Test a Patient With a Bacterial Infection

Smiths complaints suggest an ongoing infection or an underlying condition in his arm. It might be a bacterial infection such as cellulitis or cat bites disease. Lab tests include:

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- microscopy examination of the fluid or material from the affected arm;

- culture could confirm if the infection is bacterial and which subtype or fungal infection;

- full blood count to assess the various blood cells. White blood cell differential establishes which particular type of white blood cells is involved;

- serology tests and HIV antibody-antigen reaction tests. Western blot and ELISA tests confirm them.

Part 1

The physical examination results show that Smiths blood pressure is slightly elevated while his pulse rate and temperature are within the normal range as indicated by the report. The Blood Tests show that his White blood cell and platelets were normal, but his haematocrit was 31.3% which is lower than the standard for his gender. His CD4 T-cell count was very low. His HIV viral load test was very high. The HIV rapid tests and serology tests are missing they should have been included as they will show the underlying cause of the symptoms. Most of the tests I asked for are available, but the signs and symptoms he had didnt suggest that he had any other underlying condition. Dr Singers test for CD4T cell count and HIV-2 RNA copies was necessary because Smith might have contracted HIV/AIDs.

Part 2

Analysis of Pathophysiology. The patient remained asymptomatic because when he was infected the viruses enter his bodys CD4+ T cells where they established a lifelong infection of the cell. During this acute infection phase, he remained asymptomatic because the disease was self-limiting and the viruses were controlled by the development of an HIV-specific cytotoxic T-cell lymphocyte and humoral response which restored CD4+ T cell count to almost normal level, therefore, remained asymptomatic. After 3-6 weeks the latent infection phase set in. The immune system was relatively intact therefore a dynamic balance between immune cells and actively replicating viruses. T cells kept the virus in check by stimulating lysis and death of infected cells. This phase lasts for up to an average of 10 years without any symptoms. It the progressed to late infection stage where the immune system broke down. There was increasing viremia loss of CD4+ cells and therefore, he was susceptible to opportunistic infections which triggered the symptoms.

Mr. Smiths wife and Child tested negative because they might be still in the window period or the child was conceived and born before he contracted the virus and during the subsequent years, he might have been using protective measures.

Dr Singer prescribed the medications to treat prophylaxis and restore CD4+ t cells to near normal. Trimethoprim-sulfamethoxazole inhibits bacterial biosynthesis of essential nucleic acids and proteins. It treats both Pneumocystis jiroveci pneumonia and any bacterial infection such as bacillary angiomatosis caused by Bartonella henselae. Zidovudine (Retrovir, AZT) and lamivudine (Epivir 3TC) blocks reverse transcriptase thus preventing HIV viruses from replicating. Efavirenz inhibits the action of viral RNA-directed DNA polymerase at a different site lamivudine acts.

If left untreated more opportunistic infections such as Tuberculosis, Cryptococcal meningitis, toxoplasmosis among others will set in. He is likely to develop cancers such as Kaposi sarcoma and lymphomas. Other complications include wasting syndrome, AIDs related dementia complex and HIV-associated nephropathy.

Part 3

Protease inhibitors are competitive inhibitors that directly bind to HIV protease and prevent subsequent cleavage of polypeptides thus suppressing HIV replication. Examples include indinavir, nelfinavir, ritonavir, saquinavir, amprenavir among others. They are part of a combination regimen. Smith might need them in future if Highly Active Antiretroviral Therapy was required or if the doctor recommends new dose combination with Protease Inhibitor. Other possible regiments include abacavir, lamivudine plus Dolutegravir and Darunavir /ritonavir plus tenofovir disoproxil fumarate/emtricitabine. Antibiotics such as Levofloxacin and amoxicillin will be useful in the management of fever and swelling. He should also have a balanced diet and attend have psychosocial support.

References

Manosuthi, W., Ongwandee, S., Bhakeecheep, S., Leechawengwongs, M., Ruxrungtham, K., & Phanuphak, P. et al. (2015). Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014, Thailand. AIDS Res Ther, 12(1). http://dx.doi.org/10.1186/s12981-015-0053-z

McConnell, T. The nature of disease.

Papadakis, M., McPhee, S., & Rabow, M. Current medical diagnosis & treatment 2015.