A Basic Primer on HIV Infections and AIDS Cases (HIV/AIDS)
This chapter responds many of the myths, misconceptions and misunderstanding of HIV/AIDS. It provides some basic information on infectious disease agents and the diseases they cause, along with some basic concepts of infectious disease epidemiology. The chapter suggests that there has been a general problem in assuming that everyone involved with or interested in AIDS and AIDS programs has a basic knowledge of infectious disease agents and infectious disease epidemiology. The development of laboratory tests to identify HIV infections enabled clinicians to study the natural history of HIV-infected persons. The major point the table demonstrates is that an infectious disease agent such as HIV which requires sex or blood contact for transmission from person to person cannot become a "generalized" epidemic agent. Primary immune deficiency is caused by genetic defects in the immune system. The major interaction identified is with Mycobacterium tuberculosis (Mtbc), the etiologic agent or cause of pulmonary tuberculosis (TB).
The most common cause of uterine swelling is pregnancy, and this must always be considered during the reproductive years, particularly when associated with a history of amenorrhoea or menstrual upset. The size is dependent on the gestational age, but will usually become palpable abdominally from 12 weeks’ gestation. Uterine swellings have varying implications, depending on the age of presentation. The diagnosis is usually based on history and physical examination. Adolescent girls, unlike women in other age groups, may present with a uterine mass that is secondary to a Mullerian malformation, such as imperforate hymen, vaginal agenesis with a normal uterus and functioning endometrium, vaginal duplication with obstructing longitudinal septa, and obstructed uterine horns. Among the infective causes of uterine swelling, tuberculous endometritis deserves mention. It is secondary to a systemic infection by Mycobacterium tuberculosis , generally presenting in women of reproductive age.
Sputum microscopy assessment is key, and should also be screened for Mycobacterium tuberculosis . A urinary screen is particularly important to screen for Legionella, pneumococcal and mycoplasma pneumonia. Blood cultures should also be requested ideally before antibiotics are started. Antibiotics are typically continued for up to 7 days in low- or moderate-severity cases and for up to 7–10 days for high severity. Patients should undergo a full blood count, urea and electrolytes, C-reactive protein, and peak expiratory flow (PEF) rate measurement, in addition to a chest X-ray and an arterial blood gas. Sputum should also be sent for microscopy, culture and sensitivity. If the patient is on theophylline, a theophylline level should be taken at admission. Non-invasive ventilation should be considered for patients who are slow to wean from invasive ventilation and for those with hypercapnic ventilatory failure. Doxapram is an alternative to non-invasive ventilation.
Isolated parapharyngeal cold abscess in a 9-year-old boy
Published in Paediatrics and International Child Health, 2019
Tuberculous adenitis presenting as an isolated cold abscess in the parapharyngeal space is very uncommon and has not been reported in the paediatric age group; presentation as a retropharyngeal abscess, however, is well known. Nine-year-old boy with a progressively increasing swelling on the right side of the neck for 2 months was referred with a clinical diagnosis of neuroblastoma. Surgical exploration of the parapharyngeal space by needle aspiration yielded a cheesy material and Mycobacterium tuberculosis was detected by DNA TB PCR. Tuberculosis should always be considered in the differential diagnosis of a cervical swelling in a child.
Personalizing therapy for multidrug resistant TB: the potential of Rapid Whole Genome Sequencing
Published in Expert Review of Anti-infective Therapy, 2016
Multidrug resistant tuberculosis is an increasing problem globally. The current gold standard in drug sensitivity testing is slow and cumbersome. To tackle drug resistance effectively, a more rapid method of testing is required. Current molecular tests are fast, but only offer information on a limited number of genetic loci. Whole genome sequencing presents an attractive alternative that can provide comprehensive, clinically relevant information on all described loci. Although the standard approach to whole genome sequencing of Mycobacterium tuberculosis is slow due to the requirement of culture, this article will describe recent advances that mean it has the potential to provide results within days.
Chronic tuberculous empyema in an 8-year-old boy
Published in Paediatrics and International Child Health, 2020
Mycobacterium tuberculosis (MTB) as a causative organism of empyema thoracis is rare, especially in children. An 8-year-old boy with tuberculous empyema and no history of contact with tuberculosis presented with minimal symptoms other than mild deformity of the chest wall. He had been vaccinated with bacillus Calmette–Guérin. A chest CT scan demonstrated intrathoracic lymphadenopathy, thickened and calcified pleural rind and rib thickening adjacent to the empyema. The diagnosis was confirmed by post-operative histopathological examination, positive acid-fast stains and DNA PCR. In countries with a high burden of tuberculosis, MTB should be considered in the differential diagnosis of empyema despite minimal symptoms.