Chapter 25: infectious Diseases IV

Question 1

Immunocompromised states include: HIV

Answer 1

CD4 count <200

Question 2

Immunocompromised states include: Prednisone

Answer 2

systemic steroids for 14 days of longer at a prednisone dose (or equivalent) >=20mg/day or >=2mg/kg/day

Question 3

Immunocompromised states include: Asplenia

Answer 3

Lack of functioning spleen as with sickle cell disease

Question 4

Immunocompromised states include: use of immunosuppressant

Answer 4

Such as TNF-alpha inhibitors for autoimmune conditions

Question 5

Immunocompromised states include: cancer

Answer 5

Chemotherapy agents destroy white blood cells, particularly with severe neutropenia (ANC <500)

Question 6

Prophylactic Criteria for Starting Tx, Regimen, D/C: Pneumocystitis jirovecii pneumonia (PJP or PCP)

Answer 6

Starting: CD4 count <200 cell/mm
Regimen: SMX/TMP DS or SS daily
Alt: dapsone, dapsone + pyrimethamine + leucovorin, or atavoquine
D/C: CD4 count >200 for >3 months on ART

Question 7

Prophylactic Criteria for Starting Tx, Regimen, D/C: Toxoplasma gondii encephalitis

Answer 7

Starting: toxoplasma IgG positive and CD4 count <100
Regimen: SMX/TMP DS po qd
Alt: dapsone + pyrimethamine + leucovorin, or atavoquine
D/C: CD4 count >200 for >3 months on ART

Question 8

Prophylactic Criteria for Starting Tx, Regimen, D/C: Mycobacterium avium complex (MAC)

Answer 8

Starting: Initiate if not taking ART and CD4 count <50
Regimen: Azith 1200mg po weekly
D/C: Taking fully suppressive ART

Question 9

Tx of OI, Regimen, Alt, Secondary Prophylaxis: Candidiasis (oropharyngeal/esophageal)

Answer 9

Thrush: appears as a white film in mouth/throat
Regimen: fluconazole
Alt: Itraconazole
Secondary Proph: not usually recommened

Question 10

Tx of OI, Regimen, Alt, Secondary Prophylaxis: Cryptoccal Meningitis

Answer 10

Regimen: Amp B + flucytosine
Alt: Fluconazole +/- flucytosine
Secondary proph: low-dose fluconazole

Question 11

Tx of OI, Regimen, Alt, Secondary Prophylaxis: CMV

Answer 11

Regimen: Valganciclovir or Ganciclovir
Alt: Foscarnet or Cidofovir
Secondary proph: none, maintain CD4 >100

Question 12

Tx of OI, Regimen, Alt, Secondary Prophylaxis: MAC

Answer 12

Regimen: Clarithromycin or Azithromycin + ethambutol
Alt: add a 3rd or 4th agent using rifabutin, amikacin, streptomycin, moxi, levofloxacin
Secondary Proph: same a Tx regimen

Question 13

Tx of OI, Regimen, Alt, Secondary Prophylaxis: PJP or PCP

Answer 13

Regimen: SMX/TMP (high dose) +/- pred or methylpred
Alt: Atavoquone or pentamidine IV
Secondary Proph: SMX/TMP DS or SS qd

Question 14

Tx of OI, Regimen, Alt, Secondary Prophylaxis: Toxoplasmosis gondii encephalitis

Answer 14

Regimen: Pyrimethamine + Leucovorin + sulfadiazine
Alt: SMX/TMP
Secondary Proph: same as tx but with reduced doses