• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of cmrPermissionsJournals.ASM.orgJournalCMR ArticleJournal InfoAuthorsReviewers
Clin Microbiol Rev. Jul 1995; 8(3): 440–450.
PMCID: PMC174635

Cutaneous manifestations of opportunistic infections in patients infected with human immunodeficiency virus.

Abstract

Bacillary angiomatosis (BA) presents most commonly as a cutaneous disease and is caused by two organisms. Bartonella (Rochalimaea) henselae and Bartonella (Rochalimaea) quintana. Biopsy confirmation of cutaneous BA is essential because lesions can mimic nodular Kaposi's sarcoma in appearance. Although the vast majority of human immunodeficiency virus (HIV)-infected patients with BA have CD4 lymphocyte counts of less than 100 cells per mm3, the disease responds well to antimicrobial therapy. Staphylococcus aureus is the most common bacterial skin pathogen affecting HIV-infected patients. The prevalence of skin disease due to S. aureus may be explained by high nasal carriage rates for the organism ( > or = 50%) and altered immune function in conjunction with an impaired cutaneous barrier. Herpes simplex virus causes mucocutaneous disease early in the course HIV infection and ulcerative lesions at any site in advanced HIV infection. Herpes zoster is common early in the course of HIV infection; recurrent and disseminated herpes zoster infections are characteristic of patients with advanced HIV disease. Acyclovir resistance is usually seen in patients with large, untreated, ulcerative lesions of herpes simplex virus and in patients with chronic, verrucous lesions of varicella-zoster virus. Cutaneous cryptococcosis, histoplasmosis, and coccidiomycosis are markers of disseminated disease and require biopsy confirmation. Scabies is easily diagnosed but may be atypical in presentation and difficult to eradicate in advanced HIV disease.

