Ms. C.A., a 38-year-old dancer, went to the emergency department one night after
ID: 143410 • Letter: M
Question
Ms. C.A., a 38-year-old dancer, went to the emergency department one night after work. She reported a worsening condition of shortness of breath with an unproductive cough, mild chest pain, and tiredness. She also reported persistent diarrhea for the past 6 weeks and weight loss (without dieting) of 16 pounds.
She had no history of smoking or of previous respiratory illness. Her medical history included genital herpes and gonorrhea within the past 2 years. She has had unprotected intercourse with numerous sexual partners.
A complete blood count (CBC), electrocardiogram (ECG), and chest radiograph were ordered. Subsequent to the chest film report of diffuse, bilateral, interstitial shadowing, a bronchoscopy with bronchoalveolar lavage (BAL) was performed.
Laboratory Data
Assay Patient Result Reference Range
Hemoglobin 11.5 g/dL 13.5-17.5
Hematocrit 38% 39-51
Total WBC 5.8 × 109/L 4.5-11.0
Absolute lymphocyte count 0.75 × 109/L 1.6-3.5
T lymphocytes
CD4+ 0.13 × 109/L 0.7-1.1
CD8+ 0.42 × 109/L 0.5-0.9
B lymphocytes 0.10 × 109/L 0.2-0.5
BAL Positive for Pneumocystis carinii
Questions:
Is this patient considered to be immunodeficient? (3 pts)
2. What further diagnostic assays would be useful in establishing a diagnosis? (5 pts)
3. What opportunistic pathogens are typically associated with patients who have an immunodeficiency? (2 pts)
a. Cryptococcus neoformans
b. Cytomegalovirus
c. Hepatitis B virus
d. Both a and b
Explanation / Answer
1. Yes the patient is considered to be immunodeficient. In our body immunity is mainly provided by lymphocytes. B lymphocytes provide humoral immunity by producing antibodies where as T cell provides cell mediated immunity. From the diagnostic data, we can see the patient has low B and T lymphocyte than the normal value whereas absolute lymphocyte count is also below the normal reference range.
2.
HSV testing which is also known as a herpes culture can be done. It will confirm the diagnosis if sores are present on genitals. During this test, a swab sample of fluid from the sore will be taken for testing. However, when sores are not present on the genitals, blood tests are done for looking antibodies to HSV-1 and HSV-2 that can also diagnose this infections.
NAAT (Nucleic Acid Amplification Test) is a molecular test which detects the genetic material (DNA) of Neisseria gonorrhoeae. It is generally more sensitive and specific and specific than other gonorrhea tests and can be performed on a vaginal swab on women, or urine from the women.
3. Cryptococcus neoformans is an opportunistic fungi which causes infection in weakened immune system. Cytomegalovirus is another opportunistic pathogen which are associated with immunodeficient patient.
So the answerr is "Both a and b"
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