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Case 5: A 32-Year-Old with Chronic Cough

You answered:

E The patient’s CD4 cell count is almost certainly less than 100 cells/mm3.

This answer is incorrect. Tuberculosis can occur at any CD4 count in an HIV-infected patient. This patient’s ability to mount a reaction to the tuberculin skin test indicates some degree of cell-mediated immunity, but cannot be reliably used to estimate his CD4 count.

Choose another answer:

A If a nucleic acid amplification test on sputum is positive for Mycobacterium tuberculosis, sputum culture is not required.
B If the pleural effusion is tapped, there is greater than 80% likelihood that a Ziehl-Neelsen stain of pleural fluid will show AFB.
C The patient’s small tuberculin skin test reaction is probably due to prior BCG vaccination, and an alternative diagnosis should be sought.
D Therapy for TB should be initiated while the diagnostic work-up continues.

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