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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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| Answers and Discussions | ||
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1.The answer is A.
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| The most likely diagnosis in infant born to HIV-infected mother who does not receive Pneumocystis carinii pneumonia prophylaxis should be Pneumocystis carinii pneumonia. | ||
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2.The answer is E.
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| The second most likely diagnosis in this case is viral respiratory infection, particularly with RSV, influenza, or parainfluenza. Common respiratory viral infections, with RSV, influenza, and parainfluenza in particular, are the most frequent causes of lower respiratory infection in immunocompetent children. | ||
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Question:
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| 3. What is the treatment of choice for PCP? | |
| Answer: | |
| Other than respiratory support the patient should receive co-trimoxazole ( 20 mg/kg/day of trimethoprim ) for 3 weeks. Prednisolone or hydrocortisone is also beneficial in severe cases with hypoxia. Doses are 2 mg/kg/day in day 1-5, 1mg/kg/day in day 6-10 and 0.5 mg/kg/day in day 11-21. | |
| Progression of the patient in the hospital: | |
| With respiratory support, co-trimoxazole and prednisolone administration, the patient gradually recovered in two weeks and was discharged from the hospital. A week later she was followed up in the out-patient department, when co-trimoxazole ( 20 mg/kg/day of trimethoprim ) was decreased to 5 mg/kg/day of trimethoprim, given 3 days a week (Monday, Wednesday and Friday) for PCP prophylaxis. Her CXR taken 3 weeks after initiation of the treatment demonstrate less dense interstitial infiltrates. | |
| Ref: | |
| วิรัต ศิริสันธนะ. โรคติดเชื้อ Pneumocystis carinii ในเด็กติดเชื้อเอชไอวี. ใน: บุญมี สถาปัตยวงศ์, (บรรณาธิการ). HIV / AIDS in Thailand 1996 : Adults & Pediatrics. กรุงเทพฯ : โรงพิมพ์สวิชาญการพิมพ์, 2539:157-66. (ISBN 974-89660-1-1) หรือ วิรัต ศิริสันธนะ โรคติดเชื้อ Pneumocystis carinii ในเด็กติดเชื้อเอชไอวี วารสารกุมารเวชศาสตร์ 2538 ;34:186-93. | |