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SBL Exam 2 > 5. HIV-AIDS and Opportunistic Infection > Flashcards

5. HIV-AIDS and Opportunistic Infection Flashcards

1
Q

when should you consider prophylaxis treatment for pneumocystis jirovecii

A

CD4 < 200

or

Orophayngeal candidiasis (even w/ <300 CD4!)

or

prior bout of PCP

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2
Q

what vaccine is given to children that are HIV infected and older than 2 months

A

meningococcal conjugate vaccine (serogroup A, C, W, and Y)

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3
Q

what are lab findings for toxoplasmosis

A

*seen in pt w/ CD4 < 100*

T.gondii in CSF - but could be false neg!

(serologic tests NOT useful bc antibodies to T. gondii are prevalent in general population)

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4
Q

how is cryptococcal meningitis diagnosed

A

(+) latex agglutination test of serum that detects cyptococcal Ag (CRAG)

or (+) culture of spinal fluid for cryptococcus

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5
Q

Where does the tumor associated w/ HHV-8 spread?

A

=kaposi sarcoma

extracutaneous spread - oral cavity, GI tract and resp tract

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6
Q

what is the DDx if CD4 counts are <50

A

Mycobacterium-avium complex (MAC)

CMV

Primary CNS lymphoma

HIV

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7
Q

where is MAC markedly increased?

A

metropolitan areas bc homelessness

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8
Q

How will a pt with active TB and >350 CD4 count present?

how about with advanced immunodef?

A

present w/ similar findings as uninfected persons

w/ advanced immunodeficiency: lower & middle lobe, interstitial and miliary infiltrates w/ mediastinal adenopathy and extrapul involvement

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9
Q

what are symptoms for primary CNS lymphoma

A

mass lesion, HA,

neuropsychiatric symptoms: confusion/ disorientation

lateralizing signs: altered gait & balance, falls, focal deficits

seizures

onset days - weeks

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10
Q

what do the skin lesions for kaposi sarcoma look like?

where are they most often located?

A

=papular, ranging in size from several mm to cm in diameter

-most often LE, face (ESP NOSE), oral mucosa and genitalia

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11
Q

what is the cornerstone of diagnosis for PJP

A

chest radiograph

  • diffuse/perihilar infiltrates
  • normal CXR
  • atypical infiltrates (viral pneumonia, micoplasma pneumonia)
  • apical infiltrates (TB & aspiration pneumonia)

last 3 used to rule other Dx out

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12
Q

list the 5 major problems encountered in CMV (most likely to least) in immunocompromised pts

A

*retinitis*

colitis

esophageal ulceration

encephalitis

pneumonitis

(retinitis present as “cottage cheese and ketchup infiltrate” on fundoscope exam)

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13
Q

what is the most common cause of pul dz in HIV infected pt

A

community aquired pneumonia

(bacterial, mycobacterial and viral pneumonias)

recurrent = AIDs defining

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14
Q

DDx for >300 CD4 count

A

pneumococcal pneumonia

pulmonary TB

herpes zoster

oral candidiasis

vaginal candidiasis

fatigue

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15
Q

what are AIDS-defining illnesses?

A

opportunisitic infxns

  • multiple/recurrent bacterial infxn
  • PJP
  • kaposi sarcoma
  • lymphoma
  • CMV infxn
  • histoplasmosis
  • coccidiodomycosis (disseminated/extrapul)
  • crytococcosis, (extrapul)
  • mycobacterium TB of any site
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16
Q

what is the sequence of lab findings completed for HIV?

and how do you test if your results are a false positive?

A

combined immunoassay for HIV Ab w/ a test for HIV p24 Ag (which is detectable a week before Ab in acute infection)

if (+) –> HIV 1/2 Ab differentiation immunoassay

if differentiation assay (-) –> HIV-1 nucleic acid amplification test (NAAT)

==>(+) w/ neg-Ab = acute HIV

==> (-) = false positive

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17
Q

what organisms cause the common GI problem found in HIV pts

A

=enterocolitis

bacteria : Campylobacter, salmonella, shigella

viruses: CMV, adenovirus

Protozoans: Cryptosporidium, entamoeba histolytica, giardia, isospora, microsporidia

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18
Q

How often should CD4 counts be checked

A

every 3-6 months

(esp pts taking antiretroviral treatment)

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19
Q

HIV mimics a variety of other medical illnesses

What should you add to your DDx is pt presents with neurological dz

A

conditions that cause mental status changes/neuropathy

alcoholism

liver dz,

kidney dysfxn,

thyroid dz,

Vit deficiency

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20
Q

what helps to obtain a definitive diagnosis for pneumocytosis in 50-80% of cases?

A

wright giemsa stain

direct fluorescence antibody (DFA) of sputum

bronchoclaveolar lavage: if sputum (-) but still suspect pneumonia (95% pts)

21
Q

what are the PE findings for HIV

A

maybe completely normal, nonspecific or highly specific

specfic for HIV infxn:

  1. hairy leukoplakia of the tongue
  2. disseminated Kaposi sarcoma
  3. cutaneous bicillary angiomatosis

general LAD common in early infxn

22
Q

what can be a cause of considerable morbidity in severely immunocompromised HIV infected individuals?

