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On Medication For Fungal Infection. Started Losing Weight, Having Loose Motion And Vomiting. Any Suggestion?
Question: Patient's body weight is 38 kg which is come down from 40 in last one week, height is 5'4". TB and fungal infection Oflxacin 400, Isoniazid 300, computal 800, Pyrizinamide 750 are being given (complete list of current medication is given below). Patient is losing weight, having loose motion and vomitting, please suggest. Email id: YYYY@YYYY
Test Report:
Potassium - 2.5; Total Protein - 4.90; Creatinine - 2.90; Urine - normal, Urine Culture - No growth, Aspergillus Galactomannan - 2.343; X XXXXXXX chest PA - A nodular shadow is seen; Hemogobin - 6.4; Culture TB MGIT-Acid Fast Baccilli - Present+; Pus Cell - Few; TCO2 - 9.50Total Iron Binding Capacity - 224; 25Hydroxy Vit D - 17.02.
Test Report:
Potassium - 2.5; Total Protein - 4.90; Creatinine - 2.90; Urine - normal, Urine Culture - No growth, Aspergillus Galactomannan - 2.343; X XXXXXXX chest PA - A nodular shadow is seen; Hemogobin - 6.4; Culture TB MGIT-Acid Fast Baccilli - Present+; Pus Cell - Few; TCO2 - 9.50Total Iron Binding Capacity - 224; 25Hydroxy Vit D - 17.02.
Hello XXXXXXX
Thank you for asking a question.
Firstly, from your history some most important points are
- weight loss which is 5% in one week.
- Tuberculosis infection.
- Fungal infection.
- Loose motion.
All these indicates a deficiency of immune mechanism. It means may be there is acquired immunodeficiency syndrome or AIDS. Immediately do anti HIV 1 and 2 Elisa test. And also do a blood test for CD4 Count. Because in a patient with chronic kidney disease it is very unnatural to have such presentation.
If the test shows positive result, then treatment should be started immediately with antiretroviral therapy, depending on the CD4 count. Because, if the underlying mechanism is AIDS, then no treatment against the Tuberculosis and fungal infection does not give any definite result.
Other treatments are quite adequate and according to the abnormality found in the laboratory test reports. Like antibiotics, potassium, vitamin D supplements, and antifungal agents. Continue the treatment as instructed. Repeat the sodium and potassium levels every 3 to 4 days. And inform the report to your treating doctor. The dose of potassium chloride should be maintained accordingly.
Hope this information suffices. Let me know if you have any more question.
Regards.
Thank you for asking a question.
Firstly, from your history some most important points are
- weight loss which is 5% in one week.
- Tuberculosis infection.
- Fungal infection.
- Loose motion.
All these indicates a deficiency of immune mechanism. It means may be there is acquired immunodeficiency syndrome or AIDS. Immediately do anti HIV 1 and 2 Elisa test. And also do a blood test for CD4 Count. Because in a patient with chronic kidney disease it is very unnatural to have such presentation.
If the test shows positive result, then treatment should be started immediately with antiretroviral therapy, depending on the CD4 count. Because, if the underlying mechanism is AIDS, then no treatment against the Tuberculosis and fungal infection does not give any definite result.
Other treatments are quite adequate and according to the abnormality found in the laboratory test reports. Like antibiotics, potassium, vitamin D supplements, and antifungal agents. Continue the treatment as instructed. Repeat the sodium and potassium levels every 3 to 4 days. And inform the report to your treating doctor. The dose of potassium chloride should be maintained accordingly.
Hope this information suffices. Let me know if you have any more question.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
Thank you for writing back.
HIV test does not become positive if the patient is in window period.
Consult with your treating doctor for ordering a DNA PCR for HIV and a p24 protein assay.
HIV is the most possible cause because it is the most common cause of wasting disease. That means when a patient is wasting body weight more than 10% within 6 months, then it clearly indicates presence of HIV if not otherwise specified.
So, consult with your treating doctor for the abovementioned investigation.
Regards.
Thank you for writing back.
HIV test does not become positive if the patient is in window period.
Consult with your treating doctor for ordering a DNA PCR for HIV and a p24 protein assay.
HIV is the most possible cause because it is the most common cause of wasting disease. That means when a patient is wasting body weight more than 10% within 6 months, then it clearly indicates presence of HIV if not otherwise specified.
So, consult with your treating doctor for the abovementioned investigation.
Regards.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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