HIV Case Presentation

Question 1

What is a typical HIV presentation?

Answer 1

• Dry cough for 2 weeks or more
• Symptoms similar to allergies
• Cough nonproductive
• Running fever
• Feeling Ill

Question 2

What is the type of history associated with HIV presentation?

Answer 2

• Not seeing physician for 3 years
• Moving to New York
• Travels world constantly (Kenya, Belize)
• Date raped at 15 yrs.
• Sexually active with one man now and practices safe sex

Question 3

What are typical physical exam findings in HIV?

Answer 3

-Respiratory distress
-Little fever
-Lips and nailbeds are purple
-High respiration rate: 30
-Some flaring of nostrils when breathing
-Lungs have diffuse crackles and wheezes
-O2 Sats = 85%
Patient has Pneumocystis - Pneumonia

Question 4

What is the Differential Diagnosis with HIV?

Answer 4

1. Pneumonia (CAP - Community Acquired Pneumonia - Viral, Hospital acquired pneumonia - Aspiration, Immunosuppressed)
2. HIV (history of unprotected sex, odd hypoxic symptoms)
3. Tuberculosis (recent travel, sick looking, persistent URI)
4. Neoplasm (lung cancer)
5. Viral (parvovirus)
6. Whooping Cough (length, dry cough)
7. Sarcoidosis (tend to have hialar adenopathy - center part of CXR has nodes - long term lung involvement)

Question 5

What will a sputum culture show with HIV?

Answer 5

Negative for strep & yeast

Question 6

What will the blood count (CBC) show in HIV?

Answer 6

High white count, lymphocytes are down, eosinophils are a little elevated

Question 7

What will the CXR show in HIV?

Answer 7

• Need abnormal chest X-ray to diagnose pneumonia
• Diffuse haziness all throughout the chest X-ray
• This is probably interstitial pneumonia

Question 8

What will sputum for AFB show in HIV?

Answer 8

Normal, no TB

Question 9

What will HIV antibody test (ELISA) show in HIV?

Answer 9

Positive - After you do ELISA, you need to do Western Blot to confirm diagnosis

Question 10

What do you see in sputum fungal stain with HIV?

Answer 10

• Pneumocystis - use special stain

- Has PCP pneumonia - Immunosuppressed type of pneumonia

Question 11

What do you see in CD4+ Cell count in HIV?

Answer 11

It’s used to check how immunosuppressed an HIV patient is!

Too low = abnormal

Question 12

What do you see in HIV Viral Load?

Answer 12

High, abnormal!

Question 13

What do you see in the CBC of typical HIV case?

Answer 13

• -Normal: RDW, platelet count, MCV, Hemoglobin, Hematocrit, Erythrocyte count, Automated differential percentages, Auto Monocytes, Auto Granulocytes, Auto Basophils
• -Abnormal: High Eosinophils, High Lymphocytes, High Leukocyte count (WBC)

Question 14

What does sputum fungal stain show in HIV with pneumonia?

Answer 14

Abnormal - green with blue cells - indicate pneumocystis jirivicii

Question 15

What does CXR show in HIV with pneumonia?

Answer 15

Abnormal - lots of cloudiness all over and you can see branching (white)