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Lymphadenopathy in HIV

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161. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs of drug-induced hypersensitivity syndrome [DIHS]/drug reaction with eosinophilia and systemic symptoms [DRESS]). Assess for pustules or blisters or erosions in addition to areas of “dusky erythema,” which may feel painful to palpation. To assess for a positive Nikolsky sign, place a gloved finger tangentially over erythematous skin and apply friction parallel to the skin surface. Nikolsky sign is positive if this results (...) in the nares, sores or discomfort in the oropharynx, odynophagia, hoarseness, dysuria, sores or discomfort in the vaginal area for women or involving the meatus of the penis for men, sores in the perianal area, or pain with bowel movements. ○ Physical examination: include vital signs and a full skin examination specifically evaluating all skin surfaces and mucous membranes (eyes, nares, oropharynx, genitals, and perianal area). Assess for lymphadenopathy, facial or distal extremity swelling (may be signs

2018 American Society of Clinical Oncology Guidelines

162. CRACKCast E171 – Pediatric Cardiac Disorders

not present at the same time, and there is no typical order of appearance. As an example, some patients have only developed fever and cervical lymphadenopathy by the time of admission (so-called KD with isolated cervical lymphadenopathy, KDiL) *Check out for more: KD can also occur in adults – most of them have HIV infections as well. Don’t forget to include measles on your DDX of KD (in measles the rash starts on the face and then spreads) From Rosen’s: Infants 6 months of age or younger are more likely

2018 CandiEM

164. British Association of Dermatologists? guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis

with this class of agent. 75 Pruritus is a common side- effect of epidermal growth factor inhibitors, which have either biological or intracellular mechanisms of action. 76 Oncology patients receiving biological therapies should be asked about pruritus on review. Table 3 Clinical features of cancers associated with generalized pruritus without rash Pruritus-associated cancers Symptoms Signs Any (including haematological) Loss of appetite, lethargy Weight loss, lymphadenopathy, fever Breast cancer Breast (...) in the corre- sponding dermatome, and nerve ?bre degeneration (such as small ?bre neuropathy) can cause a localized or generalized pruritus. Small ?bre neuropathy can occur in systemic diseases such as diabetes mellitus, Guillain–Barr e syndrome, sarcoidosis, neuro?bromatosis type 1 and HIV. 167,168 Diabetic neuropathy can lead to a regional pruritus affecting the trunk. 97 Small ?bre neuropathy may be too small to produce clinical or © 2017 British Association of Dermatologists British Journal

2018 British Association of Dermatologists

165. Spot the Diagnosis! The Case of the Dutch Painter

with the following risk factors : 2 Men who have sex with men (81% of syphilis patients) 4 HIV co-infection Sexual partner tested positive for syphilis What are the clinical stages of syphilis? Syphilis is notoriously difficult to diagnose because its clinical manifestations vary drastically depending on the stage, from completely asymptomatic to a variety of potential complications involving different organ systems. Primary syphilis is classically described as a single well-demarcated painless chancre (ulcer (...) ) at the point of sexual contact, sometimes associated with painless lymphadenopathy. 5 The innoculation period is 3-90 days and the lesion generally resolves spontaneously in <6 weeks. 6 Chancre on inner, upper lip Secondary syphilis usually presents 3-5 months after the initial infection and occurs when the bacteria in the lesion enters the bloodstream via the lymphatic system. The clinical manifestations include 1) non-pruritic maculopapular rash of the palms and soles described as copper in colour, 2

2018 CandiEM

166. Appropriate Use Criteria: Imaging of the Head & Neck

, Gorlin syndrome, Li-Fraumeni syndrome, neurofibromatosis type 1 and type 2, Turcot syndrome, and von Hippel-Lindau syndrome) ? Immunodeficiency (including HIV) ? Personal or family history (at least one first-degree relative) of aneurysm, subarachnoid hemorrhage (SAH), or arteriovenous malformation (AVM) ? Heritable condition associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, neurofibromatosis type 1

2018 AIM Specialty Health

167. Appropriate Use Criteria: Imaging of the Chest

in immunosuppressed (e.g. HIV, after organ or bone marrow transplant, on infliximab or other tumor necrosis factor antagonists individual (In these individuals, a higher level of suspicion is warranted); OR ? Other etiologies for chronic cough which include, but are not limited to: ? Smoking ? Chronic bronchitis ? Cough-inducing medications (e.g., ACE inhibitors) ? Exposure to an environmental irritant ? Respiratory infection ? Neoplasm Fever of unknown origin ? Lasting more than three weeks with exceptions (...) , when findings suggest recurrent laryngeal nerve dysfunction or identify a suspicious lesion ? Symptoms persisting longer than one month which are unexplained by laryngoscopy ? Presence of at least one of the following high-risk features: ? Tobacco use ? Alcohol abuse ? Hemoptysis ? History of radiation therapy ? Known head and neck malignancy Known hilar and/or mediastinal lymphadenopathy / mass ? Periodic follow-up Mediastinal widening on recent chest X-ray Penetrating atherosclerotic aortic ulcer

