Fungal Skin Infections in HIV Patients with Darker Skin

00:01 Now let's talk about fungal skin infections in HIV patients.

00:05 The first one that we're going to focus on is candidiasis.

00:08 It is the most common mucocutaneous manifestation of HIV AIDS.

00:14 One gets occurrence of oropharyngeal or esophageal candidiasis as an indicator of immune suppression.

00:24 This is not to say that patients who have oral Candida always have HIV.

00:29 We spoke about some of the predisposing factors in our previous lecture.

00:32 For example, patients with poorly controlled diabetes and patients with other malignancies. So one may present with oral or fracture lesions that are affected with Candida, and it may be severe and recurrent.

00:46 This is a typical example of extensive oral candidiasis.

00:51 You would even think that this patient is drinking sour milk or is eating natural yogurt. That is typical extensive oral candida due to a patient who's been infected with HIV or AIDS.

01:07 The treatment is similar to immunocompetent patients, but may require a longer duration, more potent medication, and a more aggressive approach.

01:17 Now let's talk about dermatophyte infections in HIV.

01:21 They are very common amongst HIV patients and can occur at any point of illness.

01:26 They usually are atypical.

01:28 The multiple or there can be extensive.

01:31 I remember this patient actually, who presented with extensive involvement of the body due to a tinea corporis, and we actually tried to publish this case as an example of an electrodynamic dermatophytic infection.

01:49 It can also present with little to no inflammation at all, and we call this energetic infection.

01:55 This is an example of extensive tinea corporis.

01:58 And you can see that on the right hand side of the picture, it's very difficult to see the spreading edge of tinea corporis that we spoke about in our previous lecture.

02:08 And this is due to the depressed immunity.

02:12 Another example is extensive onychomycosis, which involves multiple toenails. And we spoke about superficial white onychomycosis.

02:21 And you can see that in this patient.

02:23 And of course the other lesions are like looking on the right big toe.

02:27 You see dystrophic and discolored nails, which are all cutaneous manifestations of onychomycosis. The treatment is similar to immunocompetent patients. However, one may require a longer duration of treatment, potent medication and a more aggressive approach, sometimes a combination of antifungals.

02:50 Now let's talk about deep fungal infections.

02:54 It occurs in cases of severe immunodeficiency.

03:00 It could be histoplasmosis, cryptococcosis, sporotrichosis or any of the deep fungal infections.

03:06 It can present as papules, nodules, plaques, abscesses with further systemic involvement meaning that the patient the lesions the infection can spread from the skin to the systemic organs, be it the lungs or the liver.

03:24 Cryptococcus is a typical cutaneous manifestations of deep fungal infection in patients with HIV.

03:31 You see the umbilicated lesions with central hemorrhagic necrosis.

03:35 And this is how we differentiate it from molluscum contagiosum.

03:41 Histoplasmosis is another deep fungal infection and this can present a myriad of skin manifestations could be papules, plaques, umbilicated lesions, ulcerations, nodules, any of those skin manifestations.

03:57 The treatment, again is similar to immunocompetent patients but may require high doses, longer duration and more aggressive approach.

04:06 It's always crucial that in these patients you look for systemic involvement.