HIV - Opportunistic Infections Flashcards
CD4+ count in Early Stage HIV:
> 500
Opportunistic infections that occur in early stage HIV when CD4+ count is > 500:
Varicella Zoster, Herpes Simplex Virus, Strep pneumo
CD4+ count in Middle Stage HIV:
250-500
Opportunistic infections that occur in middle stage HIV when CD4+ count is between 250 and 500:
Bartonella, Salmonella, Candida, Syphilis, Kaposi sarcoma, Mycobacterium TB
CD4+ count in Late Stage HIV:
<200
Opportunistic infections that occur in late stage HIV when CD4+ count is below 200:
PCP, Cryptococcus, Histoplasma, Coccidiodes, Toxoplasma, Rhodococcus equi
CD4+ count in very late stage HIV:
<100
Opportunistic infections that occur in very late stage HIV when CD4+ count is below 100:
MAC, Cryptosporidiosis, PML, CMV
When does “HIV become AIDs?”
When CD4+ count drops below 200
If a patient’s CD4+ count drops to 100 and then returns to 300, does that patient have HIV or AIDs?
AIDs
Causative agent of Pneumocystis Carnii Pneumonia (PCP):
Pneumocystitis jirovecii
Symptoms of PCP
non-specific, “I just don’t feel good,” hypoxia might be severe
CXR findings of PCP:
“Bilateral, fluffy whiteness that is everywhere”
When do you start prophylaxis for PCP? / What do you use?
Undiagnosed fever, night sweats, thrush, weight loss & CD4+ count is over 200 OR CD4+ count is below 200 & no symptoms / TMP-SMX, bactrim
Describe Kaposi Sarcoma:
Purple, non-blanching lesions; can require chemo if severe
Do you prophylax for Candidiasis?
No
Candidiasis is usually seen in a CD4+ count less than what?
100
Most common spots for candidiasis?
Esophageal, oral, vaginal, dermal
Most common space-occupying CNS lesion in HIV infected patients? / Symptoms
Toxoplasmosis / AMS & neuro defecits
Prophylaxis for Toxoplasmosis?
TMP-SMX, bactrim (like PCP, convenient)
What is Progressive Multifocal Leukoencephalopathy?
PML = viral infection in white matter of brain
Classic finding of PML / Symptoms
Nonenhancing white matter lesions without mass effect / aphasia, hemiparesis, cortical blindness
Mycobacterium Avium Complex (MAC):
Organism ubiquitous in the environment but can be deadly to HIV patients
CD4+ count associated with MAC?
less than 50
Prophylaxis for MAC:
Azithromycin
DX for MAC:
It is a MYCOBACTERIUM so you acid-fast stain it! Culture will take way too long.
Treatment for Cryptosporidium?
We don’t have one
When does enterocolitis occur? / what usually causes it? / Dx?
All stages of HIV / viral, bacterial, or protozoal / Dx using stool Cx
Cytomegalovirus is the most common cause of what? / Dx
Retinitis (blurred vision, loss of central vision, retinal detachment) / Fundascopic exam
Do you prophylax for CMV? / When / with what?
Yes / CD4 lower than 50 / Ganciclovir
All opportunistic infections you use prophylaxis for and with what?
PCP, CD4 under 200, Bactrim / Toxoplasmosis, Bactrim / Mycobacterium Avium Complex, Azithromycin / Enterocolitis, proper hygiene & avoid raw oysters / Cytomegalovirus, under 50, Ganciclovir
Causative agent of oral hairy leukoplakia
EBV
Viral cause of Kaposi Sarcoma
HHV 8
