DTMH HIV

Question 1

PCP in HIV+ patients - fungal load and mortality rate?

Answer 1

Much higher fungal loads
Lower mortality rate (17-30%)

Question 2

PCP in HIV- patients - fungal load and mortality rate?

Answer 2

Lower fungal load
Higher mortality rate (28-58%)

Question 3

Life cycle of PJP?

Answer 3

Both asexual and sexual cycle in humans

Question 4

Transmission of PJP?

Answer 4

Exclusively airborne

Question 5

Diagnostic methods for PCP?

Answer 5

BAL - more sensitive than induced sputum

-Staining (silver, direct FAT more sensitive)
-PCR
-Metagenomic sequencing (more sensitive than B-D-glucan)
-B-D-glucan (high sensitivity but not as good as PCR, low specificity) Test poor in HIV-

Question 6

Tx of PJP (name 5)

Answer 6

TMP-SMX

Alternatives:
-Pentamidine
-Dapsone-trimethoprim
-Clindamycin-primaquine
-Atovaquone
Possibly Echinocandins?

Question 7

What are the two main microsporidia causing diarrhea/enteric disease in HIV+?

Answer 7

Enterocytozoon bieneusi - most common
Encephalitozoon intestinalis

Question 8

Tx of Encephalitozoon intestinalis?

Answer 8

Responds well to Albendazole

Question 9

Tx of Enterocytozoon bieneusi?

Answer 9

Does not respond well to albendazole

Question 10

What does Encephalitozoon hellem cause?

Answer 10

Ocular infection in AIDS patients
-Can cause intestinal disease in non-HIV immunocompromised people

Question 11

Transmission of intestinal microsporidiosis?

Answer 11

Mostly fecal-oral

Some waterborne, foodborne, water,

Question 12

Dx of Microsporidiosis?

Answer 12

Staining and light (Chromotrope 2R, calcofluor white and Uvitex 2B) microscopy (speciation difficult)
EM (Species ID)
NAAT

Question 13

Clinical picture of microsporidiosis?

Answer 13

GI infection w diarrhea
Rare: encephalitis, ocular infection, sinusitis, myositis, and disseminated infection

Question 14

Tx of Microsporidiosis?

Answer 14

-Start ART, CD4>100
-Manage symptoms
-Antimotility agents for diarrhea control if needed

Question 15

Tx of GI Infection caused by E. bieneusi?

Answer 15

-ART and fluid support
-Fumagillin 60 mg PO daily and TNP-470
-Nitazoxanide 500 mg PO BID x14d possible (little effect with low CD4 counts)

Question 16

Tx of GI infection not E. bieneusi?

Answer 16

Albendazole 400 mg PO BID x14d, continue therapy until CD4 count >200 with ART start

Question 17

Dx of amoebic keratitis?

Answer 17

Corneal scraping –>
-Culture (E. coli lawn)
-Trophs/cysts stained with calcofluor white or peroxidase-labelled antibody
-PCR