ID: GUM HIV viral Flashcards
Jarisch-Herxheimer vs anaphylactic reaction,
Jarisch-Herxheimer reaction, unlike an anaphylactic reaction, will not present with hypotension and wheeze
low CSF glucose
Mumps dumps glucose
herpes encephalitis
HIV-associated nephropathy (HIVAN) 5 features
Size of kid
Type of nephrotic
BP
massive proteinuria = nephrotic syndrome
focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy
normal or large kidneys
elevated urea and creatinine
normotension
SE: indinavir
renal stones, asymptomatic hyperbilirubinaemia
Protease inhibitors (PI) examples
examples: indinavir, nelfinavir, ritonavir, saquinavir
hepatitis B rx
pegylated interferon-alpha
what is a hepatitis B non responder and what action should be taken
<10 anti-HBs level
HIV , heo B test
Give another dose
What cell can HIV can infect
CD4 T cells, macrophages and dendritic cells
anti-retrovirals - P450 interaction
nevirapine (a NNRTI): induces P450
protease inhibitors: inhibits P450
Describe the process of HIV entering cell
It contacts the GP who put him in contact with a band or exam = entrance & get genetic material copied and …
- HIV targets CD4+on membrane of Macrophages, T-helper cells, & dendritic cells
- HIV targets and attaches to the CD4 molecule via a protein called gp120 found on its envelope.
HIV bind to co-receptor (With the help of gp120). The co receptor isCXCR4 (only found on T-cells )or CCR5 - Once bound to the co-receptor enters the cell
reverse transcriptase to transcribe a complementary double-stranded piece= Proviral DNA
- Proviral DNA enter nucleus and pops itself into the cell’s DNA, ready to be transcribed
Describe HIV treatment in pregnancy
- No breastfeeding
- Mother presents early: @ 14 WKS before delivery ART with the aim of achieving 0 viral @28 wks if this happens baby only needs zidovudine (AZT) for a month
- If mother presents late @ 36 weeks= intensive therapy 4 drugs; during labour get zidovudine IV, C-section baby gets triple therapy for 4 weeks.
- viral load <50 copies/ml at 36 weeks = vaginal delivery + zidovudine is usually administered orally; Neonatal antiretroviral therapy If viral load is <50 copies/ml zidovudine is usually administered orally.
- viral load >50 copies/ml at 36 weeks c-section + a zidovudine infusion should be started 4 hours before beginning the c. section. Neonatal antiretroviral therapy triple ART should be used for 4-6 weeks.
what is Truvada
emtricitabine and tenofovir disoproxil fumarate
What is PREP
Pre exposure prophylaxis; taken by HVI-ve pt. used to reduce chance of transmission in those who engage in risky behavior; Truvada + Kaletra
What Post Exposure Prophalaxis for HIV
With in 72 hour of exposure = Truvada (Emtricitabine/tenofovir) + Kaletra for 4 wks
What is TasP
TasP- Treatment as prevention – taken by HIV + person to reduce chance of transmission
How is AIDS defined
CD 4 COUNT <200
Window period
4wk
but can range from 10d-3mo
How can you differentiate candida from hairy leukoplakia
Nb hairy- hairy leukoplakia caused by EBV
hairy leukoplakia is unscrapable from tongue
what is Kaposi sarcoma and what is it caused by
malignant tumor of the skin and soft tissues
caused by the human herpesvirus 8, or HHV-8.
HPV in HIV causes
squamous cell carcinoma of the anus in males and cervix in females.
How do you differentiate histoplasmosis from PCP
histoplasmosis,
peripheral blood smear are oval yeast cells within macrophages. Eosinophilia may predominate. bilateral hilar lymphadenopathy
PCP- ground glass appearance
what causes progressive multifocal leukoencephalopathy
SX
Ix
JC virus
progressive motor and cognitive neurologic symptoms
MRI, =demyelination (non-enhancing areas ).
How dose Cryptococcus infection present how do you test for it
headache, fever, malaise, nausea/vomiting, seizures, focal neurological deficit
CSF: high opening pressure, India ink test positive = a clear halo around the yeast cells.
latex agglutination test
CT: meningeal enhancement, cerebral oedema
AIDS dementia on imaging
Cortical atrophy
Encephalitis in HIV is caused by and on imaging
oedematous brain
due to CMV or HIV itself
HIV: Tuberculosis on CT head
CT: single enhancing lesion
Primary CNS lymphoma
cuased by and imaging
Rx
Primary CNS lymphoma
30% of cases
Epstein-Barr virus
Single enhancement
Thallium SPECT positive
Toxoplasmosis
Rx & imaging
Single or Multiple lesions
Ring enhancing lesions w/ central necrosis or nodular enhancement
+/- mass effect
Thallium SPECT negative
sulfadiazine and pyrimethamine
In HIV what causes chronic watery diarrhea, associated with abdominal pain.
