Document 0655
 DOCN  M94A0655
 TI    Undiagnosed HIV infection presenting with disseminated primary cutaneous
       nocardiosis in the Northern Territory.
 DT    9412
 AU    Patel A; Bowden F; Heath T; Fisher D; Currie B; HIV/STD Unit,
       Communicable Diseases Centre, Casuarina NT.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:55 (abstract no.
       FCP2). Unique Identifier : AIDSLINE ASHM5/94349000
 AB    Nocardia asteroides is a soil saprophyte. Human infection is
       predominantly acquired by inhalation and is not uncommonly associated
       with immunosuppression due to therapeutic drugs, haematological
       malignancy or general debility as occurs with chronic alcoholism.
       Surprisingly few cases of nocardiosis in HIV infected patients have been
       reported. This has been thought to be due in part to widespread use of
       prophylactic sulphamethoxazole-trimethoprim therapy. Given this and the
       fact that the infection can occur in normal hosts, it has not been
       included as an AIDS defining illness. Our case is a 48 year old married
       Caucasian male with no identifiable risk factors for HIV who presented
       with disseminated nocardiosis affecting primarily the skin with no
       evidence of pulmonary or cerebral infection. Of interest are: the portal
       of entry of the organism as the patient had considerable occupational
       exposure to soil, effects of HIV in the skin associated immune system
       with potential for disseminated opportunistic cutaneous infections, the
       importance of early isolation of the organism, the need for, combined
       medical and surgical management and the decreasing requirement for
       multi-drug therapy for N. asteroides once zidovudine was commenced. This
       case highlights the different spectrum of HIV-related opportunistic
       infections we may expect to encounter in tropical Australia.
 DE    AIDS-Related Opportunistic Infections/*DIAGNOSIS/THERAPY  Case Report
       Combined Modality Therapy  Diagnosis, Differential  Human  HIV
       Infections/*DIAGNOSIS/THERAPY  Male  Middle Age  *Nocardia asteroides
       Nocardia Infections/*DIAGNOSIS/THERAPY  Northern Territory
       Zidovudine/THERAPEUTIC USE  MEETING ABSTRACT

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