4. CDC category C diagnoses

4.2 Protozoal diseases and infections with pneumocystis jiroveci
4.2.1 Pneumocystis jiroveci pneumonia
4.2.2 Extrapulmonary pneumocystis disease
4.2.3 Cerebral toxoplasmosis
4.2.4 Disseminated toxoplasmosis
4.2.5 Cryptosporidiosis
4.2.6 Isosporiasis

4.3 Fungal diseases
4.3.1 Oesophageal candidiasis
4.3.2 Candidiasis of trachea, bronchi or lungs
4.3.3 Cryptococcal meningitis
4.3.4 Other disseminated cryptococcosis
4.3.5 Disseminated coccidioidomycosis
4.3.6 Disseminated histoplasmosis

4.4 Bacterial diseases
4.4.1 Pulmonary TB
4.4.2 Extrapulmonary TB
4.4.3 Disseminated MAC disease
4.4.4a M. kansasii disease
4.4.4b M. avium or kansasii disease (old code MAK)
4.4.5 M. genavense disease
4.4.6a Disseminated mycobacterial disease other or indeterminated
4.4.6b Other pulmonary mycobacterial diseases
4.4.7 Recurrent Salmonella septicemia
4.4.8 Recurrent bacterial pneumonia

4.5 Viral diseases
4.5.1 Chronic mucocutaneous HSV ulceration
4.5.2 Visceral HSV disease
4.5.3 CMV retinitis
4.5.4 Other CMV disease
4.5.5 Progressive multifocal leukencephalopathy

4.6 Neoplastic diseases
4.6.1 Kaposi sarcoma
4.6.2 Non-Hodgkin's lymphoma
4.6.3 Primary cerebral lymphoma
4.6.4 Invasive cervical carcinoma

4.7 Indeterminate intracerebral lesions

4.1 HIV related syndromes

4.1.1 HIV wasting syndrome (database code WAS)

Presumptive diagnosis by

Documented profound involuntary weight loss >10% from baseline. Baseline weight is weight at first consultation. Weight loss is calculated by averaging two similar weights on consecutive occasions during follow-up and comparing this mean to baseline

PLUS either
persistent diarrhea (at least three stools of reduced consistency per day for >30 days)

OR
fever for >30 days without concurrent specific cause (such as cancer, TB, MAC, specific cause of enteritis).

date
first date on which 1), 2) OR 1) + 3) exist together.

Definitive diagnosis not accepted

4.1.2 HIV encephalopathy (database code DEM)

Presumptive diagnosis by clinical findings of disabling cognitive and/or motor dysfunction interfering with occupations or activities of daily living (not "depression" or psychosis)

AND no condition other than HIV infection to explain the findings. (CSF examination or autopsy evidence helpful)

AND must have had CT or MRI scan.

date
from time of scan.

Definitive diagnosis not accepted

4.2 Protozoal diseases

4.2.1 Pneumocystis jiroveci pneumonia (database code PCP)

Definitive diagnosis by cytology/microscopy or histology

Presumptive diagnosis
a) IF ON PCP PROPHYLAXIS: History of dyspnea on exertion, or non-productive cough (within 3 months), AND typical appearance of diffuse bilateral pulmonale infiltrate, AND no bronchoscopy done or negative bronchoscopy after having received at least one week of PCP treatment, AND no evidence of bacterial pneumonia, AND responds to PCP treatment.

b) IF NOT ON PCP PROPHYLAXIS FOR AT LEAST TWO WEEKS & CD4 COUNT LESS THAN 200: History of dyspnea on exertion, or non-productive cough (within 3 months), AND CXR normal, atypical or typical for PCP, AND no bronchoscopy done or negative bronchoscopy after having received at least one week of PCP treatment, AND no evidence of bacterial pneumonia, AND responds to PCP treatment.

date
from abnormal CXR (or start of treatment).

4.2.2 Extrapulmonary pneumocystis disease (database code EPD)*

Definitive diagnosis by histology/microscopy.
(Presumptive diagnosis not accepted)
_{* This diagnosis used in the SHCS does not correspond to any of the CDC definitions.}

4.2.3 Cerebral toxoplasmosis (database code TOX)

Definitive diagnosis by histology or cytology

date
from date of biopsy

Presumptive diagnosis by recent onset of focal neurological abnormality consistent with intracranial disease, or reduced level of consciousness, or headache
AND CT or MRI scan evidence of at least one lesion having a mass effect or enhancing with contrast medium
AND Responded to toxo. treatment (evidence from repeat scan and/or clinical improvement).

date
from time of scan

4.2.4 Disseminated toxoplasmosis (database code TOD)*

Definitive diagnosis by histology or microscopy (not culture). There should be a concurrent illness consistent with the diagnosis. Can include lung.

