QUATER-1-PE-HEALTH-LC2- this is just a sample of unpacked lesson
PPT TC HIV.pptx
1. VISI PROGRAM STUDI
• Menjadi Program Studi Dermatologi dan Venereologi
yang terkemuka dan bermartabat serta unggul dalam
menangani penyakit kulit dan kelamin tidak menular
dengan bahan dasar alam di Indonesia pada tahun
2023
DERMATOLOGY & VENEREOLOGY
DEPARTMENT OF
2. • Menyelenggarakan dan mengembangkan pendidikan
berkualitas untuk menghasilkan tenaga Dokter Spesialis
Dermatologi dan Venereologi yang profesional dengan
penguatan kurikulum penyakit kulit dan kelamin tidak
menular dengan bahan dasar alam
• Melaksanakan penelitian dalam mengembangkan ilmu
pengetahuan di bidang Dermatologi dan Venereologi
yang sesuai dengan perkembangan
DERMATOLOGY & VENEREOLOGY
DEPARTMENT OF
MISI PROGRAM STUDI
3. • Melaksanakan pengabdian kepada masyarakat yang
berkualitas berdasarkan perkembangan ilmu kedokteran
di bidang Dermatologi dan Venereologi terkini dengan
melibatkan peran serta masyarakat
• Mengembangkan organisasi dalam meningkatkan tata
kelola yang baik serta mampu beradaptasi dengan
perubahan lingkungan yang strategis
MISI PROGRAM STUDI
DERMATOLOGY & VENEREOLOGY
DEPARTMENT OF
4. CLINICAL APPEARANCE OF TINEA CORPORIS
RESEMBLES WITH TINEA IMBRICATA AND
CONDYLOMA ACUMINATA GENITAL IN HIV
PATIENT:
A CASE REPORT
DERMATOLOGY & VENEREOLOGY
INDAH KENCANA
1650308203
Infection Division
Counselor: dr. Tutty Ariani, Sp.DV
DEPARTMENT OF
6. HIV (human immunodeficiency virus) is a
virus that attacks and impairs the
function of immune cells, infected
individuals gradually become
immunodeficiency.
Immunodeficiency results in increased
susceptibility to opportunistic infections
(OI), cancers, and other conditions.
The risk for the development of OI in HIV patients depends on exposure to potential pathogens,
virulence of the pathogens, the degree of host immunity, and the use of antimicrobial prophylaxis.
• Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. The
incidence of dermatophytosis in HIV patients was about 15–40%.
• There is a significant increase in the number of HIV target cells in CA genital and provides evidence
of enhanced HIV infection of CA genital in vitro CA genital may provide portals for HIV
transmission
7. Patient Identity
Name : Ms DS
Age : 33 years old
Sex : Female
Occupation : Midwife
Religion : Moslem
Status : Unmarried
Ethnic : Minangnesse
Address : Dipenogoro Street No. 21, Kampung Pondok, Pariaman Tengah
9. Initially, there were itchy reddish patches on the right back since 3 weeks ago.
Patients often scratch it especially when sweating and hot weather.
The itchy reddish patches with scaly were increased in number and size on the
right back then spreading over the edge to form ring-like patches. Patient did not
treat that ring-shaped reddish patches.
Anamnesis
A 33 years old woman, came to outpatient clinic of Dermato-Venereology
Department of Dr. M. Djamil Hospital on March 26th 2021 with :
Chief complaint:
There were ring-shaped reddish patches with scaly and itchy which is expanding
on the right back since 1 weeks ago.
10. 1 week ago, patient complained ring-shaped reddish patches getting
more red, scaly, itchy and wider. Then patient’s mother sprinkle the ring-
shaped reddish patches with salicylic powder.
The itchy was reduced but there is no improvement of ring-shaped
reddish patches.
There was a history bathing and changing clothes 1 times a day.
Patient did not have pet with patchy hair loss and scaling skin.
There was no history often playing with soils and usually didn’t wash the
hands.
There was a history of discoloration of the nails turning yellow is denied.
11. Patient lives with her parents and 1 sister with good ventilation.
Her sister complaint the reddish patches on bottom since 1 month ago
and never treated. No complaint of nail destruction.
There was no history sharing use of shirt and towel with her family.
There was no history of traveling to abroad before itchy reddish patches.
There was no history of took corticosteroid or antibiotic in long time
period.
There was no history of decrease the body weight drastically.
