Evaluation of clinically normal appearing skin for systemic infectious diseases in human immunodeficiency virus...

The observation of a human immunodeficiency virus (HIV)-infected patient with cutaneous ulcers which contained both fungal and viral pathogens, and in which the fungal organisms were grown in culture yet could not be demonstrated microscopically, suggested the possibilities: 1) that the skin lesions might have been primarily caused by the viral pathogen, and 2) that the concurrent presence of that fungal pathogen was coincidental and perhaps secondary to fungemia. Assuming that these postulates are valid, it is reasonable to hypothesize that fungal organisms would have been detected if perilesional or distal, clinically normal appearing, skin had been evaluated. This hypothesis could be further assessed by performing a prospective study of clinically normal appearing skin for pathogens of suspected systemic infectious diseases in HIV seropositive patients. Since the quantity of infectious pathogens in nonlesional skin may be limited, it might be difficult to grow the organisms in culture or demonstrate them microscopically using standard methods. Therefore, in addition to routine cultures and histologic evaluation, immunohistochemical techniques using monoclonal antibodies to pathogen antigens and DNA amplification techniques based upon the polymerase chain reaction should be used to enhance the detection of the infectious pathogens.