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Tropical Viruses > HIV Opportunistic Infections > Flashcards

HIV Opportunistic Infections Flashcards

1
Q

What causes PCP?

A

Pneumocystis jiroveci fungus

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2
Q

What are the features of a PCP infection?

A 
Reduced sats on exertion
History longer than three days
High RR
Dry cough, fever, chest pain
Scanty sputum
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3
Q

How do you diagnose PCP?

A

CXR: diffuse B/L interstitial infiltrates. NAD in 10%
HRCT: groundglass
PCR or immunofluorescence on deep lung sample (induced with hypertonic saline)

Unlikely if on prophylaxis or CD4>200

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4
Q

How do you treat PCP?

A

21 days cotrimoxazole Then secondary prophylaxis
IV then PO when improving

Steroids if needing O2 on RA or high RR
Takes a while to improve

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5
Q

What are the guidelines for PCP prophylaxis?

A

Primary: if CD4<200 cotrim daily
Secondary: daily cotrim until CD4>200 for at least 3 months

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6
Q

What are the differential diagnoses for contrast enhancing CNS lesions in PLHIV?

A 
Toxoplasmosis
TB
Lymphoma
Fungal
Abscess
Mets/tumour
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7
Q

What are the differential diagnosis for diffuse/non focal MRI changes in PLHIV?

A 
PML
CMV encephalopathy
HIV encephalopathy 
TB
Cryptococcal meningitis
Listeria meningitis
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8
Q

What is toxoplasmosis and how do you get infected with it?

A

A cat parasite, spread by the ingestion of cysts in raw meat or cat faeces

In HIV, infection is usually due to reactivation

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9
Q

How do you diagnose toxoplasmosis?

A

Focal CNS lesion ?multiple
CSF: high protein and lymphocytes, toxoplasmosis PCR (negative cannot be used to r/o Dx)
Toxo IgG- can rule out

Brain biopsy demonstrating parasites is the definite Dx

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10
Q

How do you treat toxoplasmosis?

A

Consider empirical Tx if >1 suggestive lesion, serology +ve and CD4<200

At least 6wks Tx
Sulfadiazine (or clindamycin), pyrimethamine and folate
Steroids if oedema or initial deterioration

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11
Q

What is the prophylaxis for toxo?

A

Secondary prophylaxis of cotrim daily until CD4>200

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12
Q

What are the features of primary CNS lymphoma?

A

EBV associated

More likely than toxo if solitary lesion, toxo -ve, lesion >4cm or no response to toxo Tx

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13
Q

How do you diagnose primary CNS lymphoma?

A

Biopsy
CSF cytology
+ve CSF EBV is supportive

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14
Q

How do you treat primary CNS lymphoma?

A

Median survival 4 months!

Palliative DXT and chemo

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15
Q

What are the pathogenic sub species of cryptococcus?

A

Cryptococcus neoformans var grubii

Cryptococcus neoformans var neoformans

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16
Q

What are the manifestations of cryptococcal disease?

A

Meningitis
Pulmonary disease- may have negative CrAg
Cutaneous
Bone and prostate

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17
Q

How would you diagnose cryptococcal meningitis?

A

CD4 <50

Severe HA, fever, confusion, focal neuro

CSF: high OP, high WCC and protein, low glucose, India ink +ve, CRAG +ve

BCs
High mortality due to RICP

18
Q

What is the treatment for cryptococcal meningitis?

A

2wks liposomal amphotericin and flucytosine
8wks fluconazole

Monitor RICP: if OP>25 then daily LP to reduce and consider VP shunt

Secondary prophylaxis with fluconazole until CD4>100 for at least 3/12

19
Q

What causes progressive multifocal leukoencephalopathy?

A

JC virus (Human polyomavirus 2) 70% adults are seropositive

20
Q

What are the features of PML?

A

Progressive cognitive and neurological deficit

CSF: high protein and cells, PCR JV virus +ve

21
Q

How do you treat PML?

A

Only Tx is ART

Median survival is 6 months

22
Q

What is Mycobacterium Avium Complex?

A

Species of nonTB Mycobacterium

M avium is the most common cause of disseminated MAC disease in AIDS pts

23
Q

What are the clinical manifestations of MAC?

A

CD4<50
Fever, weight loss, sweats, diarrhoea, lymphadenopathy, hepatosplenomegaly

Anaemia, hypoproteinaemia and deranged LFTs

24
Q

How do you diagnose MAC?

A

Clinical history

Isolation of M.Avium from BCs, BM, LN, sputum

25
Q

How do you treat MAC?

A

Clarithromycin/azithromycin and ethambutol

Add in Rifabutin if CD4<25, v. symptomatic or unable to give effective ART

Tx until good clinical response and CD4>100 for 3/12

26
Q

What are the prophylaxis guidelines for MAC?

A

Primary: Azithromycin once weekly if CD4<50

27
Q

What is localised MAC and how d you treat it?

A

Usually seen in PLHIV on ART with higher CD4 counts

Rifampicin, clarithromycin, ethambutol for 12-24/12

28
Q

What is Penicillium marneffei and where is it found?

A

Fungus

Endemic in SE Asia and China

29
Q

What are the clinical features of penicilliosis?

A

CD4 <100

Fever, night sweats, weight loss, cough, pancytopenia, hepatosplenomegaly, LN and skin lesions (looks like molluscum)

30
Q

How do you diagnose penicilliosis?

A

Biopsy and culture finding typical yeast like cells

31
Q

How do you treat penicilliosis?

A

Amphotericin B then itraconazole

Secondary prophylaxis with itraconazole

32
Q

What are the clinical features of CMV in PLHIV?

A

Primary infection asymptomatic
Reactivation when CD4<50: retina>colon>lung>CNS

CMV retinitis is usually unilateral but can become bilateral if untreated

33
Q

How do you diagnose CMV disease?

A

Viraemia and end organ disease
Retina: clinical
Colon/lung: biopsy to see owls eye inclusion bodies
CNS: CSF is lymphocytic, high protein, PCR+ve

34
Q

How do you treat CMV disease?

A

14 to 28 days of ganciclovir or foscarnet
Intravitreol ganciclovir for retinitis

Start ART

Regular eye screening if CD4<50

35
Q

How do you investigate chronic diarrhoea in PLHIV?

A 
Baseline stool and microscopy
Stool antigen testing
Stool parasitology
BCs
Sigmoidoscopy and histology for parasites, CMV and mycobacteria
36
Q

How do you manage chronic diarrhoea in PLHIV?

A

Start ART (get CD4>50)

If no Dx the empirical metronidazole, cotrimoxazole, azithromycin

37
Q

What are some enteric parasites that affect PLHIV?

A 
Cryptosporidia
Isospora
Microsporidia
Cyclospora
Giardia
Amoebiasis
Strongyloides
38
Q

When should you start ART in a Pt with cryptococcal meningitis?

A

After 2 weeks of Tx

39
Q

When should you start ART in toxoplasmosis?

A

When Pt clinically stable, usually after 2 weeks of Tx

40
Q

What are the side effects of amphotericin B?

A

Renal impairment -prehydrate
Hypokalaemia
Anaemia from reduced EPO production

Tropical Viruses (19 decks)

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