The patient has neurocystircercosis due to an active Taenia solium infection. Therapy should be directed at eliminating both the intestinal and central nervous system parasites.
The patient is also infected with tuberculosis and should be offered therapy with Isoniazid in order to prevent the occurrence of pulmonary disease.
Patient Management and Counseling Plan
- Neurocystircercosis: The patient was given praziquantel for two weeks in order to treat the central nervous system lesions. He was also given prednisone to decrease the risk of developing cerebral edema during therapy. His intestinal infecti
on was treated with niclosamide. Stool ova and parasite exams were performed on persons living in the patient's apartment. All specimens were negative. The patient remained on anti-convulsant medications. A repeat CAT scan 3 months after therapy revea
led significant resolution of the CNS lesions. Repeat stool exams were
negative for ova and parasites.
- Tuberculosis: The patient was started on Isoniazid for 6 months
in order to prevent the development of pulmonary tuberculosis. He was told to avoid the use of alcohol and tylenol during treatment since both drugs tend to increase the risk of
Isoniazid induced liver failure. The symptoms of liver toxicity were described to the patient and he was told to report to the clinic immediately if abdominal pain, jaundice, generalized weakness and nausea were noted. Monthly follow-up visits were sche
duled with a nurse-practitioner to review symptoms and medication
compliance.
- Illiteracy: Mr. V. was counseled on the importance of obtaining
literacy in English. He subsequently enrolled in adult education classes with the help of the clinic social worker.
Assignment
Please give brief answers to the following questions:
- Based on your review of the diagnosis and management plan, do you
believe the health status of immigrants is a significant public health
issue in this country?
- What would happen to this patient if access to health care for
illegal immigrants were to be restricted,a s recently proposed by voters
in California?
- What would be the public health impact of denying health care access
to this patient and others like him?
- Does the management paln adequately address social issues that might
affect compliance and the patient's future health status?