Consejería y hongos

I spent the first part of yesterday morning observing the CFLAG counselors. They provide both pre- and post-HIV test counseling to every patient that comes to the clinic for an HIV test. They really do an excellent job of asking patients why they have come to be tested, what they know about HIV, and then providing appropriate information in a very clear and concise fashion. Of note, CFLAG only has funding to provide free HIV tests to pregnant women, so if you are a nonpregnant female or a male, then you have to pay 60 Quetzales ($8) for the test, as well as purchase the needle and syringe for the blood sample (10 Quetzales). If the patient is absolutely unable to pay, then he/she can speak with the social worker about having the fee waived. I asked one of the counselors why the patients had to purchase their own needles and syringes (since they have a decent supply in the clinic), and she said that it was due to funding, as well as the fact that when patients purchase their own needles and syringes, they will be certain that the needle was not contaminated or reused – decreasing the likelihood that someone might blame the HIV+ result on a contaminated needle. Interesante.

After spending some time with the counselors, I headed over to the Tuberculosis and Fungal laboratory to work with the incredible Licenciada Sandra. She is the head of the laboratory, and she spent an hour telling me what they do in the lab, as well as showing me some really neat specimens of fungus and mycobacteria that have been isolated from patients at the hospital. The predominant stains used by the lab are Giemsa, H&E, India Ink, Ziehl Neelson, Kenyan, and occasionally the Gomori methenamine silver stain. By far the most commonly isolated organism in the lab is Mycobacterium. She said that they isolate 150-200 cases per year. The most common fungus is histoplasmosis at 47-50 cases per year. Coccidioidomycosis has a much smaller representation at 4-5 cases per year. When it comes to Mycobacteria, the lab does not currently have the technology necessary to differentiate species of mycobacteria, but are hoping to get the DNA probes within the next month, which will be very exciting for the lab, and beneficial to the patients as well.

Macroconidia of histoplasmosis growing from a bone marrow aspiration

Tinta China (India Ink) positive for crytococcus in CSF