening) so cannot be used as a screening test for ‘all HPV types’. 10 What are the important points to know about HPV associated anal cancer? • The incidence of anal cancer is increasing and the burden of disease is highest in men who have sex with men and HIV positive MSM. There is no effective method (including anal (...) cytology/smear) for screening for anal cancer. Annual digital anorectal examination (DARE) is recommended for HIV positive MSM who are aged 50 years or over (see HPV vaccination is the most effective method of prevention. What are the important points to know about HPV-associated oropharyngeal cancer? • Although oral cavity cancers associated with smoking and alcohol are decreasing, HPV-associated oropharyngeal cancer is increasingly common – especially

2017 New Zealand Sexual Health Society

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