Bacterial Skin Infections in HIV Patients with Darker Skin

00:00 Moving on to bacterial skin infections. In HIV patients.

00:06 The common pathogens are the streptococcal and streptococcal bacteria, tends to be recurrent, persistent, and more severe.

00:16 This is more common because of the increased nasal staff coverage within with declining CD4.

00:23 You will remember we spoke about the nasal coverage even in normal patients.

00:27 But in patients who are immunocompromised, there's even more concentration of the staph aureus in the nasal location.

00:36 There's also an increased prevalence of community acquired methicillin resistant staph aureus.

00:44 For example, impetigo tends to be more extensive and severe, as seen on this slide.

00:51 You can see extensive crusting, as well as lesions that involve a larger surface area.

00:59 Other clinical manifestations are ecthyma folliculitis for ankylosis, cellulitis, and abscesses.

01:07 Patients may just present with multiple abscesses.

01:10 So besides thinking about diabetes and other and other as a chemotherapy agent, you always have to think about HIV and offer the patient for HIV screening when you see extensive bacterial infections on the skin. So as mentioned, these tend to be extensive and severe. And again, treatment may need to be taken by the patient for longer days.

01:37 This is a patient with cellulitis.

01:39 You can see the erythema the swelling of the leg and the blistering and bullae on the leg. Eczema, as I mentioned, also tends to be quite extensive. Numerous lesions, deep induration and inflammation. Moving on to mycobacterial skin infections. These are quite common among patients with AIDS.

02:04 There's always a high risk of dissemination of the disease and a high risk of hypersensitivity reactions, what we call the tuberculous.

02:14 We'll talk about this later.

02:17 Another ID reaction or tuberculoid is papular necrotic tuberculoid. And we also have a nice picture here showing a patient with papular necrotic tuberculoid with a blistering mantle, which is sometimes what we do to make sure that we are dealing with the correct diagnosis.

02:41 Here are some other manifestations of cutaneous tuberculosis.

02:46 This is a typical patient with lupus vulgaris, granulomatous cauliflower like lesions involving the nose, and you can see that this area of the nose seems to be collapsing as well.

02:59 Another example of TB of the skin is scrofula edema.

03:02 Again, we spoke in detail about this when we were talking about mycobacterium infections of the skin.

03:12 Syphilis is another condition that occurs commonly in patients with HIV AIDS. Most cases are clinically and serologically.

03:21 Typical syphilitic ulcers are believed to increase HIV transmission. Remember when you have a breakdown of the skin barrier, it is very easy for any infection to penetrate the skin.

03:37 There's a high rate of reinfection in patients who have HIV.