2018 AIM Specialty Health

168. Hoarseness (Dysphonia)

conditions exist for which early laryngeal visualization can minimize morbidity and mortality and reduce negative QOL consequences. For example, smokers with new-onset dysphonia with or without lymphadenopathy

2018 American Academy of Otolaryngology - Head and Neck Surgery

169. Good practice paper on the diagnosis and investigation of patients with mantle cell lymphoma

stage (Ann Arbor III–IV) disease. Lymphadenopathy is generally widespread at diagnosis, and splenomegaly, bone marrow infiltration and peripheral blood involvement are common. Bulk disease at diagnosis and B symptoms are less common. Extra nodal involvement is frequent, particularly affecting the gastro‐intestinal tract (Romaguera et al , ) and liver, but infiltration of breast, lung, skin, soft tissue, salivary gland and orbit are also seen. Involvement of more than 2 extra nodal sites is seen (...) ‐positive (Jares et al , ; Saeow, ). The second type presents as a leukaemia with splenomegaly and lack of (or low volume) lymphadenopathy. It has highly mutated IGHV genes, a simple karyotype, kappa (rather than lambda) restriction and absent or low SOX11 expression (Nodit et al , ; Fernandez et al , ; Ondrejka et al , ). It is associated with an indolent course although transformation may occur, which may be the first indication of a diagnosis of MCL (Kiel & Smith, ). Genetics and molecular

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2018 British Committee for Standards in Haematology

171. Syphilis Infection in Pregnant Women: Screening

in communities or geographic areas with higher prevalence of syphilis, those living with HIV, and those with a history of incarceration or commercial sex work. AAP and ACOG also recommend repeat screening after exposure to an infected partner. Clinicians should be aware of the prevalence of syphilis infection in the communities they serve. Most states mandate screening for syphilis in all pregnant women at the first prenatal visit, and some mandate screening at the time of delivery. Screening Tests Syphilis (...) virus, genital herpes, and HIV. National-, state-, and county-level data on syphilis infection rates are also available from the CDC. Other Considerations Research Needs and Gaps Although the benefits of screening for syphilis infection in pregnant women to prevent congenital syphilis are well established, additional studies on the use of different screening algorithms in pregnant women, as well as studies to help identify optimal rescreening intervals and populations to rescreen during pregnancy

2018 U.S. Preventive Services Task Force

172. UK National Guideline for the management of Donovanosis

UK National Guideline for the management of Donovanosis UK National Guideline for the management of Donovanosis 2018 Clinical Effectiveness Group (CEG), British Association of Sexual Health and HIV (BASHH) Nigel O’Farrell, London North West Healthcare NHS Trust, Pasteur Suite, Ealing Hospital, London UB13HW Anwar Hoosen, Medical Microbiology, University of Free State, Bloemfontein, South Africa Margaret Kingston, Consultant Genitourinary Medicine, The Northern Sexual Health, Contraception (...) and HIV Service, The Hathersage Centre, 280 Upper Brook Street, Manchester M13 0FH (BASHH CEG Editor) Clinical Effectiveness Group, British Association for Sexual Health and HIV: Keith Radcliffe, Darren Cousins, Helen Fifer, Mark Fitzgerald, Deepa Grover, Sarah Hardman, Stephen Higgins, Margaret Kingston, Michael Rayment, Ann Sullivan. Introduction The objective of this guideline is to provide guidance for the diagnosis and management of Donovanosis, a now rare sexually transmitted infection

2018 British Association for Sexual Health and HIV

173. Prenatal and Perinatal Human Immunodeficiency Virus Testing - Expanded Recommendations

trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who are incarcerated; who reside in jurisdictions with elevated HIV incidence; or who have signs and symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias (...) in the third trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who are incarcerated; who reside in jurisdictions with elevated HIV incidence; or who have signs or symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias

2018 American College of Obstetricians and Gynecologists

174. 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

2018 European Association of Urology

175. Lash Infestation or Phthiriasis

in young adults via sexual transmission Can be contracted within families through poor hygiene Symptoms Intense itching of lid margins Red watery eye Unilateral or bilateral Signs madarosis (loss of lashes) conjunctival hyperaemia superficial punctate keratopathy (SPK) bites leave red inflamed areas on lid margins possible pre-auricular lymphadenopathy adult lice (1.0–1.5mm long) attached to lash; almost completely transparent (high magnification [x40] required at slit lamp) eggs (termed nits (...) prescription of drugs: telephone GP to discuss referral and for advice on local safeguarding arrangements in the case of a child Possible management by ophthalmologist Heavy infestation can be reduced by Argon laser photo-ablation or cryotherapy (freezing) Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation ( ) Sources of evidence Clinical Effectiveness Group (British Association of Sexual Health and HIV) United Kingdom National Guideline on the Management of Phthirus

