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Infectious diseases > HIV + syphilis > Flashcards

HIV + syphilis Flashcards

1
Q

HIV diagnosis - protocol

A

Presumptive diagnosis made with ELISA –> positive results are then confirmed with Western blot assay

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2
Q

HIV - ELISA/Western blot test - disadvantages

A
  1. falsely negative in the fist 1-2 months of HIV infection

2. falsely positive in babies born to infected mothers (anti-gp120 crosses placenta)

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3
Q

how to diagnose HIV in infants younger than 18 months (no antibodies production) born to seropositive mothers

A

p24 antigen test
PCR
viral culture (not common)

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4
Q

AIDS diagnosis?

A
  1. less than 200 CD4+ cells/mm3
  2. HIV+ with AIDS-defining conditions
  3. CD4 percentage less than 14%
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5
Q

normal CD4 COUNT

A

500-1500 cells/mm3

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6
Q

HIV - disease (and pathogen) IF CD4 lower than 500

A
  1. oral thrush - Candida ablicans
  2. Oral hairy leukoplakia (EBV)
  3. Kaposi sarcoma (HHV-8) (?????)
  4. SCC, commonly of anus (men who have sex with men, or cervix (HPV)
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7
Q

HIV - disease (and pathogen) IF CD4 lower than 200

A
  1. dementia (HIV)
  2. Progressive multifocal leukoencephalopathy (JC)
  3. Pneumocystic pneumonia (Pneumocystis jirovecii)
  4. Histoplasma capsulamtum
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8
Q

Progressive multifocal leukoencephalopathy (JC) findings

A

Non-enhancing areas of demyelination on MRI

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9
Q

HIV - disease (and pathogen) IF CD4 lower than 100

A
  1. Hemoptysis, pleuritic pain (Aspergilus)
  2. Meningitis (Cryptococcus neoformans)
  3. esophagitis (Candida)
  4. Retinitis, esophagitis, colitis, pneumonitis, encephalitis (CMV)
  5. B-cell lymphoma (non-Hodgkin, CNS) (EBV)
  6. Fever, weight loss, fatique, cough, dyspnea, nausea, vomiting, diarrhea (Histoplasma)
  7. Nonspecific systemic infection (fever, nigh sweats, weight loss) or focal lymphadenitis (M. avium-intracellulare)
  8. Brain abscesses (Toxoplasma gondi)
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10
Q

HIV - Hemoptysis, pleuritic pain (Aspergilus) - findings

A

cavitation or infiltrates on chest imaging

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11
Q

prophylaxis in HIV patients

A

less than 200: TMP-SMX (PCP)
less than 100: TMP-SXM (PCP + Toxo)
less than 50: azythromycin or clarythromycin (Myc avium)H
- acyclovir only if frequent reccurence of HIV regardless CD4

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12
Q

HIV patients are at risk for toxoplasmosis when … / prophylaxis

A

CD4 less than 100
- if positive serology (for latent infection) and less than 100 –> TMP/SXM –> can discontinue when more than 200 for 3 months

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13
Q

TB in HIV - prophylaxis

A

isoniazid if (+) skin test or contact with active person

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14
Q

Approach to odynophagia + dysphagia in patients with HIV

A

suspected esophagitis

  1. if mild symptoms + orla thursh –> candida (fluconazol) –> endoscopy if no improvement
  2. Severe without thursh –> endoscopy:
    - white plaques –> fluconazole
    - linear ulcers –> ganciclovir (CMV)
    - vesicles and round/ovoid ulcers –> acyclovir (HSV)
    - apthous ulcers –> symptomatic therapy
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15
Q

viral vs fungal esophagitis in HIV

A
  1. fungal: oral thrush

2. viral: severe odynophagia (pain) without dysphagia (difficulty) or thrush

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16
Q

Common causes of esophagitis in HIV

A
  1. Candida (MC): white plagues, oral thrush
  2. HSV: herpetic vesicles + round/ovoid ulcers, concurrent perioral/oral HSV
  3. CMV: deep LINEAR ulcers, Distal esophagus
  4. Idiopathic/aphthous: concurrent oral aphthous ulcers
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17
Q

Progresive multifocal leukoencephalopathy - diagnosis / treatment / how many CD4 in HIV

A
  1. CT brain: white matter lesions with no enhancement or edema
  2. LP: CSF PCR for JC virus
  3. Brain biopsy (rarely)
    treatment: often fatal / if HIV: antiretroviral therapy
    - less than 200 CD4
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18
Q

acute HIV infection - epidimiology

A

2-4 wks after exposure

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19
Q

acute hiv infection - clinical features

A
  • Mono-like syndrome (fever, lymphadenopathym sore throat, arthralgias
  • generalised macular rash
  • GI symptoms
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20
Q

infectious mono causes a febrile illness, closely resemble to 1ry HIV infection - the key distinctions are

