CASE 1 55 yo man…Baker HIV+ since 1996 Refused bloodwork over the years as was ‘Feeling fine’ Oral hairy leukoplakia noted on oral biopsy in 2001.

Slides:

Advertisements

Similar presentations

Chronic Productive Cough Dr. Miao Shang Su. Present History - A 5-year-old girl come to your clinic for the first time. Her mother reports that the child.

Advertisements

FUNGAL DISEASES IN THE RESPIRATORY , EXCRETORY & CIRCULATORY SYSTEMS

Treatment and Prevention of Opportunistic Infections: Options for the Caribbean Region Excerpted from presentation by Jonathan E. Kaplan, M.D.

Case 7 23 year-old woman From former Soviet state Arrived in UK October 2008 Living in London 1.

Biological Terrorism HARRT Anthrax (Inhalational) Bacillus anthracis Early Symptoms/Signs  Fever, Malaise, Fatigue, Chills, Myalgia  Cough Delayed.

Preliminary materials Practical Cytological and Histological Approach to Lymphoid Lesions Workshop 8, 55 th annual meeting Canadian Association of Pathologists.

Fungal Infections in HIV-patients

ANTHRAX By: Justin Tursellino. Anthrax is a…. Anthrax is an infection caused by a bacterium, Bacillus anthracis. The infection can take three forms depending.

Lesson 3 HIV/AIDS.

Cryptococcal pneumonia and meningitis. Cryptococcus neoformans.

Ois generalPCPCryptococcus-Toxoplasma

A Case of IRIS Edward L. Goodman, MD October 8, 2003.

Cryptococcosis in the Non-HIV Patient Kristen Amann, MD Morning Report August 12, 2009.

Unit 10 Treating the Dually Infected Patient: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.

Diagnostic testing for HIV: The symptomatic patient.

Case Discussion Dr. Raid Jastania. 19 year old female presents with fever and generalized lymphadenopathy for one month. What are the causes of Fever?

Infectious Diseases.

CASE 2 49 yo man HIV positive 16 yrs. ago CD4 15 on diagnosis Disseminated cutaneous Kaposi’s Sarcoma.

HIV & The Immune System The human immunodeficiency virus (HIV) is a pathogen that destroys infection-fighting T-Cells in the body. Acquired Immune Deficiency.

yBCUM-ldw.  HIV stands for Human Immunodeficiency Virus. Some viruses, such as the ones that cause the common cold.

Wasting Syndrome and Prolonged Fever in HIV-Infected Children

CASE 3 55 yo man HIV positive 2008 CD4 320/23% Viral load 123,557 c/ml Genotype clear TDF/FTC/EFV initiated.

‘Difficult’ Case 1 Sanjay Bhagani Royal Free Hospital and UCL, London.

1 Case year-old White UK male Lived with wife Living in urban area in England.

Management of the Newly Diagnosed Patient. Jane Bruton Clinical Research Nurse Imperial College.

1 Respiratory Diseases in HIV-infected Patients HAIVN Harvard Medical School AIDS Initiative in Vietnam.

IAS–USA When to Start Antiretroviral Therapy Constance A. Benson, MD Professor of Medicine University of California San Diego FINAL: Presented.

HIV related Opportunistic Diseases HIV related Opportunistic Diseases M.MEIDANI,MPH.MD.

CASE 2 49 yo man HIV Bipolar 2 disorder highlighted by major depression with a few serious suicide attempts and necessitating multiple hospital admissions.

Communicable Disease Aim: How can someone contract a communicable disease?

Infectious Respiratory Diseases

Two Men with Extensive Genital Ulcer Disease Recent Cases at the Denver Metro Health Clinic.

1 Starting ART in the Context of Opportunistic Infections HAIVN Harvard Medical School AIDS Initiative in Vietnam.

Bronchitis Causes Bronchitis occurs most often during the cold and flu season, usually coupled with an upper respiratory infection. A number of bacteria.

Mr X and Mr Y 1 Case 4: July year-old Caucasian man ‘Mr X’ 2.

Infections in the Immunocompromised Hail M. Al-Abdely, MD Consultant, Infectious Diseases King Faisal Specialist Hospital and Research Centre.

Prattana Leenasirimakul

CASE 5 54 yo man HIV positive in 2001 Immune Thrombocytopenia Chronic G1a Hepatitis C Crack use daily Normotensive.

HIV/TB – Case Studies David Schlossberg, MD, FACP Medical Director, TB Control Program Philadelphia Department of Health.

HIV/AIDS. Human Immunodeficiency Virus  Virus attacks the immune system  Invades and destroys certain white blood cells  Takes time for the HIV to.

CASE 4 39 yr-old man HIV Asymptomatic CD4 810 HIV viral load

NYU Medical Grand Rounds Clinical Vignette Mark H. Adelman, M.D. PGY-2 2/19/13 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

CASE 3 48 yo man HIV positive/HEP C positive 12 yrs ago Tenofovir/FTC/RTV/Lopinavir x 7 yrs CD4 310/40% HIV Viral Load

1 HIV Clinical Staging HAIVN Harvard Medical School AIDS Initiative in Vietnam.

AIDS. Most important facts Acquired immune deficiency syndrome Caused by the human immunodeficiency virus(HIV). Firstly recognized on June 5, Impossible.

