ID General Flashcards
When should you start HIV screening?
DC- 13-65 yrly
CDC- 15-65
What is the the most common non-tuberculous pulmonary mycobacterial infection?
M. kansasii
What is IRIS?
Severe decline in clinical status after ART initiation despite improved immune function due to inflammatory response against infectious agent
How often should you do cervical ca screening in HIV infected women?
2x a yr when first HIV +
Then yearly if normal and no change in sexual partner, use of safe sexual practices, no history of sexual abuse, and no symptoms
Fever
> 37.2 C (98.9 F) in the morning and 37.7 C (99.9 F) in the evening + ↑ hypothal set point
FUP
Fever > 38.3 C (101 F) & illness lasting 3 weeks & no known immunocompromise
Endocarditis
infection of the endocardial surface of the heart (includes valves, septal defects and mural endocardium)
Endarteritis
infection of arterial endothelium (includes infected aneurysms, AV fistulae)
What factors predispose immunocompromised pts to infection?
Neutropenia and defects in the phagocytic defenses
Defects in cellular immunity
Defects in humoral immunity
What pt pop typically has neutropenia and defects in the phagocytic defenses
pts post chemotherapy or other myelosuppressive therapy
bone marrow transplant recipients
acute leukemics
What ANC level is risk of infection significant?
<500
In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize skin?
Staph, Gram negatives, fungi
In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize oropharynx?
oral candidiasis, HSV
In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize lungs?
bacterial/fungal pneumonias
In neutropenia and defects in the phagocytic defense pts, what organisms typically colonize colon/perianal area?
abscesses
Pt pop CI to get live vaccines (MMR, varicella, ZVL)
preg women and immunosupp pts (Must have CD4 >200)
What vaccines should a pt who is 19-49 yrs old have?
influenza
Tdap or Td
MMR (if born in 1957 or later)
Varicella
What is cut off for MMR requirement
if born before 1957 don’t need it (assumed you got the dz)
if born in 1957 or later must get vaccine
What pt pop should get high dose and adjuvant vaccine of influenza?
> 65 and HIV +
Severe egg allergy w/ influenza vac
administer in an observed setting
HPV vaccine recommendation
start age 9-14
female by age 26
male by age 22
What vaccines should pts who are 65 and above get?
Influenza
Tdap or Td
Varicella
RZV (preferred) OR ZVL
PCV13
PPSV23
What vaccines should pts who are 50-64 yrs old get?
influenza
Tdap or Td
MMR (if born in 1957 or later)
Varicella
RZV (preferred) OR ZVL
What vaccines should preg pts get?
influenza and tdap or Td
What vaccines should immunocomp pts get?
flu Tdap HPV (up to age 26) PCV 13 PPSV23 Hib
What vaccines should HIV pts get?
flu Tdap MMR and varicella (unless CD4 <200) HPV (up to age 26) PCV 13 PPSV23 Hep B MenACWY
What vaccines should MSM get?
flu Tdap MMR and varicella RZV or ZVL (if >50) HPV (up to age 26) PCV 13 PPSV23 Hep A Hep B
What vaccines should health care personnel get?
flu Tdap MMR Varicella RZV or ZVL (if >50) HPV (up to 26 female and 21 male) Hep B
What age group can varicella immunity be assumed for even if vaccination status is unknown?
born in US before 1980
When can you give ZVL?
> 60 yo but RZV is preferred
What is PCV13 and PPSV23 vaccine recommendation?
> 65 yo
PCV13 first then 1 yr later PPSV23
If RF can give PPSV23 <65
When is Hib vaccine indicated?
Aspenia (if elective surg give 2 wks before)
Hematopoetic stem cell transplant (HSCT)
SIRS criteria
2 or more of the following:
Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
Heart rate > 90/min
Respiratory rate >20/min or arterial carbon dioxide (PaCO2)
< 32 mm Hg
WBC >12,000/μL or < 4,000/μL or >10% immature [band] forms
What is the significance of elevated lactate?
Lactate is a byproduct of anaerobic metabolism. Cells go into anaerobic metabolism when there is not enough oxygen to complete aerobic metabolism.
Lactic acidosis (inc lactate) is a sign of hypoperfusion and hypooxygenation
