Immuno quick associations Flashcards
Grandual onset of nonproductive cough, dyspnea on exertion (significant desat), fever
CXR: B/L central infiltrates
Elevated LDH
CD4 less than 200
Pneumocystis jirovecii pneumonia (PCP)
Tx:
TMP-SMX (bactrim) or IV pentamidine if sulfa allergy
Add prednisone if pO2 less than 70 or A-a 35 or more
ppx: TMP-SMX or pentamidine
Pain with swallowing
Endoscopy - pseudohyphae
CD4 less than 200
Candida esophagits
Tx: PO or IV fluconazole, nystatin swish and swallow, oral amphotericin
Cough, night sweats, weight loss +/- bloody sputum
CXR: cavitary lesions
CD4 less than 200
TB
Treat: RIPE
PPD positive at 5 mm induration
Headache, confusion, fever, focal neurological symptoms, seizures
CT/MRI: multiple ring enhancing lesions
CD4 less than 100
Reactivation of Toxoplasmosis
Tx: pyrimethamine + sulfadiazine + leucovorin
OR Pyrimethamine + clindamycin
ppx: TMP-SMX or primaquine
fatigue, wt loss, fever, diarrhea, abd pain, HSM
CD 4 less than 50
Mycobacterium avium intracellulare complex (MAC)
Tx: MACrolides - clarithromycin or azithromycin with ethambutol +/- rifabutin
ppx: azithromycin or clarithromycin weekly dose
Headache, mental status changes
LP: elevated pressure, large encapsulated yeast on india ink stain
CD 4 less than 50
Cryptococcal meningitis (Cryptococcus neoformans)
Tx: IV amphotericin B + flucytosine -> oral fluconazole
yellow retinal lesions with hemorrhage with rapid vision loss
And/Or
painful ulcers in esophagus/intestines
CD 4 less than 50
CMV
Tx: ganciclovir or valganciclovir
fosgarnet has some activity
Prolonged diarrhea, malaise, wt loss, abd pain
O&P in stool
HIV positive patient
Parasitic disease:
Giardia lamblia - metronidazole
Cystoisospora belli - TMP-SMX
Cryptosporidium spp. - Nitazoxanide
Cough, fever, dyspnea
CXR: b/l reticulonodular infiltrates or diffuse infiltrates
Blacks: disseminated dz -> meninges, skin, LN involvement
CD4 less than 250
Coccidiodomycosis (Coccidiodes immitis)
Tx: fluconazole or amphotericin B
ppx: can use fluconazole, but HAART regimen more effective
Fever, wt loss, fatigue, abd pain, GI bleeding, skin lesions, dyspnea, meningitis, adrenal insufficiency
CXR: b/l infiltrates
Urine/serum antigen tests +
CD4 less than 150
Histoplasmosis (Histoplasma capsulatum)
Tx: amphotericin B or itraconazole
Ppx: itraconazole
Progressive CNS demyelination
PCR on CSF positive for JC Virus
CD4 less than 100
Progressive multifocal leukoencephalopathy (PML)
Tx: HAART
Vascular tumors on skin and internal organs (lungs -> hemoptysis)
CD4 less than 250
Kaposi’s sarcoma
HHV 8
Abnormal pap smear
CD4 less than 200
Cervical cancer
HPV
Headache, confusion, focal neurological symptoms
MRI: ring enhancing lesion
CD4 less than 100
Non-Hodgkin lymphoma - primary CNS lymphoma
some associated with EBV
Tx: chemo
weight loss >10% from baseline, chronic diarrhea, weakness, fever
CD4 less than 100
Wasting syndrome
Tx: HAART, improved nutrition
Appetite stimulants - megesterol
Intelectual decline, ataxia, apathy
CD4 less than 200
AIDS dementia
Tx: HAART
ART class causes lactic acidosis
NRTI
ART class causes GI intolerance
Protease inhibitors
ART class causes rash
NNRTIs
ART class causing hyperglycemia, DM, lipid abnormalities
Protease inhibitors
ART drug causing bone marrow suppression with megaloblastic anemia
zidovudine
ART drug potentially fatal hypersensitivity reaction
abacavir
