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Case studies in OI management

Case studies in OI management. Module 4 Sub module case studies OI. Case study 1. 24 year-old man with oral thrush, presented with low grade fever, progressive dyspnea on exertion and dry cough for 2 weeks Physical examination showed

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Case studies in OI management

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  1. Case studies in OI management Module 4 Sub module case studies OI

  2. Case study 1 • 24 year-old man with oral thrush, presented with low grade fever, progressive dyspnea on exertion and dry cough for 2 weeks • Physical examination showed T 38.5°C, RR 26/min, O2 saturation was 97% on room air but decreased to 90% with minimal exertion. No cervical lymphadenopathy. Lung clear to auscultation • CXR as shown

  3. Case study 1 What is the differential Dx?

  4. Case study 1 • Differential Dx: - PCP - Miliary TB - Disseminated fungal infection - CMV infection - Bacterial e.g. Salmonella

  5. Case study 1 • What will you do? a. Start empirical Rx for PCP b. Sputum examination and await result c. Fiberoptic bronchoscopy with BAL (if available)

  6. Case study 1 • BAL result : PCP

  7. Case study 1 • Presumptive PCP & Empirical Rx : correct Rx in 72% ( CDC criteria : HIV+, dyspnea, nonproductive cough, no previous prophylaxis, had previous H/O PCP, CXR: diffuse interstitial disease with moderate hypoxemia ) • In severe or atypical cases : Early FOB • In slow or non-responded cases after empirical Rx for 3-5 days : FOB • FOB: procedure of choice for Dx PCP • Sensitivity of BAL >95% if no Rx • Trans bronchial biopsy is not necessary but may be helpful for Dx of concomitant infections

  8. Case study 2 28 yr-o female, known HIV positive for 5 yrs, presents with headache 1 month history of progressive headache without fever or neurological deficit No previous opportunistic infection except herpes zoster 8 moths ago at her left chest wall

  9. Case study 2: Physical exam T 37.2oC BP 110/60 P 90/min RR 20/min Oral thrush Pruritic papular eruption rash over extremities Other general exam unremarkable Neuro exam: fully conscious, cooperative Cranial nerves: intact Motor and sensation: intact Stiff neck positive, mild photophobia Pupil 3 mm, equal, reactive to light, Fundus: no papilloedema

  10. What is the most likely diagnosis?What is the appropriate management? • Serum cryptococcal Ag: positive >1:100 • LP: pressure 40cm Hg (high) RBC 5 cells/mm3, WBC 50 cells/mm3 Protein 88, sugar 60/98 India ink +ve What should be the management?

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