Clinicopathologic Conference Advanced Update in HIV Medicine and Clinical Research October 1, 2009 Tammy M. Meyers, BA, MBBCh (WITS), FCPaed (SA), Mmed,

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

June 2004 HITCH Training Slide Set #3 Special Considerations in Antiretroviral Therapy.
Case 2: 40-year-old Woman with Long-standing HIV Infection
Global Health Case Studies – HIV and Tuberculosis Clinical Pearls in Diagnosis and Management Michael Tuggy, MD.
Hemoptysis Mentioned in the Review of Systems… Gretchen Shaughnessy, MD Clinical Fellow Dept of Infectious Diseases.
Case 7 23 year-old woman From former Soviet state Arrived in UK October 2008 Living in London 1.
Tuberculosis in Children: Prevention Module 10C - March 2010.
Pediatric Case Presentation BOGNON TANGUY Care Unit Children Exposed or Infected by HIV/AIDS Military Teaching Hospital - Cotonou - BENIN.
Melioidosis case report of a pediatric patient in Cambodia with extrapulmonary findings of mastoiditis and visceral abscesses Yos Pagnarith MD Angkor Hospital.
A 32 year old Gay man is admitted with a three month history of weight loss, fatigue, intermittent fever and lymphadenopathy. One month ago he developed.
Clinical Case Female, 27 years of age 3 rd year Internal Medicine resident at the Mexicali General Hospital Never smoked; does not ingest alcoholic beverages.
Development and pilot an automated Pregnancy and Birth Registry Kara Wools-Kaloustian M.D. M.S.
IMCI Dr. Bulemela Janeth (Mmed. Pead) 1IMCI for athens.
In the name of God Fariba Rezaeetalab Assistant Professor.
Unit 10 Treating the Dually Infected Patient: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.
Diagnosis of TB.
Clinical Pathological Conference Kartikya Ahuja, M.D. Resident Physician Department of Medicine NYU School of Medicine July 20 th, 2007.
 Pulmonary Tuberculosis BY: MOHAMED HUSSEIN. Cause  Caused by Mycobacterium tuberculosis (M. tuberculosis)  Gram (+) rod (bacilli). Acid-fast  Pulmonary.
NYU Medical Grand Rounds Clinical Vignette Demetrios Tzimas, PGY 2 October 27, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine
NYU Medical Grand Rounds Clinical Vignette Matthew B. Brown M.D. PGY-2 10/4/11 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
“Don’t tell me TB is under control!” Understanding TB
NYU Medical Grand Rounds Clinical Vignette Elizabeth Selden, MD PGY-2 November 8, 2011 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
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.
Unit 9 Diagnosis and Treatment of Paediatric TB: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.
NYU Medical Grand Rounds Clinical Vignette Lucy Doyle MD, PGY-2 March 24, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
NYU Medical Grand Rounds Clinical Vignette Verity Schaye MD, PGY-2 February 3, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
NYU Medicine Grand Rounds Clinical Vignette Keri Herzog, PGY 2 December 8, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Unit 7 Treatment of TB: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.
Patient presenting with altered mental status
Unit 6 Diagnosing TB: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.
TB Control Program County of San Diego Challenges: Cross border Continuity of TB Care Response:CureTBUS/Mexico Tuberculosis Referral and Information Program.
NYU Medical Grand Rounds Clinical Vignette Karyn Singer, PGY3 September 22, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Extrapulmonary Site 2 :_____________________ Name (surname, first name) Age (in years) Sex F Alternative address Physical Address (in full) M INTERIM TUBERCULOSIS.
Case Series of HIV-infected children with Bacillus Calmette-Guérin Vaccine Related Lymphadenopathy in Lilongwe, Malawi John Midturi Kazembe, PN., Schutze,
Two Men with Extensive Genital Ulcer Disease Recent Cases at the Denver Metro Health Clinic.
Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine
Clinical Tracking and Management of HIV-Positive Children National Pediatric HIV Training 1.
1 Antiretroviral Therapy in HIV-infected Children HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection DR. S.K CHATURVEDI DR. KANUPRIYA CHATURVEDI.
1 Starting ART in the Context of Opportunistic Infections HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Treatment of Tuberculosis: New Case Case Studies Module 7A2 – March 2010.
Baseline survey was conducted in 92 households covering 6 villages, three each from both the Dhandhar and Jherli village panchayats. Dhandhar Village Panchayat.
NYU Medical Grand Rounds Clinical Vignette Lisa Cioce MD, PGY-2 March 10, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
NYU Medical Grand Rounds Clinical Vignette Christopher Schultz, MD, PGY-2 February 24, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Chapter 4 Cough or difficult breathing Case III. Case study: Mary is an 8 year old girl with cough and weight loss for some weeks.
Case 8 38 year-old man from Sub-Saharan Africa Came to UK in 2001 Living in London First wife died 10 years ago of TB Remarried for 7 years, wife currently.
NYU Medical Grand Rounds Clinical Vignette Verity Schaye, MD PGY-3 September 15, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Extrapulmonary Site 2 :_____________________ TUBERCULOSIS TREATMENT CARD BOTSWANA NATIONAL TUBERCULOSIS PROGRAMME Date RegisteredIN ToOUT RegisteredIN.
1 HIV Clinical Staging HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Clinical Case Female, 27 years of age Female, 27 years of age 3 rd year Internal Medicine resident at the Mexicali General Hospital 3 rd year Internal.
Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine
NYU Medical Grand Rounds Clinical Vignette Benjamin Eckhardt, MD PGY-3 October 6, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Unit 11 Drug Resistance and MDR-TB: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.
1 Communicating to Other Health Professionals About Your Patient: Doing Case Presentations HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Integrated Management of Childhood Illnesses
Tuberculosis By Fion Kung. Objective  Describe tuberculosis  Describe sigh and symptoms of tuberculosis  Describe the nursing diagnosis for tuberculosis.
Sub module 3 Pre-ART and ART registers. Purpose of registers Key individual information for: Facilitating patient management by the identification of.
Treatment Failure HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Tuberculosis in Children and Young Adults
Human Immune Deficiency Virus Infection Dr Huda Taha Sep 2015.
LEARNING MODULE TITLE SUBTITLE. HISTORY OF PRESENT ILLNESS An 18 year-old woman with no past medical history and no known risks for TB presents with several.
Response to Antiretroviral Treatment In an Ethiopian Hospital Samuel Hailemariam, MD, MPH; J Allen McCutchan, MD, MSc Meaza Demissie, MD, PMH, PHD; Alemayehu.
Spotlight Case Watch the Warfarin!. 2 Source and Credits This presentation is based on the July 2011 AHRQ WebM&M Spotlight Case –See the full article.
Case Discussion 2 - TB IN CHILDREN by Dr. Jeyaseelan P. Nachiappan & Dr. Suryati Adnan 1 Picture of CPG Cover.
This is an archived document.
Dr Dawood Quiz questions.
Claire Gamble Friday 30th June 2017
بسم الله الرحمن الرحيم.
Presentation transcript:

