Friedman Continues Experience at Chiang Mai

The following was submitted by DeAnna Friedman, third year pediatric resident.

Today, I spent the morning in the outpatient Pediatric Infectious Diseases Clinic. We saw many children with HIV, some doing well and some not. One 17-year-old boy had a falling CD4 count and a rising viral load, so was stopped from his ARVs months ago.

They did resistance testing and found that he is resistant to all NNRTI's as well as 3TC (which was part of his initial regimen). Before starting him on a second line, they were trying to get him to commit to being adherent, and he kept stating that he was not ready yet.  His CD4 count is now down to 6%, so the doctor that I'm working with stated that she hopes that he will buy in soon before he gets a bad opportunistic infection.  I would have to agree.  

One interesting appointment was the first one of the day. It was a girl who presented because she was exposed to TB. Her skin test at the last visit was 20 mm induration, so she was started on INH. She was having some nausea and vomiting with the medication sometimes, and my attending stated that her dose was high for her age because she was above her ideal body weight.  The parents wanted to know how to get her to lose weight. We then spent about 10-15 minutes counseling on healthy eating and lifestyle habits.  Very much like an appointment back in the US.  

We also saw an HIV-exposed infant who was HIV DNA PCR negative at 1 month of age. She will get a repeat at 4 months and then antibody testing at 18 months to confirm that she is negative. Also, very much like the US. The government has really done a good job of committing important resources where they need to, even if they are more expensive tests/therapies.  

On the inpatient side, we saw an interesting case of endocarditis from S. aureus who presented with longstanding fever and inability to walk due to painful nodules on her feet (Osler's nodes). Her ESR and CRP were now normal (after 6 weeks of therapy), so she was being discharged home and will follow up with cardiology in a month.

That was just a smattering of the cases I saw today that I thought you guys might find interesting. I haven't had any opportunities to take good pictures of any visible pathology yet, but I'll keep you updated.

I had this past weekend off, which was much needed given all of
the traveling earlier in the week. Plus, the place where I was staying
at first only had a room available until the weekend, so I had to move
to another hotel (it's okay, this one's much nicer). That ate up most of
my Saturday.  




On Sunday, I took a cooking class (highly recommend if you ever find
yourself in Chiang Mai)...


...and then went to the Sunday night market (also a
fascinating cultural experience).

I hope you are all enjoying what I hear is very beautiful weather in Minnesota for this time of year!