There was no history of reddish patches, scaly that felt itchy in other
areas of the body.
12. There was no history of consumption or applying drugs or other herbal
ingredients to treat her complaints.
About 6 months ago, there was a lump that sometime felt itchy in below
part of vulva. Patient was never treating the lump until the lump
increased in size and number in vulva.
There was no history of vaginal discharge, swallowing pain and sore
throat.
There was no history of malignancy and take chemotherapy.
13. There were no history of recurrence mouth ulcer, long term fever (> 1
month), chronic diarrhea > 1 month, weight loss drastically before, and
denied any other skin disorder elsewhere.
There were no history of baldness on the head, reddish spot and patches
in both of palm, sole and other part of body before.
The history of ulcer that did not painful on the genital area was denied.
The history of seizure before was denied.
14. There was no history of painful blisters on the genital area before.
There was no history of painful ulcer in the genital area before.
There was no history of bumps in the inguinal area before.
There was no history blood transfusion, tattoo and injecting any ilegal
drug.
There was no history of vomiting blood, blood of stools, often abdominal
pain, feeling full after eating only a small meal.
15. Patient is a single and never gets married before.
Patient had a sexual relation with married male.
The last sexual intercourse was 2 years ago,
genito-genitally, oro-genitally and ano-genitally.
There was no protection (condom) during the
sexual intercourse.
Patient partner’s job is a police. The history of
partner sexual intercourse with others was
unknown. Patient also never finds out whether the
sexual partners have a history of sexually
transmitted diseases. Patient partner was died
with HIV about 1 year ago.
6 months ago, patient complaint shortness of breathe
and admitted in Pulmonology Department with CAP
(community acquired pneumonia). Then performed a
laboratory examination with result HIV positive and
regularly taking ARVs drug; Tenolam E once a day.
Sexual Intercourse History
16. There was no history of itchy reddish patches on the body
before.
There was no history of other sexually transmitted disease such
as syphillis, gonorrhea, genital herpes and ulcer.
Patient is a midwife in Pariaman.
Past illness
history:
Socioeconomic
history:
17. • Consciousness : Compos mentis cooperative
• General State : mild illness
• Height : 165 cm
• Weight : 45 Kg
• BMI : 16,528 underweight
• Vital sign - Pulse rate: 85x/ minute
- Respiratory rate: 15x/ minute
- Temperature: 36,5 C
• Eyes : conjungtiva anemis (-), icteric (-)
Physical examination: General State
18. Head : alopecia mouth eaten (-)
Skin : no abnormality
Eyes : conjungtiva was not anemic, sclera was not icteric
Mouth :oral thrush (-), pseudomembran (-), oral hairy leukoplakia (-)
ENT : pharyngeal hyperemia (-)
Cor : in normal limit
Pulmo : in normal limit
Abdomen : in normal limit
Lymph nodes : there was no enlargement of lymph nodes on inguinal area
Genitalia : venerologycal state
Extremities : oedema (-), reddish patch on palms and soles (-)
Nail : syphilitic onychia (-)
19. • Location : right back
• Distribution : localized
• Shape / arrangement : round - unspecified/annular concentric ring
• Border of the lesions : defined-undefined
• Size : plaquet
• Efflorescence : plaque erythema, scale, blackish crust
DERMATOLOGY & VENEREOLOGY
DEPARTMENT OF
Dermatologic State
24. • There were ring-shaped reddish patches with scaly and itchy on the right back since 1
weeks ago.
• There were itchy reddish patches on the right back since 3 weeks ago. Patients often
scratch it especially when sweating and hot weather. The itchy reddish patches with
scaly were increased in number and size on the right back then spreading over the
edge to form ring-like patches. Patient did not treat that ring-shaped reddish patches.
• 1 week ago, patient complained ring-shaped reddish patches getting more red, scaly,
itchy, and wider. Then patient’s mother sprinkle the ring-shaped reddish patches with
salicylic powder. The itchy was reduced but there is no improvement of ring-shaped
reddish patches.
• Her sister complaint the reddish patches on bottom since 1 month ago and never
treated.
Resume
25. • There was a history bathing and changing clothes 1 times a day.
• About 6 months ago, there was a lump that sometime felt itchy in below part of vulva.
Patient was never treating the lump until the lump increased in size and number in
vulva.
• Patient is a single and never gets married before. Patient had a sexual relation with
married male 2 years ago with HIV, genito-genitally, oro-genitally and ano-genitally.
