When a patient presents with fever and headache one always worries about meningitis. Here us a quick overview of the basics provided by the facilitator.
In addition to the differential of fever and headache including meningitis, another consideration in the appropriate clinical scenario may be seroconversion of HIV. Fever is a common presenting complaint. Headaches can also accompany acute illness and tends to be described as retro-orbital pain exacerbated by eye movement.
SEROCONVERSION ILLNESS:
The symptoms of acute primary HIV infection are non-specific and often resemble those of other viral illness such as mononucleosis. The most frequent symptoms include fever, lymphadenopathy, sore throat, mucocutaneous lesions, myalgias / arthralgias, diarrhea, nausea vomiting, weight loss and headache. Although it is challenging to discern the frequency of the syndrome vs. subclinical acute infections, many people feel this syndrome is under recognised and occurs in approaching 90% of patients.
The acute illness occurs generally within 2-4 weeks of infection although has been documents up to 10 months after exposure. The symptoms described come on rapidly to their most severe within about 24-48 hours. They are self-resolving within 2 weeks although general fatigue may continue for months.
Lab findings: Initially leukocytes fall. Eventually lymphocyte recovery is seen with CD8> that CD4 resulting in the ratio (CD4:CD8) less than 1.0. Other findings include hepatitis and thrombocytopenia.
Clinical Implications: Patients with severe acute illness are felt to have high infectivity and have a worse long term prognosis in terms of rate of progression of their disease. More recently, evidence for initiation of treatment during the acute illness is mounting.
Of final note… during the acute illness HIV antibody testing may be used to make the diagnosis. If is falsely negative due to lack of seroconversion an HIV RNA may be used in suggestive cases. A CD4 count is occasionally used as a surrogate but there is a differential associated with a low CD4 count so it is far from a diagnostic test. Please see article: Current Opinion in Rheumatology 2006;18:389-95
In addition to the differential of fever and headache including meningitis, another consideration in the appropriate clinical scenario may be seroconversion of HIV. Fever is a common presenting complaint. Headaches can also accompany acute illness and tends to be described as retro-orbital pain exacerbated by eye movement.
SEROCONVERSION ILLNESS:
The symptoms of acute primary HIV infection are non-specific and often resemble those of other viral illness such as mononucleosis. The most frequent symptoms include fever, lymphadenopathy, sore throat, mucocutaneous lesions, myalgias / arthralgias, diarrhea, nausea vomiting, weight loss and headache. Although it is challenging to discern the frequency of the syndrome vs. subclinical acute infections, many people feel this syndrome is under recognised and occurs in approaching 90% of patients.
The acute illness occurs generally within 2-4 weeks of infection although has been documents up to 10 months after exposure. The symptoms described come on rapidly to their most severe within about 24-48 hours. They are self-resolving within 2 weeks although general fatigue may continue for months.
Lab findings: Initially leukocytes fall. Eventually lymphocyte recovery is seen with CD8> that CD4 resulting in the ratio (CD4:CD8) less than 1.0. Other findings include hepatitis and thrombocytopenia.
Clinical Implications: Patients with severe acute illness are felt to have high infectivity and have a worse long term prognosis in terms of rate of progression of their disease. More recently, evidence for initiation of treatment during the acute illness is mounting.
Of final note… during the acute illness HIV antibody testing may be used to make the diagnosis. If is falsely negative due to lack of seroconversion an HIV RNA may be used in suggestive cases. A CD4 count is occasionally used as a surrogate but there is a differential associated with a low CD4 count so it is far from a diagnostic test. Please see article: Current Opinion in Rheumatology 2006;18:389-95
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