Case study is always a best practice to check your learning stage. in this article you’re going to learn about HIV infection with opportunistic infections, disseminated tuberculosis, with possibly tuberculous meningitis (TBM).
HIV infection and TBM Related Scenario:
A 35 years old male truck driver reports to hospital emergency with high-grade fever, headache and productive cough and rapid breathing. He gives history of progressive fatigue and weight loss of about 20 kg during the last 6 months. On examination, he has generalised lymphadenopathy and mild hepatosplenomegaly. The skin shows many warts on neck, hands and genitals. On auscultation, lung fields are clear and CVS examination is normal. CNS examination shows stiffness of neck, positive Kernig’s sign. Fundus examination shows papilloedema.
1. Discuss the clinical correlation with the parthenogenesis of the features.
2. What is the probable diagnosis?
3. How will you investigate and confirm the diagnosis?
Clinical Correlation :
This patient has an acute exacerbation of a chronic disease that has caused significant weight loss in 6 months and progressive fatigue. Highway truckers are a recognized high risk group for HIV / AIDS due to their occasional multiple sexual activity. Its acute symptoms of high fever, productive cough, and rapid breathing point to a severe lung infection such as pneumonia or tuberculosis, which are more common in HIV-AIDS due to the immunosuppressed state. Headache, neck stiffness, and a positive Kernig’s sign are hallmarks of meningitis, which could be the spread of infection to the brain and meninges, such as the hematogenous miliary spread of tuberculosis. Papilledema is due to increased CSF pressure from meningitis. Lymph node enlargement and hepatosplenomegaly are due to the role of reticuloendothelial organs in AIDS. The presence of warts at various sites points to opportunistic infections in these patients.
HIV infection with opportunistic infections, disseminated tuberculosis, with possibly tuberculous meningitis (TBM)
here we know how to investigate HIV infection with opportunistic infections, disseminated tuberculosis, with possibly tuberculous meningitis (TBM) probable diagnosis.
i) CBC (haemoglobin, counts, indices), ESR, PCV, blood smear examination.
ii) Urine examination (albumin, glucose, microscopy).
iii) Biochemical estimation: Renal function tests (urea, creatinine, BUN), liver function tests (bilirubin, ALT, AST, alkaline phosphatase, total proteins and AG ratio), blood glucose, lipid profile.
iv) Sputum (culture, cytologic examination, Gram’s stain and tubercle bacilli).
v) Blood culture.
vi) X-ray chest.
vii) Ultrasound examination of abdomen.
- Serology for HIV, HBV, HCV.
- Western blot.
- CD4 +T cell count and ratio of CD4:CD8+ cells.
- CSF examination (microscopy, chemical analysis).
- Bronchoscopy along with cytologic and/or biopsy material.
- Pulmonary function tests.
- FNAC of enlarged lymph node
Reference: Harsh and Mohan Pathology
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