A middle aged man w/ well-controlled HIV and seasonal allergies p/w recurrent episodic flu-like illness during travel to arizona + persistent cough. His work-up is still ongoing, but he’s undergone allergy testing and has seen pulmonology as an outpatient.
This patient tested negative for cocci, but a few interesting teaching points about cocci came up during our discussion:
1) The cocci antibody should be used as a screening test – it is sensitive but not specific. The immunodiffusion and complement fixation tests are specific, and can be used to monitor response to therapy
2) Healthy young people with primary cocci (PNA) not requiring hospitalization generally do NOT need to be treated! Treat if >10% weight loss, persistent night sweats x 3 weeks, complement fixation titers > 1:16, out of work, HIV, or sx > 2 months
*Individuals of African or Philippine descent have an increased risk of extra-pulmonary complications