Uganda. A 25-year-old man is HIV positive. He is admitted because of neurological problems: convulsions (fits) and muscle weakness in the left arm. What do you think and do?
Benin. A 24-year-old woman is HIV positive and has had diarrhoea for 3 months. Isosporabelli is found in the faeces. What do you do?
Guatemala. A 24-year-old woman is HIV positive and has had diarrhoea for 3 months. Cryptosporidia are found in the stools. What do you do?
Tanzania. An HIV positive patient has had a cough for 2 months. An initial sputum investigation shows nothing abnormal, but acid-fast bacilli are found in the third analysis. You have no means of starting a culture. What do you do?
Bangkok, Thailand. A 34-year-old man is severely emaciated, has had a cough for a month and exhibits white spots in the mouth. He complains of retrosternal discomfort when swallowing. What do you think and do?
Ghana. A 17-year-old girl becomes progressively blind in the right eye. She exhibits dark cutaneous nodules on her nose and arms. You also notice a white ribbon-shaped skin zone on the right side of the abdomen. What do you think and do?
Belize. An HIV patient is admitted because of persistent fever and headache. The physical examination is normal. A thick blood smear is negative. Blood cultures remain sterile. A chest X-ray is normal. A lumbar puncture shows multiple spherical organisms surrounded by a thick capsule. What do you think and what do you do?
India. A child is born from a seropositive mother. The child is tested after 1 week and the result shows positive antibodies to HIV. What do you think?
Zimbabwe. Your local colleagues ask you how they should protect themselves against accidental infection with HIV. Your answer?
Brazil. A 32-year-old man is examined because of persistent cough. Acid-fast bacilli are found in the sputum and tuberculostatic therapy is started. After 4 weeks there is still no improvement. What are the possibilities? What simple check can you make to determine if he is really taking the medication?
Togo. A man is emaciated and is admitted because of difficulty in swallowing. You notice a white coating, that can be scraped from the inside of the cheek. An HIV test is negative. What do you think?
Congo. A man is tested for HIV. The test is negative. He asks you whether he can now be completely sure that he is not infected. Your answer?
New Guinea. A woman is tested for HIV. The ELISA is positive. What do you do?
Thailand. In a small remote town a health worker proposes beginning discussions with the local monks for partly turning their monastery into an orphanage in a few years’ time. Somebody remarks that only 2 AIDS patients have been confirmed in the last month. Your contribution to the discussion?
Cambodia. An HIV patient exhibits a severe allergic reaction to cotrimoxazole. If he has an attack of malaria, give some objections to medication with Fansimef®.
Tanzania. A 25-year-old female teacher with a previously unremarkable medical history comes to your surgery with a thoracic herpes zoster. An HIV test is positive. A CD4 cell count is not possible. The family budget is limited. What do you propose ? Do you do a chest X-ray? What about INH-prophylaxis ?
Kenya. A financially well-to-do 45-year-old HIV positive businessman in Nairobi has persistent diarrhoea and emaciation / weight loss. Coproculture and testing for intestinal parasites are negative. Trial therapy with metronidazole and ampicillin brought no improvement. There is no tuberculosis. The CD4 cell count is 200/mm3. The viral load amounts to 110,000 copies/ml plasma. Which treatment could you propose?
