04-03-2007, 01:15 PM
History: A 34-year-old man presented 10 days after returning from a six-week holiday in South-East Asia. He had an eight-day history of malaise, chills, headache, sore throat and generalised rash. He had stayed mostly at five-star hotels, but reported many mosquito bites.
Examination: He had fever, a macular rash and generalised lymphadenopathy with mild splenomegaly, but no meningism and no eschar present.
Investigations: Full blood examination revealed lymphocytosis with numerous atypical lymphocytes and thrombocytopenia. Blood cultures and malaria films were negative. Liver function tests revealed marginally elevated serum transaminase levels. Serological testing revealed past infection with Epstein“Barr virus and cytomegalovirus and was negative for Q fever, dengue, rubella, measles and rickettsial infection.
Management: The presumptive diagnosis was dengue, and supportive treatment was instituted. However, symptoms persisted for the next three weeks.
Dengue serological testing was repeated and found to be still negative.
A repeat sexual history revealed unprotected intercourse with a number of men during the holiday. HIV antibody tests were positive on enzyme immunoassay and indeterminate on western blot. A p24 antigen test was positive. HIV seroconversion illness was diagnosed, and appropriate counselling and therapy offered.
Acute HIV infection may mimic several tropical diseases, including dengue and typhus, as well as infectious mononucleosis.
A sexual history is important in assessing infection risk in any traveller with a febrile illness.
Early diagnosis of HIV infection is important in preventing transmission, as well as allowing the correct timing of antiretroviral therapy.
Examination: He had fever, a macular rash and generalised lymphadenopathy with mild splenomegaly, but no meningism and no eschar present.
Investigations: Full blood examination revealed lymphocytosis with numerous atypical lymphocytes and thrombocytopenia. Blood cultures and malaria films were negative. Liver function tests revealed marginally elevated serum transaminase levels. Serological testing revealed past infection with Epstein“Barr virus and cytomegalovirus and was negative for Q fever, dengue, rubella, measles and rickettsial infection.
Management: The presumptive diagnosis was dengue, and supportive treatment was instituted. However, symptoms persisted for the next three weeks.
Dengue serological testing was repeated and found to be still negative.
A repeat sexual history revealed unprotected intercourse with a number of men during the holiday. HIV antibody tests were positive on enzyme immunoassay and indeterminate on western blot. A p24 antigen test was positive. HIV seroconversion illness was diagnosed, and appropriate counselling and therapy offered.
Acute HIV infection may mimic several tropical diseases, including dengue and typhus, as well as infectious mononucleosis.
A sexual history is important in assessing infection risk in any traveller with a febrile illness.
Early diagnosis of HIV infection is important in preventing transmission, as well as allowing the correct timing of antiretroviral therapy.