Clinicopathologic Conference Advanced Update in HIV Medicine and Clinical Research October 1, 2009 Tammy M. Meyers, BA, MBBCh (WITS), FCPaed (SA), Mmed, DTM&H University of the Witwatersrand Thumbi Ndung'u, DVM, PhD. Nelson R. Mandela School of Medicine

“A 7-year-old boy with elevated HIV ribonucleic acid levels despite antiretroviral medications” Presentation of Case Brian C. Zanoni, M.D.

History of Present Illness 7 year old HIV positive child on ART transferred care to Sinikithemba Clinic

Past Medical History Birth history –Full term normal spontaneous vaginal delivery –3.4 Kg –Mother with prenatal care but no HIV testing –Breastfed for 3 months –Received all routine immunizations Including BCG

History of Present Illness At age 3 hospitalized for pneumonia –Clinically diagnosed with pulmonary TB –Completed 6 months of RIF, INH, PZA

History of Present Illness 5 years 10 months old admitted for respiratory distress –Mantoux negative –HIV positive –Treated with ceftriaxone, clarithromycin, trimethoprim-sulfamethoxazole (TMP/SMX), albuterol (salbutamol), and hydrocortisone No improvement

History of Present Illness Admission continued –CD 4 : 9 / 1% –VL: 2.2 million copies / ml –Weight: 14 Kg (<5%) –After 5 days of no improvement started on RIF, INH, PZA for presumptive TB –Began HAART with AZT, 3TC, Ritonavir –Discharged on day 11 Continued TMP/SMX, TB treatment, and ART

History of Present Illness 4 months later –Developed a supraclavicular abscess No response to antibiotics I and D –Culture: No growth (bacterial or mycobacterial) –Pathology: Caseating granulomas with necrosis »Consistent with TB

History of Present Illness 6 months after admission and ART/TB Treatment –Supraclavicular node resolved –TB treatment stopped (6 months completed) –CD 4 : 236 / 6% (↑ 9 / 1% at baseline) –VL: 3342 –Weight: 15 kg (~3%)

History of Present Illness After 18 months on ART –Unable to continue with private physician for financial reasons –Transferred to McCord Hospital Sinikithemba Clinic –Mother reported good adherence with ART and TMP/SMX –Patient was unaware of his HIV status

Social/Family History Father died of unknown illness when patient was an infant Mother tested HIV positive after diagnosis of patient Siblings tested HIV negative No known TB contacts

Presentation to Sinikithemba Physical exam –Weight < 5% –Axillary adenopathy –Otherwise normal Preliminary management –AZT dose increased –3TC dose increased –Ritonavir changed to lopinavir/ritonavir –TMP/SMX continued

Lab Results 18 Months on ART –CD 4 : 146 / 6.1 % –VL: 4300 –Hb: 10.6 MCV 96 –LFTs: Normal

Follow-up 5 months after presentation to Sinikithemba –Mother reported good adherence No side effects –CD 4 : 471 / 17.9% –VL: 22,000 copies / ml –Weight: Kg (<5%) A diagnostic test was performed

Differential Diagnosis Dr. Tammy M. Meyers

Discussion of Management Dr. Tammy M. Meyers

Follow-up Brian C. Zanoni, M.D.

Follow-up CD4 nadir 59 / 6% Darunavir – Obtained on a compassionate basis from company –Drug registered with Medicine Counsel Regimen changed: –Darunavir 375 mg twice daily –Ritonavir 100 mg twice daily –EFV 300 mg daily

Follow-up 2 weeks later –Developed fever, cough, and new right middle lobe infiltrate –Diagnosed with pneumonia Responded to oral antibiotics 8 weeks after change of regimen –Clinically well –Weight: Kg (5% - 10%) –CD4: 193 / 5.8% –VL: 150