(apologies for its
delay in posting)
Our clinical work continues to reveal compelling cases, some
similar to the “U style” patient in complexity (transplant patients,
cancer patients, etc), while others are compelling based on the low prevalence
of their disease in the US.
We’ve been consulted on several similar AML patients which neutropenic fever in the hospital, however, in clinic we see a large population of seropositive patients. Recently we saw a case of pythiosis that required a left AKA. We see many cases of seropositive patients for biannual checkups regarding their medications and checking for toxicities. We see a lot of lipodystrophy with older HAART medications (as we transition from stavudine to tenofovir). There were 3-5 cases of disseminated aspergillosis with abscesses intra-abdominally, all occurring in a seropositive background. The burden of HIV was quoted to be 5% for Thailand but was recently increased to 8% by rough estimates. However, the attendings believe the prevalence to be closer to 15%. The discrepancy is probably due to underreporting/people not regularly seeing the medical system.
We also have seen more and more cases of an interesting
entity called Adult Onset Immunodeficiency (AOID). These patients are
typically from rural northeastern Thailand, present at middle age, and have
antibodies to IFN-gamma. They present with recurrent infections equivalent to
what would be seen in an immunocompromised/HIV population.
We’ve been consulted on several cases of candidemia, though
they mostly see Candida tropicalis in their hospital, unless they are
post-surgical at which point it is usually Candida krucei.
We have two excellent residents working with us: Jack and
Fern. Jack a third year, is in an accelerated program, and Fern worked in a
rural community hospital for about 3 years before ceding to come back and
complete a residency. Their energy and laughter are infectious, and are always
smiling throughout the day. Their English is very good, which allows them to
present in English during rounds for our benefit and their practice. We realize
however this is a time drain on their work flow and appreciate their
effort.
There was a visiting lecturer on seizure disorders from
Texas, I believe Texas A&M. Kristina and I attended the lecture that
began with two cases including an extended discussion on pseudoseizures.
Thereafter he plunged into the nuances of different anti-epileptics and their
interactions/side effects. Visiting lecturers are considered a special event
and our attendance was encouraged.
There have been a steady amount of consults on patients
injured from motorcycle accidents, which is in-line with MVAs being the most
common health issue for travelers. We had one patient whose abdomen was
punctured and required an emergent ex-lap. We were consulted later as he
contracted acinetobacter meningitis! His condition was thankfully improving.
More to come shortly!
