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miércoles, 13 de julio de 2016

HIV and fever of unknown origin

Evidence Base Medicine - Posted on July 11, 2016 - By mizzouem
"What is the current recommendations for management in an HIV patient with a fever of unknown origin?
In the post-HAART era (highly active antiretroviral therapy) infectious disease is the most common cause in the US and Europe (90.6%) of fever of unknown origin followed by malignancies, and drugs.
The most common infection is pneumonia.
  • Bacterial – acute presentation, lobar consolidation on CXR
  • Pneumocystis jiroveci (PCP) – subacute, CDC count < 200 , hypoxia, tachypnea, hypoxemia
  • Tuberculosis (TB) – chronic disease, travel history to endemic areas, incarceration, homelessness
In the emergency department empiric antibiotic therapy should be instituted including coverage for community acquired pneumonia (unless patient has risk factors for health care acquired pneumonia).
How does this apply to clinical practice? 
In an HIV+ patient presenting with fever of unknown origin have a high clinical suspicion for infection and consider early empiric antibiotic therapy.
Bottom linenot a lot of high quality evidence on FUO in HIV but these patients are at high risk for multiple infections and should be treated accordingly."