India HIV Case Discussion - Case #1 Patient with hemiparesis

Case Description:
42 year old HIV-infected woman presenting with hemiparesis

Learning Objectives:
1. Recognize the causes of brain abscess in HIV-infected patients in India
2. Discuss the key diagnostic steps to evaluating an HIV-patient with brain abscess in India
3. Recognize how to utilize the microbiology laboratory to distinguish an infection with mycobacterium tuberculosis from other mycobacterium

1. Which of the following is the LEAST likely cause of a focal motor deficit in an HIV-infected patient with a total CD4 count of >100 cells/cmm?

Which of the following is the LEAST likely cause of a focal motor deficit in an HIV-infected patient with a total CD4 count of >100 cells/cmm? Bacterial brain abscess

Tuberculosis

Syphilis

Cytomegalovirus (CMV) infection

Stroke

2. Which of the following radiologic findings is MOST consistent with Progressive multifocal leukoencephalopathy (PML)?

Which of the following radiologic findings is MOST consistent with Progressive multifocal leukoencephalopathy (PML)? Non-enhancing subcortical white matter lesions without mass effect

An enhancing 2cm periventricular lesion with mass effect

Ventricular enlargement with obstructive hydrocephalus

Multiple enhancing intracerebral lesions

3. Which of the following statements are TRUE about disseminated mycobacterial avian complex (MAC) infection in an HIV-infected adult?

Which of the following statements are TRUE about disseminated mycobacterial avian complex (MAC) infection in an HIV-infected adult? More than 25% of all documented cases occur in patients with a CD4 count >100cells/cmm

Monotherapy with Levofloxacin 500mg per day by mouth for 8 weeks has been shown to be effective treatment

Immune reconstitution syndrome associated with fever and adenitis are rarely seen (incidence <0.2%) within 3 months of starting HAART.

MAC is a ubiquitous mycobacterium found in the environment

presented April 16, 2008

1. Which of the following is the LEAST likely cause of a focal motor deficit in an HIV-infected patient with a total CD4 count of >100 cells/cmm?

2. Which of the following radiologic findings is MOST consistent with Progressive multifocal leukoencephalopathy (PML)?

3. Which of the following statements are TRUE about disseminated mycobacterial avian complex (MAC) infection in an HIV-infected adult?