Case Study 2_ AIDS

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition AIDS (Acquired Immunodeficiency Syndrome) Case Studies The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed right-sided pneumonitis. The following studies were performed: Studies Complete blood cell count (CBC), p. 156 Hemoglobin (Hgb), p. 251 Hematocrit (Hct), p. 248 Chest x-ray, p. 956 Bronchoscopy, p. 526 Lung biopsy, p. 688 Stool culture, p. 797 Acquired immunodeficiency syndrome (AIDS) serology, p. 265 p24 antigen Enzyme-linked immunosorbent assay (ELISA) Western blot Lymphocyte immunophenotyping, p. 274 Total CD4 CD4% CD4/CD8 ratio Human immune deficiency virus (HIV) viral load, p. 265 Results 12 g/dL (normal: 14–18 g/dL) 36% (normal: 42%–52%) Right-sided consolidation affecting the posterior lower lung No tumor seen Pneumocystis jiroveci pneumonia (PCP) Cryptosporidium muris Positive Positive Positive 280 (normal: 600–1500 cells/L) 18% (normal: 60%–75%) 0.58 (normal: >1.0) 75,000 copies/mL Diagnostic Analysis The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is an opportunistic infection occurring only in immunocompromised patients and is the most common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his prognosis is poor. The patient was hospitalized for a short time for treatment of PCP. Several months after he was discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually and died 18 months after the AIDS diagnosis. Copyright © 2018 by Elsevier Inc. All rights reserved. Case Studies 2 Critical Thinking Questions 1. What is the relationship between levels of CD4 lymphocytes and the likelihood of clinical complications from AIDS? 2. Why does the United States Public Health Service recommend monitoring CD4 counts every 3–6 months in patients infected with HIV? 3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you approach to your patient to inform about his diagnosis? 4. Is this a reportable disease in Florida? If yes. What is your responsibility as a provider? . Copyright © 2018 by Elsevier Inc. All rights reserved.