Treatment of bacterial, fungal, and parasitic infections in the HIV-infected host

Abstract

In the human immunodeficiency virus (HIV) infected patient, skin infections caused by S aureus are extremely common. Impetigo, ecthyma, and folliculitis are all seen. Recurrences are common due to a nasal carriage rate of 50%. Dermatophytosis usually manifests as tinea pedis or unguium and is caused by Trichophyton rubrum. Oral candidiasis may be the initial evidence of HIV infection, and is predictive of more rapid progression to acquired immune deficiency syndrome (AIDS). Topical agents are usually effective for oral lesions, but involvement of the esophagus requires oral imidazole therapy. Systemic fungal infections are most commonly caused by cryptococcosis or histoplasmosis. The finding of either of these infectious agents in the skin is pathognomonic of disseminated infection. Cryptococcus presents as umbilicated papules resembling molluscum or as large ulcerations. Histoplasmosis has no specific cutaneous morphology. Scabies is very common in HIV-infected persons, and once the helper T-cell count is less than 200, it may present atypically. Permethrin is the recommended treatment in this setting.