GEMP III HIV DAY QUIZ

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GEMP III HIV DAY QUIZ

• SKIN MANIFESTATIONS OF HIV IN CHILDREN

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Skin Infections

• Skin lesions are seen frequently in HIV infected
  children
• Certain skin conditions may help in clinical
  staging of disease e.g Herpes Zoster
• When common childhood skin conditions occur in
  HIV-infected children they have an atypical
  presentation
• Severe and extensive, refractory to conventional
  treatment or recurrent

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Seborrhoeic Eczema/Dermatitis

• Dry scaly rash, tends to recur
• Involves scalp, face,trunk and axillae
• Crusting may indicate secondary infection
• Avoid soap and use emoillients on skin
• Treat with topical steroid (betamethasone 0.1)
• On face use hydrocortisone 1cream
• Treat secondary infection with flucloxacillin

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Impetigo

• Skin infections caused commonly by Strep.
  Pyogenes and Staph. Aureus
• Crusted lesions with shiny yellow appearance
• Can cause secondary infection of atopic
  dermatitis or herpetic ulcers
• Treat by applying povidone-iodine or topical
  mupirocin to lesion
• As lesions tend to be more extensive give oral
  flucloxacillin

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Chickenpox

• Varicella-zoster virus (VZV) infection
• Tends to be more widespread in immunocompromised
  children
• Mortality rate as high as 20 if untreated
• Apply calamine lotion
• Give oral acyclovir for 7 days
• Interval between chicken pox and reactivated VZV
  disease may be reduced to weeks or months instead
  of decades

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Herpes-zoster

• Unilateral,painful,vesicular,erosive dermatomal
  eruption
• Can be multidermatomal, disseminated or recurrent
  with severe immunesuppresion
• May be followed by post-herpetic neuralgia and
  scarring
• A recurrence of zoster infection can occur in
  first weeks after starting HAART
• Treat with adequate analgesia (paracetamol,codeine
  )
• Oral acyclovir for 7 days

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Scabies

• Caused Sarcoptes scabiei mite
• May be severe and involve the trunk and limbs
• Wash linen and hang to dry in the sun
• Apply benzyl benzoate to body for 24 hrs and
  repeat after 72hrs
• In babies use sulphur ointment 3 times daily for
  3 days

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Molluscum Contagiosum

• Caused by pox virus
• Variable sized papules with central umbilication
  usually affects the face
• May be extensive and disfiguring in severely
  immunocompromised patients
• Treat with liquid nitrogen. Tend to recur

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Tinea

• Tinea capitis, corporis
• Fungal infection
• Treat with clotrimazole or miconasole cream
• Systemic or chronic fungal infection can be
  treated with oral griseofulvin

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GEMP III HIV DAY QUIZ

• GASTROINTESTINAL MANIFESTATIONS OF HIV

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Oral Candidiasis

• Common paediatric finding in young infants
• The most common fungal infections among
  HIV-infected children are caused by Candida
  species.
• Oral thrush and diaper dermatitis occur among
  5085 of HIV-infected children.
• Candida albicans is the most common cause of
  mucosal and esophageal candidiasis.

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Oropharyngeal Candidiasis (OPC)Treatment

• Mycostatin (Nystatin) 1ml 4x daily
• Daktarin gel (Miconazole) Apply 3-4x daily
• Diflucan (Fluconzaole)
• (3-6mg/kg od X 14 days)

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Herpes Stomatitis
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Herpes Stomatitis

• Acyclovir oral dose in
• gt 2yrs 400mg 8hrly/ 200mg 5x day for 10 days
• lt 2yrs half dose 200mg 8hrly for 10days

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Gastroenteritis

• Acute Vs Chronic (lt or gt 2 weeks)
• G/E viral, bacterial, fungal, parasitic
• Malabsorbtion
• Antibiotic induced super-infection
• Other e.g. TB abdomen/ MAC

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Acute Gastroenteritis

• Out-patient
• Oral rehydration
• Continue oral feeds and maintain nutrition

• In-patient
• IVI rehydration
• ? Antibiotics (which cases)
• Exclude UTI in all cases of GE !
• Treat electrolyte disturbances Na/K
• Continue oral feeds and maintain nutrition

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Chronic Gastroenteritis

• Out-patient?

• In-patient
• Rehydration and treat electrolyte problems - Na/K
• Search for cause - Stools for mcs parasites
  Clostridium Difficle and lactose test. Urine
  for mcs
• Remember abdominal TB or MAC (abdo sonar /- CT
  scan)
• Bowies regime Trial of Genta/Metronid/Cholestyr
• Continue oral feeds and maintain nutrition

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PEP

• A GEMP IV student is putting in a drip in a 3
  year old HIV infected child
• Whilst he is resheathing the yellow jelco, he
  accidentally sticks himself with the needle
• What questions do you want to ask him?
• What do you want to know about the baby?
• What blood tests do you want to pull?
• What prophylaxis do you want to offer him?