AIDS fever of unknown origin

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]

CD4 >500

  • Work-up similarly to nonimmunocompromised pts

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)

Workup

  1. CBC
  2. Chemistry
  3. LFT
  4. LDH
  5. RPR
  6. UA/Cx
  7. Blood cx
    • Aerobic, anaerobic, fungal
  8. Crypto
  9. Toxo
  10. Coccidiodomycosis
  11. CXR
  12. Stool cx / O&P
  13. CT
  14. LP
    • Cell count, protein, glucose, VDRL, cryptocoocal antigen, cytology, toxo, CMV, JC, EBV

See Also

HIV - AIDS (Main)

Source

  1. ↑ 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.
Retrieved from "https://www.wikem.org/w/index.php?title=AIDS_fever_of_unknown_origin&oldid=35551"