ID IV: Opportunistic Infections

Question 1

what are considered immunocompromised states

Answer 1

HIC CD4 <200
systemic steroids x>14d at presnidone >/= 20mg/day or >/= 2mg/kg/d or equivalent
asplenia 2/2 SCD or splenectomy
immunocompromising meds
cancer chemotherapy, especially in severe neutropenia ANC <500

Question 2

PJP/PCP
when to start ppx
drug and dose
when to stop ppx

Answer 2

start when CD4 <200 or patient has AIDS-defining illnesses
SMX/TMP SS or DS tab PO daily
stop when CD4 >200 for >3 months of ART

Question 3

toxoplasmosis gandii (encephalitis)
when to start ppx
drug and dose
when to stop ppx

Answer 3

start ppx when CD4 <100 AND toxoplasma IgG positive
SMX/TMP DS po daily
stop when CD4 >200 for >3 months of ART

Question 4

mycobacterium avium complex (MAC)
when to start ppx
drug and dose
when to stop ppx

Answer 4

start ppx when CD4 <50 and NOT on ART
azithromycin 1,200mg weekly

stop when on fully suppressive ART

Question 5

treatment of OI thrush in
secondary ppx?

Answer 5

fluconazole
no secondary ppx

Question 6

treatment of OI CMV
secondary ppx?

Answer 6

valganciclovir or ganciclovir
no secondary ppx

Question 7

treatment of cryptococcal meningitis

Answer 7

amph B + flucytosine
secondary ppx with low dose fluconazole

Question 8

MAC (mycobacterium avium complex) OI treatment
secondary ppx?

Answer 8

clarithro/azithro + ethambutol
same for tx and secondary ppx

Question 9

toxoplasmosis gandii (encephalitis) OI treatment?
secondary ppx?

Answer 9

PLS
pyrimethamine
+ leucovirin
+ sulfadiazine
secondary ppx with the same drugs at lower doses

Question 10

PCP/PJP OI treatment?
secondary ppx?

Answer 10

high dose SMX/TMP +/- prednisone or MEPN
secondary ppx with SMX/TMP daily same as primary ppx

Question 11

Patient with HIV and the following labs
CD4 150
toxoplasmosis IgG (+)

what primary prophylaxis or active treatment(s) should be initiated?

Answer 11

CD4 <200 –> PCP/PJP ppx with SMX/TMP DS tablet daily

toxoplasmosis IgG + BUT CD4 >100 so do not need treatment for encephalitis (toxoplasmosis gandii)

Question 12

CMV ppx

Answer 12

not recommended!

Question 13

toxoplasmosis gandii tx

Answer 13

PLS
pyrimethamine
leucovirin
sulfadiazine

Question 14

MAC treatment

Answer 14

azithro or clarithro plus ethambutol

Question 15

MAC secondary ppx

Answer 15

same as treatment (azithro or clarithro plus ethambutol)

Question 16

thrush tx

Answer 16

fluconazole

Question 17

cryptococcal menningitis ppx

Answer 17

low dose fluconazole

Question 18

PCP/PJP tx

Answer 18

high dose SMX/TMP plus prednisone or MEPN

Question 19

PCP/PJP primary and secondary ppx are

A. the same
B. primary is daily, secondary is weekly
C. primary is weekly, secondary is daily
D. secondary ppx not needed

Answer 19

A. the same

Question 20

toxoplasmosis gandi (encephalitis) is treated with ______________ vs MAC which s treated with ______________

Answer 20

encephalitis - PLS
pyrimethamine
leucovirin
sulfadiazide

MAC
azithro/clarithro + ethambutol