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AIDS fever of unknown origin
From WikEM
Contents
Background
Sources of fever vary by stage of disease. The CD4 count of < 200 × 106 cells/μL is very likely if the ED absolute lymphocyte count is < 950 × 10(6) cells/μL and less likely if the absolute lymphocyte count is > 1,700 × 106 cells/μL[1]
HIV Associated Diseases by CD4 Level
| CD4 Count | Stage | Diseases |
| >500 | Early disease | Similar to non-immunocompromised patients (Consider HAART medication side-effects) |
| 200-500 | Intermediate disease | Kaposi's sarcoma, Candida, bacterial respiratory infections |
| <200 | Late disease | PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis, endocarditis, lymphoma, histoplasmosis, cryptococcus, PML |
| <100 | Very late disease | Cryptococcus, Cryptosporidium, Toxoplasmosis |
| <50 | Final Stage | CMV retinitis, MAC |
CD4 >500
- Work-up similarly to nonimmunocompromised patients
CD4 200-500
- Early bacterial respiratory infection most common
CD4 <200
- PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis
- Also consider: endocarditis, lymphoma, histo, crypto
CD4 <100
- Consider disseminated MAC
- Toxoplasmosis (CNS or pulmonary)
Differential Diagnosis
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- AIDS fever of unknown origin
- Immune reconstitution inflammatory syndrome
- HIV diarrhea
- Kaposi's sarcoma
- Pruritic papular eruption of HIV
- HAART medication side effects[2]
- Lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
- CBC
- Chemistry
- LFT
- LDH
- RPR
- Urinalysis/Urine cultures
- Blood cultures
- Aerobic, anaerobic, fungal
- Crypto
- Toxo
- Coccidiodomycosis
- CXR
- Stool culture / O&P
- CT
- LP
- Cell count, protein, glucose, VDRL, cryptocoocal antigen, cytology, toxo, CMV, JC, EBV
Management
Disposition
See Also
References
- ↑ Napoli AM et al. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9.
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
