Dilemma

Emmanuel no longer with rigors and fever

Emmanuel is a 24 year old who was admitted 12 days ago with 2 months of cough and fever.  It was not surprising that he was HIV positive and his chest x-ray was strongly suggestive of Tuberculosis.  Last week we had no HIV or TB medications so it was frustrating watching Emmanuel endure his non-stop cough and recurrent fever.  Out of desperation I placed him on Cipro and Clarithromycin which both have some effect on TB but are not a treatment substitute.  I was able to start him on HIV medications Monday and today TB medications became available.  Hence the dilemma. 

The last 4 days Emmanuel has made a remarkable improvement on my substitute regimen.  With limited resources you frequently have to make best guess decisions.  I think Emmanuel has TB so I initiated his 6 month treatment program today.

Emmanuel's fever chart with sudden clearing of his fever