Day 45 : In pursuit of cause for reddish right thigh swelling and ELISA

 15/11/2022, Tuesday, Adarsha Hospital, Kundapura

The day began boring as I finished rounds with Dr. Adarsha Hebbar, then I went to his OPD to see his patients. The patients were usual and there was no interesting case.

He said me to remove suture of a RTA patient discharged a week back. I removed sutures. Adarsh sir visited casualty to see a patient who had difficulty in walking. 

The patient was Mr.Suresh Shetty, Midlle aged man who was a k/c/o HTN . He presented with c/o swelling, reddness and pain over right thigh which made him difficult to walk. While examining him, he had urticaria like symptoms over his right thigh. He also had pitting pedal edema. He also had a h/o fever a week back. The condition of his leg looked bad. He also had murmurs (abnormal heart sounds). He needed higher antibiotics to stop the spread of the infection. He was advised for admission.

His treatmennt plan was as following 

1. INJ SINIBEC 4.5MG IV 1-1-1-1

2. INJ XOLID 600MG IV 1-1-1

3. INJ METRO 500MG 1-1-1

4. INJ PANTOP 40MG IV 1-0-0

5. INJ EMESET 4MG IV 1-0-0

6. TAB DOLO 650 P/O 1-1-1

7.TAB XYMOHEAL P/O 1-1-1

and other supportive treatment.

He ordered some lab tests as usual which also had serology tests like HIV,HBSAG,HCV and VDRL.

After some time,supprisingly as me and sir were seeing other patients Mr.Gururaj, the lab technician called me aside to tell me something. He said that the patient Mr.Suresh Shetty is HIV positive!!

We all had touched the patient during his examination so I rushed to Dr.Adarsh to inform him about this news. I rushed to him and said 'Mr.Suresh Shetty is HIV positive '.

Actually he was infront of another patient and I had disclosed the sensitive information in front of him. Sir, silently said me to stop and later he said me that this a sensitive information and it should not be openly said in front of public.

Later I realised that I had commited a mistake and after realising my mistake I started telling everyone that the patient is ELISA poitive and Retro positive. Sometimes talking in medical terms is very helpful. Need to learn more of these kinds of things in the future. 

How Is HIV/AIDS Transmitted?

Sexual contact - HIV is spread most commonly by sexual contact with an infected partner. The virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth during sexual activity.

Blood contamination - HIV may also be spread through contact with infected blood. However, due to the screening of blood for evidence of HIV infection, the risk of acquiring HIV from blood transfusions is extremely low.

Needles - HIV is frequently spread by sharing needles, syringes, or drug use equipment with someone who is infected with the virus. Transmission from patient to healthcare worker, or vice-versa through accidental sticks with contaminated needles or other medical instruments, is rare.

Mother-infant - HIV also can be spread to babies born to, or breastfed by, mothers infected with the virus.

HIV/AIDS cannot be spread through:

Saliva

Sweat

Tears

Casual contact, such as sharing food utensils, towels, and bedding

Swimming pools

Telephones

Toilet seats

Biting insects (such as mosquitoes)

How is it Diagnosed?

1. ELISA

2. Western Blot test

3. PCR

4. Genetic testing 

16/11/2022 Wednesday Adarsha Hospital, Kundapura 

Update on Mr. Suresh Shetty

During the rounds of Dr. Adarsh Hebbar, his legs were still very much red and swollen. He looked little depressed due to recent discovery of HIV infection. He talked privately with Dr. Adarsh. Then Dr. Adarsh ordered CD4 counts test and Western blot test.

Some details about CD4 lymphocyte count test

The CD4 count is a test that measures how many CD4 cells you have in your blood. These are a type of white blood cell, called T cells, that move throughout your body to find and destroy bacteria, viruses, and other invading germs.

Uses :

1. To know how much damage has been done to your immune system and what's likely to happen next if you don't start taking antiretroviral treatment (ART). 

(Everyone with HIV should take ART regardless of whether their CD4 count is high or low.)

2. Also track CD4 levels to check the effectiveness of your treatment and make adjustments as necessary. Your CD4 count should go up if your ART is effective.

Keeping your CD4 count up with ART can hold off symptoms and complications of HIV and help you live longer. Studies have found that people with HIV who stick to their treatments can live as long as people who do not have HIV.

Some details about the Western blot test

The Western blot test separates the blood proteins and detects the specific proteins (called HIV antibodies) that indicate an HIV infection.

A Western blot test is typically used to confirm a positive HIV diagnosis.

It is used to detect HIV antibodies, not the HIV virus itself. 

The Western blot is used to confirm a positive ELISA, and the combined tests are 99.9% accurate.