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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Fever And Abdominal Pain

HI Kindly guide me for my patient who is having hiv positive since 3 yrs presented to me with history of fever ,cough,dyspnoea ,abdominal pain of two day origin. his lab investigation s/o TC 16600 hb 9.6 RFT ,LFT amylase normal CXR s/o right pleural effusion which i have tapped 1.5 ltr which is exudative with lymphocytic leucocytosis.USG ABD s/o peri pancreatic enlarged lymph nodes rest of abd. normal . PAST HISTORY: he was admitted for same before 5 month at that time he is having rt pul. kochs he was kept on akt HRZE and after 6 weeks on VIROIMUNE (triple drug combination) CD4 count was 49 at present he is on TAB.risorine (H+R) ,tab. bactrimn ds 1 od ,tab .viroimune 1 od . Inj. Amikacin 750 od,Tab. claribid 500bd .kindly advice for furthur management. myco bacterial culture sent .result awaited.
Tue, 23 Dec 2014
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Infectious Diseases Specialist,  's  Response
Thank you doctorfor your query at HCM!
As CD4 count is very low so there is chances of contracting various infections.
I suggest the tap should be sent to microbiology laboratory of repute to check for Pneumocystis jiroveci infection of lungs. Send the tap/sputum also for aerobic/anaerobic culture examination. Teat for fungal and parasitic microscopy as well.
I suggest treat according to etiology and wait for all reports including TB. Also get HAIN's test done for TB to get sensitivity for primary/secondary ATT.
WHO has changed guidelines in 2014 for HIV go through that also.
Take care!
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Suggest Treatment For Fever And Abdominal Pain

Thank you doctorfor your query at HCM! As CD4 count is very low so there is chances of contracting various infections. I suggest the tap should be sent to microbiology laboratory of repute to check for Pneumocystis jiroveci infection of lungs. Send the tap/sputum also for aerobic/anaerobic culture examination. Teat for fungal and parasitic microscopy as well. I suggest treat according to etiology and wait for all reports including TB. Also get HAIN s test done for TB to get sensitivity for primary/secondary ATT. WHO has changed guidelines in 2014 for HIV go through that also. Take care!