5-77
Using Advanced Tools: Lab: Urinalysis reveals positive urobilinogen
Assessment:
Differential Diagnosis
Same as for Hepatitis A.
Plan:
Treatment
Primary: Supportive care
Patient Education
General: Most persons with acute infection will recover within four weeks.
Activity: Bedrest
Diet: Refrain from use of all alcohol products
Medications: Avoid medications that are cleared by the liver, including acetaminophen.
Prevention and Hygiene: Safe drinking water source is of the utmost importance. Handwashing, safe food
preparation and waste disposal (feces are highly infective) are essential. Stool is infectious 1 week prior to
symptoms and remains so as long as 2 weeks into the illness. Isolation of those infected from susceptible
persons is not necessary because person-to-person transmission is low.
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Consultation Criteria: Refer cases of HEV that do not improve or progress to encephalopathy.
NOTES: The mortality rate of HEV is low (0.07% -0.6%) except for pregnant women in whom a high mortality
is reported (15-25%). During outbreaks the attack rate is higher in pregnant women, highest in those in their
second or third trimesters.
ID: Human Immunodeficiency Virus
COL Naomi Aronson, MC, USAIntroduction: Human Immunodeficiency Virus (HIV), a retrovirus, is transmitted through sexual contact,
needlestick/sharps, perinatally, infected blood/body fluid contact with non-intact skin or mucous membranes,
breastfeeding and blood transfusion. Infected individuals may be free of signs of disease for years after
infection. Acquired Immune Deficiency Syndrome (AIDS) is the failure of the immune system seen during the
late stage of HIV infection. Untreated infection is eventually fatal. The incubation period for HIV is several
weeks (commonly) to months (less usual) after exposure.
Subjective: Symptoms
Acute (1-30 days): Fever to 102°F, malaise, myalgias, night sweats, sore throat, gastrointestinal symptoms,
maculopapular rash, oral ulcers. Sub-acute (30 days-1year): Generalized adenopathy. Chronic (> 1 year):
Fevers, sweats, fatigue, weight loss, oral thrush, shingles, symptoms of opportunistic infection, including
wasting syndrome, recurrent Salmonella infections, HIV dementia, Pneumocystis carinii pneumonia, chronic
fevers, Toxoplasmosis of brain, chronic diarrhea of >one month, Cryptococcal meningitis and more other
unusual infections, oral and esophageal candidiasis, chronic Herpes simplex, severe seborrheic dermatitis,
recurrent pneumonia, tuberculosis. These malignancies are also frequently seen in AIDS: invasive cervical
cancer, Kaposi’s sarcoma, brain lymphoma, non-Hodgkin’s lymphoma
Focused History: Are any of your sexual partners chronically ill? Have you tested positive for HIV? Have
you had unexplained weight loss, whitish curds in mouth, fevers, sweats or chronic diarrhea? (increased risk
if answer YES to above) Do you ALWAYS use protection (such as condoms) during sex? (increased risk if
answer NO) When did you last test negative for HIV? (document to assess time period for future testing).