Managing Patients with HIV-Related Diseases

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Managing Patients with HIV-Related Diseases

• Part A Module A2
• Session 9

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Purpose

• To learn about fever including common etiologies,
  recommended diagnostics, common findings,
  management and treatment of bactermia/septicemia.

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Objectives

• To describe the various etiologies that cause
  fever
• To describe the clinical presentation of
  bacteremia/septicemia
• To explain the recommended diagnostics and
  describe the common findings for these tests

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Objectives, continued

• To describe the management and treatment for
  bacteremia/septicemia.
• To make a differential diagnosis using a case
  study approach.

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Overview

• Fever
• a recurrent or persistent elevation in
  temperature (gt37.5 ºC) for a duration of more
  than 2 weeks as the only clinical presentation
  in a patient with HIV infection

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Fever

• Differential diagnosis Includes the following
  etiologies
• Protozoal infection Malaria
• Bacterial infection Pyogenic infections of the
  chest, CNS, or urinary tract, etc.
• Bacteremia due to Borreliosis, Salmonella,
  Streptococcus pneumonia, H. influenzae, etc.
• Mycobacterial infection Mycobacterium
  tuberculosis, atypical mycobacteria
• Viral infection Upper respiratory tract
  infections, Cytomegalovirus, EBV, HIV infection
  itself
• Malignancies Lymphomas

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• Bacteremia/Septicemia
• Common etiological agents Pneumococcal,
  meningococcal
• Clinical presentation fever (intermittent),
  chills at onset, pulse weak and rapid, skin
  eruptions (petechial or purpuric most common),
  headache, anorexia, vomiting diarrhea, delirium,
  shock, hypotension, vascular collapse, renal
  failure, death

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Recommended Diagnostics

• Urinalysis for albumin, erythrocytes, leukocytes.
  
• Blood cultures for aerobic and anaerobic
  organisms
• Blood counts for anemia

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• Common findings
• Urine may be positive for albumin, etc.
• Blood cultures may be positive
• Patient may be anemic
• Management and treatment
• Amoxicillin and gentamycin or ciprofloxacin.
• Supportive measures adequate nutrition and fluid
  intake maintain electrolyte balance with IV
  fluids
• Comments requires vigorous treatment, including
  hospitalization