HIV AIDS differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ujjwal Rastogi, MBBS, Ammu Susheela, M.D. [2]
Overview
Acute HIV infection may be asymptomatic or may cause a mononucleosis-like syndrome. It should be differentiated from similar diseases that cause fever, fatigue, sore throat, myalgia, and lymphadenopathy. On the other hand, AIDS should be considered in all patients presenting with symptoms of immunodeficiency or opportunistic infections. AIDS should be distinguished from congenital disorders that cause childhood immunodeficiency. It should also be distinguished from various medical states that cause immunosuppression including common variable immune deficiency (SCID), chemotherapy treatment, steroid therapy, and severe malnutrition.[1]
Differential Diagnosis
Acute HIV
| Disorder | Disease Definition |
|---|---|
| Burkitt's lymphoma | Burkitt's lymphoma (or "Burkitt's tumor", or "Malignant lymphoma, Burkitt's type") is a cancer of the lymphatic system (in particular, B lymphocytes). It is associated with the Epstein-Barr virus, also the cause of infectious mononucleosis as well as other cancers such as nasopharyngeal carcinoma and thymic carcinoma. |
| Influenza | Influenza is an infectious disease caused by RNA viruses of the biological family Orthomyxoviridae. The common symptoms of influenza infection are fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort. In more serious cases, influenza causes pneumonia, which can be fatal, particularly in young children and the elderly |
| Streptococcal pharyngitis | Streptococcal pharyngitis is a form of group A streptococcal infection that affects the pharynx, and possibly the larynx and tonsils and presents as sore throat. Similar symptoms may be seen with acute HIV syndrome |
| Viral gastroenteritis | Gastroenteritis is the inflammation of the stomach and the small and large intestines. Viral gastroenteritis is an infection caused by a variety of viruses or bacteria that presents with abdominal pain, vomiting, and/or diarrhea. |
| Viral upper respiratory tract infection | A variety of acute viral infections of the upper respiratory tract can cause symptoms similar to the acute HIV syndrome including fever, myalgia, pharyngitis, and malaise. |
| Acute viral hepatitis | Acute viral inflammation of the liver can cause loss of appetite, malaise, jaundice and other constitutional syndromes similar to acute HIV. |
| Primary herpes simplex infection | Herpes simplex is a viral infection that causes that can produce various symptoms depending on the sites of infection. Oral herpes can cause cold sores in mouth and is the most common for of Infection. It can have active and latent phases. Although Herpes can occur as an opportunistic infection in the immunocompromised state of AIDS infection, primary herpes simplex infection can be a differential diagnosis of AIDS. |
| Secondary syphilis | After 4-10 weeks of primary syphilis , secondary syphilis can occur affecting skin, mucous membrane and lymph nodes. They can present with fever, malaise, sore throat, weight loss, headache , hair loss. |
| Acute CMV infection | Human cytomegalovirus is a genus of viruses belonging to the viral family herpesviridae. CMV infection is typically unnoticed in healthy people, but can be life-threatening for immunocompromised patients, particularly those with AIDS, organ transplant recipients, and newborns. CMV infections may present with a mononucleosis-like syndrome seen in patients with acute HIV syndrome. |
| Acute toxoplasmosis | A parasitic disease caused by ingestion of cat feces, affect all organs and particularly dangerous in pregnant woman. Toxoplasma infections may also present with a mononucleosis-like syndrome seen in patients with acute HIV syndrome. |
| Brucellosis | Brucellosis is a Zoonotic disease caused by bacteria of the genus Brucella. It is primarily a disease of domestic animals (goats, pigs, cattle, dogs, etc) and humans and has a worldwide distribution, mostly now in developing countries. |
| Disseminated goncoccemia | Gonococcemia is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or arthritis. |
| Measles | Measles is a disease caused by the measles virus belonging to the genus Morbillivirus. It is transmitted into by contact and aerosols. Symptoms include the appearance of a diffuse maculopapular rash along with fever, cough, coryza, conjunctivitis, malaise, and fatigue. |
| Meningitis/Encephalitis | Encephalitis is an acute inflammation of the brain, commonly caused by a viral or bacterial infections. |
| Primary immunodeficiencies | Other immunodeficiency syndromes can produce similar symptoms of AIDS. These include primary congenital immunodeficiencies, secondary immunodeficiencies particularly iatrogenic and neoplastic in nature. |
| Malaria | Malaria is a vector-borne infectious disease caused by protozoan parasites. Malaria is one of the most common infectious diseases and an enormous public-health problem. The disease is caused by protozoan parasites of the genus Plasmodium. The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodium ovale,Plasmodium malariae, and sometimes Plasmodium knowlesi) can also infect humans. Malaria may present with cyclical fevers, myalgia, and other flu-like syndromes that may be observed in patients with acute HIV syndrome.
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| Typhoid | Typhoid fever, also known as enteric fever, is an illness caused by the bacterium Salmonella enterica serovar typhi. Common worldwide, it is transmitted by the fecal-oral route. Symptoms include adbominal pain, fever, malaise, headache, and bradycardia. |
| Rubella | Rubella is a common childhood infection usually with minimal systemic manifestations. Transplacental infection is a particular concern given the increased risk of congenital defects. |
AIDS
The table shown bellow describes the most common conditions that should be differentiated from AIDS as they all cause immunodeficiency and patients with those diseases are prone to opportunistic infections.
| Condition | Description |
|---|---|
| Cancer | |
| Chemotherapy [2][3] | Immunosuppresive drugs will benefit patients with certain conditions, such as cancer or rheumatic diseases, but will diminish the immune response by interfering with nucleic acid synthesis and affecting B and T cells. This includes drugs such as methotrexate, azathioprine, mercaptopurine, fluorouracil, and dactinomycin. |
| Steroid Therapy | Glucocorticoids act by inhibiting genes that code for the cytokines and humoral activity, which leads to immunosuppresion when used for long periods of time. Opportunistic infections such as candidiasis or herpes zoster may be seen in these patients. |
| Malnutrition | Patients with malnutrition will have a weakened immune system due to the lack of essential nutrients to create new immune cells and are prone to infections that are also seen in AIDS. Special populations are prone to malnutrition, such as kids (marasmus, kwashiorkor) and the elderly. |
| Common Variable Immunodeficiency (CVID) | |
| Other Congenital Immunodeficiencies | This include: Severe Combined Immunodeficiency (SCID), X-linked agammaglobulinemia, DiGeorge syndrome, Wiskott-Aldrich syndrome, and Selective IgA deficiency. |
References
- ↑ "AIDSinfo".
- ↑ Morrison VA (2014). "Immunosuppression associated with novel chemotherapy agents and monoclonal antibodies". Clin Infect Dis. 59 Suppl 5: S360–4. doi:10.1093/cid/ciu592. PMID 25352632.
- ↑ Fabiani S, Bruschi F (2014). "Rheumatological patients undergoing immunosuppressive treatments and parasitic diseases: a review of the literature of clinical cases and perspectives to screen and follow-up active and latent chronic infections". Clin Exp Rheumatol. 32 (4): 587–96. PMID 25065776.