Management Of Opportunistic Infections Research Articles

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of pulmonary opportunistic infections 2024.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of pulmonary opportunistic infections 2024.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: Considerations in pregnancy 2024.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: Considerations in pregnancy 2024.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical investigation and management of pyrexia of unknown origin 2023.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical investigation and management of pyrexia of unknown origin 2023.

Ocular toxoplasmosis following anti-tumour necrosis factor-α therapy combined with oral methotrexate therapy: A case report and review of literature.

Purpose: To report a case of ocular toxoplasmosis following long-term treatment with adalimumab and review the literature on ocular toxoplasmosis following anti-Tumour necrosis factor-α therapy. Method: A retrospective chart review of A 21-year-old male who developed retinochoroiditis in his left eye following adalimumab therapy combined with oral methotrexate. Result: A known patient of juvenile idiopathic arthritis (JIA) on adalimumab and oral methotrexate for the last four years presented to us with a blurring of vision for the last 15 days. Fundus examination of the left eye revealed severe vitritis and two patches of retinochoroiditis in the inferior part of the fundus. Subsequent investigations confirmed it to be a case of toxoplasma retinochoroiditis, and he responded to anti-toxoplasma treatment. A review of literature on a similar topic revealed five such cases, and the index case was the first such report in patients with JIA. Conclusion: The index case highlights the importance of early recognition and management of opportunistic infections in patients receiving biologicals.

Utilizing Telemedicine as a Tool for Management of PLHIV at a Tertiary Care Institute

ABSTRACT Telemedicine has been increasingly utilized in health sector. In our study we bring to light various applications of telemedicine consultation for patients receiving anti-retroviral therapy. We have observed that in a resource-limited setting, CD4-based assessment via telemedicine can still be useful, provided a serial record is maintained. We evaluated 430 cases in terms of demographics, CD4-trend and adverse effect profile. Tracking and monitoring of lost to follow-up cases could be done using this platform. Aim: The study focuses on the benefits of using telemedicine as a tool for consultation and referral of people living with HIV at centers located away from tertiary care institutes. Settings and Design: The study was conducted at telemedicine center, which is a tertiary referral center for all the districts in Maharashtra. We retrospectively analyzed the data obtained from telemedicine consultations carried out for patients from district-level antiretroviral therapy (ART) center. Methods and Material: The subjects who satisfied the following criteria were included for data analysis. Inclusion Criteria: All the HIV-infected persons on antiretroviral therapy enrolled at distant ART centers for which opinion was sought through telemedicine. This is an observational retrospective study. We reviewed the records of all patients enrolled in HIV healthcare through National Aids Control Organization from distant treating antiretroviral therapy centers (henceforth referred to as ART centers) for whom expert consultation was sought through telemedicine. These patients were given opinion for several consultations including response to therapy, management of opportunistic infections, drug-related adverse events, and treatment failure. We analyzed the demographics, the duration of treatment, and response to therapy. Statistical Analysis Used: Descriptive data analysis is used in this study. Results: We analyzed 430 case referrals through telemedicine from ART center. In 21% (N = 94) patients, CD4 was less than 50 and 11 cases had CD4 more than 500. An increasing CD4 trend was noted in 190 cases and a decreasing trend in 204 cases. In 36 cases, there was no change in CD4 progression. We had 20 cases lost to follow-up. The baseline regimen was Zidovudine Lamivudine Nevirapine (ZLN) in most cases (N = 237). Adverse drug reactions were the reasons for referral in 79 cases, maximum being AZT-induced anemia (N = 57). Of the total 430 cases referred, 253 cases had been wait-listed for SACEP meeting as per existing protocol. In 177 cases, physical attendance for the SACEP meeting could be deferred. Conclusion: Telemedicine has emerged as an immensely useful tool in management of People Living with HIV (PLHIV).

Immunovirological discordance among people living with human immunodeficiency virus at a center in Western India: A retrospective study.

