Crunch Time Infection Flashcards
Blood transfusions prior to _____ led to increased risk of HIV transmission
1985
Test to screen for HIV
Test to confirm HIV
ELISA to screen
Western blot to confirm
A CD4 count of < ____ is AIDS-defining
200
If you see an HIV patient with eye symptoms, you should think of ______. What symptoms will they have?
CMV retinitis
blurry/worsening vision and eye pain
oral thrush ______(does/doesn’t) scrape off easily
DOES!
Treatment for CMV retinitis
ganciclovir
Diagnostic test for candidal esophagitis. Treatment?
KOH prep
nystatin or clomitrazole
MC cancer in AIDS patients
Kaposi’s sarcoma
HIV pt with subcutaneous, reddish-brown or bluish nodule on face or hands/feet. Dx?
Kaposi’s sarcoma
2 bugs that you should think of if you see neuro symptoms in an HIV patient
cryptococcus neoformans
toxoplasmosis gondii
In toxoplasmosis gondii, the lesions are ______
ring-enhancing
treatment for toxoplasmosis gondii
pyrimethamine AND sulfadiazine AND folate
classic diagnostic finding in cryptococcus neoformans
high opening pressure on LP
Which has more specific neuro deficits? Toxoplasmosis or cryptococcus?
Toxoplasmosis (crypto is more cryptogenic, or general; headache, non-specific findings); toxo can have focal neuro deficits, seizures, is more severe
Diagnostic test for Cryptococcus neoformans
india ink stain or cryptococcal antigen on CSF
treatment for cryptococcus neoformans
amphotericin B +/- flucytazine
Some diagnostic clues for pneumocystis jirovecii
groundglass opacities on CXR
high LDH
diagnostic test for pneumocystis jirovecii
tx?
bronchiolar lavage
bactrim for 21 days, +/- prednisone if v sick
2 common bugs that cause diarrhea in HIV pts
cryptospiridium
isosporum
diagnostic test for cryptosporidium
acid-fast stain of stool, serology or ELISA
treatment for cryptosporidium in HIV pts
parmomycin or azithromycin for 4 weeks
treatment for isospora diarrhea in HIV pts
bactrim for 21 days
most notable AE of didanosine
pancreatitis
Most notable AE of indinavir
kidney stones
Most notable AE of ifavirenz
psychosis
most notable AE of pentamide
hyper or hypoglycemia
common parasitic GI infx in HIV pts
dx?
cryptosporidium and isospora
ACID FAST STAIN
common fungal diarrheal infx in HIV pts
cryptococcus
histoplasma
common invasive bacteria that cause diarrhea in HIV pts
salmonella, shigella, e coli, campylobacter, C diff (just as with non-HIV patients!)
tests to consider in diarrhea in HIV pts
stool ova/parasites stool leukocyts stool bacterial culture c diff acid-fast stain
how to treat diarrheal infection in HIV patients
supportive care if not super sick
can consider fluoroquinolone if immunocompetent
if think it’s opportunistic infx –> metronidozole +quinolone
sick: fluids, admit
treatment for esophagitis
likely admission
supportive care
IV antimicrobials (antifungals or antivirals)
THIS IS AN AIDS-DEFINING ILLNESS (from candida, HSV, CMV)
work up for suspected neuro infection in HIV pt
CT, LP (not if mass effect), empiric coverage
empiric coverage for neuro infection in HIV pts
covering for common bugs
- ceftriaxone
- vanc if hardware/MRSA
- younger or older: ampicillin
- if concern for encephalitis (seizures): acyclovir
abnormal opening pressure in LP
over 20
opportunistic infections in HIV pts
cryptococcus
toxoplasmosis
syphillis
Tests to order on CSF in HIV pts
India Ink (for cryptococcus) cryptococcal antigen toxoplasmosis antibodies RPR (in addition to standard studies)
tx for cryptococcus meningitis
amphotericin B
CT findings in toxoplasmosis
ring-enhancing lesions (focal lesions; focal deficits or seizures are common)
tx for syphillis meningitis
a LOT of penicillin (just choose the biggest dose that’s given)
