Day 2, TB TB TB
On day two we have further talks about Tuberculosis, Dr. Evans gave a fantastic talk on tuberculosis, he spent a great time helping us understand the issues of transmission as well as who is considered high risk. Patients malnourished being a large risk factor for active TB and even showed some data that if you look at population attributable fraction, malnourishment is a greater risk of disease over HIV! He had mentioned that patients that have been treated for latent TB but re-exposed, may not be protected, hence the idea of treating people in highly endemic areas might not be cost effective.
We had another talk on presentations of TB by Dr.Gotuzzo. He was also great. Reviewed positive skin test (which varies from Canada, US, WHO), but 5 mm positive in HIV, recent contact, fibrotic change son CXR, organ transplant on immunosuppressed patients.
Cases today
TB Lecture with Dr. Evans
We had another talk on presentations of TB by Dr.Gotuzzo. He was also great. Reviewed positive skin test (which varies from Canada, US, WHO), but 5 mm positive in HIV, recent contact, fibrotic change son CXR, organ transplant on immunosuppressed patients.
Cases today
47 yo male from a coast city but lives in Lima, has previously
travelled to the Jungle last year. He is known HIV, issues with adherence but
CD4 was 220 last year, recent viral load detectable. He has come in with
fatigue, fevers, odynophagia and diarrhea for months (up to 6 per day), no
blood. He supposedly had a diagnosis of TB peritonitis previously but now we’ve
discussed him have TB ileitis. Unfortunately, it seems there was many details
that were unclear (how was the previous diagnosis made, how long he was treated
for, etc). But hopefully we will have more details soon.
32 year old F born in Lima, HIV since 2005 but poorly
controlled, most recent CD4 20. Had a previous diagnosis of bacillary angiomatosis
(BA). Came in with fever, anemia, GGT 1000, ALK PHOS 1200 alt 70, AST 220. Skin
biopsy was consistent with BA, positive warthin starry silver stain! Scope
showed some ulcers in stomach but negative path. Patient also had a bone marrow
which showed a granuloma. Still waiting on further stains – disseminated histo?
6 year with previously leishmaniasis on face, was receiving
ampho, details on how exactly he presented or what species he had were unclear.
Bacillary angiomatosis
Clinical rounds outside bedroom
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