Treatment of people living with human immunodeficiency virus (HIV) (PLHIV) is monitored using plasma HIV viral load levels and CD4 counts. Patients with either immunological nonresponse (virological suppression achieved) or virological nonresponse (immune reconstitution achieved) are termed as having a discordant response. These patients are at higher risk for acquired immunodeficiency syndrome (AIDS)-related infections/diseases/neoplasms, non-AIDS-related illnesses (cardiovascular, neurological, renal, hepatic diseases), and all-cause death. This study was conducted to assess the prevalence of immunovirological discordance among PLHIV after completion of at least 1 year of combination antiretroviral therapy (cART) at an antiretroviral therapy (ART) plus center in India and analyze contributory factors. The study was a retrospective study of PLHIV receiving cART at the ART plus clinic in Western India from January 18 to December 21. Four hundred and ninety-six patients were studied based on sample size calculated and assessed for CD4 and viral load response at 0, 6, and 12 months of ART. Of the 496 patients, 48 patients (9.7%) had immunovirological discordance. Out of them, 36 patients (75%) had a virological response (immunological nonresponse) and 12 (25%) patients had an immunological response (virological nonresponse). The factors contributing to immunological nonresponse were as follows - low baseline CD4 levels (<100 cells) (36.1%), adherence <95% (33.3%), presence of opportunistic infections (16.6%), and failure on first-line therapy (11.1%). Other factors noted included higher baseline viral load (2.7%), chronic kidney disease (5.5%), and chronic hepatitis B virus co-infection (5.5%). Virological nonresponse was associated with poor adherence to therapy <95% (33%) and failure of first-line regimen (33%). Opportunistic infections were noted among 33% of patients and 8.3% of patients were found to have higher baseline viral load. Immunovirological discordance is an important factor influencing response to cART and is associated with many complications such as AIDS and non-AIDS-related events and even death. Improved adherence and timely identification and management of opportunistic infections are measures that are beneficial in reducing the incidence of immunovirological discordance.

P115 Implementation of a vaccination tool in the electronic patient health record significantly increases vaccination coverage

BackgroundPatients with immune-mediated inflammatory diseases (IMID) are at higher risk for infectious diseases. Despite this increased risk and the available guidelines1, we reported a sub-optimal vaccination rate of 27.4% of IMID patients in 2018. In the meantime, a vaccination module was introduced in the electronic patient health record of our hospital to accurately document and monitor vaccination status of patients. The impact of this new module on vaccination coverage was re-evaluated in the same IMID patients in 2021.MethodsBetween Aug and Oct 2021, the vaccination status of 1448 (out of the original 1488) IMID patients (44.8% male, median age 53.6 years) was collected (798 patients with IBD, 612 with rheumatological, and 38 with dermatological inflammatory conditions) and compared to that of 2018. The vaccination status was obtained mainly through the patients’ electronic medical records. Missing data were added after contacting patients or their general practitioner.ResultsFrom 2018 to 2021, the overall vaccination coverage of all IMID patients significantly increased from 27.4% to 51.9% (p<0.001, Figure 1).The vaccination coverage in IBD patients increased significantly from 75.9% to 86.3% for influenza (p<0.001), from 72.9% to 88.7% for pneumococci (p<0.001), from 66.0% to 80.2% for hepatitis B (p<0.001), from 79.9% to 85.7% for tetanus (p=0.041) and from 42.2% to 60.4% overall (p<0.001) (Figure 1 and Table 1).Similarly, the vaccination coverage significantly increased for rheumatology patients, namely from 69.3% to 78.3% for influenza (p<0.001), from 34.5% to 85.0% for pneumococci (p<0.001), from 32.8% to 36.5% for hepatitis B (p<0.001) and from 7.8% to 32.6% overall (p<0.001) (Figure 1 and Table 1).For patients with dermatological inflammatory conditions, vaccination coverage significantly increased from 60.5% to 81.6% for pneumococci (p=0.031) and from 47.1% to 55.3% for hepatitis B (p=0.002) (Table 1). ConclusionThe suboptimal vaccination rate measured in 2018 and the COVID-19 pandemic stressed the importance of vaccination recommendations to patients and healthcare professionals. We here show that the implementation of a vaccination tool integrated in the electronic medical record of patients is correlated with a significant increase in specific vaccination rates and also in the total amount of IMID patients that were fully vaccinated according to guidelines.Reference1. Rahier JF, Magro F, Abreu C, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014;8:443–468.

