6) INFECTIOUS DISEASE M.SRI SAI PAVAN ROLL NO :79 8TH SEM

A.LINK TO PATIENT DETAILS:

A) https://vyshnavikonakalla.blogspot.com/2021/05/a-40-year-old-lady-with-dysphagia-fever.html

Q) 1.Which clinical history and physical findings are characteristic of tracheo esophageal fistula?
Laryngeal Crepitus,Difficulty in swallowing initially to the solids,
Cough,are Suggestive of TracheoEsophageal Fistula.

Q) What are the chances of this patient developing immune reconstitution inflammatory syndrome? Can we prevent it? 
Risk Factors For Development of Immune Reconstitution Inflammatory Syndrome (I R I S)
1) Low Baseline CD4 Count
2) Higher Baseline Viral Load
3) Shorter Interval between commencing ATT and HAART
4) Disseminated TB
5) A Greater Decrease in Viral Load after starting HAART.
As this patient has a low baseline CD4 count and also disseminated TB there are chances that this patient may develop IRIS.
If the following symptoms are seen after the Initiation of ART then IRIS can be suspected
1) Fever,Anemia,Wt loss.
2) CNS
3) Lymphadenopathy
4) Radiological Findings 
5) Exacerbation of Pulm. Lesion or occurence Of a new Lesion.
Prevention of IRIS :
CD4+ T cell deficiency when ART is commenced is a risk factor for an IRIS, prevention of CD4+ T cell depletion through early diagnosis and treatment of HIV infection regardless of CD4+ T cell count, as supported by the findings of the START study (33), is the most effective measure for reducing the risk of developing an IRIS.
However, 'late presenters' with advanced immunodeficiency continue to present and they must be assessed carefully for HIV-related infections that might trigger an IRIS when ART is commenced.

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