(Presumptive diagnosis not accepted)
_{* This diagnosis used in the SHCS does not correspond to any of the CDC definitions.}

4.2.5 Cryptosporidiosis (database code SPO)

Definitive diagnosis by
By stool microscopy or histology,
AND
must have reliable history of persistent diarrhea for >1 month.

date
from when diarrhea has persisted >1 month AND stool specimen taken with positive result.
(Presumptive diagnosis not accepted)

4.2.6 Isosporiasis (database code ISO)

Definitive diagnosis by microscopy of stool,
AND must have a reliable history of persistent diarrhea for >1 month.

date
from when diarrhea has persisted >1 month
AND stool specimen taken with positive result

4.3 Fungal diseases

4.3.1 Oesophageal candidiasis (database code ESO)

Definitive diagnosis by macroscopic inspection at endoscopy,
OR
histology of biopsy,
OR
cytology of specimen from the mucosal surface (NOT by culture, NOT by barium swallow alone)

Presumptive diagnosis

Recent onset of retrosternal pain/discomfort on swallowing (not nausea), AND
Oral candidiasis diagnosed as pseudomembranous candida on inspection, or diagnosed by microscopy of specimen from mucosal surface (not culture), or patient noted "oral candida", was familiar with the appearance (e.g., documented prior episodes) and patient started treatment before seeing a doctor, AND must respond to antifungal treatment.

date
from when 1 + 2 together

(Presumptive diagnosis not accepted for 4.3.2 - 4.3.5)

4.3.2 Candidiasis of trachea, bronchi or lungs (database code CAN)

Definitive diagnosis by macroscopic inspection at endoscopy,
OR
histology of biopsy or cytology of specimen from mucosal surface. Not by culture.

4.3.3 Cryptococcal meningitis (database code COM)

Definitive diagnosis by microscopy, or detection of antigen, or culture from CSF

4.3.4 Other disseminated cryptococcosis, extrapulmonary (database code COC)

Definitive diagnosis by histology of extrapulmonary tissue, microscopy, or detection of antigen, or culture (e.g., blood, not sputum),
AND must have concurrent illness consistent with the diagnosis.

4.3.5 Disseminated coccidioidomycosis (database code CCM)

Definitive diagnosis by microscopy, culture, or detection of antigen. Not from lungs, cervical or hilar lymph nodes.

4.3.6 Disseminated histoplasmosis (database code HIS)

Definitive diagnosis by microscopy, culture, or detection of antigen. Not from lungs, cervical or hilar lymph nodes.

4.4 Bacterial diseases

4.4.1 Pulmonary tuberculosis (database code TBC)

Definitive diagnosis by culture (not PCR)

Presumptive diagnosis by showing acid-fast bacilli in sputum that is not confirmed by culture or PCR,
AND must respond to specific treatment

OR
suggestive infitrate on CXR,
AND (ananmnestic exposure to TB, or positive PPD test),
AND response to specific treatment

date
from specimen and CXR, respectively

4.4.2 Extrapulmonary tuberculosis (database code TEX)

(If patient has concurrent pulmonary TB please code also TBC)

Definitive diagnosis by culture (not lung alone).

Presumptive diagnosis by showing acid-fast bacilli in stool, blood, body fluid or tissue, or in histology of cervical or hilar lymph nodes, of a species not identified by culture,
AND There is a concurrent definitive diagnosis of pulmonary TB

OR
responds to standard TB treatment

date
from specimen

4.4.3 Disseminated mycobacterium avium intracellular complex disease (database code MAC)

Definitive diagnosis by culture (not by PCR) other than sputum, stool or skin
AND must have concurrent illness consistent with the diagnosis, e.g., weight loss, fever, diarrhea or anemia

date
from specimen

4.4.4a Mycobacterium kansasii disease (database code KAN)

Definitive diagnosis by culture (not by PCR) in sputum, urine or stool (at least two specimens), or in normally sterile body fluid or biopsy
AND must have concurrent illness consistent with the diagnosis, e.g., pulmonary infitration, weight loss.

date
from specimen

4.4.4b Mycobacterium avium or kansasii disease (old database summary code MAK)

If sufficient information is available, this code should be replaced by MAC or KAN.

4.4.5 Mycobacterium genavense disease (database code GEN)

date
from specimen

4.4.6a Disseminated mycobacterial disease other or indeterminate (database code MYC)

Definitive diagnosis by culture (not by PCR) other than sputum, stool or skin. Include species other than M. tuberculosis, M. avium complex, M. kansasii or M. genavense,
AND must have concurrent illness consistent with the diagnosis.

date
from specimen

Presumptive diagnosis by showing acid-fast bacilli in stool, or normally sterile body fluid (not sputum alone), or biopsy (not skin or lungs) where species not identified by culture,
AND must have a concurrent illness consistent with the diagnosis, as above.

date
from specimen

4.4.6b Other pulmonary mycobacterial diseases* (database code MYP)

Definitive diagnosis by culture (not by PCR). Include species other than M. tuberculosis, M. kansasii or M. genavense,
AND must have concurrent illness consistent with the diagnosis.