A
  • rash + diarrhea are less common in IM

- exudative pharyngitis is uncommon in 1ry HIV

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21
Q

acute HIV infection - diagnosis

A
  • viral load is elevated
  • HIV antibody are (-)
  • normal CD4
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22
Q

clinical features in HIV in infancy

A
  1. failure to thrive
  2. chronic diarrhea
  3. Lymphadenopathy
  4. PCP
    asymptomatic at birth
    NORMAL COUNT OF CD4
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23
Q

postexposure prophylaxis to HIV

A

3 drug antiretrovial therapy for 4 weeks for high risk occupational exposure to blood or body fluids
- 2 nucleotide/nucleoside reverse transcriptase inj PLUS integrase inh or protease inh or non-nucleoside reverse transcriptase inh

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24
Q

high risk contact HIV (prophylaxis recommended) - exposure of / to

A
  • mucus membrane, nonintact skin, percutaneous exposure
  • blood, semen, vaginal secretions ,any body fluid with visible blood
  • uncertain risk: CSF, pleural/pericardial fluid, synovial fluid, peritoneal fluid, anmiotic fluid
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25
Q

low risk contact HIV (prophylaxis NOT recommended) - exposure

A

urine fecees, nasal, saliva, sweat, tears (with no visible blood)

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26
Q

bacillary angiomatosis

A

bright red, firm, friable exophytic nodules in HIV patient

- caused by Bartonella

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27
Q

common causes of diarrhea in patients with AIDS - CD4 count - bloody?

A

Cryptosporidium - less than 180
Microsporidiumi/isosporidium: less than 100
Mycobacterium avium complex: less than 50
CMV: less than 50 - THE ONLY WITH BLOOD

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28
Q

AIDS - cryptosporidium diarrhea: CD4 + manifestation

A
  • less than 180
  • low grade fever
  • weight loss
  • severe watery
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29
Q

AIDS - microsporidium diarrhea: CD4 + maniefestation

A
  • less tan 100
  • watery, crampy abd pain
  • Fever is rare
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30
Q

AIDS - Mycobacterium avium diarrhea: CD4 + manifestation

A
  • less than 50
  • watery
  • weight loss
  • high fever
31
Q

AIDS - CMV diarrhea: CD4 + manifestation

A
  • less than 50
  • frequent, small volume diarrhea
  • hematochezia
  • abd pain
  • low grade fever
  • weight loss
32
Q

initial screening for HIV - who

A
  1. age 15-65 (+ younger or older if at risk)
  2. TREATMENT FOR TB
  3. Treatment for another STD
33
Q

annular (or more frequent) screening for HIV - who

A
  1. IV + sex partners
  2. men sex men
  3. Sex for money or drugs
  4. partner of HIV (+)
  5. patient or panter has had more than 1 partner since last HIV test
  6. homeless shelter living
  7. cirrectional facility incarceration
34
Q

HIV additional screening

A
  1. pregnancy
  2. occupational exposure to blood/body fluids
  3. any new STD symptoms
  4. Suggested: prior to any new sexual relationship
35
Q

vaccines for adults with HIV

A
  1. HBV
  2. HAV: chronic liver disease, men sex men, IV drugs
  3. HPV if 11-26
  4. influenza: inactivated, annually
  5. Mening: all
  6. Pneumonioc: PCV13 once, PPSV23 8 ks later, 5 yyears later + at age 65
  7. Tdap as needed and each pregnancy
36
Q

varicella vaccination in HIV

A

only if CD4 more than 200 and LOW TITERS of virus

37
Q

watery diarrhea in AIDS - best initial test

A

culture, ova, parasites, acid fast stain, C. difficile antigen

38
Q

HIV therpay - groups of drugs

A
  1. protease inhibitors
  2. Nucleoside Reverse Transcriptase Inhibitor (NRTI)
  3. Non-nucleoside reverse transcriptase inhibitors (NNRTI)
  4. Integrase inhibitors
  5. Fusion inhibitors
39
Q

HAART regimen consist of

A

2NRTIs (Nucleoside Reverse Transcriptase Inhibitor) and 1 of the following: NNRT1 (Non-nucleoside reverse transcriptase inhibitors) or protease inhibitor or integrase inhibitor

40
Q

Protease inhibitors - drugs

A

-NAVIR

41
Q

HIV-1 Protease in encoded by / function

A
  • pol gene
  • assembly of virions depend on HIV-1 protease, which cleaves the polypeptide products of HIV mrna into theri functional parts
42
Q

HIV Protease inhibitors - toxicity

A
  1. hyperglycemia
  2. GI tolerance (nausea, vomiting)
  3. Lipodystrophy (Cushing-like syndrome)
  4. Nephropathy (indinavir)
  5. hematuria (indinavir)
  6. inhibit cytochrome P-450 (ritonavir)
43
Q

HIV protease inhibitors with antimycobacterial drugs

A

Rifampin (a potent CYP/UGT inducer) contraindicated with proteae inhibitors because it can decrease protease inhibitor concentration