There was no protection (condom) during the sexual intercourse.
• Location of dermatologic state in right back with efflorescence are plaque erythema,
scale, and blackish crust. From venereologycal state, there is vegetation in vulvawith
size 0,2 - 1,5 x 1 x 0,5 cm with verrucous surface and white discharge in vagina.
Acetowhite test is positive result.
Resume
31. Working Diagnosis :
Suspect Tinea Corporis
Condyloma acuminate genital
Suspect vaginitis gonorrhoea
Suspect late latent syphilis
Differential diagnosis for Suspect
Tinea Corporis:
Suspect Tinea Imbricata
Suspect Tinea pseudoimbricata
Suspect Erythema gyratum repens
Suspect Superficial erythema
annulare centrifugum
Differential diagnosis for Suspect
vaginitis gonorrhea :
Suspect vaginitis non specific
Planning:
• Routine examination (gram examination) from
vagina discharge
• Culture of fungi from different location of the
lesions
• Culture and sensitivity test from vagina
discharge with Thayer Martin Agar
• Serology test; VDRL and TPHA with a titer
ratio.
32. • Routine examination (gram
examination) from vagina
There is no PMN and no
diploccocus gram negative in
intracell or extracell.
There is no fungal element.
• Syphilis serologic examination
result:
VDRL and TPHA with a titer ratio :
non reactive
• Culture examination from
vagina with Thayer Martin Agar:
no growth
• Fungal culture for 20 days : Tricophyton
rubrum
• CD4 : 70 (404-1612) se/ul
• CD8 : 10 (33-58) %
• Rasio CD4: CD8 : 0,03 (Normal 0,69-2,83)
34. Treatment
General treatment
• Explain to the patient’s mother that the disease caused by fungal infection
and also associated with HIV.
• Explain to the patient and patient’s mother to keep humidity of room.
• Explain to the patient’s mother do not sharing clothes and towels with
patient.
• Explain to the patient about her wart is condyloma acuminata caused by a
virus (Human Papilloma Virus) that can be transmitted through sexual
intercourse.
• Explain to the patient that this wart has significant rate of recurrence.
Regular control is suggested.
• Explain to the patients to remain committed not to have sexual intercourse.
35. • Griseovulfin 900 mg
• Cetirizin tablet 10 mg a day
• Ketokonazol cream 2% twice a day
• Application of Tricholoroacetat 90% on condyloma
acuminata genital
Treatment
36. Prognosis for Tinea Corporis:
• Quo ad vitam : bonam
• Quo ad sanationam : bonam
• Quo ad cosmeticum: dubia ad bonam
• Quo ad fungsionam : bonam
Prognosis
Prognosis for Condyloma Acumminata
Genital:
• Quo ad vitam : bonam
• Quo ad sanationam : dubia ad
bonam
• Quo ad cosmeticum : dubia ad
bonam
• Quo ad fungsionam : dubia ad
bonam
37. Anamnesis There were hypopigmentated and hyperpigmented macules on right back. There is no new
itchy reddish patches.
A lump no reduces in size.
Dermatologic
State
Location : right back
Distribution : localized
Shape / arrangement : round - unspecified/annular concentric ring
Border of the lesions : defined-undefined
Size : plaquet
Efflorescence : hypopigmentated and hyperpigmented macules
Supporting
examination
We cannot do examination because patient did not came.
Diagnosis Tinea corporis
Condyloma Acumminata Genital
HIV
Therapy Griseovulfin 900 mg, cetirizin tablet 1x10 mg, ketokonazol cream 2% twice a day.
Follow up : April, 2th 2021
40. HIV (human immunodeficiency virus) is a
virus that attacks and impairs the
function of immune cells, infected
individuals gradually become
immunodeficient.
Immunodeficiency results in increased
susceptibility to opportunistic infections
(OI), cancers, and other conditions.
The risk for the development of OI in HIV patients depends on exposure to potential pathogens,
virulence of the pathogens, the degree of host immunity, and the use of antimicrobial prophylaxis.
Patient is a single. Patient had a sexual relation with maried male. Patient partner was died with HIV
about 1 year ago. Patient also suffered HIV and got ARV since 6 month ago. There was no protection
(condom) during the sexual intercourse.
41. The diagnosis of tinea corporis is usually
clinically based on a through history and
physical examination. Skin scrapings
examined under a microscope with a
potassium hydroxide (KOH) preparation will
reveal septate and branching long narrow
hyphae.