_{* This category of diseases used in the SHCS does not correspond to any of the CDC definitions.}

4.4.7 Recurrent Salmonella septicemia (database code SAL)

Definitive diagnosis by blood culture, with history of previously treated blood-culture-confirmed Salmonella septicemia.

4.4.8 Recurrent bacterial pneumonia (database code BPN)

Definitive diagnosis by two episodes of bacterial pneumonia within the last twelve months.

date
use the time of onset of the second episode
relapse
Is considered as a relapse every following bacterial pneumonia

4.5 Viral diseases

4.5.1 Chronic mucocutaneous Herpes Simplex ulceration (database code HSV)

Definitive diagnosis byculture, microscopy, or detection of antigen,
AND must have a reliable history of persistent ulceration for >1 month, NOT including recurrent ulceration.

Presumptive diagnosis
Must have a reliable history of persistent ulceration for >1 month, NOT including recurrent ulceration,
AND responds to standard treatment

4.5.2 Visceral herpes simplex disease (database code HSD)

Definitive diagnosis by culture, microscopy or detection of antigen with associated visceral disease
OR
positive specific PCR from CSF or from acqueous humor with associated CNS or retinal disease. (Presumptive diagnosis not accepted)

4.5.3 CMV retinitis (database code RET)

Definitive diagnosis by typical appearance,
AND positive specific PCR from acqueous humor
AND responds to CMV treatment.

Presumptive diagnosis by characteristic appearance on ophthalmoscopic examination. (Discrete patches of retinal whitening with distinct borders speeding in a centrifugal manner, frequently associated with retinal vasculitis, hemorrhage and necrosis. Resolution of active disease leaves retinal scarring and atrophy with retinal pigment epithelial mottling).

date
from when clinician was sure of diagnosis

4.5.4 Other CMV disease (database code CMV)

Definitive diagnosis by histology or cytology. Not liver, spleen, or lymph nodes. A positive culture alone from any site (except CSF) without histologic or cytologic evidence is not sufficient.
(Presumptive diagnosis not accepted)

4.5.5 Progressive multifocal leukencephalopathy (database code PML)

Definitive diagnosis by histology (not PCR for JC virus)

Presumptive diagnosis by recent onset of neurological abnormality consistent with intracranial disease,
AND CT or MRI evidence of lesion consistent with PML
AND lack of evidence for lymphoma, toxoplasmosis (response to treatment),
or HIV encephalopathy. Evidence for JC virus not necessary.

4.6 Neoplastic diseases

4.6.1 Kaposi's sarcoma (database code KSA)

Definitive diagnosis by histology

Presumptive diagnosis by characteristic gross appearance of erythematous or violaceous plaque-like lesion on skin or mucous membrane. A presumptive diagnosis should not be made by a clinician who has seen few cases of KSA.

date
from time clinician was sure of the diagnosis

4.6.2 Non-Hodgkin's lymphoma (database code NHL)

Corresponds to the old diagnoses IML (immunoblastic lymphoma) and BUL (Burkitt lymphoma)

Definitive diagnosis by histology
(Presumptive diagnosis not accepted)

date
from date of biopsy or time of good evidence of the presence of a mass (by scan) which is later biopsied to show lymphoma.

4.6.3 Primary cerebral lymphoma (database code LOB)

Definitive diagnosis by histology

Presumptive diagnosis by recent onset of focal neurological abnormality consistent with intracranial disease, or reduced level of consciousness
AND CT or MRI scan evidence of a lesion or lesions having a mass effect,
AND no response to toxo. treatment,
AND no evidence for lymphoma outside the brain.

date
from time of scan

4.6.4 Invasive cervical carcinoma (database code ICC)

Definitive diagnosis by histology. Not intraepithelial neoplasia (CIN) or carcinoma-in-situ
(Presumptive diagnosis not accepted)

**4.7 Indeterminate intracranial lesions* (database code ILE)**

Presumptive diagnosis by disease due to intracranial lesion(s) where the differential diagnosis is primary cerebral lymphoma, toxoplasmosis, PML or HIV encephalopathy (DEM) but evidence is not sufficient to satisfy the corresponding criteria. Must have abnormal CT or MRI scan.

(Definitive diagnosis not accepted)

date
from time of scan

_{* This category of diseases used in the SHCS does not correspond to any of the}_CDC_definitions.