Name
KAPOSI SARCOMA
DESCRIPTION
DETAIL
CAUSES β’ A herpes virus designated Kaposi sarcoma herpes virus (KSHV) or human herpes virus type 8 (HHV8) is required for the development of KS β’ Samples from KS lesions have been found to contain DNA sequences identical with HHV8, and HHV8 can be propagated from skin lesions of patients with KS β’ Immunosuppression of host is important co-factor in development of KS -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS Bacillary angiomatosis, granuloma faciale, vascular proliferation and purpuric lesionsLABORATORY β’ Specific HHV8 antibodies present in 70-90% β’ Southern blot hybridization assay of KS lesions for HHV8 β’ Polymerase chain reaction (PCR) assay SPECIAL TESTS Tissue examination IMAGING CT or MRI scan (chest, abdomen) may assess visceral involvement DIAGNOSTIC PROCEDURES β’ Biopsy of skin or lymph node β’ Bronchoscopy with biopsy β’ Liver biopsy
TYPENOTES
RISK FACTORS β’ HIV infection β’ Living in endemic area (especially Zaire or Uganda) β’ Immunosuppressant medications β’ Transplantation and chemotherapy β’ Sexual activity β’ Maternal-fetal transmission β’ Maternal-child transmission β’ Injection drug use β’ Exposure to infectious saliva β’ Possible association with trauma in susceptible host β’ Many cases transmitted by unknown route APPROPRIATE HEALTH CARE β’ Outpatient β’ Outpatient surgery GENERAL MEASURES β’ If KS due to immunosuppressant medications, eliminate or reduce medication dosage β’ If KS is HIV-related, optimize anti-HIV therapy to reduce HIV viral load β’ Treatment is otherwise determined by extent and location of the disease β’ Observation β’ Radiotherapy (electron beam) or x-ray therapy 1000 to 2000 rads β’ Systemic chemotherapy, immunotherapy, or antiviral therapy SURGICAL MEASURES β’ Cryotherapy β’ Intralesional chemotherapy or immunotherapy β’ Surgical excision β’ CO2 laser ACTIVITY Remain active as long as possible DIET No special diet PATIENT EDUCATION β’ HIV risk prevention β’ Injection drug rehabilitation DRUG(S) OF CHOICE . Chemotherapy. (Note: Both doxorubicin and daunorubicin are available and approved for use in liposomal forms. These liposomal formulations offer improved outcome with less toxicity.) . Doxorubicin . Bleomycin . Vinblastine - parenteral or intralesional . Vincristine . Daunorubicin . Paclitaxel . Interleukins . Thalidomide . Interferon - parenteral or intralesional . Alitretinoin gel ALTERNATIVE DRUGS β’ Several studies have reported that some individuals have responded to anti-viral medications such as foscarnet (Foscavir), ganciclovir (Cytovene, Vitrasert), and cidofovir (Vistide) β’ Photodynamic therapy PATIENT MONITORING In HIV patients with KS, other opportunistic infections must be aggressively treated PREVENTION/AVOIDANCE β’ Safe sex practices β’ Possible prophylaxis with anti-viral medications β’ Avoid needle sharing β’ Avoid deep kissing POSSIBLE COMPLICATIONS β’ Extensive pulmonary involvement may lead to hypoxemia β’ Extensive lymphatic involvement may lead to severe edema EXPECTED COURSE/PROGNOSIS β’ Improved HIV treatments and anti-viral drugs may result in improved HIV-related KS survival β’ Indolent form - 10 year survival
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PCR, BRONCHOSCOPY, MRI, BIOPSY