The patient was a 55-year-old male with a 2-month history of fevers, night sweat
ID: 15230 • Letter: T
Question
The patient was a 55-year-old male with a 2-month history of fevers, night sweats, increased cough with sputum production, and a 25-lb (ca. l1-kg) weight loss. The patient denied intravenous drug use or homosexual activity. He had had multiple sexual encounters, "sipped" a pint of gin a day, was jailed 2 years ago in New York City, and had a history of gunshot and stab wounds. His physical examination was significant for bilateral anterior cervical and axillary adenopathy and a temperature of 39.4°C. His chest radiograph showed paratracheal adenopathy and bilateral interstitial infiltrates. His laboratory findings were significant for a positive HIV serology and a low absolute CD4+ lymphocyte count.1. WHAT RISK FACTORS IN HIS MEDICAL HISTORY DO YOU THINK ARE IMPORTANT IN HIS CONTRACTING THIS ORGANISM?
2.WHAT CONTROL MEASURES MUST BE TAKEN DURING THIS PATIENTS HOSPITALIZATION?
3. WHAT THERAPY WOULD YOU SUGGEST FOR THIS PATIENT?
4.WHAT PUBLIC HEALTH MEASURES SHOULD BE TAKEN GIVEN THIS DIAGNOSIS?
Explanation / Answer
Bronchoalveolar Lavage Fluid (BALF): Body fluid obtained by washout of the alveolar compartment of the lung. BALF is a medical procedure in which a bronchoscope is passed through the mouth and nose into the lungs. Fluid is then squirted into a small part of the lung and recollected for examination. Based on the medical history of the patient, the most likely organism to be causing the infection is Mycobacterium tuberculosis. Spread through droplets: when someone coughs, sneezes, or talks, tiny droplets of saliva or mucus are expelled into the air, which can be inhaled by another person. Once infectious particles reach the alveoli, macrophage engulfs the TB bacteria, transmitting it to the lymphatic system and bloodstream, where it gets spread to other organs. The bacteria further multiply in organs that have high oxygen pressures (i.e upper lobes of lungs, the kidneys, bone marrow, and meninges) Some effective drugs: Isoniazid (INH) Rifampin Streptomycin Pyrazinamide Ethambutol Prevention: BCG vaccine (could give TB skin test a false-positive) Those identified with latent tuberculosis are given INH every 6-12 months to prevent M. tb from becoming active. Those identified with active tuberculosis are hospitalized and kept in a room with controlled ventilation and airflow until they can no longer spread the tb germs. Hospitals and clinics can take precautions to prevent the spread of tb by using ultraviolet light to sterilize the air, special filters, and special. Infection with the human immunodeficiency virus, non-White race/ethnicity, and foreign birthplace were each associated with a sixfold or greater increase in risk. Each of the following was associated with at least a doubled risk: history of medical conditions, low weight for height, low socioeconomic status, and age 70 years and older. Men had 1.9 times the risk of women, smokers of 20 years or more duration had 2.6 times the risk of nonsmokers, and heavy alcohol consumers has 2 times the risk of nondrinkers
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