A wide range of clinical presentations can occur with OIs in HIV/AIDS. PCP can manifest with cough, tachypnea, and fever. Chest films may be relatively normal early in the course of disease but eventually may show diffuse, bilateral, symmetric interstitial infiltrates in a butterfly pattern. Hypoxia,
Initial Repeat evaluation evaluation
Figure 18-8 Treatment algorithm for inactive tuberculosis (TB) and for active, culture-negative pulmonary TB. (American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America: Treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-662, and MMWR 52(RR-H):l-77. http://www.cdc.gov/mmwr/ preview/mmwrhtml/rr52iiai.htm.)
Pao2 less than 70 mm Hg, and an increased A-a O2 gradient are typical. Pneumothorax occurring in a patient infected with HIV suggests PCP, which typically produces pneumato-celes as lung tissue is destroyed.
Clinicians should also have a high index of suspicion for pulmonary TB in HIV-infected patients. Presentation of pulmonary TB is fairly typical (upper lobe patchy infiltrates with or without cavitation) in patients with CD4^, whereas patients with more severe immune suppression often have atypical lung presentations (lobar infiltrates or miliary pattern) or extrapulmonary forms of TB. In severely immuno-compromised patients, sputum AFB cultures can be positive even in the presence of normal chest radiograph.
The attention to Ols should not diminish clinical suspicion for bacterial pneumonia as a cause of significant morbidity and mortality in HIV-infected patients. S. pneumoniae, H. influenzae, Pseudomonas aeruginosa, and S. aureus are the most frequently isolated organisms (Rimland et al., 2002). Patients present with typical symptoms such as fever, tachy-pnea, cough, and constitutional symptoms and a pattern of lobar pneumonia or other infiltrates on chest x-ray film.
Was this article helpful?
All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.