Question

A 29 year old married male from Manipur who presented with generalized asymptomatic skin lesions for six months, fever and cough with expectoration for two months, and significant weight loss. There are no oro-genital lesion. Multiple erythematous, discrete papules and nodules with umbilication, varying in size (5-20mm) were situated over the face, chest, back, and proximal parts of the extremities. Oral candidiasis was present. Systemic examination was normal.

Investigations revealed Hb 8.1g/dL, WBC 2800/cu. mm and ESR 120 mm at the end of one hour. ELISA test for HIV was reactive. Absolute CD4 count was 48/cu.mm. Mantoux test was negative. Blood culture in SDA and KOH showed the following:

Questions:

a. What is the most likely diagnosis and the causative agent?

b. Describe the culture and microscopic picture.

c. What is the treatment of choice? Discuss the mode of action.

Answer 1

a) Human immunodeficiency virus (HIV), a retrovirus is the causative agent for Acquired Immunodeficiency Syndrome (AIDS).

b) HIv infected patient can have disseminated a potassium hydroxide (KOH) preparation show yeast.

Detection of anti HIv in whole blood, saliva, oral fluid, urine and dried blood spot have commonly used and economical medium is SDA.

c) HIV medicine is called antiretroviral therapy (ART). There is no effective cure for HIV. But with proper medical care you can control HIV. Most people can get the virunder control within six months.

Tab. Abacavir, Tab. Didanosine, Tab. Emtricitabine, Tab. Lamivudine, Tab. Stavudine, Tab. Tenofovir alafenamide, Tab. Zidovudine.