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Apropriate answers to likely questions Patient: I would rather not know the diagnosis. There is nothing you can do about HIV anyway, is there? Doctor: I am pleased to say that that’s not true: there are several good reasons why you should know the diagnosis. If you have HIV, we can do tests to see how badly your immune system has been affected: the CD4 count. If the count is low you would need to go on treatment, and modern treatment is very safe and effective. Even if you don’t need treatment, we can monitor your health with regular blood tests and start treatment when the time is right; this would stop you becoming ill.

When near death the respiratory rate will fall as the patient becomes more exhausted, reaching zero when he or she dies. • Respiratory tract: sputum for bacterial culture. Always perform a diagnostic aspirate on any pleural effusion to exclude an empyema. Pleural biopsy may be helpful if there is suspicion of TB Don’t forget that atypical pneumonias commonly present with a gradual onset, dry cough and without any focal chest signs. Always perform a CXR if you suspect atypical pneumonia (Fig. 13).

Animal or human bite: may inoculate pathogens; bites are associated with a high incidence of infection. • Could there be a foreign body within the wound? • Coexistent illness, eg diabetes mellitus Also check that the patient has been immunised with tetanus toxoid within the last 10 years. TABLE 10 AETIOLOGICAL AGENTS OF CELLULITIS Scenario Likely pathogens Most common Streptococcus pyogenes Common Staphylococcus aureus Uncommon Clostridium perfringens: cellulitis or gas gangrene Other Streptococcus spp.

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Infectious diseases and dermatology by coll.

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