Hiv in Ent: Harshitha U S Roll No-97
Hiv in Ent: Harshitha U S Roll No-97
Hiv in Ent: Harshitha U S Roll No-97
Harshitha U S
Roll no-97
INTRODUCTION
Retrovirus – Viral RNA into DNA.
Two types – Type 1 and 2.
Type 1 – more common and more pathogenic.
Type 2 – less common and less pathogenic.
Once entering the host , this attacks the T-
lymphocytes and other CD4 surface markers..
With the fall of the CD4
lymphocytes[<500/cu.mm], the immunodeficiency
is seen and many other opportunistic and
malignancy can appear.
When the CD4cell counts appear less than 200,
death may appear in about 2-3 years.
MODES OF TRANSMISSION
STRUCTURE OF HIV
LIFE CYCLE
COURSE OF DISEASE
INITIAL VIRAEMIA :
mild c/f[1-2 weeks]
Fever
Headache
Bodyache
Macular rash
Lymph node enlargement
LATENT PERIOD
> Asymptomatic up to 10 years.
> No virus is detected in plasma.
> Virus replicates in lymphoid
tissues such as LYMPHNODES,TONSILS and
ADENOIDS.
> Infection can be detected by CD4
number and their deteriorating function.
>Antibody test becomes positive in 2-4
months of infection.
ADVANCED DISEASE
• After several years.
• CD4<200 cells/cu mm.
• Patient’s immunity is compromised
and is more susceptible for
opportunistic infections.
WINDOW PERIOD[3-12 weeks]
Following infection antibodies
appear in serum only after a period
of interval.
ENT MANIFESTATIONS IN HIV
3 types of lesions are seen-
Opportunistic infections
• Pneumocystic carinii
• Tuberculosis
• Candida albicans
• Cryptococcus neoformans
• Toxoplasma
• CMV
• Herpes simplex
Unusual malignancies
• Kaposi sarcoma and lymphomas are common.
• KS can involve skin, mucus membrane or
viscera.
Neurological disorders
• Can be due to primary HIV infection or
opportunistic organisms
• Primary HIV infections of CNS can cause
encephalopathy, myelopathy, peripheral
neuropathy and CN involvement[VII most
coomon,V,VIII occasionally]
HIV MANIFESTATIONS IN
DIFFERENT AREAS
EAR
External ear - Otitis externa
- Kaposi sarcoma
- Seborrhoeic dermatitis of Ext.canal
Middle ear - Serous otitis media
- Acute otitis media
- Pseudomonas and Candida infections
Inner ear – SNHL[due to viral infection of auditory
nerve or cochlea and demeylination of CNS
Herpes zoster[Ramsay hunt syndrome]
Facial paralysis
ASOM Candida infection
of middle ear
NOSE AND PARANASAL SINUSES
Parotitis
Xerostomia
Diffuse parotid enlargement
Lymphoepithelial cysts of parotid.
They arise from parotid nodes, often
on both sides.
Kaposi sarcoma
Non-Hodgkin lymphoma
Parotitis
Xerostomia
NECK
Lymphadenopathy - It could be only
a follicular hyperplasia or due to a
disease such as tuberculosis,
histoplasmosis, toxoplasmosis or
non-Hodgkin or Hodgkin lymphoma.
KAPOSI SARCOMA
It is a multicentric noninvasive neoplasm
which may involve any part of
skin ,mucosa or viscera.
It appears purplish in colour and may
need to be differentiated from angioma
or pyogenic granuloma.
Diagnosis- biopsy shows proliferation of
spindle cells,endothelial cells,
extravasation of RBCs and haemosiderin
laden macrophages.
Treatment- localised
radiation,intralesional vinblastine or
cryotherapy.
NON HODKINS LYMPHOMA
B-cell lymphomas are more common (90%)
and many are due to Epstein–Barr virus.
Risk of lymphomas increases as disease
progresses generally in patient with CD4+
count less than 200/mm3.
CNS lymphomas occur in late stages of the
disease while systemic ones can occur
early.
Nose ,PNS, oral cavity are commonly
involved.
HAIRY LEUKOPLAKIA
It is a white, vertically corrugated
lesions on the anterior part of the
lateral border of tongue.
It is probably caused by Epstein–Barr
virus.
Differential diagnosis includes
leukoplakia, carcinoma in situ,
hypertrophic candidiasis or lichen
planus.
Biopsy should be done to confirm.
Non Hodgkins
Lymphoma
Hairy
leukoplakia
DIAGNOSTIC TESTS
1. ELISA – very sensitive test.
2. Western blot – confirmatory test,
specific for HIV Ab.
3. CD4 count – normal 600-1500/cu.mm
decrease in count indicates
immunecompromised.
Classified a/c to CD4 count