Cert ID(SA) Paed Practice Questions - CMSA Sub-specialty Certificate In Infectious Diseases Cert ID(SA) Paed - South Africa Exam

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A 6-year-old HIV-infected child who commenced ART (ABC/3TC/DTG) 3 weeks ago presents with high fever, tender bilateral cervical lymphadenopathy, and enlarging right supraclavicular lymph node abscess. Pre-ART CD4 count was 45 cells/mm³ (3.2%) and viral load was 850,000 copies/mL. Current viral load has dropped to 1,200 copies/mL. A needle aspirate of the lymph node shows acid-fast bacilli (AFB) positive, and culture grows M. tuberculosis. What is the most appropriate management strategy?

Continue ART, initiate 4-drug anti-TB therapy, and add systemic corticosteroids for IRIS Drain the lymph node and withhold anti-TB therapy as this represents dead bacilli clearance Switch ART to a 2nd-line protease inhibitor regimen and stop anti-TB drugs Discontinue ART immediately and treat TB for 6 months before restarting ART

Correct Answer:

Continue ART, initiate 4-drug anti-TB therapy, and add systemic corticosteroids for IRIS

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