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34. A 23-year-old, HIV-infected female presents with a 2-day history of fever and productive cough. She is on antiretroviral therapy and her CD4 count is 300/cu. mm. Her vitals are, Temperature: 39C(102.5F); PR: 95/min; BP: 115/76mm Hg; RR: 20/min. Percussion note is dull on right lower chest with increased vocal resonance. Chest x-ray shows right-sided pleural effusion and right middle zone infiltrates. What is the most likely cause of the patient™s symptoms?
A. Pneumococcus
B. Mycobacterium tuberculosis
C. Disseminated coccidiomycosis
D. Pneumocystis carinii
E. Kaposi™s sarcoma
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Chest x-ray shows right-sided pleural effusion and right middle zone infiltrates.
THIS IS NOT TB XRAY
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ANS IS AAA Acute onset, high-grade fever and pleural effusion all suggest bacterial pneumonia in this HIV-infected patient. Pneumococcus and other encapsulated bacteria can cause infections in such patients due to impaired humoral immunity. Pneumococcus is still the most common cause of pneumonia in HIV patients. Mycobacterium tuberculosis infection presents with chronic cough, fever and weight loss. Disseminated fungal infection will result in a miliary pattern or nodular infiltrate on chest X-ray. Pneumocystis carinii pneumonia presents with dry cough and dyspnea. Pleural effusion is not a feature of this infection. Pulmonary Kaposi™ s sarcoma may present with mild cough. Chest x-ray shows pulmonary nodules.
Educational Objective:
Encapsulated bacteria especially Pneumococcus is the most common cause of pneumonia in HIV patients