Viral Infections

Presents with painful ulcerative lesions. In immunocompromised individuals, there is a risk of disseminated disease, such as life-threatening hepatitis and encephalitis.

Varicella zoster virus causes either chickenpox (primary infection) or shingles (reactivation). Chickenpox is characterised by rapid progression of maculopapular to vesicular and pustular rash.
Shingles present as painful vesicular rash in a dermatomal distribution.

Human herpesvirus-8 (HHV-8) causes Kaposi’s sarcoma (see AIDS and Other Complications of HIV).

Chickenpox is generally self-limiting. In immunocompromised (and pregnant) individuals, exposure can be treated prophylactically with aciclovir, and high-dose aciclovir is indicated to treat the disease.

Prophylaxis with varicella-zoster immunoglobulin (VZIG) is indicated in immunocompromised individuals unable to take oral antivirals and neonates who are less than one week old.

Aciclovir is indicated in shingles if present within 72 hours of onset.

People aged over 70 are eligible for a shingles vaccination in the UK.

It may also cause oral hairy leukoplakia – tongue disease, which presents as white ridged patches on lateral borders or buccal mucosa.

Anti-cancer treatment, if indicated.

HPV-16 and 18 are associated with an increased cervical, anal and oropharyngeal cancer risk.

HIV positive patients should be offered the vaccine.

Warts can be treated with podophyllin topical agents, cryotherapy, cautery, or laser ablation.

Anti-cancer treatment, if indicated.

Presents with progressive neurological or cognitive deficits – generally rapidly progressive.

Characteristic multiple non-enhancing white matter lesions on MRI. The virus can be identified through PCR of CSF from the lumbar puncture.

CMV colitis presents with abdominal pain, tenderness, bloody or non-bloody diarrhoea, and fever.

An abdominal x-ray may show dilated large bowel. Sigmoidoscopy shows ulcerated mucosa, and histology demonstrates cytoplasmic inclusion bodies with a characteristic “owl’s eye” appearance.

Neurological manifestations include encephalopathy and polyradiculopathy.

CMV retinitis occurs when the CD4 count is less than 50. Presents as painful visual field loss associated with a headache – classically unilateral, may progress to bilateral.

Clinical diagnosis through fundoscopy – characteristic “pizza pie” appearance of the retina.

In CMV retinitis, if not fully treated, then the virus can become reactivated and cause permanent visual loss.