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### Comprehensive Case Study of a 26-Year-Old Migrant Worker with Severe Health Complications in Nepal ###

This case presentation details the diagnosis and treatment of a 26-year-old unmarried male migrant worker from Dhangadi, Nepal, who presented with high-grade fever, headaches, and severe neurological symptoms including altered sensorium and left-sided weakness. Initially treated for typhoid and malaria in India without improvement, he was referred to Seti ART Clinic after testing positive for HIV. Upon admission, he exhibited poor condition but showed significant recovery following targeted treatment, including IV antibiotics and anti-tubercular therapy. The case highlights challenges in Nepal's healthcare system such as late presentations and stigma. ###

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### Comprehensive Case Study of a 26-Year-Old Migrant Worker with Severe Health Complications in Nepal ###

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Presentation Transcript

  1. CASE PRESENTATION Dr. Rajya Shree Nyachhyon Kunwar Seti- ART, Dhangadi, Nepal

  2. Patient descrition • Migrant worker • 26 years old male • Unmarried • Literate • Consumes alcohol (everyday) and has smoking habit

  3. Complain of: • High-grade fever continuous – 4 weeks • Associated with headache, cough dry initially followed by productive • Altered sensorium and mooning, slurring of speech and unable to walk due to left sided of the body weakness -1 day

  4. History of present illness • For the above complain treated in India for typhoid fever and malaria but no improvement • Got deteriorated, so brought to home town for care and support • VCT done in Nepal (Tikapur) found positive and was referred to Seti- ART CLinic

  5. Physical examination • General condition- poor • GCS- E2 V3 M4 • Vital signs normal • Chest- BL VBS, Creps and wheezes present • CVS, PA- normal • CNS- Reflex and tone increased in left side, Power in left limbs 2/5, Planter bilateral upgoing

  6. Investigations • Blood picture, Urine RME , RFT, LFT- NAD • HBsAG, Anti-HCV, VDRL- negative • CSF: TC- 540/mm3, DC- L (90%) and N (10%), Protein 3+, sugar 64mg%, AFB- not seen, Gram stain- negative • CD4 count- 69

  7. CXR-PA View

  8. Treatment • IV fluids • NG tube for feeding • Urethral Catheterization • IV Antibiotics (Inj. Ceftriaxone 2gm IV BD), Tab. Cotrimoxazole Ds • Anti-Tubercular Treatrment (Isoniazide, Rifampicin, Pyrizinamide,Ethambutol)

  9. After one week of treatment • Patient oriented to time, place and person • GCS 15/15 • Vital sign normal • Fever subsided • Discharged on oral medication, advised for physio-therapy and proper nutrition • Plan to start ARV after 2 months of ATT

  10. Challenges in Nepal • Difficult to estimate no. of PLHAs due to inadequate surveillance mechanism and poor data keeping although - 15,945 has been recorded (NCASC,June 2010) but no. estimated is quite high (70,000) • Late presentation of case- due to lack of awareness and knowledge, lack of health facility, not well equipped, and lack of medical professional

  11. Poor expenditure in Health by Government • Stigma and discrimination not only in family, community but also in HOSPITALS

  12. THANK YOU

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