Opportunistic Infections in the Immunocompromised: Hiv Vs Non-HIV Patients - A Narrative Review

Opportunistic infections affect patients with immunocompromised status and are caused by common microorganisms with more severe presentations, or atypical organisms that do not cause disease in the immunocompetent. The type of infection varies with the type of immune dysfunction. Patients with cell-mediated immune dysfunction tend to be infected with a range of viral infections, intracellular bacteria, and fungi. This contrasts to patients with defects in humoral immunity, where infections with encapsulated bacteria, and enteric organisms such Giardia lamblia and enteroviruses predominate. Patients with phagocytic defects are especially prone to infections with Gram-negative bacteria and fungi, whilst those with complement disorders are prone to recurrent infections with encapsulated bacteria. In contrast to patients with primary immunodeficiencies, which usually present with only one defect of the above, acquired immunodeficiencies present with a variety of those, and clinical presentations are diversified. The epidemic of HIV and AIDS shed some light into infections that were before extremely rare, by making them frequent, but with the advent of anti-retroviral therapy their clinical presentation has shifted. Also, the emergence of novel immunotherapies for cancer and autoimmune diseases, allied with an increase in organ transplant has increased the pool of immunosuppressed patients without HIV, which present differently regarding opportunist infections. Rapid and specific microbiologic diagnosis is essential. Newer microbiologic assays have improved the diagnosis and management of opportunistic infections. Our aim was to revise and summarize the most frequent opportunist infections, and how their presentation and course compares in different immunosuppressed diseases (HIV and non-HIV).

SPECTRUM OF DISEASE, MANAGEMENT, EFFICIENCY, CLINICAL PROFILE AND OUTCOMES OF RETROVIRAL DISEASE PATIENTS

HIV is a virus that targets and alters the immune system, increasing the risk and impact of other infections and diseases. Without treatment, the infection might progress to an advanced disease stage called AIDS. A prospective study was conducted for a period of 6 months in a tertiary care hospital with the sample size of 102 patients. A data collection form was taken, which includes the details of demographics date of visit to the hospital, diagnosis, past and current medication history. 102 Inpatients and Outpatients diagnosed with HIV were considered. For the management of HIV, 52 % of 2 NRTI and 1 NNRTI combination and 35 % of 2 NRTI and 1 integrase inhibitor combination were used. The drug usage pattern was found to be tenofovir 74.5 %, lamivudine 83.3 % and Efavirenz 50.9 %. The percentage of subjects with opportunistic infections was 66.6 % and, among these opportunistic infections, tuberculosis was found to be 47.05 %. The viral load after 6 months of ART was found to be undetectable in 95.09 % patients. The levels of CD4 counts were raised after initiation of the ART in 6 months of duration. The death rate was found to be 4.90 %. Due to highly active antiretroviral therapy and effi cient opportunistic infection management, the patients had elevated CD4 levels and undetectable viral load. Hence HAART is highly effi cient in management of HIV which ultimately improves the quality of life of patients.

Machine learning based predictive model and systems-level network of host-microbe interactions in post-COVID-19 mucormycosis

Mucormycosis, a rare infection is caused by fungi Mucorales. The affiliation of mucormycosis with Coronavirus disease (COVID-19) is a rising issue of concern in India. There have been numerous case reports of association of rhino-cerebral-orbital, angioinvasive, pulmonary, respiratory and gastrointestinal tract related mucormycosis in patients with history of COVID-19. The immune dysregulation, preposterous use of steroids, interleukin-6-directed therapies and mechanical ventilation in COVID-19 immunocompromised individuals hypothesizes and predisposes to advancement of mucormycosis. The gaps in mode of presentation, disease course, diagnosis and treatment of post-COVID-19 mucormycosis requires critical analysis in order to control its morbidity and incidence and for prevention and management of opportunistic infections in COVID-19 patients.Our study performs machine learning, systems biology and bioinformatics analysis of post-COVID-19 mucormycosis in India incorporating multitudinous techniques. Text mining identifies candidate characteristics of post-COVID-19 mucormycosis cases including city, gender, age, symptoms, clinical parameters, microorganisms and treatment. The characteristics are incorporated in a machine learning based disease model resulting in predictive potentiality of characteristics of post-COVID-19 mucormycosis. The characteristics are used to create a host-microbe interaction disease network comprising of interactions between microorganism, host-microbe proteins, non-specific markers, symptoms and drugs resulting in candidate molecules. R1A (Replicase polyprotein 1a) and RPS6 (Ribosomal Protein S6) are yielded as potential drug target and biomarker respectively via potentiality analysis and expression in patients. The potential risk factors, drug target and biomarker can serve as prognostic, early diagnostic and therapeutic molecules in post-COVID-19 mucormycosis requiring further experimental validation and analysis on post-COVID-19 mucormycosis cases.

