Wednesday, February 5, 2014

An Unwelcome Visitor From the Past

A young man’s cough, present for two week, had grown worse. He had a fever, and my stethoscope revealed lung noises typical of pneumonia.

I enjoy diagnosing pneumonia because, in an otherwise healthy person, it’s the only common illness with a cough that doctors can cure. Everything else is a virus. 

I didn’t like this particular diagnosis. It takes a tough germ to cause pneumonia in most people, so unpleasant symptoms begin quickly. This man’s cough had persisted for some time. Furthermore, he was gay and admitted to having unprotected sex. I suspected, correctly, that he had a pneumocystis infection. Pneumocystis is a fungus so benign that it lives in the lungs of most of us, causing no trouble.

Until thirty years ago, it was rare, affecting patients already sick with cancer or other serious diseases requiring drugs that suppressed immunity. Doctors were mystified when Pneumocystis began attacking previously healthy young men during the 1980s. It turned out to be the most common sign of AIDS.

It’s rare again today because we track immune cells of HIV patients and prescribe preventive drugs when the numbers drop. This young man had not been tested, but he was no fool. Dipping into the internet had given him the usual frightening information.

My news was mildly reassuring. AIDS is no longer a death sentence but a chronic illness that can be controlled with a great deal of input from the medical profession. Like diabetes.

He cut short his visit and returned home.

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