Chapter 25: ID IV - Opportunistic Infections Flashcards
What are opportunistic infections
Infections that occur when the immune system is unable to respond normally, typically in immunocompromised patients
Immunocompromised states include:
- HIV with CD4+ T lymphocyte count < 200 cells/mm3
- Systemic steroids for 14 days or longer at a prednisone dose >/= 20 mg/day or >/= 2 mg/kg/day
- Asplenia
- Use of immunosuppressants
- Use of cancer chemotherapy agents
OIs can be prevented with antibiotics, antifungals or antivirals . This is known as
Chemoprophylaxis
T/F: Prophylaxis for Candida infections in the mouth/esophagus is not usually recommended
True
Severe neutropenia is another major risk factor for developing infections and is determined by an ANC < ___ cells/mm3
500
Which drugs are used as alternatives in OI if a patient has a sulfa allergy
Atovaquone, dapsone, pentamidine
Which drugs are used as alternatives in OI if a patient has G6PD deficiency
Atovaquone & pentamidine
PCP or PJP infection in HIV is indicated by CD4+ count < ___ cells/mm3
200
remember, PCP and PJP have 2 Ps in them
Toxoplasma gondii encephalitis (aka Toxo) in HIV is indicated by CD4+ count < ___ cells/mm3
100
remember: Ghandi lived to be 100 years old
Mycobacterium avium complex infection in HIV is indicated by CD4+ count < ___ cells/mm3 & treatment should be initiated if:
50
not taking ART
In PCP or PJP, primary ppx in HIV should be discontinued when CD4+ count >/= ___ cells/mm3 for >/= __ months on ART
200
3 months
In Mycobacterium avium complex, primary ppx in HIV should be discontinued when
taking fully suppressive ART
Preferred ppx regimen for PCP or PJP (including frequency)
Bactrim daily
Alternative ppx regimens for PCP or PJP
Dapsone OR Dapsone + pyrimethamine + leucovorin OR Atovaquone
Preferred ppx regimen for Toxoplasma gondii encephalitis
Bactrim
Alternative ppx regimens for Toxoplasma gondii encephalitis
Dapsone + pyrimethamine + leucovorin
OR
Atovaquone
Preferred ppx regimen for Mycobacterium avium complex (including dose)
Azithromycin 1,200 mg PO weekly
Think of MAC & Z-pak
Candidiasis preferred treatment
Fluconazole
Candidiasis alternative treatment
Itraconazole
Cryptococcal meningitis preferred regimen
Amphotericin B (dexycholate or liposomal) + flucytosine
Cryptococcal meningitis alternative regimen
Fluconazole
Cytomegalovirus preferred treatments
Valganciclovir or ganciclovir
Cytomegalovirus alternative treatments
Foscarnet or cidofovir
Mycobacterium avium complex preferred treatment regimen
(Clarithromycin or azithromycin) + ethambutol
PCP preferred treatment regimen
Bactrim
PCP alternative treatment regimen
Atovaquone or pentamidine IV
Toxoplasmosis gondii encephalitis preferred treatment
Pyrimethenamine + leucovorin + sulfadiazine
Toxoplasmosis gondii encephalitis alternative treatment
Bactrim