44
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - mechansim of action

A

Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain (Lack of OH group

45
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - drugs

A
  1. Abacavir (ABC)
  2. Didanosine (ddl)
  3. Emtricitabine (FTC)
  4. Lamivudine (3TC)
  5. Stavudine (d4T)
  6. Tenofovir (TDF)
  7. Zidovudine (ZDV, formerly AZT)
46
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - structure

A

Tenofovir –> nucleotide

the others –> nucleosides and need to be phosphorylated to be active

47
Q

Nucleoside Reverse Transcriptase Inhibitors (NRTIs) - side effects

A
  1. Bone marrow suppression
  2. peripheral neuropathy
  3. lactic acidosis (nucleosides)
  4. anemia (ZDV)
  5. pancreatitis (didanosine)
48
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - drugs and mechanism of action

A
  1. Delavirdine 2. Efavirenz 3. Nevirapine
    Bind to reverse transcriptase at site different from NRTIs. Do not require phosphorylation to be active or compete with nucleotide
49
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - toxicity

A
  1. rash
  2. hepatotoxicity
  3. vivid dreams (efavirenz)
  4. CNS sympoms (efavirenz)
  5. contraindicated in pregnancy (Delavirdine and efavirenz)
50
Q

Non-nucleoside reverse transcriptase inhibitors (NNRTI) - which drugs are contraindicated in pregnancy

A

Delavirdine and efavirenz

51
Q

HIV - integrase inhibitors - drugs? / mechanism of action

A
  1. raltegravir
  2. Elvitegravir
  3. Dolutegravir
    inhibits HIV genone integration into host cell chromosome by REVERSIBLY inhibiting HIV integrase
52
Q

integrase inhibitors - toxicity

A

increased creatine kinase

53
Q

HIV - fusion inhibitors - drugs and mechanism of action

A
  1. Enfuvirtide –> Binds gp41, inhibiting viral entry

2. Maraviroc –> Binds CCR-5 on surface of T cells/monocytes, inhibiting interaction with gp120

54
Q

HIV - fusion inhibitors - toxicity

A

skin reaction on injection sites (Enfuvirtide)

55
Q

Jarisch - Herheimer reaction - epidemiology

A

48 hr after initiating treatment for sypilis (MC 1ry or 2ry / May also seen with treatment of other spirochete (Lyme, leptospirosis)

56
Q

Jarisch - Herheimer reaction -clinical presentation

A
  • acute onset of fever, chills, myalgias, hypotension

- rash progression in 2ry syphilis

57
Q

Jarisch - Herheimer reaction - treatment

A

supprortive (self limited in 48 h)

58
Q

2ry sypthilis - treatment / how to confirm treatment

A

single IM penicillin benzathine

confirm treatment by a 4-fold decrease in serologic test in 6-12 months

59
Q

2ry syphilis - mouth

A

raised, grey, mucosal patches

60
Q

epitrocheleal lymphadenopathy is pathognomonic of

A

2ry syphilis

61
Q

treatment of syphilis if penicillin allergy

A

doxocycline

62
Q

VDRL in primary syphilis - FN

A

20-30% –> if u suspcet syphilis but is (-), make a FTA ABS (sensitivity 97%)

63
Q

RPR, VDRL - features

A
  • antibody to cardiolipin-chlesterol-lecithin antingen
  • quantitive
  • FN in early infection
  • decrease titers confrism treatment
64
Q

FTA, ABS - features

A
  • antibody to treponemal antigens
  • qualitative (reactive/nonreactive)
  • greater sensitivity in early infection
  • (+) after treatment
65
Q

indications for syphillis screening

A
  • pregnant women at 1st preatal visit
  • Anohter STD
  • men sex men
  • commercial sex workers
66
Q

sign of succesfull syphilis treatment

A

4 fold decrease in antibody titers at 6-12 months

67
Q

syphilis - neonatal manifestation

A

OFTEN RESILTS IN STILLBIRTH, HYDROPS FETALIS

  1. facial abnormalities
  2. snuffles (nasal discharge)
  3. saddle nose
  4. notched (Hutchinson) teeth
  5. mulberry molars
  6. short maxilla
  7. saber shins
  8. CN VIII deafness
68
Q

congenital infection - unique for syphilis

A

Rhinorrhea
abd long bone radiographs
desquamating or bullous rash

69
Q

indications for syphillis screening

A
  • pregnant women at 1st preatal visit
  • Anohter STD
  • men sex men
  • commercial sex workers
70
Q

Bacillary angiomatosis - epidemiology

A
  • Bartonella
  • Ct expodure or homelessness
  • severe immunodef: CD4 less than 100
71
Q

bacillary angiomatosis - manifestation

A
  1. vascular cutaneous lesions (papular, nodular, peduncilar)
  2. systemic symptoms (fever, nodular, fatigue)
  3. oragn involvement rarely (liver, bone, CNS)
72
Q

bacillary angiomatosis - diagnosis / treatment

A

lesional biopsy

treatment: doxycycline or erythromycin, antiretroviral

73
Q

kaposi - how many CD4

A

less than 200

Infectious diseases (13 decks)

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