Infectious Diseases Long Case

Question 1

HIV

Answer 1

1. Diagnosis
   - mode of acquisition
   - seroconversion
2. Risk factors
   - sexual
   - injecting drug use
   - blood transfusions
3. Presentation
   - seroconversion
   - weight loss/diarrhoea
   - CD4 < 50 - MAC, CMV retinitis
   - CD4 <200 - PJP/toxoplasma, candidiasis
   - others - TB, recurrent HSV
4. Investigations
   - CD4 count
   - HIV viral load
   - drug resistance testing
   - screen for other STI - syphilis, hepatitis, chlamydia/gonorrhoea, latent TB
5. Management
   - HAART
   - compliance with therapy
   - side effects of therapy
   - drug interactions
6. Complications
   - infections/vaccinations/prophylaxis
   - cardiovascular
   - metabolic
   - bone health
   - malignancy
   - renal failure
   - liver disease
   - cognitive impairment
7. Outlook/impact
   - impact on family/partners (PREP, barrier contraception)
   - impact on work
   - impact on mental health - support groups
   - impact on society - undetectable count, partner notification, contact tracing, safe sex

Question 2

Fever of unknown origin (Causes)

Answer 2

1. Neoplasms
2. Infections (bacterial, viral, parasitic)
3. Connective tissue diseases (RA, SLE, rheumatic fever, Still’s disease, vasculitis)
4. Drug fever
5. Inflammatory bowel disease
6. Thyrotoxicosis
7. Haemolyisis