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Table 34.2

Urgent Investigation of the HIV-Positive Patient with Respiratory Symptoms

Chest X-ray

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)

Blood glucose

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)