Continuous quality improvement in HIV and TB services at selected healthcare facilities in South Africa.

BackgroundContinuous quality improvement (CQI) is essential for HIV and tuberculosis (TB) services. Similarly, a thorough understanding of the requirements and impact of CQI is critical to its successful institutionalisation. However, this is currently lacking.ObjectivesThe objective of this study is to describe the CQI implementation process and examine its effect on HIV and TB service delivery at selected primary healthcare facilities in two South African districts.MethodWe used a separate sample, pre- and post-test, quasi-experimental study design based on data collected from the clinical audit of patient cohorts seen in 2014 and 2015 respectively. Quality was measured based on the extent to which prescribed services were provided. Tailored CQI interventions were implemented based on service delivery gaps identified by the 2014 CQI audit. Data were summarised and analysed using a combination of univariate and multivariate analysis.ResultsThe services identified as low quality were related to opportunistic infections management and laboratory practices. Compliance to prescribed service items in antiretroviral treatment initiation and monitoring, pharmacy and laboratory management, exceeded 70% across study sites. Over 80% of low quality service delivery items were optimised in less than six months with targeted quality improvement support.ConclusionThe observed improvements signal the effectiveness of the CQI approach, its capacity to rapidly improve under-performance, its high replicability and the need to provide quality maintenance support to sustain or improve healthcare facilities performing well. The study strongly underscores the need to improve the management of opportunistic infections and complications, particularly TB.

Sino-orbital mucormycosis in a COVID-19 patient: A case report

IntroductionWe report a case of post COVID-19 Sino-orbital Mucormycosis infection caused by Rhizopus oryzae and its management.Presentation of caseThe patient was diagnosed with COVID-19 and treated according to the persisting protocols. Following recovery, on the 18th day, the patient developed chemosis and pain in the left eye. A diagnosis of mucormycosis was established after Magnetic Resonance Imaging (MRI) and Functional Endoscopic Sinus Surgery (FESS). Initially, conservative management with intravenous (IV) Fluconazole & Amphotericin B was done and later on with surgical debridement. The patient recovered with minimal residual deformity.DiscussionMucormycosis generally develops secondary to immunosuppression or debilitating diseases. In Head and Neck cases, the mold usually gains entry through the respiratory tract involving the nose and sinuses, with possible further progression into the orbital and intracranial structures. Hence, an early diagnosis and intervention is required for a good prognosis, decreasing the morbidity. This can be achieved on the basis of clinical picture and direct smears.ConclusionResearch needs to be carried out in COVID-19 patients for better prevention and management of opportunistic infections in order to reduce its incidence and morbidity. Prophylactic treatment protocols need to be established, along with rational use of corticosteroids.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020.

