Fungal infections

Cutaneous presentations of fungal infections in HIV in Australasia include tinea, CandidaMalassezia, cryptococcosis, penicillinosis and pneumocystis.

Dermatophyte infections

Clinical presentation

Dermatophytosis is most   commonly   due to Trichophytum rubrum, frequently causing tinea cruris, corporis and onychomycosis. Despite ART and fluconazole prophylaxis, superficial dermatophyte infections can be atypical, widespread and refractory in this setting. Dermatophyte infections may also have deep dermal morphologies. These present as multiple fluctuant erythematous ulcerative nodules on the extremities and often are in areas of chronic superficial dermatophytosis. Atypical presentations of T. rubrum also include firm violaceous nodules and papules due to nodular granulomatous perifolliculitis usually with co-existing onychomycosis and tinea pedis. Proximal nail white onychomycosis is also a marker of HIV infection, although some studies have shown that HIV infection is not associated with an increased susceptibility to dermatophytosis.[67][68][69] Culture of the fungal skin or nail scraping may be required if the speciation of the fungus is required or microscopic analysis of the samples give negative results.