A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time?
ACytomegalovirus
BToxoplasma gondii
CMycobacterium tuberculosis
DAspergillus fumigatus
EPneumocystis jirovecii
A 35-year-old man is brought to the emergency department after experiencing a seizure. According to his girlfriend, he has had fatigue for the last 3 days and became confused this morning, after which he started having uncontrollable convulsions throughout his entire body. He was unconscious throughout the episode, which lasted about 4 minutes. He has not visited a physician for over 10 years. He has smoked one pack of cigarettes daily for 12 years. His girlfriend admits they occasionally use heroin together with their friends. His temperature is 38.8°C (101.8°F), pulse is 93/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. The lungs are clear to auscultation and examination shows normal heart sounds and no carotid or femoral bruits. He appears emaciated and somnolent. There are multiple track marks on both his arms. He is unable to cooperate for a neurological exam. Laboratory studies show a leukocyte count of 3,000/mm3, a hematocrit of 34%, a platelet count of 354,000/mm3, and an erythrocyte sedimentation rate of 27 mm/h. His CD4+ T-lymphocyte count is 84/mm3 (normal ≥ 500). A CT scan of the head is shown. Which of the following is the most appropriate next step considering this patient's CT scan findings?
APyrimethamine, sulfadiazine, and leucovorin
BTrimethoprim-sulfamethoxazole
CAlbendazole
DGlucocorticoids
ECT-guided stereotactic aspiration
A 40-year-old man with AIDS comes to the physician because of a 3-week history of intermittent fever, abdominal pain, and diarrhea. He has also had a nonproductive cough and a 3.6-kg (8-lb) weight loss in this period. He was treated for pneumocystis pneumonia 2 years ago. He has had skin lesions on his chest for 6 months. Five weeks ago, he went on a week-long hiking trip in Oregon. Current medications include efavirenz, tenofovir, and emtricitabine. He says he has had trouble adhering to his medication. His temperature is 38.3°C (100.9°F), pulse is 96/min, and blood pressure is 110/70 mm Hg. Examination shows oral thrush on his palate and a white, non-scrapable plaque on the left side of the tongue. There is axillary and inguinal lymphadenopathy. There are multiple violaceous plaques on the chest. Crackles are heard on auscultation of the chest. Abdominal examination shows mild, diffuse tenderness throughout the lower quadrants. The liver is palpated 2 to 3 cm below the right costal margin, and the spleen is palpated 1 to 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 12.2 g/dL Leukocyte count 4,800/mm3 CD4+ T-lymphocytes 44/mm3 (Normal ≥ 500 mm3) Platelet count 258,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 4.9 mEq/L Alkaline phosphatase 202 U/L One set of blood culture grows acid-fast organisms. A PPD skin test shows 4 mm of induration. Which of the following is the most appropriate pharmacotherapy for this patient's condition?
ARifampin and isoniazid
BVoriconazole
CErythromycin
DAmphotericin B and itraconazole
EAzithromycin and ethambutol
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