How do you investigate it ?
Cryptosporidium + other protozoa (most common)
Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts
CMV in HIV and Ix
may present with
-Eosphagitis
-colitis,
encephalitis,
-pneumonia,
For diagnosis, a biopsy = owl’s eye inclusion bodies within their nuclei.
HIV Modes of transmission & % of those infected
Blood transfusion 100%
Vertical transmission – 25%
Horizontal transmission 3%
Needle stick 0.3%
When do you start Prophylaxis for Mycobacterium avium complex and what is it ?
Give an unusual clinical feature
clarithromycin or azithromycin when CD4 is less than 100 cells/mm³
focal lymphadenitis
What cancers are more likely in HIV
ass EBV
HL, NHL, Burkitts & CNS
lymphoma
False positive VDRL/RPR:
‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)
HIV seroconversion timing and presentation
60-80% pts
typically presents as a glandular fever-type illnes
occurs 3-12 weeks after infection
Name viral haemorrhagic fevers
dengue fever,
Lassa fever,
Ebola
Yellow fever
What are the 4 main causes of Diarrhoea in HIV?
Cryptosporidium + other protozoa (most common)
Giardia
CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare
Rx Mycobacterium avium intracellulare
MAC
rifabutin, ethambutol and clarithromycin (REC)
cysts turn red following acid-fast staining
Cryptosporidium
Staining for PCP
Silver
What are the 4 main causes of Diarrhoea in HIV?
Cryptosporidium + other protozoa (most common)
Giardia
CD count < 50: Cytomegalovirus, Mycobacterium avium intracellulare
Staining for PCP
Silver
CD4 count < 200/mm³ what prophylaxis should be started
PCP
co-trimoxazole (trimethoprim and sulfamethoxazole )
rx pcp
severe cases
when pO2 < 9.3
Rx: co-trimoxazole(trimethoprim and sulfamethoxazole );
Severe + IV/ aerosol pentamidine (aerosol more side effects)
If PO2 < 9.3 steroids
Mode of delivery if @ 36 wks
Viral load <50 copies
Viral load is >50 copies
<50 copies= Vaginal + zidovudine administered orally
> 50 copies - C-section; IV zidovudine infusion should be started 4 hours before & triple ART 4-6 wks
Seborrhoeic dermatitis is common in which conditions
HIV
Parkinson’s disease
Commonest cause of Hepatocellular carcinoma
Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.
Chancroid
Cause by
SX
Rx
- Haemophilus ducrey (gram-negative coccobacillus)
- unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
Rx Azithromycin
rx Neisseria gonorrhoea.
IM ceftriaxone 1g
% Hepatitis C that have chronic disease
55-85%
Rx chronic Hepatitis C
Combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
Inhibits reverse transcriptase = double strand isn’t formed
-Dine VIr
Protease inhibitor
Stop maturing of virus “protease inhibitors NAVIR mature
Nnrti se
No no Den
Integrase inhibitors
-teg-
Provital DNA can’t be integrated
Myopathy HA & N
Hep B: Immunity following vaccination
anti-HBs + Only Antibody to Hep B surface antigen
Hep B: Immunity following infection
+ anti-HBs
+ anti-HBe/ + anti-HBc
+ Anti-HBc IgG
HBe Ag
indicates how easily spread
HBs
Sick with HB
anti-HBc
caught, i.e. negative if immunized
The only Hep that is a DNA
Hep B
What is the mnemonic GAMED for
prevalence of Ig’s
Rx HepC
combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
Rx hep B
pegylated interferon-alpha used to be the only treatment available.
reduces viral replication
A better response is predicted by being:
- female,
-< 50 years old,
-low HBV DNA levels,
-non-Asian,
-HIV negative, high degree of inflammation on liver biopsy
Complications of hepatitis B infection
- chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
- fulminant liver failure (1%)
- hepatocellular carcinoma
- glomerulonephritis
- polyarteritis nodosa
6 cryoglobulinaemia
causes PAINFUL genital ulcers
3- 2H’s hurt except L w/ tender lymph
Genital Herpes
(HSV-2);more common than chancroid
Haemophilus ducreyi
Gram -ve
Lymphogranuloma Venereum
Chlamydia (gram -ve) nb painless ulcer painful lymphadenopathy
Causes Ix & Rx:
Painful, itchy, dysuria, vesicles usually umbilicate,
Painful lymphadenopathy
systemic features: F, HA+ myalgia
Can be latent and reappear
Genital Herpes
HSV-1& 2
Ix: nucleic acid amplification tests (NAAT)
RX: Supportive saline baths; oral acyclovir
Genital Ulcer-
Cause and Rx:
Chancroid - painful ulcer with soft irregular margins + purulent exudate. may bleed
unilateral, painful inguinal lymph node enlargement
Haemophilus ducreyi
Gram -ve
IX: CR, culture, and gram staining
Rx: Azithromycin or ceftriaxone
What causes
shallow Painless ulcer + small papules / granulomas,
> 2 wks later buboes form -painful inguinal lymphadenopathy, or enlarged lymph nodes- can form abcesses & procto-colitis
Lymphogranuloma Venereum
Chlamydia (gram -ve)
Rx doxycycline.
