TB, ever present.

In our HIV patients we continually need to remember Tuberculosis.  10-15 % of the HIV patients will develop active TB each year.  Because of their immunosuppression they will not always present with classic Tuberculosis symptoms.  Additionally their TB may be non-pulmonary in location.
 
Deborah is a 34 year old lady with HIV who has been in the hospital for over 2 weeks.  She has been spiking fevers of 105 daily.  Despite her fever she continued to smile and claimed to be well except for headache related to fever.  She has been treated for malaria and been given antibiotics for every possible bacterial infection.  Despite this, every night Deborah  continued with spiking fevers.  Last week Dr Eugene started TB medications.  It took 5 days but finally Deborah’s temperature has been normal for 2 days.  She was so happy to be discharged today.

TB, Ever Present

Timothy is a 16 year old boy who presented to the clinic 1 week ago with a history of cough of 3 months duration.  His Chest X-ray and sputum check showed Tuberculosis.  Timothy and his parents initially balked at the recommendation that he be hospitalized.  He is preparing for his A level exams.  It would be like sending someone at home taking his SAT exam while being extremely contagious with Tuberculosis. 

After one week of treatment his cough has dramatically reduced and Timothy has promised to have good cough hygiene next week while taking his exams.  Timothy is fortunately HIV negative.

Tuberculosis, again.

When I finished yesterday's blog on TB I really was not sure why I had chosen that topic.  I suppose it was because I had seen a couple of new TB cases yesterday.  

One of those was a 24 year old lady referred from an outlying health clinic.  She looked healthy but was recently diagnosed with HIV and had been coughing for 2 months.  I obtained a chest x-ray which was suspicious for TB.  We obtain 3 sputum samples over 24 hours looking for the TB bacteria.  She submitted her first sample yesterday and was to bring in 2 more this morning.  

While doing rounds this morning the nurse informed me she apparently started coughing up blood during the night and was brought back to the hospital this morning dead.  TB and HIV are deadly and we are reminded of that on a regular basis.

Monday

As usual it was a very busy Monday in the Out Patient Department.  

I had 6 new HIV cases today and 3 new TB cases, quite a change from back at home.  

The sad case was seeing a 7 year old come in for a 2 week follow up after being started on HIV medications.  She was accompanied by her 12 year old sister who was her guardian since their mother had died.  

It was sad thinking of the family situation but I had to admire the strength of the big sister as she walked out of the room with her hand on her sister's shoulder, guiding her.  

Pray for their family and their future.