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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.
posted on Thu, 13 Mar 2014
Twitter Tue, 23 Dec 2014 Answered on
Twitter Tue, 23 Dec 2014 Last reviewed on
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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!