CHARACTERISTICS AND IMPACT OF OPPORTUNITY INFECTIONS ON GASTROINTESTINAL TRACT IN HIV-INFECTED PEOPLE

A decrease in the number of CD4 + lymphocytes in HIV infection is known to increase the risk of opportunistic infections, malignancies and other diseases classified as diagnostic criteria for AIDS. The purpose of this work is to analyze the main groups of opportunistic infections and infectious lesions commonly affecting the gastrointestinal tract in HIV-positive patients. Up to 90% of deaths from HIV infection are directly or indirectly caused by opportunistic infections that emphasize the importance of further research aimed at their prevention and management. A progressive decline in the number of CD4 + lymphocytes due to their non-stop destruction and insufficient replenishment from progenitor cells underlies the development of immunodeficiency in HIV infection. Pathological changes in the gastric mucosa may be associated with Mycobacterium avium complex. Cryptosporidosis is an opportunistic infection reported as common among immuno-suppressed patients. It occurs as a long-term, mild infection without severe clinical symptoms. In recent decades, opportunistic infections have become a medical and social challenge due to their spread and significant impact on the quality of life of HIV-positive people. It should be also noted that the presence of opportunistic infection has little effect on the characteristics of the microbial picture in the intestine. But, at the same time, it can deteriorate metabolic processes in the intestinal epithelium, proliferation and maintenance of its resistance to aggressive factors. Therefore, the issue of detection and timely treatment of opportunistic infections is of a great medical and social importance. Conclusions: Early diagnosis, prevention and management of opportunistic infections play an essential role in increasing the life expectancy of HIV-positive people and improving the course of the disease.

Development of an interprofessional curriculum to improve team-based HIV care in sub-Saharan Africa: a training programme for undergraduate and early career health professionals

BackgroundDespite evidence of the impact of interprofessional education (IPE) strategies to improve the efficiency and quality of training, few undergraduate health professions education programmes in sub-Saharan Africa have implemented such approaches. Furthermore, few pre-service health professions educational institutions have developed educational interventions that target trainees during the transition between pre-service training and professional practice. We developed HIV-specific, interprofessional, team-based resources to better support trainees during the transition period. MethodsBetween April 1 and July 31, 2019 ten faculty members representing nine medical and nursing schools in Uganda and South Africa developed a training package focused on core clinical, public health, IPE, and quality improvement (QI) domains related to HIV service delivery. Using small-group learning principles, they developed 17 case-based modules to address a diverse set of HIV-related topics, including, but not limited to, HIV prevention, diagnosis, linkage to care, treatment, and management of opportunistic infections. All modules were aimed at newly, or nearly, qualified health-care professionals, including nurses, doctors, pharmacists, and laboratory scientists and were intended to be taught in workshops that will complement existing institution-specific HIV curricula. FindingsTraining resources were launched in August, 2019; in the following 6 months, 66 nursing and medical schools and their affiliated training sites in 14 countries in sub-Saharan Africa used the training modules to support interprofessional training for health professionals in training. In the first 6 months of the project, 3500 learners participated in the training. InterpretationFurther evaluation of this project and its effects on pedagogical approaches, trainee competencies, as well as wider changes in the organisation and delivery of HIV care, are warranted. The collaborative, interinstitutional, interprofessional approach to curriculum development could provide a benchmark for how best-practice approaches to education can be rapidly disseminated and scaled up across training programmes in Africa. FundingHealth Resources and Services Administration, HRSA

Impact of Strain Competition on Bacterial Resistance in Immunocompromised Populations

Despite the risk of emerging drug resistance that occurs with the frequent use of antimicrobial agents, targeted and prophylactic antibiotics have been considered crucial to opportunistic infection management among the HIV/AIDS-immunocompromised. As we recently demonstrated, the disrupted selective pressures that occur in AIDS-prevalent host populations increase the probability of novel emergence. This effect is concerning, given that bacterial strains unresponsive to first-line antibiotics can be particularly dangerous to hosts whose immune response is insufficient to fight infection in the absence of antibiotic support. While greater host susceptibility within a highly immunocompromised population may offer a fitness advantage to drug-resistant bacterial strains, this advantage could be mitigated by increased morbidity and mortality among the AIDS-immunocompromised. Using a Susceptible-Exposed-Infectious-Recovered (SEIR) epidemiological model parameterized to reflect conditions in an AIDS-prevalent host population, we examine the evolutionary relationship between drug-sensitive and -resistant strains of Mycobacterium tuberculosis. We explore this relationship when the fitness of the resistant strain is varied relative to that of the sensitive strain to investigate the likely long-term multi-strain dynamics of the AIDS-mediated increased emergence of drug resistance.

