A 38-year-old man goes to the doctor because of intermittent fevers, recurrent n
ID: 93655 • Letter: A
Question
A 38-year-old man goes to the doctor because of intermittent fevers, recurrent night sweats, diarrhea and a 28 lb loss. He says that he is gay, used to use IV drugs in the past, and adds that he hasn't been as careful about sex, as he should have been. The results of his blood work reveal that he is HIV positive: he is given the appropriate treatment, which he fails to follow. He shows up two more times in the Emergency Room, the first time 14 months later complaining of shortness of breath and severe diarrhea. His second coming at the ER ten months later is marked by a semi comatose status. His caregivers report that he is suffering from severe memory problems, persistent coughing, diarrhea, and weight loss. He dies the following day. Autopsy indicates congestion of the lungs and alveoli filled with microorganisms. His brain shows gross atrophy, chronic inflammation and collection of multinucleated giant cells. The small bowel and colon are extensively ulcerated and inflamed. 1. Why can we say that the patient belongs to main AIDS risk groups? 2. What should we expect to happen with CD4+ lymphocyte count, upon the second and third encounter? 3. Which is the most common microorganism that we expect to detect in his alveoli? 4. What is your diagnosis behind the brain atrophy and inflammation? 5. What might have caused the diarrhea?Explanation / Answer
Answer:
1. Bisexual men have the largest number of new diagnoses of HIV positive in the United States. Risky behaviors, like having anal or vaginal sex without using a condom or taking medicines to prevent or treat HIV, and sharing needles or syringes play a big role in HIV transmission. Anal sex is the highest-risk sexual behavior. The patient said that he is having usafe sex and takes IV drugs and did not complete his HIv treatment so he is tend to be in the main risk zone of AIDS.
2. High number of CD4+ cell count indicates stronger immune system.
A normal range of CD4+ cell count 500-1500, but HIV virus kills these cells which are responsible for immunity. In second encounter he might have 400+ CD4+ count and in third less than 200 CD4+ count.
3. Yeast-like fungus Pneumocystis jirovecii causes Pneumocystis pneumonia (PCP) in most of the HIV patients also Mycobacterium tuberculosis could also be there causing tuberculosis.
4. Distinct multifocal-disseminated and diffuse brain tissue lesions, which can be regarded as HIV-induced brain lesions: multifocal giant cell encephalitis are observed in the HIV infected patients.
5. Mycobacterium avium complex (MAC), Cytomegalovirus (CMV), and Cryptosporidium were very often responsible for diarrhea in AIDS patients. CMV infection is most common infection in the gastrointestinal track of HIV infected patients.