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 TRANSPLANT......60 yo man 6 months....  



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Author6 Posts
  #1

┬ĚCASE: A 60 year old man, 6 months after renal transplantation comes with cough, SOB, fever of 100 F. Sputum is positive for Gomori coloration. Best step in the treatment:
a. gancyclovir
b. trimetoprim IV
c. Amphotericine
d. Imipemen
e. Acyclovir




  #2

I THINK THIS PATIENT IS HAVING PNEMOCYATIS CARNII PULMONARY INFECTION BECAUSE GOMORI STAIN TECHNICUE WAS USED FOR DIAGNOSIS.

ALSO THIS PATIENT HAD HISTORY OF RENAL TRANSPLANTATION AND SO HE MUST BE ON IMMUNOSUPPRESIVE THERAPY AND SO MORE LIKELY TO GET THIS INFECTION..

TREAT OF CHOICE--- TRIMETHOPRIM IS THE ONLY OPTION FROM YOUR CHOICES THAT FIT'S WELL....


  #3

WELL I WOULD LIKE TO ADD ONE MORE THING TO THIS...

GOMORI STAIN TECHNICUE IS TRADITIONALLY USED IN DIAGNOSIS OF-------

1) FUNGAL INFECTIONS- GOMORI METHENAMINE SILVER STAINING WHICH STAINS THE FUNGUL HYPHAE AND SPORES AS WELL AS THE FUNGAL GLYCOGEN-ALL BLACK WHEN WE SEE IN MICROSCOPE

2) PNEUMOCYSTIC CARNII -- GOMORI METHENAMINE SILVER SATIN- STAINS THE CYST WALLS OF THE P. CARNII CYST BLACK COLOURED

3) HEPATITIS-B--CYTOPLASM OF VIRALLY INFECTED HEPATOCYTES APPEAR GRANULAR WHEN STAINED WITH MEDIFIED GOMORI-ALDEHYDE FUCHSIN TECHNICUE

THE ABOVE ARE THE ONLY THREE INSTANCES THE LABS USE GOMORI STAIN FOR DIAGNOSIS.


  #4

ONE MORE POSSIBILITY THIS PATIENT COULD HAVE IS CMV INFECTION i.e. CYTOMEGALOVIRUS PNEUMONITIS.

BUT DIAGNOSIS OF CMV INFECTION IS DIFFICULT.
JUST PRESENCE OF CMV VIRUS IN STAINED TISSUE SPECIMENS OR THE PRESENCE OF ANTI-BODIES IN PATIENTS SERUM IS NOT DIAGNOSTIC OF CMV INFECTION--

WHY ? ---------

BECAUSE PRESENCE OF CMV MAY BE NORMAL FINDING IN IMMUNOCOMPROMISED PATIENTS.......
AND MOST OF THE IMMUNOCOMPROMISED PATIENTS ALSO HAVE ANTIBODIES AGAINST CMV VIRUS IN THEIR SERUM.....
IN FACT SMITHA NOT ONLY IMMUNOCOMPROMISED PATIENTS BUT MOST OF THE NORMAL POPULATION EVEN ALSO HAVE ANTIBODIES TO CMV IN THEIR SERUM-- YES THIS IS THE COMMONOST ANTIBODY FOUND WORLDWIDE EVEN IN NORMAL POPULATION......


BUT YES----IF WE CAN DEMONSTRATE THE TYPICAL INCLUSION BODIES IN THE VIRALLY INFECTED CELLS--THEN IT'S DIAGNOSTIC OF CMV INFECTION IF IT IS ALSO ASSOCIATED WITH SYSTEMIC SIGNS AND SYMPTOMS........
THAT WAS ABOUT CMV.......
HOPE YOU ENJOYED IT...... :lol: :lol:


  #5

THAT WAS MARVELLOUS shirish, as ussual grin grin ......
And of course the answer too is absolutely CORRECT.......... grin


  #6

source: usmle.net





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