Case 14

Cryptococcosis is an opportunist infection that should be considered in HIV/AIDS and in other at risk immunosuppressed patients such as those following solid organ transplantation. Cryptococcus neoformans is found in bird droppings and is the commonest cause in temperate climates but C. gattii is increasingly recognized in warmer climates. Diagnosis is usually via antigen detection, microscopy, and culture of blood, respiratory specimens and cerebrospinal fluid (CSF), in addition to histological analysis of appropriate tissue with specialised stains. New antigen assays facilitate point-of-care testing in resource-poor countries. Management includes initial treatment regimens with liposomal amphotericin B (the echinocandins have little activity) followed by follow-up antifungal therapy for up to a year, usually with fluconazole.

Gambaran Klinis Stomatitis Aftosa Rekuren pada Pasien dengan Infeksi Human Immunodeficiency Virus (Laporan Kasus)

Recurrent oral ulceration usually induced pain and influence patient’s quality of life. Reccurent Aphthous Stomatitis (RAS) is a common disorder with recurring ulcers, affecting the oral mucosa, painful and no other signs of systemic disease. Human Immunodeficiency Virus (HIV) is considered as a predisposing factor for RAS. Lesion of RAS associated with HIV, usually more severe, longer lasting to healing and non specific clinical features. This case report describe clinical features of recurrent oral ulceration in HIV patient. A 23 year old female came with complaint oral ulceration in soft palate and tongue since 2 months ago. Patient was diagnosis HIV since seven years ago. Several examinations were done to explore possibility of opportunist infection in HIV patient. Intra oral examination showed regular ulcer, with yellowish base, surrounding erythematous halo. The locations of ulcer were in labial mucosa, dorsum and ventral of the tongue, and soft palate. Ulceration in keratinized mucosa and non keratinized mucosa, gives un-specific features mimicking Tuberculous oral ulcer but in this case there was no indurations on all ulcer. Based on anamnesis and clinical examination, the diagnosis of this case is RAS with differential diagnosis of Tuberculous oral ulcer. The therapy given was gold standard of RAS, the outcome was successful without TB therapy. RAS on HIV Patient can give unspecific clinical features, mimicking oral manifestation of opportunist infection commonly occurred in HIV patient.

AIDS: Neurological Opportunist Infections in Central London

Twenty six (41%) of 64 central London cases of AIDS with nervous system involvement during the course of the illness had neurological opportunist infection. Cytomegalovirus and Toxoplasma gondii were the commonest agents in 22 cases with central nervous system (CNS) infection. Eight cases had herpes zoster radiculopathy. Other infections included those caused by Cryptococcus neoformans, Mycobacterium tuberculosis and papova JC virus. Prognosis was generally poor, irrespective of whether the opportunist infection was treatable.

Facultative Pasteurella ophthalmitis in Hooded Lister rats

Hooded Lister rats were found to exhibit symptoms of Mycoplasma pulmonis infection. During the course of this chronic respiratory disease they developed ophthalmia and conjunctivitis which proved to be an opportunist infection with Pasteurella multocida. The severity of disease varied in individual rats, newborn rats entirely escaping infection. All cases responded to treatment with appropriate topical antibiotic and no sequelae were observed.