Author Topic: Case (61)  (Read 7505 times)

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Offline Muna1

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Case (61)
« on: April 15, 2010, 03:10:19 PM »
A 27-year-old woman presents to her physician because of 5 days of fever and cough. She has no significant past medical history but has been “fighting colds” for the past 3 months, which she attributed to the winter season. She began having low-grade fevers as well as a dry cough 5 days ago. She has also become increasingly short of breath over the past 2 days. Her temperature is 38.7°C (102°F), heart rate is 110/min, respiratory rate is 24/min, blood pressure is 110/70 mm Hg, and oxygen saturation is 90% on room air. Physical examination reveals pallor and oral thrush. Lung auscultation is significant for bilateral crackles and rhonchi throughout. The remainder of her examination is unremarkable. She lives with her husband, who is HIV-positive but is currently asymptomatic. She has no pets and no recent travel history. X-ray of the chest reveals diffuse bilateral interstitial infiltrates.

What is the most likely diagnosis?what is the treatment?

Offline Kassim

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Re: Case (61)
« Reply #1 on: April 17, 2010, 07:28:20 PM »
Since her partner is HIV positive, and she has Oral Thrush, then she is most likely to be HIV Positive.  Therefore I believe the most likely diagnosis is  pneumocystis jiroveci (pj) , previously known as Pneumocystis Carinii Pneumonia (PCP).

PJ is the most common opportunistic infection in people with HIV. Without treatment/ ARV, over 85% of people with HIV would eventually develop PCP. Since our patient was not aware that she was HIV positive, she was not on treatment.   It has been the major killer of people with HIV. However, but is now almost entirely preventable and treatable.

PJ is caused by a fungus.  A healthy immune system can control the fungus. However, PJ causes illness in children and in adults with a weakened immune system.

Pneumocystis almost always affects the lungs, causing a form of pneumonia. People with CD4 cell count under 200/µL have the highest risk of developing PCP. People with counts under 300 who have already had another opportunistic infection are also at risk.


The first and most important is to confirm/prove that she is a HIV positive, by using Rapid Diagnostic test.
Secondly after confirming the diagnosis of HIV, then do the basic Investigations:
LFTRENAL FUCTIONCD4 Count                                 
ABG (arterial blood gases)
If possible sputum for AFB

In terms of treatment, the most important is Oxygen therapy 5L/Min
Then start Co-Trimoxazole  20 mg trimethoprim and 100 mg sulfamethoxazole per kg of body weight per day in two or more divided doses for 3 weeks
Plus other Ampicillin and Chloramphenicol to cover other G+ve, G-ve, and Haemophelus.
Then continue co-trimoxazole as prophylactive.
These agents are used as adjunctive initial therapy only in patients with HIV infection who have severe PCP .
Prednisolone 40 mg PO bid for 5 d, then 40 mg/d for 5 d, then 20 mg qd for 11 d ( 30 min before TMP-SMX.
Then after that council the patient to start ARV
Paracetamol for the fever.
Importantly  social support.

Hope this is the right answer

And hope our beloved country will not be affected as much as other African countries, where i am practicing in Tanzania.  i would say this is a KILLING MACHINE, is not sparing young, Adult, Old, women and Man. this is heart breaking.
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Offline Muna1

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Re: Case (61)
« Reply #2 on: April 18, 2010, 10:57:36 PM »
mashaalh tabark allh  ;D
your answers was 100% correct


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