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I am a Doctor and I need help
Nov 13, 2000

Hello Dr.,

I am a Doctor and I have a patient. He had intercourse with a girl from guyana. He was with her till this year of February. I diagnosed him with CMV, EBV and Toxoplasma. He has white tongue. He always complains about his intestines. He has lots of gas. He has fungal infections. He's losing weight. I though it was HIV I tested him for HIV 1 and HIV 2 almost after 7 months from last exposure. The test are negative. I did PCR DNA and PCR RNA test twice it's undetectable. I check his immune system, he's CD 4 on July was 717. But I noticed that he's WBC is decreasing? Please help.Should I do a bDNA? Or do you think is another strain? What do you think I should do I am at lost, I hope you can help me.

Response from Dr. Stryker

This sounds like a tough case, and possibly one with an immunodeficiency component. But it seems unlikely to be HIV, based on the thorough testing you have done. A negative bDNA would be fairly definitive at this point.

You don't give enough other history, including the manifestations of CMV, EBV, toxo, etc., to allow me to comment in more detail. If you mean that he has evidence of exposure (only) to these pathogens, then this is not particularly helpful, as many otherwise healthy folks have evidence of past exposure, but not active disease. Further, his normal CD4+ count makes active disease in these categories very unlikely...

White tongue is not a diagnosis, but a "sign", with many possible explanations. So are the other symptoms you describe. If you are a physician, than you probably realize that you are in over your head at this point; the patient needs more specialized diagnostic input if he is truly suffering. If he is largely asymptomatic, or if more specialized care is unavailable, than you should watch him closely and continue to followup on his symptoms.

In general, this is intended as a patient forum for questions, not for expert consultation from doc to doc. If you are truly in need of a medical consultation for your patient, I would advise you to continue your search through more traditional channels. Good Luck! RAS

Rick Stryker, M.D., M.P.H.



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