Pyrexia of unknown origin and HIV infection in a middle aged woman. A case study

Area of Science:

• Infectious Diseases
• Immunology
• Public Health

Background:

• Pyrexia of unknown origin (PUO) is defined as fever lasting over three weeks without a clear diagnosis after initial investigations.
• Human Immunodeficiency Virus (HIV) infection can present with diverse symptoms, including opportunistic infections and prolonged fever.
• AIDS-related complex (ARC) encompasses a spectrum of symptoms in HIV-positive individuals preceding a formal AIDS diagnosis.

Observation:

• A patient presented with prolonged fever, esophageal candidiasis, and multiple systemic symptoms, indicative of significant immunosuppression.
• Despite extensive evaluation, the source of HIV infection remained unclear, with no history of typical transmission routes like sexual contact or blood transfusions.
• The patient had a history of frequent hospital admissions with repeated intravenous infusions and dental procedures, suggesting potential iatrogenic or nosocomial transmission routes.

Findings:

• The patient was diagnosed with HIV infection and advanced disease, consistent with AIDS-related complex.
• Esophageal candidiasis was a prominent opportunistic infection, highlighting the severity of immune deficiency.
• The likely mode of HIV acquisition was attributed to repeated healthcare exposures, including intravenous therapies and dental work, rather than conventional transmission pathways.

Implications:

• This case underscores the importance of considering non-traditional HIV transmission routes in patients with PUO and opportunistic infections.
• Healthcare-associated infections and procedures, such as repeated IV use and dental interventions, may pose a risk for HIV transmission in specific clinical contexts.
• Further research into the epidemiology and prevention of HIV transmission through healthcare settings is warranted, particularly in immunocompromised patients presenting with complex febrile illnesses.