Therefore another method for
confirmation is a fungal culture. Cultures
may begin to see growth in about five
days but may take up to four weeks in
certain species.
Dermatophytes are a group of pathogenic fungi that cause mostly superficial diseases, further it is
more difficult to diagnose dermatophytosis in immunocompromised patients, as clinical presentation
is often atypical, in the present case multiples localization were recorded
HIV-positive patients is most commonly associated with T. rubrum, which is also the most common
agent in skin fungal infections.
42. Erythema gyratum repens Tinea pseudoimbricata Tinea imbricata
• A paraneoplastic figurate erythema
typically associated with breast,
lung, and esophageal cancer that
presents within 1 year of a cancer
diagnosis.
• Tinea pseudoimbricata and
erythema gyratum repens can have
similar morphology, with pruritic,
annular, erythematous plaques
composed of concentric rings with a
woodgrain appearance and fine
scale.
• There are no fungal elements.
• A dermatophytosis with the same
clinical appearance of multiple
concentric rings as tinea imbricata.
• Caused by Trichophyton
concentricum, tinea
pseudoimbricata is caused by T
tonsurans and other
dermatophytes.
• Tinea pseudoimbricata is thought to
be a form of tinea incognito
associated with longterm topical
steroid use.
• Uncommon, superficial mycosis
caused by the anthropophilic
dermatophyte Trichophyton
concentricum.
• This fungus is limited to some
islands of Oceania (Melanesia and
Polynesia) and several regions of
Southeast Asia (India, Vietnam) and
Central or South America (Mexico,
Brazil).
• Typical cutaneous lesions present as
scaly and polycyclic rings that can
extend to form polycyclic plaques,
with a lamellar detachment of the
scales.
43. There were ring-shaped reddish patches with scaly
and itchy on the right back since 3 weeks ago.
More itchy when sweating and hot weather. The
itchy reddish patches with scaly were increased in
number and size then spreading over the edge to
form ring-like patches.
6 months ago, there was a lump that sometime
felt itchy in below part of vulva. Patient is a single.
Patient had a sexual relation with male who HIV
about 2 years ago. Patient also suffered HIV and
got ARV since 6 month ago. There was no using
condom during the sexual intercourse.
Dermatologic state in right back with efflorescence
is plaque erythema with annular concentric ring
forms, scale, and blackish crust. Venereologycal
state show vegetation in vulva with verrucous
surface.
Acetowhite test is positive result. KOH 10% of skin
scrapping show fungal element and fungal culture
result is tricophyton rubrum. Patient was
diagnosed tinea corporis (TC) and condyloma
acuminata (CA) genital.
Patient in this case
44. Clinical manifestations of dermatophytosis
associated with CD4 cell count of HIV patients
show varied level of CD4.
In one study, 3 in patients cases of tinea corporis
with low CD4 counts (<200 cells/mm3) and 1 case
of tinea cruris with CD4 count of 200–350 cells /
mm3.
Another study, dermatophyte fungi cases was
more found in patient with CD4 count <200
cells/mm3.
A decrease in the patient's immunological status has an
effect on the increased likelihood of dermatophyte
fungal infection, so that more clinical manifestations are
found at low CD4 counts.
HIV - Dermatophytosis
45. Anogenital warts are the most common
manifestation of genital HPV infection. Estimates
show that among patients who contact HPV, only
10% develop genital warts, with HIV being the most
significant predisposing risk factor.
Patient with HIV and lower CD4 T count could be
increasing risk of infection.CA genital are prevalent
in groups at high risk for HIV acquisition and in HIV-
infected individuals.
HIV-infected men and women have a higher
prevalence of HPV infection, CA genital, and
premalignant and malignant lesions, compared
with age-matched uninfected controls.
A number of recent studies have shown an
increased risk of HIV acquisition in individuals with
HPV infection and those with CA genital, and it has
been speculated that HPV may enhance HIV
acquisition because of inflammation and an
increased numbers of HIV target cells at the
infection site.
HIV – Condyloma Acuminata
46. • A case of clinical appearance of tinea corporis resembles with tinea
imbricata and condyloma acuminate genital with HIV in 33 years-old
women.
• The diagnosis was based on anamneses, physical examinations,
mycological findings, and acetowhite test.
• After 4 weeks treatment, tinea corporis show improvement with
hypopigmentation and hyperpigmentation macules on back, however
CA size lesion no reduced.
CONCLUSION
