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11 yr old immunosuppresed boy with hx of occasional spelunking with his friends presents with unexplained fever, wt loss, interstitial pulmonary dis, oropharyngeal ulcers n meningitis. He is HIV negative. What is the most efficacious lab dx for this condition? tx?
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| no more a loser
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well no one attempted to answer the q so i am writing the answer:
this is disseminated histoplasmosis so for dx: fungal antigen by radioimmunoassay n tx with amphotericin
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| jb00727
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Thanks
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| dr.vasim
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11 yr old immunosuppresed boy with hx of occasional spelunking with his friends presents with unexplained fever, wt loss, interstitial pulmonary dis, oropharyngeal ulcers n meningitis. He is HIV negative. What is the most efficacious lab dx for this condition? tx?
# so ALREADY immunosuressed? (spelunking with friends, so only 1 boy presents or his friends too).
this is disseminated histoplasmosis so for dx: fungal antigen by radioimmunoassay n tx with amphotericin
# Disseminated Histoplasmosis - fevr, night sweats, wt loss, PRODUCTIVE COUGH, enlargment of reticloendoth.Organs, MUCOCUTANEUS lesions(oropharyn. Ulcers). (* itz a chronic course).
so My friend Ur question was incomplete n if u want to make DD according to Ur Q, then as I specified immunosuppresed - it can b TB, Neoplasia, Other systemic Mycosis, Chronic Malaria too.
# regarding lab Dx: smears of oropharyn. Ulcers orelse biopsy of Reticloendothelial organ.; sputum culture, skin testing - delyd hypersn. reac. , serologic - CF titers rise to 1:332.
# Tx: good Amphotericin B is drugof choice, even Ketokonazole is often used.
but anywez was quite interesting Q. I appriciate it. n im sorry that Im NEW
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| drvic
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Hey Dr.Vasim, there are only two infections associated with spelunking and subsequent inhalation of Bat Droppings - Histoplasmosis and Rabies.
now if you knew about spelunking, you'd narrow down your differential to these two only. but i'm surprised why this kid with immunosuppression went spelunking - since he is HIV negative, so it must be some form of congenital immunodeficiency for which most of which activities are restricted.....mostly its the asthmatics who do spelunking....to try and achieve some therapeutic effect....a practice prevalent in Europe...effectiveness really doubtful...
anyways, histoplasma is found in fresh bat droppings, so portal of entry is the respiratory tract by inhalation, then subsequent spread in the bloodstream....the rest is explained by the clinical picture....
firstly not all bats are carriers of rabies and although Rabies can cause meningo-encephalitis like picture but the Interstitial Lung Disease,fevers and ulcers are not explained by it.
immunsuppressed people are obviously prone to disseminated infection, so that's why the boy presented, his other friends didn't...maybe they'll run the usual chronic course and present later...
as for chronic malaria, i'd strongly consider the country of residence of this boy. keeping that in D/D in USA would be difficult to explain....plus neoplasia in immunodeficiency syndromes is usually due to the genetic defect, not due to the immunosuppressed state per se....if that were so, then all chronically immunosuppressed patients (prolonged steroids therapy, transplant, cancer chemotherapy) would get malignancies.....and we would all become oncologists 
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| dr.vasim
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GR888888888888888888888 man .. gr8 .. I got U .
thnx fr explanation, but as a JUNIOR to U, i gave my opinion n was expectin if sm corrections so i did got One .. Thnx PAL 
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