AIDS fever of unknown origin: Difference between revisions
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==Background== | ==Background== | ||
Sources of fever vary by stage of disease. The CD4 count of '''< 200 × 10<sup>6</sup> cells/μL''' is very likely if the ED absolute lymphocyte count is '''< 950 × 10(6) cells/μL''' and '''less likely if the absolute lymphocyte count is > 1,700 × 10<sup>6</sup> cells/μL'''<ref>Napoli AM et al. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9.</ref> | |||
===CD4 >500=== | |||
*Work-up similarly to nonimmunocompromised pts | |||
===CD4 200-500=== | |||
*Early bacterial respiratory infection most common | |||
===CD4 <200=== | |||
*PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis | |||
*Also consider: endocarditis, lymphoma, histo, crypto | |||
===CD4 <100=== | |||
*Consider disseminated MAC | |||
*Toxoplasmosis (CNS or pulmonary) | |||
==Workup== | ==Workup== | ||
Revision as of 13:07, 6 April 2015
Background
Sources of fever vary by stage of disease. The CD4 count of < 200 × 106 cells/μL is very likely if the ED absolute lymphocyte count is < 950 × 10(6) cells/μL and less likely if the absolute lymphocyte count is > 1,700 × 106 cells/μL[1]
CD4 >500
- Work-up similarly to nonimmunocompromised pts
CD4 200-500
- Early bacterial respiratory infection most common
CD4 <200
- PCP, central line infection, MAC, TB, CMV, drug fever, sinusitis
- Also consider: endocarditis, lymphoma, histo, crypto
CD4 <100
- Consider disseminated MAC
- Toxoplasmosis (CNS or pulmonary)
Workup
- CBC
- Chemistry
- LFT
- LDH
- RPR
- UA/Cx
- Blood cx
- Aerobic, anaerobic, fungal
- Crypto
- Toxo
- Coccidiodomycosis
- CXR
- Stool cx / O&P
- CT
- LP
- Cell count, protein, glucose, VDRL, cryptocoocal antigen, cytology, toxo, CMV, JC, EBV
See Also
Source
Tintinalli
- ↑ Napoli AM et al. Absolute lymphocyte count in the emergency department predicts a low CD4 count in admitted HIV-positive patients. Acad Emerg Med. 2011 Apr;18(4):385-9.