HIV/TB Flashcards
Primary TB infectious usually is asymptomatic and then becomes latent. How do you evaluate for latent disease?
PPD +/- CXR
Whose PPD is (+) at > 5mm?
Those with close contacts that have TB
Whose PPD is (+) at > 10mm?
Healthcare workers
Homeless
Foreigners
Whose PPD is (+) at > 15mm?
Normal people with no risk factors
Once REactivation of latent TB occurs, the patient will be?
Symptomatic
What will be seen on CXR with TB?
Upper lobe cavitation
If you suspect TB but see fine nodular densities on CXR, that is likely?
Miliary TB
What is the treatment for Latent TB?
Isoniazid for 9 months
What is the treatment for Active TB?
RIPE for 2 months
RI for 4 months
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Side effect of Rifampin?
Turns body fluids orange
Side effects (2) of Isoniazid?
Peripheral neuropathy
Drug-induced hepatitis
What can you give to prevent peripheral neuropathy with Isoniazid?
B6
Side effect Pyrazinamide?
Hyperuricemia/Gout
Side effect of Ethambutol?
Eyes
– Optic neuritis
– Color vision changes
What is the treatment for active TB?
RIPE for 2 months
RI for 4 months
Describe how HIV infects CD4 cells?
- Enters via CCR5/CXCR4
- Reverse Transcriptase to turn RNA to DNA
- DNA is replicated
- Protease to exit cell
What is the mainstay of treatment for HIV?
2+1
= 2 Nucleotide Reverse Transcriptase (-)’ers
+ 1 Integrase/Protease (-)’er
What is used as prophylaxis against HIV?
2+1 for 4 weeks
(2NRTI + 1 Integrase/Protease Inhibitor)
If a mother with HIV is not on ART at delivery, what should be given to her and baby?
Zidovudine
How may an acute HIV infection present?
Flu-like illness or asymptomatic
During the Acute HIV phase, what test can be done to establish diagnosis?
HIV PCR to assess viral load
– antibodies not yet (+)
Once someone with HIV is past the acute illness, what tests can be done to assess?
- ELISA antibodies confirmed with Western blot
- HIV viral load
- CD4 count
Once someone with HIV is past the acute illness, what tests can be done to assess?
- ELISA antibodies confirmed with Western Blot
- HIV Viral load
- CD4 count
CD4 count < _____ you should prophylactically treat against Pneumocystis Jirovecii
< 200
What is the prophylactic/treatment for Pneumocystis Jirovecii?
TMP-SMX OR Dapsone
What is the prophylactic/treatment for Pneumocystis Jirovecii?
TMP-SMX OR Dapsone
CD4 count < ____ you should prophylactically treat against Toxoplasmosis
< 100
What is the treatment for Toxoplasmosis infection?
Pyrimethamine
Sulfadiazine
Leucovorin
What is the prophylaxis for Toxoplasmosis?
TMP-SMX
CD4 < ____ you should prophylactically treat against Myocbacterium Avium Complex
< 50
What is the prophylactic treatment for Mycobacterium Avium Complex?
Azithromycin +/- Ethambutol
What lab finding may be seen with Mycobacterium Avium Complex infection?
HIGH Alk Phos
How will oropharyngeal candidiasis present?
White plaques on a red base of the tongue that can be scraped off
What are the treatment options for oral candidasis?
Nystatin suspension
Oral Fluconazole
Where is Cryptococcus Neoformans found?
Pigeon droppings
What does Cryptococcus Neoformans commonly cause?
Meningitis
Signs of Cryptococcal Meningitis?
Fever
Headache
Elevated ICP
AMS
What will be unique on LP if Cryptococcal Meningitis is to blame?
HIGH opening pressure!!
– Low glucose, High protein/WBC too
What is the best test to perform on CSF if worried about Cryptococcal Meningitis?
CSF antigen better than India Ink
What is the treatment for Cryptococcal Meningitis?
Amphotericin B + Flucytosine
– Followed by Fluconazole
Where is Histoplasmosis and Blastomycosis found?
Ohio/MI River Valleys
Histoplasmosis can present with a wide range of symptoms, what are 2 unique ones?
Palatal ulcers
Pancytopenia
What findings are CXR are associated with Histoplasmosis?
Hilar LAD
Nodular densities
How is Histoplasmosis diagnosed?
Urine histoplasma antigens
Treatment for Histoplasmosis?
Amphotericin B followed by Itraconazole
– Just Itraconazole if mild
Blastomycosis can have _____ involvement
Skin/Bone/Prostate
What will be seen on biopsy with Blastomycosis?
Broad budding yeast
Where is Coccidioidomycosis found?
Southwestern US
How is Coccidioidomoycosis diagnosed?
Bronchiolar lavage that shows an endospore containing many spherules
What test should be done to confirm Pneumocystis Jirovecii?
Silver stain of sputum
How will Pneumocystis Jirovecii look on silver stain?
Comma shaped spores in folded cysts
Bilateral ground glass appearance is seen with Pneumocystis Jirovecii. What lab finding can be present?
HIGH LDH
Bilateral ground glass appearance is seen with Pneumocystis Jirovecii. What lab finding can be present?
HIGH LDH
Histoplasmosis/Blastomycosis/Coccidioidomycosis present with wide symptoms. What are 2 unique features of Histoplasmosis?
Palatal ulcers
Pancytopenia
