Re: HIV patient..some scenarios
harry206 - 05-13-09 11:53

1) HIV patient presented with weight loss, fever, night sweat, cevical and axillary LP. cxr...>rt. apical density ----> CD4 count next step ----> CD4 high ---> most likely TB (confirm with sputum culture? & Tt)

2) HIV patient with weight loss, fever, night sweat. o/e he is cachactic. cxr: normal ---> CD4 count (If CD4 <50: most likely MAI --->Rx: calrithro +ethambutol +/- Rifampin)

3) HIV patient with fever, cough and hemoptesis. cxr: bilateral nodular densities ---> first next step: bronchoscopic biopsy

Re: HIV patient..some scenarios
zkadhem - 05-13-09 11:56

great. don't forget to isolate the patient in the first scenario i.e respiratory isolation

Re: HIV patient..some scenarios
harry206 - 05-13-09 12:08

oh yes, very imp point.
Thnx

Re: HIV patient..some scenarios
meduploader - 05-13-09 13:04

Good work guys.
Keep it up

Re: HIV patient..some scenarios
meduploader - 05-13-09 14:18

HIV patient with fever, night sweats, wt loss, cervical and axillay lymphadenopathy. CXR: Right upper lung infiltrate: TB
HIV patient with fever night sweats, weakness, severe wt loss. O/E cachectic no obvious source of fever. CXR: -- ive. CD 4 < 50 --> MAI
Rx: calrithro +ethambutol +/- Rifampin
HIV patient with fever cough, hemoptysis. CXR: bilateral nodular densities. Best next step: bronchoscopic biopsy
it shows regular branced septate hyphae --> Aspergellus
Rx: Amphotericin B or veroconazole
patient is not improving with Rx. Next step in management--> surgical consult
Remeber: if HiV or neutropenic patient presents with cough, fever and hemoptysis the most important in DDX is aspergellus