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Patient History and Physical Exam Roles
In this case study, a 44-year-old male complains about non-productive cough and chest pain. Since the patient has the history of HIV/AIDS and hepatitis C, his immune system should be regarded as compromised (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Adults having concomitant diseases such as hypertension in the given case are at a higher risk of developing pulmonary health issues. The physical examination helps to reveal the critical details associated with the patient’s conditions: tachypnea, rhonchi, tachycardia, dullness, and egophony. Most importantly, an X-ray image also allows considering differential diagnoses based on the comprehensive view of the reported symptoms and objective data assessment.
Primary Diagnosis and Differential Diagnoses
- Tuberculosis. It is an infectious disease that is caused by Mycobacterium tuberculosis. The bacterium penetrates the body through the respiratory tract and then migrates to the bronchial mucosa, the alveoli, and the blood flow (Grossman, Hsueh, Gillespie, & Blasi, 2014). The most representative symptoms may be noted in the given patient such as high grade fever, weight loss, non-productive cough, chest pain, and dyspnea at rest. X-ray results also pinpoint consolidation in lungs along with hilar enlargement caused by lymphadenopathy. The symptomatology of tuberculous inflammatory process is similar to the clinical picture of other respiratory diseases of the viral and bacterial etiology.
- Bacterial pneumonia. This microbial infection of the respiratory parts of the lung proceeds with the development of intraalveolar exudation and inflammatory infiltration of the pulmonary parenchyma, fever, and productive cough with mucopurulent sputum (Grossman et al., 2014). Patients may feel weakness, headache, dyspnea, myalgia, arthralgia, pleural pain in the chest, and tachycardia.
- Viral pneumonia. In the inflammation of the lungs of the viral nature, the cells lining the respiratory tract as well as the alveoli are destroyed, in which liquid accumulates later under the action of leukocytes (Grossman et al., 2014). These factors lead to disruption of oxygen metabolism and hypoxia. Productive cough and fever are the key symptoms.
- Pulmonary embolism. It is a sudden blockage of the trunk or branches in the artery supplying the lungs with blood. Symptoms include severe dyspnea, dizziness, fainting, tachycardia, a sharp decrease in blood pressure, hemoptysis, cyanosis, and cough (at first – dry, later – sparse sputum with blood) (Sharifi, Bay, Skrocki, Rahimi, & Mehdipour, 2013).
Potential Treatment Options
The treatment of tuberculosis requires the long-term medication intake, namely, from six months to one year period. In the presence of HIV in combination with tuberculosis, specific anti-HIV therapy is used in parallel with the anti-tuberculosis therapy, while rifampicin should be considered with great attention in such patients. Raltegravir 400mg twice per day should be prescribed to this patient as the one who is co-infected with HIV and tuberculosis (Grinsztejn et al., 2014). The alternative medication is the administration of efavirenz 600mg daily, as recommended by the World Health Organization (WHO) (Bhatt et al., 2015).
The immune system of the patient should be supported by means of proper nutrition, adequate physical activity, and avoiding drug and alcohol abuse. Self-care is of great importance for patients diagnosed with tuberculosis since timely medication administration affects the effectiveness of the whole recovery process (Buttaro et al., 2017). It is stated that bacteria remain in the air even when a patient leaves a room; therefore, it is essential to consider preventative measures and abstain from communicating with others without a mask at least for a few weeks.
Bhatt, N. B., Baudin, E., Meggi, B., da Silva, C., Barrail-Tran, A., Furlan, V.,… ANRS 12146/12214-CARINEMO Study Group. (2015). Nevirapine or efavirenz for tuberculosis and HIV coinfected patients: Exposure and virological failure relationship. Journal of Antimicrobial Chemotherapy, 70(1), 225-232.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Grinsztejn, B., De Castro, N., Arnold, V., Veloso, V. G., Morgado, M., Pilotto, J. H.,… Vorsatz, C. (2014). Raltegravir for the treatment of patients co-infected with HIV and tuberculosis (ANRS 12 180 Reflate TB): A multicentre, phase 2, non-comparative, open-label, randomised trial. The Lancet Infectious Diseases, 14(6), 459-467.
Grossman, R. F., Hsueh, P. R., Gillespie, S. H., & Blasi, F. (2014). Community-acquired pneumonia and tuberculosis: Differential diagnosis and the use of fluoroquinolones. International Journal of Infectious Diseases, 18, 14-21.
Sharifi, M., Bay, C., Skrocki, L., Rahimi, F., & Mehdipour, M. (2013). Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). American Journal of Cardiology, 111(2), 273-277.