1. Name the fluids known to transmit HIV?
2. What is the underlying cause for Jack’s initial confusion, disorientation and inability to remember things?
3. Since HIV infection and fully developed AIDS are not the same thing, AIDS is defined as?
Dazed and Confused
Patients with HIV/AIDS may have peculiar and confusing
presentations. Not uncommonly, the first sign may be unusual or
‘opportunistic’ infections. Patients with HIV frequently develop
lung infections with Pneumocystis jirovecii which can lead to poor
oxygenation of the blood, producing neurological symptoms such as
confusion and memory loss.
Jack is not himself. Usually well dressed and articulate, he works
as a computer programmer. He developed a cough and fever last week,
and two days ago he didn’t show up for work. He didn’t return to
his apartment either. In fact, he’s been wandering the streets lost
and confused. He can’t remember where his car is or where he lives.
Last night he paid for dinner at a local restaurant, walked off and
left his wallet. He’s been lost ever since. The police picked him
up for vagrancy. He was so out of it that he couldn’t even remember
his name. Instead of jail, they took him to a local hospital and
dropped him off in the emergency room. Jack is actually a decent
and caring person and not the vagrant he appears. In fact, several
years ago he volunteered time with an international relief agency
in Haiti. Unfortunately he was involved in a serious car accident
there and ended up with a ruptured spleen. He received six units of
blood during his emergency surgery in Haiti. About six weeks after
his surgery, he developed what he thought was the flu, but it
passed. He’s been healthy until now
Once at the hospital, an observant nurse in the ER thought Jack
looked cyanotic. Using a cutaneous oximeter, she found that Jack’s
oxygen saturation was only 68% instead of the nearly 100% it should
be. She summoned the doctor who listened to Jack’s lungs and
suggested he had pneumonia. A chest X-ray revealed extensive
changes in both lungs consistent with Pneumocystis jirovecii. This
uniquely opportunistic infection suggested that Jack was showing
the first signs of acquired immune deficiency syndrome
(AIDS).
Given his seriously low blood oxygen saturation, he was started on
supplemental oxygen plus an antibiotic that would combat the
suspected Pneumocystis organism. Within a few minutes of starting
the oxygen, his color improved and he began to ‘wake up.’ Indeed,
Jack had been ‘out of it’ because his blood oxygen level was so
low. Jack agreed to a bronchoscopic procedure to obtain some
inflammatory material from deep in his lungs. It was loaded with
Pneumocystis (little black, caved in soccer balls in the image). A
blood test confirmed Jack was HIV positive and that his CD4 cell
count was only 85/mm3.
Jack must have become infected with HIV from tainted blood during
his emergency surgery in Haiti. Fluids capable of transmitting HIV
include blood, vaginal fluids and semen. Had he not had the
transfusion, however, he would have died at that time from his
injuries. Although Jack was tested for HIV three weeks after his
surgery, at that time the test was negative. Sometimes this
happens. Screening tests look for certain classes of antibodies
against HIV and the levels may not be detectable until as long as
six weeks after the initial infection. Jack’s test was probably
done too early in the course of his infection, and prior to the
appearance of sufficient numbers of antibodies to make it positive.
Jack’s test is now positive.
HIV positivity is not synonymous with AIDS, although everyone who
is HIV positive will eventually develop AIDS. AIDS indicates immune
system failure and is defined as the presence of opportunistic
infections, i.e. those that take advantage of a compromised person,
and a CD4 cell count below 200/mm3. (A healthy number is
500-1000/mm3). Prevention rests with eliminating, or never
starting, risky behaviors, such as unprotected sex and intravenous
drug use.
1.The fluids which can transmit HIV are blood ,vaginal fluids and semen or seminal fluid.
2.The patient who are progressing or advancing towards the AIDS from HIV infections will or may have neurological impairment which can make the patient confused, disoriented ,memory loss,etc., This can make the patient to have delirium or dementia.When they are in stage of AIDS, the nerve cells are affected by the inflammation caused in central nervous system ,this will impair the function of the nerve cells causing symptoms.
3.AIDS (Acquired Immunodeficiency Syndrome ) in simple refers to a CD4 count less than 200mm³ .This will affect the immune system making it prone for all opportunistic disease.Here the patient has pneumocystitis jirovecii which is peculiar if AIDS is present.
1. Name the fluids known to transmit HIV? 2. What is the underlying cause for Jack’s...
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