Urgent Investigation of the HIV-Positive Patient with Respiratory Symptoms
Arterial blood gases and pH Full blood count and differential white count CD4 T cell count and HIV viral load Blood culture (positive in most patients with Mycobacterium avium-intracellulare infection: use specific myobacterial culture bottles) Sodium and potassium, urea and creatinine Liver function tests Lactate dehydrogenase (raised in Pneumocystis jirovecii pneumonia) Expectorated sputum if available for Gram and Ziehl-Neelsen stains and culture Induced sputum (using hypertonic saline via nebulizer) for staining or PCR for Pneumocystis jirovecii and mycobacterial stains and culture Consider fibre-optic bronchoscopy (for bronchoalveolar lavage or transbronchial biopsy) |