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019

British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

BackgroundDespite substantial improvements in accessibility of Anti-Retroviral Treatment (ART), death of children on ART remains a prevailing challenge in sub-Saharan African (SSA) countries. However, the pooled magnitude of mortality at different ART follow-up periods remains unknown for the region. We estimated the pooled proportion of all-cause mortality for pediatric patients receiving first-line ART at 3, 6, 12, and 24 months follow-up period in SSA.MethodsWe searched for relevant articles published between January 2014 and June 2018 on PubMed, Hinari and Google scholar databases. We searched for additional articles from reference lists and 2014–2018 abstracts archived by the Conference on Retroviruses and Opportunistic Infections (CROI) and the International AIDS Society Conference on HIV Science (IAS).ResultsWe reviewed 29 articles reporting mortality among pediatric ART patients at different follow-up periods in countries from 2001 to 2016. Among the 51,619 pediatric ART patients in these cohorts, studies reported 4061 (7.9%) all-cause cumulative death. The cumulative pooled proportion of mortality at 3, 6, 12 and 24 months of ART were 3% (95% CI: 3.0–4.0), 5% (95% CI: 4.0–6.0), 6% (95% CI: 5.0–7.0) and 7% (95% CI: 6.0–8.0), respectively.ConclusionsIn SSA, significant proportion of mortality among children occurs in the first 3–6 months of ART initiation. Western Africa has a little higher estimate of mortality among pediatric ART patients at 6 and 12 months of follow-up. Strategies to prevent early mortality including thorough screening and management of opportunistic infections before ART initiation are needed.

Prognostic Factors of Mortality among Adult Patients on Antiretroviral Therapy in India: A Hospital Based Retrospective Cohort Study.

Introduction HIV related deaths still continue to occur in large numbers in spite of good quality drugs being freely available in India. This study was therefore done to assess the prognostic factors of mortality among people living with HIV (PLHIV) on antiretroviral therapy (ART). This would help in planning strategies for further improving their survival. Materials and Methods Record based data from baseline and follow-up visits of a cohort of patients aged above 14 years on ART was retrospectively reviewed over a seven-year period. The Kaplan-Meier models were used to estimate life time survival probability, and Cox proportional hazard regression model was used to determine independent prognostic factors of death, among patients, after initiation of ART. Results Mean age of the total 285 patients enrolled in this study was 45.8±9.7 years. Mean duration of treatment on ART was 1127±611.8 days. During the follow-up period, 44/285(15.4%) patients died, resulting in incidence density of death rate as 3.12 per 100 person years. Good adherence with treatment was reported by 267(93.7%) patients. Nearly half of the deaths, i.e., 21(47.7%), occurred within three months of them starting ART. The mean survival time after initiation of ART was 2084.0±55.3 days (95% CI is 1975.5-2192.5). The presence of opportunistic infections (OIs) and tuberculosis before and poor/average adherence to ART and alcohol usage after starting ART were independent prognostic factors of mortality among patients. Conclusion Several prognostic factors influencing mortality among adult HIV patients receiving treatment were identified in this study. Screening efforts is essential in early detection and management of OIs among PLHIV. Good counselling and monitoring is recommended to improve adherence and also to prevent alcohol usage after initiation of ART. Such measures would help in further reducing mortality among HIV patients in the settings.

Opportunistic infections: What's new?

Guidelines from 3 clinical societies and peer-reviewed publications have been reviewed for recent changes in the management of opportunistic infections. Trimethoprim and sulfamethoxazol administered intravenously is an option to treat cerebral toxoplasmosis if oral therapy is not feasible. CD4 T cell cut-off for starting prophylaxis with trimethoprim and sulfamethoxazole is now 200/µl. For prophylaxis and treatment of Pneumocystis pneumonia trimethoprim and sulfamethoxazole still are recommended. Liposomal amphotericin B + fluconazole is a new treatment option for cryptococcosis. Addition of steroids can be considered in the treatment of tuberculosis to avoid immune reconstitution inflammatory syndrome. A new syndrome associated with HHV8 has been described: Kaposi Sarcoma Inflammatory Cytokine Syndrome (KICS). Localization and dissemination of herpes zoster have to be considered for treatment determination.