Academy Exchange

  • 1.  Testing for tuberculosis vs. other

    Posted 10-05-2021 13:55
    I have a new patient (refugee from Central America) newly diagnosed w/ B20 with a CD4 of 40 and Quantiferon Negative. His routine CXR was abnormal for cavitary lesion/mass, so f/u CT w/ contrast ordered showing 3 masses suggesting opportunistic infection such as tuberculosis or fungal infection with the radiology report suggesting inflammatory or infectious lesion. The patient's vitals are always normal and he denies any symptoms. What labs would you order for this patient?

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    Elizabeth Horvath
    Avenue360 Health & Wellness
    Houston TX
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  • 2.  RE: Testing for tuberculosis vs. other

    Posted 10-05-2021 15:08
    ugh this to me is pulmonary TB until otherwise proven, even with negative quantiferon. I would def want to get a biopsy of that lung lesion but a cavitary lesion screams TB to me. and with a poor immune system ie CD4 at 40, might just not have an immune system to cause him to feel sick, would worry about IRIS once ART are started but would def want to get a biopsy quickly.

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    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
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  • 3.  RE: Testing for tuberculosis vs. other

    Posted 10-05-2021 18:02
    Agreed.  I think most would think active TB until proven otherwise.  He likely needs isolation, and I might add crypto and cocci serology to his labs, as well as histoplasmosis urinary antigen.  Despite the possibility of IRIS, he needs ARV initiation ASAP.  The only possible reason for delay would be   positive crypto serology.   You also may want to contact Harris County DPH for guidance with possible TB.  And a timely Chest Medicine consultation if at all possible.   Great case.  Good luck!

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    Adam Zweig
    AIDS Healthcare Foundation
    San Diego CA
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  • 4.  RE: Testing for tuberculosis vs. other

    Posted 10-05-2021 18:58
    Paracoccidioidomycosis (PCM) ?
    sputum culture
    Enzyme immunoassay serology for coccidioidomycosis
    Lung Biopsy
    ESR

    Thoracic Paracoccidioidomycosis: Radiographic and CT Findings | RadioGraphics (rsna.org)


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    Michael Roggelin MSN, AGNP-C, FPA-APRN, AAHIVS
    Orlando, FL
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  • 5.  RE: Testing for tuberculosis vs. other

    Posted 10-06-2021 15:17
      |   view attached
    I co-authored this review a long time ago, but these things don't tend to change much over time. Common things are common, but there are uncommon causes of cavitary lesions as well.

    Gallant JE, Ko AH. Cavitary pulmonary lesions in the patient with HIV infection. Clin Infect Dis 1996;22:671-82. https://doi.org/10.1093/clinids/22.4.671

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    Joel Gallant, MD, MPH
    Santa Fe, NM
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    Attachment(s)

    pdf
    Cavitary Lesions.pdf   1.44 MB 1 version


  • 6.  RE: Testing for tuberculosis vs. other

    Posted 10-06-2021 16:30
    Great article. Thanks for sharing.

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    Cleophas d'Auvergne MD., MPA, AAHIVS
    Cleveland, Ohio
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