Causes of PainLess genital ulcers
Treponema Pallidum
Syphilis
Condyloma acuminata
Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve (No lymphadenopathy)
Chancre - solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx
2dary Form Sx :
non-itchy maculopapular rash, with small bumps Start on trunk –> extremities -incl the palms & soles–>genitalia, and other mucous membranes.
- condylomata lata- smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits
Treponema Pallidum
Syphilis
Rx: Penicillin G.
What causes :
Soft flesh like cauliflower appearance genital lesion
Condyloma acuminata HPV 6& 11
Rx: topical podophyllum or cryotherapy
What causes :
genital -painless papule granuloma–> becomes highly vascular & beefy red ulcer which bleeds easily.
Has no lymphadenopathy
Granuloma Inguinale
donovanosis / granuloma venereum, Klebsiella gram -ve
Rx azithromycin
Differentiate between Chancroid & Chancre
Chancre- is syphilis- solitary, painless genital ulcer,(hard base, raised borders, covered an exudate) .Appear /in 3 wks RX: heals without rx
Chancroid -Haemophilus ducreyi- painful ulcer with soft irregular margins + purulent exudate. may bleed
Differentiate between Condyloma acuminata and condylomata lata
condylomata lata-Syphilis smooth, white, painless, wart-like lesions over moist areas like the genitals, the anal region, and the armpits
Condyloma acuminata - HPV 6& 11
Soft flesh like cauliflower appearance
Causes of False positive non-treponemal (cardiolipin) tests:
pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV
Examples of non-treponemal tests- not specific
- rapid plasma reagin (RPR)
- Venereal Disease Research Laboratory (VDRL)
Examples of treponemal-specific tests-
TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
How can you differentiate Jarisch-Herxheimer reaction to anaphylaxis
SX: F, rash, tachycardia after the first dose of antibiotic
there is no wheeze or hypotension.
o due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment
o No treatment is needed other than antipyretics if required
Anaphylaxiswheeze and Hypotension
Signs of tertiary syphillis
Stages of syphilis
Argyll-Robinson Pupil describe
Seen in 3rty syphilis
– ARP – .
Forwards:ARP – Accommodation Reflex Present.
Backwards PRA – Pupillary Reflex Absent.
STI’s that cause vulvovaginitis/cervicitis causes (3)
Trichomonas vaginalis flagellated protozoan parasite
Chlamydia trachomatis
Neisseria gonorrhoeae
What causes
- Discharge: ‘fishy’, offensive; thin, white homogenous
Burning and itching
asymptomatic in 50%
IX& RX
Bacterial vaginosis
Gardnerella vaginalis.
Not STI
Ix:
* clue cells
* vaginal pH > 4.5
* positive whiff test
Rx: No SX= NONE
Sx or pregnancy= oral metronidazole for 5-7 days
Bv smells fishy in the garden
Name causitive agent, Ix & RX
discharge: offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Trichomonas vaginalis flagellated protozoan parasite
Ix: wet mount shows motile trophozoites
Rx: oral metronidazole for 5-7 days
Name causitive agent, Ix & RX
70% asymptomatic
women: cervicitis dysuria, intermenstrual & post-coital vaginal bleeding
men: urethral discharge, dysuria
can result in PID
Reactive arthritis
Chlamydia trachomatis
PID
Reactive arthritis
Ix: nuclear acid amplification tests 2 wks after exposure
Giemsa stain
Rx: doxycycline (7 day course)
Pregnant: azithromycin, erythromycin or amoxicillin
Complications
epididymitis, PID, endometritis, ectopic pregnancies, infertility, reactive arthritis, perihepatitis (Fitz-Hugh-Curtis syndrome)
Name causitive agent, Ix & RX
males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic
May led to PID & septic arthritis
Rx: IM ceftriaxone
Complications: urethral strictures, epididymitis & salpingitis (hence may lead to infertility). Disseminated infection
what causes Cervical montion tenderiness and what is the RX?
PID
* oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole