Infectious disease (gastro)

 1.Which clinical history and physical findings are characteristic of tracheo esophageal fistula

1 ans:clinical history and physical finding in this paient that suggest tracheoesophageal fistula is that ,Cough occurs on taking food and liquids 

(which was initially non productive then associated with sputum which is white in color , moderate in quantity and non foul smelling)

2) What are the chances of this patient developing immune reconstitution inflammatory syndrome? Can we prevent

2 ans: Immune reconstitution inflammatory syndrome (IRIS) occurs in two forms:

 "unmasking" IRIS refers to the flare-up of an underlying, previously undiagnosed infection soon after antiretroviral therapy (ART) is started; 

"paradoxical" IRIS refers to the worsening of a previously treated infection after ART is started.

*Patients with mycobacterial disease at the time of initiation of ART are at higher risk of developing IRIS with an approximate risk of 15%. Patients originating from endemic areas for tuberculosis and cryptococcal disease are at higher risk of developing IRIS.

How can immune reconstitution inflammatory syndrome be prevented?

*The most effective prevention of IRIS would involve initiation of ART before the development of advanced immunosuppression. IRIS is uncommon in individuals who initiate antiretroviral treatment with a CD4+ T-cell count greater than 100 cells/uL.

*Aggressive efforts should be made to detect asymptomatic mycobacterial or cryptococcal disease prior to the initiation of ART, especially in areas endemic for these pathogens and with CD4 T-cell counts less than 100 cells/uL.

*Two prospective randomized studies are evaluating prednisone and meloxicam for the prevention of paradoxical TB IRIS.