Full Text

The Full Text of this article is available as a PDF (2.3M).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Anderson B, Kelly C, Threlkel R, Edwards K. Detection of Rochalimaea henselae in cat-scratch disease skin test antigens. J Infect Dis. 1993 Oct;168(4):1034–1036. [PubMed]
  • Bagdades EK, Pillay D, Squire SB, O'Neil C, Johnson MA, Griffiths PD. Relationship between herpes simplex virus ulceration and CD4+ cell counts in patients with HIV infection. AIDS. 1992 Nov;6(11):1317–1320. [PubMed]
  • Becker BA, Frieden IJ, Odom RB, Berger TG. Atypical plaquelike staphylococcal folliculitis in human immunodeficiency virus-infected persons. J Am Acad Dermatol. 1989 Nov;21(5 Pt 1):1024–1026. [PubMed]
  • Berger TG, Greene I. Bacterial, viral, fungal, and parasitic infections in HIV disease and AIDS. Dermatol Clin. 1991 Jul;9(3):465–492. [PubMed]
  • Berger TG, Tappero JW, Kaymen A, LeBoit PE. Bacillary (epithelioid) angiomatosis and concurrent Kaposi's sarcoma in acquired immunodeficiency syndrome. Arch Dermatol. 1989 Nov;125(11):1543–1547. [PubMed]
  • Birch CJ, Tyssen DP, Tachedjian G, Doherty R, Hayes K, Mijch A, Lucas CR. Clinical effects and in vitro studies of trifluorothymidine combined with interferon-alpha for treatment of drug-resistant and -sensitive herpes simplex virus infections. J Infect Dis. 1992 Jul;166(1):108–112. [PubMed]
  • Brenner DJ, O'Connor SP, Winkler HH, Steigerwalt AG. Proposals to unify the genera Bartonella and Rochalimaea, with descriptions of Bartonella quintana comb. nov., Bartonella vinsonii comb. nov., Bartonella henselae comb. nov., and Bartonella elizabethae comb. nov., and to remove the family Bartonellaceae from the order Rickettsiales. Int J Syst Bacteriol. 1993 Oct;43(4):777–786. [PubMed]
  • Buchbinder SP, Katz MH, Hessol NA, Liu JY, O'Malley PM, Underwood R, Holmberg SD. Herpes zoster and human immunodeficiency virus infection. J Infect Dis. 1992 Nov;166(5):1153–1156. [PubMed]
  • Chatis PA, Miller CH, Schrager LE, Crumpacker CS. Successful treatment with foscarnet of an acyclovir-resistant mucocutaneous infection with herpes simplex virus in a patient with acquired immunodeficiency syndrome. N Engl J Med. 1989 Feb 2;320(5):297–300. [PubMed]
  • Cohen PR, Grossman ME. Clinical features of human immunodeficiency virus-associated disseminated herpes zoster virus infection--a review of the literature. Clin Exp Dermatol. 1989 Jul;14(4):273–276. [PubMed]
  • Colebunders R, Mann JM, Francis H, Bila K, Izaley L, Ilwaya M, Kakonde N, Quinn TC, Curran JW, Piot P. Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection. J Infect Dis. 1988 Feb;157(2):314–318. [PubMed]
  • Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection. N Engl J Med. 1993 Jun 10;328(23):1670–1674. [PubMed]
  • Crowe SM. Unusual features of herpes simplex or zoster infection that suggest HIV infection. Med J Aust. 1993 Feb 1;158(3):186–187. [PubMed]
  • Dolan MJ, Wong MT, Regnery RL, Jorgensen JH, Garcia M, Peters J, Drehner D. Syndrome of Rochalimaea henselae adenitis suggesting cat scratch disease. Ann Intern Med. 1993 Mar 1;118(5):331–336. [PubMed]
  • Duvic M. Staphylococcal infections and the pruritus of AIDS-related complex. Arch Dermatol. 1987 Dec;123(12):1599–1599. [PubMed]
  • Ellis M, Gupta S, Galant S, Hakim S, VandeVen C, Toy C, Cairo MS. Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation. J Infect Dis. 1988 Dec;158(6):1268–1276. [PubMed]
  • Engel JP, Englund JA, Fletcher CV, Hill EL. Treatment of resistant herpes simplex virus with continuous-infusion acyclovir. JAMA. 1990 Mar 23;263(12):1662–1664. [PubMed]
  • Erlich KS, Jacobson MA, Koehler JE, Follansbee SE, Drennan DP, Gooze L, Safrin S, Mills J. Foscarnet therapy for severe acyclovir-resistant herpes simplex virus type-2 infections in patients with the acquired immunodeficiency syndrome (AIDS). An uncontrolled trial. Ann Intern Med. 1989 May 1;110(9):710–713. [PubMed]
  • Erlich KS, Mills J, Chatis P, Mertz GJ, Busch DF, Follansbee SE, Grant RM, Crumpacker CS. Acyclovir-resistant herpes simplex virus infections in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1989 Feb 2;320(5):293–296. [PubMed]
  • Eyster ME, Rabkin CS, Hilgartner MW, Aledort LM, Ragni MV, Sprandio J, White GC, Eichinger S, de Moerloose P, Andes WA, et al. Human immunodeficiency virus-related conditions in children and adults with hemophilia: rates, relationship to CD4 counts, and predictive value. Blood. 1993 Feb 1;81(3):828–834. [PubMed]
