Ms. C.A., a 38-year-old dancer, went to the emergency department one night after work. She reported a worsening condition of shortness of breath with an unproductive cough, mild chest pain, and tiredness. She also reported persistent diarrhea for the past 6 weeks and weight loss (without dieting) of 16 pounds.
She had no history of smoking or of previous respiratory illness. Her medical history included genital herpes and gonorrhea within the past 2 years. She has had unprotected intercourse with numerous sexual partners.
A complete blood count (CBC), electrocardiogram (ECG), and chest radiograph were ordered. Subsequent to the chest film report of diffuse, bilateral, interstitial shadowing, a bronchoscopy with bronchoalveolar lavage (BAL) was performed.
Laboratory Data
Assay Patient Result Reference Range
Hemoglobin 11.5 g/dL 13.5-17.5
Hematocrit 38% 39-51
Total WBC 5.8 Ã 109/L 4.5-11.0
Absolute lymphocyte count 0.75 Ã 109/L 1.6-3.5
T lymphocytes
CD4+ 0.13 Ã 109/L 0.7-1.1
CD8+ 0.42 Ã 109/L 0.5-0.9
B lymphocytes 0.10 Ã 109/L 0.2-0.5
BAL Positive for Pneumocystis carinii
Questions:
Is this patient considered to be immunodeficient? (3 pts)
2. What further diagnostic assays would be useful in establishing a diagnosis? (5 pts)
3. What opportunistic pathogens are typically associated with patients who have an immunodeficiency? (2 pts)
a. Cryptococcus neoformans
b. Cytomegalovirus
c. Hepatitis B virus
d. Both a and b
Ms. C.A., a 38-year-old dancer, went to the emergency department one night after work. She reported a worsening condition of shortness of breath with an unproductive cough, mild chest pain, and tiredness. She also reported persistent diarrhea for the past 6 weeks and weight loss (without dieting) of 16 pounds.
She had no history of smoking or of previous respiratory illness. Her medical history included genital herpes and gonorrhea within the past 2 years. She has had unprotected intercourse with numerous sexual partners.
A complete blood count (CBC), electrocardiogram (ECG), and chest radiograph were ordered. Subsequent to the chest film report of diffuse, bilateral, interstitial shadowing, a bronchoscopy with bronchoalveolar lavage (BAL) was performed.
Laboratory Data
Assay Patient Result Reference Range
Hemoglobin 11.5 g/dL 13.5-17.5
Hematocrit 38% 39-51
Total WBC 5.8 Ã 109/L 4.5-11.0
Absolute lymphocyte count 0.75 Ã 109/L 1.6-3.5
T lymphocytes
CD4+ 0.13 Ã 109/L 0.7-1.1
CD8+ 0.42 Ã 109/L 0.5-0.9
B lymphocytes 0.10 Ã 109/L 0.2-0.5
BAL Positive for Pneumocystis carinii
Questions:
Is this patient considered to be immunodeficient? (3 pts)
2. What further diagnostic assays would be useful in establishing a diagnosis? (5 pts)
3. What opportunistic pathogens are typically associated with patients who have an immunodeficiency? (2 pts)
a. Cryptococcus neoformans
b. Cytomegalovirus
c. Hepatitis B virus
d. Both a and b
