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- Presentation
U010. Dermatologic Infections in the Immunocompromised Host
Description
The presentation discusses dermatologic infections in immunocompromised patients, particularly those with iatrogenic immunosuppression (like TNF alpha inhibitors) and HIV. A case study of a patient with Crohn's disease receiving adalimumab introduced the topic, highlighting that such medications increase susceptibility to various infections, particularly mycobacterial and fungal infections. The speaker outlined a differential diagnosis based on patient symptoms, exposure history, and lesion morphology. For individuals on TNF inhibitors, infections like Staphylococcus aureus and tuberculosis are common, while those with HIV may exhibit umbilicated papules linked to infections such as cryptococcosis, histoplasmosis, molluscum contagiosum, and mpox. Treatment approaches were discussed, including the usefulness of broad-range PCR and next-generation sequencing for difficult diagnoses, while emphasizing the importance of managing underlying conditions like HIV to improve skin manifestations. The presentation concluded with clinical pearls focused on recognizing types of rashes, the significance of immune status, and appropriate treatment modalities in these complex cases.
View moreConclusions
- Patients with iatrogenic immunosuppression and HIV are at increased risk for specific dermatologic infections.
- TNF-alpha inhibitors elevate the risk of infections such as mycobacterial, fungal, viral, and some bacterial infections.
- Infections can be more common in the early stages of treatment with TNF-alpha inhibitors, particularly in the first six months.
- Patients with inflammatory bowel disease on TNF-alpha inhibitors may experience a reduced risk of infections after one year of therapy.
- In instances of negative cultures, broad-range PCR and next-generation sequencing can aid in diagnosing difficult infections.
- Mycobacterium marinum was successfully identified using broad-range PCR and treated with a prolonged course of antituberculosis medication.
- HIV-positive patients, particularly with low CD4 counts, exhibit unique infections and dermatological manifestations that necessitate careful monitoring and treatment adjustment.
- Umbilicated papules in HIV patients require considering diagnoses like cryptococcosis, histoplasmosis, molluscum contagiosum, mpox, and penicilliosis.
- Early markers of severe mpox infection in uncontrolled HIV patients include specific clinical signs such as periorbital edema and central facial necrosis.
- The management of chronic dermatological infections in immunocompromised patients may often benefit from a 'tincture of time' approach alongside ART initiation.
- Jacobs M, et al. Microbes Infec 2007.
- Lichtenstein G, et al. Clin Gastroenterol Hepatol 2006.
- Bongartz T, et al. JAMA 2006.
- Dommasch ED, et al. JAAD 2011.
- Nyboe Andersen N, et al. BMJ 2015.
- Galloway J, et al. Rheumatology 2011.
- Holmgren J, et al. Inflamm Bowel Dis 2023.
- Casto A, et al. Blood Rev 2022.
- David E. Griffith, Timothy Aksamit, Barbara A. Brown-Elliott, Antonino Catanzaro, Charles Daley, Fred Gordin, Steven M. Holland, Robert Horsburgh, Gwen Huitt, Michael F. Lademarco, Michael Iseman, Kenneth Olivier, Stephen Ruoss, C. Fordham von Reyn, Richard J. Wallace, Jr., and Kevin Winthrop. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases.
- Li S, et al. Front Immunol 2022.
- Srivastava G, et al. BMJ Case Rep 2015.
- Azar M, et al. Am J Trop Med Hyg 2016.
- Wanat K, et al. J Am Acad Dermatol 2017.
- Cao C, et al. Mycopathologia 2019.