A

CMV

23
Q

HIV mimics a variety of other medical illnesses…

what should you add to your DDx if pt presents w/ wt loss & fever

A

CA

chronic infxn (TB, endocarditis)

endocrine disease (hyperthryoidism)

24
Q

what is the immunization recommendation for Streptococcus pneumoniae in pts with HIV

A

*NOTE* AVOID LIVE VACCINES

25
Q

HIV mimics a variety of other medical illnesses

What should you add to your DDx is pt presents with diarrhea

A

infectious enterocolitis

antibiotic-associated colitis

IBD

mal-abs symptoms

26
Q

which is more sensitive/specific for presenting pneumocystis pneumonia, LDH or serum B-glucan

A

serum B-glucan

LDH also elevated but specificity only 75%

27
Q

what are the limitations for CD4 count?

A

diurnal variation

depression w/ intercurrent illness

intra-lab and interlab variability

28
Q

what are symptoms associated w/ pneumocystis jirovicii

A

*most common opportunistic infxn associated w/ aids*

fever, cough, SOB

hypoxemia (if severe)

(imaging - pneumothoraces if hx of HIV)

29
Q

how common is it for a child to contract HIV who is born from HIV infected mom

A

w/o maternal treatment & perinatal prophylaxis = 13-40%

30
Q

What are the prophylaxis considerations for Pneumocystis jirovecii

A

trimethoprim-sulfamethoxazole (TMP-SMX)

- 1 DS daily PO or 1 SS daily PO

31
Q

what can you NOT tell from CD4 counts

A

how actively HIV is replicating in body

level of viral replication & prognostic info (test w/ HIV viral load)

32
Q

what is DDx if CD4 counts are < 300

A

oral hairy leukoplakia

thrush

fever

wt. loss

diarrhea

33
Q

Rate the types of transmission risks from greatest to least

A

receptive anal > ilicit drug use

> needle stick w/ infect blood > insertive anal/ receptive vaginal

> insertive vaginal > blood transfusion (greatly decreased bc screening improved)

increased risk w/ inflammed/ulcerative mucosa

34
Q

what organ system can be involved in AIDS-related KS

what are the symptoms and how can you diagnose this?

A

pulmonary

=SOB, fever, cough, hemoptysis or chest pain

-diagnose via bronchoscopy (CXR may show asymptomatic findings)

35
Q

What category had the greatest number of cases globally

A

general poplulation!

36
Q

what is the most widely used marker to provide prognostic info & help guide therapy?

A

absolute CD4 lymphocyte count

–> decreases in count –> increase riskof serious opportunistic infxn (next 3-5 years)

*trend is more imp than single determination

37
Q

HIV mimics a variety of other medical illnesses

What should you add to your DDx is pt presents with pulmonary processes

A

acute & chronic lung infxns

and other causes of diffuse interstitial pulmonary infiltrates

38
Q

what is the HPV vaccine recommendation

A

all pts 13-26 yrs of age

HPV vaccine; 3 doses

39
Q

if tests show ______ the diagnosis of pneumocystis pneumona is very unlikely

(3 scenarios)

A

normal diffuse capacity of CO

high resolution CT scan of the chest shows NO interstital lung dz

CD4 >250 w/i 2 months prior to evaluation of resp symptoms

40
Q

what is the DDx if CD4 counts are < 100

A

cryptococcal meningitis

esophageal candidiasis

toxoplasmosis

HIV

41
Q

what should you include in a differential Dx w/ ring enhancing lesions present on contrast enhanced CT

A

Toxoplasma (will show surrouding edema)

CNS lymphoma,

fungal infxn,

cerebral TB

42
Q

what is the DDx if CD4 counts are < 200

A

pneumocystis jirovecii pneumonia (PJP)

disseminated histoplasmosis

kaposi sarcoma

extrapul/miliary Tb

NHL

CNS lymphoma

*start considering HIV in DDx*

43
Q

what is the immunization recommendation for Hep B, Hep A and Influenza virus in HIV pts?

A

*NOTE* - AVOID LIVE VACCINES

44
Q

what is the epidemiology of HIV

age?

population?

A

1.1 mil teens and adults in US living w/ HIV

15% undiagnosed

age 13-24: most likely to not know they’re infected

gay/bisexual men most of new diagnoses

African-american men > hispanic/white

45
Q

what is the most common space occupying lesion in HIV

what is this a common cause for

A

toxoplasmosis

=multiple subcortical lesions with a predilection for the basal ganglia

-common cause of focal encephalitis in pt w/ AIDS

46
Q

what should pleural effusion make you think of..

A

bacterial pneumonia

TB

pleural kaposi

47
Q

what is the relationship of primary CNS lymphoma to HIV

A

2nd MCC space occupying lesion in HIV

= single ring enhancing lesions (but could be multiple)

< 50 CD4 count & highly assocaited w/ EBV (seen w/ CSF PCR)

48
Q

what are imaging findings for toxoplasmosis

A

unenhanced CT scan - multiple subcortical lesions w/ predilection for the basal ganglia

MRI more sensitive than contrast enhanced CT –> MRI show multiple ring-enhanced lesions w/ surrounding areas of edema

49
Q

discuss the global impact of HIV

A

2017 =

  1. 8 million new cases; 36.9 million ppl around the worlds
  2. 7 mil pt recieve meds

940K died from AIDs related illness

Sub-saharan africa = heaviest burden of HIV and AIDS world wide (66% all new infxns)

SBL Exam 2 (8 decks)

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