2018 College of Optometrists

176. Herpes zoster ophthalmicus

. those undergoing chemotherapy in some countries (e.g. USA) herpes zoster vaccination is offered to adults over 60. Public Health England introduced routine herpes zoster vaccination for people aged 70 years in 2013 Predisposing factors Age: although the rate increases with age, more than a half of cases occur before the age of 60 Immune compromise: HIV/AIDS, medical immunosuppression Symptoms Pain and altered sensation of the forehead on one side Rash affecting forehead and upper eyelid appears (...) a day to a week later General malaise, headache, fever Signs Skin features unilateral painful, red, vesicular rash on the forehead and upper eyelid, progressing to crusting after 2-3 weeks; resolution often involves scarring periorbital oedema (may close the eyelids and spread to opposite side) lymphadenopathy (swollen regional lymph nodes) lesion at the side of the tip of the nose (Hutchinson’s sign) indicates three times the usual risk of ocular complications, but these may also occur in one

2018 College of Optometrists

177. HIV

that will begin the replication cycle anew. Two types of HIV have been characterized: HIV-1 and HIV-2. HIV-1 is the virus that was initially discovered and termed both lymphadenopathy associated virus (LAV) and human T-lymphotropic virus 3 (HTLV-III). HIV-1 is more and more than HIV-2, and is the cause of the majority of HIV infections globally. The lower infectivity of HIV-2, compared to HIV-1, implies that fewer of those exposed to HIV-2 will be infected per exposure. Due to its relatively poor capacity (...) . Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus (LAV). As these two viruses turned out to be the same, in 1986 LAV and HTLV-III were renamed HIV. Another group working contemporaneously with the Montagnier and Gallo groups was that of Dr. Jay Levy at the . He independently discovered the AIDS virus in 1983

2012 Wikipedia

178. Lymphoma

predictable than Hodgkin lymphoma and prognosis depends on the histologic type, stage, and treatment. In Canadian males and females, the incidence rates for non-Hodgkin lymphoma showed a marked increase by approximately 50% between 1978 and the late 1990s, but have since stabilized. 1 Mortality rates have followed a similar pattern. The clearest risk factor for the disease is immunosuppression associated with HIV infection, or medications used to prevent rejection in organ transplantation. Other factors (...) ? Lymphocyte rich ? Lymphocyte depleted Peripheral T-cell, unspecified Angioimmunoblastic (AITL. formerly AILD) Enteropathy associated T-cell Hepatosplenic T-cell Subcutaneous panniculitis-like Anaplastic large cell (CD30+) ALK+ Anaplastic large cell (CD30+) ALK- Extranodal NK/T-cell, nasal type Special Burkitt lymphoma Intermediate between DLBCL and BL Intermediate between DLBCL and Hodgkin lymphoma B lymphoblastic leukemia/lymphoma B prolymphocytic leukemia Lymphomas associated with HIV infection

2016 CPG Infobase

179. WHO guideline on syphilis screening and treatment for pregnant women

acquired immune deficiency syndrome AMR antimicrobial resistance CI confidence interval DOI declaration of interests FTA-ABS fluorescent treponemal antibody absorbed GDG Guideline Development Group GRADE Grading of Recommendations Assessment, Development and Evaluation GUD genital ulcer disease HIV human immunodeficiency virus HPV human papillomavirus HSV herpes simplex virus HSV-2 herpes simplex virus type 2 MSH Management Sciences for Health MSM men who have sex with men PICO population, intervention (...) and mortality. STIs have a direct impact on reproductive and child health through infertility, cancers and pregnancy complications, and they have an indirect impact through their role in facilitating sexual transmission of human immunodeficiency virus (HIV) and thus they also have an impact on national and individual economies. More than a million STIs are acquired every day. In 2012, an estimated 357 million new cases of curable STIs (gonorrhoea, chlamydia, syphilis and trichomoniasis) occurred among 15

2017 World Health Organisation Guidelines

180. CRACKCast E120 – Dermatologic presentations

may be predisposing factors. Onychomycosis presents with toenails or fingernails that are thickened, opaque, cracked, or destroyed. Involve- ment of one or two nails may be treated with topical antifungal agents. More extensive infection requires systemic therapy with an antifungal agent, such as terbinafine or itraconazole. [5] List 8 RFs for candida infections Many conditions predispose to infection, including: diabetes mellitus, HIV infection, pregnancy, obesity, smoking, malnutrition (...) , long term care, recent sx or hemodialysis, HIV infection, prior antibiotics use). LIST in text: When to treat MRSA abscess with abx? Cellulitis Systemic illness Comorbidities Immunocompromise Extremes of age Abscess in an area difficult to drain Septic phlebitis Abscess in a difficult to treat/access location Lack of response to I&D alone PO antibiotics: TMP-SMX (usually one double strength tab BID) Doxycycline Clindamycin Minocycline Linezolid (special use only! Very $$, risk of heme side effects

2017 CandiEM

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