Case Discussion. A 24-year-old university student presents to the Student Health Service with a 3-day history of a dry cough that was initially non-productive.

Prophylaxis of Opportunistic Infections

1 Communicating to Other Health Professionals About Your Patient: Doing Case Presentations HAIVN Harvard Medical School AIDS Initiative in Vietnam.

Exacerbations. Exacerbations An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond.

Spider Bite John W. Baddley, MD, MSPH University of Alabama at Birmingham Birmingham VA Medical Cent er.

CASE 3 48 yo man HIV positive/HEP C positive 12 yrs. ago Tenofovir/FTC/RTV/Lopinavir x 7 yrs. CD4 310/40% HIV Viral Load

Cryptococcus choroiditis

TID Case Nicole Theodoropoulos, MD, MS The Ohio State University.

CASE 1 54 yo man HIV Generalized Anxiety/OCD VL 15,185 CD4 ranges from Baseline Genotype clear.

CASE 4 54 yo man HIV negative In serodiscordant relationship with untreated HIV positive man…ongoing frequent unprotected sex.

What is influenza? Influenza (also called "the flu") is a viral infection in the nose, throat and lungs. About 10% to 20% of Americans get the flu each.

By : Sarah Gobbell. Meningitis is the inflammation of the meninges, the membranes that cover the brain and spinal cord.

Global Action Fund for Fungal Infections

Severe Acute Respiratory Syndrome (SARS)

CD4+ T-lymphocyte count <100 cells/µl

Nguyen Duy Phong; Cao Ngoc Nga; Nguyen Thi Hai Men; Nguyen Le Nhu Tung

Ambreen Khalil MD, Homer Moutran MD, Cristina Corr PA, Fares Elias MD.

HIV Opportunistic infections

Pneumonia in Children. What is pneumonia? Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious.

History 56 y/o male from Cuba newly diagnosed with hepatitis C genotype 2b in Jan 2008 No symptoms of decompensation.

Management of Immune Reconstitution Inflammatory Syndrome (IRIS)

CLINICAL PROBLEM SOLVING

Patients affected by highly infectious diseases:

Presentation transcript:

CASE 1 55 yo man…Baker HIV+ since 1996 Refused bloodwork over the years as was ‘Feeling fine’ Oral hairy leukoplakia noted on oral biopsy in 2001

CASE 1 Fall 2013 Dry cough/soboe…no fevers Seen by respirology…bronchoscopy negative for pathogens

CASE 1 Fall 2013 Was felt to have extrinsic allergic alveolitis….type of ”Bakers lung” Treated with a few months of prednisone with effect

CASE 1 Winter 2014…still on Prednisone Intractable nausea and vomitting Admitted and diagnosed with Cryptococcal meningitis Multiple cutaneous KS lesions

CASE 1 Winter 2014 Steroids stopped and IV amphotericin instituted with effect…eventually switched to oral Fluconazole

CASE 1 Winter 2014 At time of Cryptococcal diagnosis…lungs had significant disseminated nodular infiltrates that were felt to represent Cryptococcal disease as part of a disseminated Cryptococcal syndrome No bronchoscpy done

CASE 1 FEB-MAR 2014 Discharged from hospital and ready to consider HIV meds but wants to see bloods first CD4 110/6% HIV viral load 98,422 Genotype clear

CASE 1 FEB-MAR 2014 Clinically still coughing without fever or SOBOE No headache or fever Multiple cutaneous KS lesions

CASE 1 MAR 2014 Still refused to start ARVS but clearly more receptive Wanted to see CD4 off steroids CD4 90/5% HIV Viral load 389,878

CASE 1 APR 2014 Initiated TDF/FTC/Raltegravir now 4 months from initiation of Cryptococcal therapy…refused PCP prophylaxis but continued on Cryptococcal maintenance therapy with Fluconazole

CASE 1 APR 2014 Cough worsened a few weeks post initiation of ARVS but no fever or flu like symptoms…otherwise improving clinically

CASE 1 MAY 2014 CT chest reveals worsening coarse nodular infiltrates in chest New KS lesions now slowing and older lesions beginning to darken

CASE 1 MAY 2014…1 month post initiaton of ARVS CD4 110/7% HIV viral load 184 Worsening respiratory symptoms with increasing soboe…unresponsive to antibacterials Bronchosocpy/BAL/Transbronchial biopsy performed

CASE 1 MAY 2014 No KS seen in bronchi…BAL negative for pathogens/biopsy revealed chronic inflammation Admitted to hospital and high dose steroids initiated

CASE 1 MAY 2014 Worsening symptoms c/w ARDS/IRIS Transferred to ICU and treated for bacteria/PCP/fungi Succumbed to respiratory illness

CASE 1 JUNE 2014 TAKE HOME MESSAGE THIS COULD HAVE ALL BEEN AVERTED WITH EARLY INITIATION OF ARVS TRY NOT TO USE STEROIDS IN HIV