  • Funkhouser ME, Omohundro C, Ross A, Berger TG. Management of scabies in patients with human immunodeficiency virus disease. Arch Dermatol. 1993 Jul;129(7):911–913. [PubMed]
  • Ganesh R, Castle D, McGibbon D, Phillips I, Bradbeer C. Staphylococcal carriage and HIV infection. Lancet. 1989 Sep 2;2(8662):558–558. [PubMed]
  • Gaut P, Wong PK, Meyer RD. Pyomyositis in a patient with the acquired immunodeficiency syndrome. Arch Intern Med. 1988 Jul;148(7):1608–1610. [PubMed]
  • Gilson IH, Barnett JH, Conant MA, Laskin OL, Williams J, Jones PG. Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome. J Am Acad Dermatol. 1989 Apr;20(4):637–642. [PubMed]
  • Hardy WD. Foscarnet treatment of acyclovir-resistant herpes simplex virus infection in patients with acquired immunodeficiency syndrome: preliminary results of a controlled, randomized, regimen-comparative trial. Am J Med. 1992 Feb 14;92(2A):30S–35S. [PubMed]
  • Heinic GS, Northfelt DW, Greenspan JS, MacPhail LA, Greenspan D. Concurrent oral cytomegalovirus and herpes simplex virus infection in association with HIV infection. A case report. Oral Surg Oral Med Oral Pathol. 1993 Apr;75(4):488–494. [PubMed]
  • Hirsch MS, Schooley RT. Resistance to antiviral drugs: the end of innocence. N Engl J Med. 1989 Feb 2;320(5):313–314. [PubMed]
  • Horn TD, Hood AF. Cytomegalovirus is predictably present in perineal ulcers from immunosuppressed patients. Arch Dermatol. 1990 May;126(5):642–644. [PubMed]
  • Jacobson MA, Berger TG, Fikrig S, Becherer P, Moohr JW, Stanat SC, Biron KK. Acyclovir-resistant varicella zoster virus infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1990 Feb 1;112(3):187–191. [PubMed]
  • Jacobson MA, Gellermann H, Chambers H. Staphylococcus aureus bacteremia and recurrent staphylococcal infection in patients with acquired immunodeficiency syndrome and AIDS-related complex. Am J Med. 1988 Aug;85(2):172–176. [PubMed]
  • Jura E, Chadwick EG, Josephs SH, Steinberg SP, Yogev R, Gershon AA, Krasinski KM, Borkowsky W. Varicella-zoster virus infections in children infected with human immunodeficiency virus. Pediatr Infect Dis J. 1989 Sep;8(9):586–590. [PubMed]
  • Koehler JE, Glaser CA, Tappero JW. Rochalimaea henselae infection. A new zoonosis with the domestic cat as reservoir. JAMA. 1994 Feb 16;271(7):531–535. [PubMed]
  • Koehler JE, Quinn FD, Berger TG, LeBoit PE, Tappero JW. Isolation of Rochalimaea species from cutaneous and osseous lesions of bacillary angiomatosis. N Engl J Med. 1992 Dec 3;327(23):1625–1631. [PubMed]
  • Koehler JE, Tappero JW. Bacillary angiomatosis and bacillary peliosis in patients infected with human immunodeficiency virus. Clin Infect Dis. 1993 Oct;17(4):612–624. [PubMed]
  • Kory WP, Rico MJ, Gould E, Penneys NS. Dermatopathologic findings in patients with acquired immunodeficiency syndrome. South Med J. 1987 Dec;80(12):1529–1532. [PubMed]
  • LeBoit PE, Berger TG, Egbert BM, Beckstead JH, Yen TS, Stoler MH. Bacillary angiomatosis. The histopathology and differential diagnosis of a pseudoneoplastic infection in patients with human immunodeficiency virus disease. Am J Surg Pathol. 1989 Nov;13(11):909–920. [PubMed]
  • Melbye M, Grossman RJ, Goedert JJ, Eyster ME, Biggar RJ. Risk of AIDS after herpes zoster. Lancet. 1987 Mar 28;1(8535):728–731. [PubMed]
  • Pahwa S, Biron K, Lim W, Swenson P, Kaplan MH, Sadick N, Pahwa R. Continuous varicella-zoster infection associated with acyclovir resistance in a child with AIDS. JAMA. 1988 Nov 18;260(19):2879–2882. [PubMed]
  • Patterson LE, Butler KM, Edwards MS. Clinical herpes zoster shortly following primary varicella in two HIV-infected children. Clin Pediatr (Phila) 1989 Aug;28(8):354–354. [PubMed]
  • Perkins BA, Swaminathan B, Jackson LA, Brenner DJ, Wenger JD, Regnery RL, Wear DJ. Case 22-1992--pathogenesis of cat scratch disease. N Engl J Med. 1992 Nov 26;327(22):1599–1601. [PubMed]
  • Perronne C, Lazanas M, Leport C, Simon F, Salmon D, Dallot A, Vildé JL. Varicella in patients infected with the human immunodeficiency virus. Arch Dermatol. 1990 Aug;126(8):1033–1036. [PubMed]
  • Picon L, Vaillant L, Duong T, Lorette G, Bacq Y, Besnier JM, Choutet P. Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS. Acta Derm Venereol. 1989;69(4):365–367. [PubMed]
