ID IV: Opportunistic Infections

Question 1

Immunocompromised patients are predisposed to infections with a variety of pathogens, including:

Answer 1

Bacteria, fungi, viruses, and protoza

Question 2

Define an immunocompromised state

Answer 2

1) diseases that destroy key components of the immune system (primarily HIV with a CD4+ T lymph count <200 cells/mm3)
2) Use of systemic steroids x 14+ days at a prednisone dose >20mg/day or >2mg/kg/day
3) Asplenia
4) immunosuppressants
5) use of chemotherapy

Question 3

HIs can be prevented with:

Answer 3

antibiotics, antifungals, or antivirals - “chemoprophylaxis”

Question 4

What are some common infections requiring primary prophylaxis?

Answer 4

• pneumocystis pneumonia
• toxoplasmosis gondii encephalitis
• mycobacterium avium complex (MAC)

Question 5

What is a major risk factor for developing infections in those that are immunocompromised?

Answer 5

severe neutropenia (ANC<500 cells/mm3)

Question 6

Atovaquone, dapsone, and pentamidine are options in the setting of

Answer 6

sulfa-allergy

Question 7

Atovaquone and pentamidine are options in the setting of a

Answer 7

G6PD deficiency

Question 8

What drug is added to all pyrimethamine-containing regimens as rescue therapy to reduce the risk of pyrimethamine-induced myelosuppression

Answer 8

Leucovorin

Question 9

CD4+ count <200cells/mm3 or orophyrngeal candidiasis or other AIDS-defining illness

Indication in HIV of what infection?

Answer 9

Pneumocystis pneumonia (PCP or PJP)

Question 10

Preferred primary prophylaxis regimen for PCP

Answer 10

Bactrim DS or SS daily

Question 11

Alternate primary prophylaxis regimen for PCP

Answer 11

Dapsone

Dapsone + pyrimethamine + leucovorin

Atovaquone

Question 12

Criteria for d/c primary prophylaxis in HIV for PCP

Answer 12

CD4+ count >200 cells for >3 months on ART

Question 13

Toxoplasma IgG positive with CD4+ count <100 cells/mm3

Indication in HIV of what infection?

Answer 13

Toxoplasma gondii encephalitis (“Toxo”)

Question 14

Preferred primary prophylaxis regimen for Toxo

Answer 14

Bactrim DS tablet PO daily

Question 15

Alternate primary prophylaxis regimen for Toxo

Answer 15

Dapsone + pyrimethamine + leucovorin

Atovaquone

Question 16

Alternate primary prophylaxis regimen for MAC

Answer 16

azithromycin PO twice weekly

Clarithromycin PO BID

Question 17

Not recommended if ART is started immediately, initiate if NOT taking ART and CD4+ count <50 cells/mm3

Indication in HIV of what infection?

Answer 17

Mycobacterium avium complex (MAC)

Question 18

Preferred primary prophylaxis regimen for MAC

Answer 18

Azithromycin 1200mg PO WEEKLY

Question 19

Criteria for d/c Toxo primary prophylaxis regimen

Answer 19

CD4+ count >200 cells for >3 months on ART

Question 20

Criteria for d/c MAC primary prophylaxis regimen

Answer 20

Taking full suppressive ART

Question 21

Newly diagnosed patients with HIV and an OI should be monitored closely for:

Answer 21

IRIS: immune reconstitution inflammatory syndrome

Question 22

When treating thrush in patients with HIV, even with mild disease, what treatment is preferred?

Answer 22

Systemic treatment

Question 23

Treatment of thrush

Answer 23

Fluconazole

Question 24

Treatment of cryptococcal meningitis

Answer 24

Induction therapy:

Ampho B (deoxycholate or liposomal) + flucytosine

Question 25

Alt treatment of cryptococcal meningitis

Answer 25

fluconazole + flucystosine

Question 26

Treatment of CMV

Answer 26

Valganciclovir or ganciclovir

Question 27

Treatment of MAC

Answer 27

(clarithromycin or azithromycin) + ethambutol

Question 28

Treatment of PCP

Answer 28

Bactrim +/- predisone or methylprednisolone x 21 days

Question 29

Alt treatment for PCP

Answer 29

Atovaquone

Pentamidine IV

Question 30

Treatment of Toxo

Answer 30

Pyrimethamine + leucovorin + sulfadiazine

Question 31

Alt treatment of Toxo

Answer 31

Bactrim