HIV

Interactive Quiz: Is It an Infection?

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Welcome to Infectious Diseases Consultant's latest interactive diagnostic quiz. Over the next few pages, we'll present a case and ask you to make the diagnosis and treat the patient. Along the way, we'll provide details about the case, and at the end, we'll share the patient's outcome.

 

Ready to get started?

First, let’s meet the patient.

An 18-year-old boy with perinatal HIV and hepatitis C coinfection, cirrhosis, coagulopathy, and chronic thrombocytopenia, presented with 4 days of cough and 2 days of right chest pain and dyspnea, but no fever. The patient was not adherent to antiviral medications. His latest CD4 lymphocyte count was 11%, and his viral load was 28,300 copies/ml.

The patient had received 2 doses of PCV-13 and 3 doses of pneumococcal polysaccharide vaccine (PPV-23), most recently at age 16 years. He had no previous history of IPD.

The patient appeared ill but he was alert and oriented. His temperature was 37°C, respiratory rate was 24 breaths/min, heart rate was 99 beats/min, blood pressure was 115/48 mmHg, and oxygen saturation was 98% on room air.

The patient had subcostal, intercostal and suprasternal retractions, decreased breath sounds, and tracheal breathing in the right base. The spleen was palpable 2 cm below the costal margin. The rest of the physical examination findings were unremarkable.

The white blood cell (WBC) count was 7800/µL, the platelet count was 38 × 103/µL, blood urea nitrogen level was 36 mg/dL, and creatinine level was 3.05 mg/dL. A chest radiograph showed right lower-lobe consolidation and moderate effusion, findings that were confirmed with chest ultrasonography (Figure).

 

Check out the patient’s scan

 

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Outcome of the case

The patient was discharged after 10 days of treatment with oral amoxicillin. At follow-up 2 weeks later, he was asymptomatic and had normal findings on lungs auscultation. The patient had restarted HAART and reported full medication adherence.

Although extremely rare, afebrile IPD is possible and should be considered, especially in an immunocompromised host.

Authors:
Sandra M. Camacho-Gomez, MD, and Yekaterina Sitnitskaya, MD

Department of Pediatrics, NYC Health + Hospitals/Lincoln, The Bronx, New York

Citation:
Camacho-Gomez SM, Sitnitskaya Y. Invasive Streptococcus pneumoniae infection in an afebrile adolescent with human immunodeficiency virus [published online November 14, 2017]. Consultant360. https://www.consultant360.com/exclusives/invasive-streptococcus-pneumoniae-infection-afebrile-adolescent-human-immunodeficiency.

 

References:

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