  • Raphael SA, Wolfson BJ, Parker P, Lischner HW, Faerber EN. Pyomyositis in a child with acquired immunodeficiency syndrome. Patient report and brief review. Am J Dis Child. 1989 Jul;143(7):779–781. [PubMed]
  • Reed JA, Brigati DJ, Flynn SD, McNutt NS, Min KW, Welch DF, Slater LN. Immunocytochemical identification of Rochalimaea henselae in bacillary (epithelioid) angiomatosis, parenchymal bacillary peliosis, and persistent fever with bacteremia. Am J Surg Pathol. 1992 Jul;16(7):650–657. [PubMed]
  • Regnery RL, Anderson BE, Clarridge JE, 3rd, Rodriguez-Barradas MC, Jones DC, Carr JH. Characterization of a novel Rochalimaea species, R. henselae sp. nov., isolated from blood of a febrile, human immunodeficiency virus-positive patient. J Clin Microbiol. 1992 Feb;30(2):265–274. [PMC free article] [PubMed]
  • Regnery RL, Olson JG, Perkins BA, Bibb W. Serological response to "Rochalimaea henselae" antigen in suspected cat-scratch disease. Lancet. 1992 Jun 13;339(8807):1443–1445. [PubMed]
  • Relman DA, Loutit JS, Schmidt TM, Falkow S, Tompkins LS. The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens. N Engl J Med. 1990 Dec 6;323(23):1573–1580. [PubMed]
  • Rolston KV, Uribe-Botero G, Mansell PW. Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. Am J Med. 1987 Sep;83(3):604–605. [PubMed]
  • Safrin S, Berger TG, Gilson I, Wolfe PR, Wofsy CB, Mills J, Biron KK. Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection. Ann Intern Med. 1991 Jul 1;115(1):19–21. [PubMed]
  • Safrin S, Crumpacker C, Chatis P, Davis R, Hafner R, Rush J, Kessler HA, Landry B, Mills J. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. The AIDS Clinical Trials Group. N Engl J Med. 1991 Aug 22;325(8):551–555. [PubMed]
  • Safrin S, Kemmerly S, Plotkin B, Smith T, Weissbach N, De Veranez D, Phan LD, Cohn D. Foscarnet-resistant herpes simplex virus infection in patients with AIDS. J Infect Dis. 1994 Jan;169(1):193–196. [PubMed]
  • Schwartz JJ, Myskowski PL. Molluscum contagiosum in patients with human immunodeficiency virus infection. A review of twenty-seven patients. J Am Acad Dermatol. 1992 Oct;27(4):583–588. [PubMed]
  • Slater LN, Welch DF, Hensel D, Coody DW. A newly recognized fastidious gram-negative pathogen as a cause of fever and bacteremia. N Engl J Med. 1990 Dec 6;323(23):1587–1593. [PubMed]
  • Snoeck R, Andrei G, Gérard M, Silverman A, Hedderman A, Balzarini J, Sadzot-Delvaux C, Tricot G, Clumeck N, De Clercq E. Successful treatment of progressive mucocutaneous infection due to acyclovir- and foscarnet-resistant herpes simplex virus with (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC). Clin Infect Dis. 1994 Apr;18(4):570–578. [PubMed]
  • Stockman L, Clark KA, Hunt JM, Roberts GD. Evaluation of commercially available acridinium ester-labeled chemiluminescent DNA probes for culture identification of Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans, and Histoplasma capsulatum. J Clin Microbiol. 1993 Apr;31(4):845–850. [PMC free article] [PubMed]
  • Stoler MH, Bonfiglio TA, Steigbigel RT, Pereira M. An atypical subcutaneous infection associated with acquired immune deficiency syndrome. Am J Clin Pathol. 1983 Nov;80(5):714–718. [PubMed]
  • Tappero JW, Koehler JE, Berger TG, Cockerell CJ, Lee TH, Busch MP, Stites DP, Mohle-Boetani J, Reingold AL, LeBoit PE. Bacillary angiomatosis and bacillary splenitis in immunocompetent adults. Ann Intern Med. 1993 Mar 1;118(5):363–365. [PubMed]
  • Tappero JW, Mohle-Boetani J, Koehler JE, Swaminathan B, Berger TG, LeBoit PE, Smith LL, Wenger JD, Pinner RW, Kemper CA, et al. The epidemiology of bacillary angiomatosis and bacillary peliosis. JAMA. 1993 Feb 10;269(6):770–775. [PubMed]
  • Toth IR, Kazal HL. Botryomycosis in acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1987 Mar;111(3):246–249. [PubMed]
  • Zangwill KM, Hamilton DH, Perkins BA, Regnery RL, Plikaytis BD, Hadler JL, Cartter ML, Wenger JD. Cat scratch disease in Connecticut. Epidemiology, risk factors, and evaluation of a new diagnostic test. N Engl J Med. 1993 Jul 1;329(1):8–13. [PubMed]

Articles from Clinical Microbiology Reviews are provided here courtesy of American Society for Microbiology (ASM)

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...