ART drug with neuropsychiatric sxs - depression and vivid nightmares
efavirenz
ART drug causing hyperbilirubinemia, jaundice
atazanavir
ART drug that is teratogenic
efavirenz
ART drug that inhibits CYP450
ritonavir - boost mechanism
ART drug that can cause kidney injury and bone loss
Tenofovir
Congenital heart defect + low calcium + recurrent infections
Digeorge syndrome - thymic aplasia
Chronic mucocutaneous candidiasis + chronic diarrhea + failure to thrive
SCID
Negative nitroblue tetrazolium test
Chronic granulomatous disease
Poor smooth pursuit of eyes + elevated AFP after 8 months
Ataxia telangectasia
Partial albinism + recurrent URIs + neurological disorders
Chediak-HIgashi syndrome
Hypersensitivity reaction associated with IgE binding Ag, mast cell degranulation -> histamine and bradykinin release -> vasodilation, increased vascular permeability
Type 1
Tx: Antihistamines Leukotriene inhibitors Bronchodilators Glucocorticoids
Hypersensitivity reaction associated with antibodies binding to cellular surface antigens -> activation of compliment, macrophages, and NK cells
Type 2
Tx:
Antiinflammatories
Immunosuppressants
Plasmaphoresis
Hypersensitivity reaction associated with antibodies binding soluble antigens -> immune complexes deposited in tissues -> activation of complement
Type 3
Tx: anti-inflammatories
Hypersensitivity reaction associated with T cells binding antigens -> IL2 and IFNy activate macrophages -> tissue damage
Type 4 - “delayed”
Tx:
Glucocorticoids - topical or systemic
Anti-inflammatories
Hypersensitivity reaction associated with allergic rhinitis, urtricaria, asthma, angioedema, anaphylaxis
Type 1
Tx: Antihistamines Leukotriene inhibitors Bronchodilators Glucocorticoids
Hypersensitivity reaction associated with SLE, RA, polyarteritis nodosa, poststreptococcal GN, serum sickness
Type 3
Tx: anti-inflammatories
Hypersensitivity reaction associated with autoimmune disorders without deposition of immune complexes such as:
Autoimmune hemolytic anemia Hemolytic disease of the newborn ITP Acute rheumatic fever Goodpasture syndrome Bullous pemphigoid Pemphigus vulgaris Graves disease Myasthenia gravis
Type 2
Tx:
Antiinflammatories
Immunosuppressants
Plasmapheresis
Hypersensitivity reaction associated with: Chronic transplant rejection Graft-vs-host disease MS Hashimoto thyroiditis PPD tests Contact dermatitis associated with poison oak/ivy latex
Type 4 - “delayed”
Tx:
Glucocorticoids - topical or systemic
Anti-inflammatories
transplant rejection occurs within initial 24 hours, anti-donor antibodies, untreatable
Caused by poor organ matching
Hyperacute transplant rejection
Transplant rejection occurs 6 days to 1 yr after transplant, anti-donor T cell proliferation, reversible through immunosuppression
Acute transplant rejection - Type 4 HSR
Transplant rejection occurs more than 1 year after transplant due to fibrosis and hyalinization of blood vessels, immunosuppression may delay it
Chronic transplant rejection
Adult with frequent bronchitis, pneumonia, sinusitis, otitis media with giardiasis or spruelike intestinal malabsorption. Labs: Ig levels decreased, decreased response to antigen stimulation by B cells
Combined Variable Immunodeficiency
Tx: Abx for infections
Maintenance - regular infusion of IVIG
Risk: pernicious anemia, seronegative arthritis
Young boy with decreased or absent tonsils, adenoids, lymphnodes, spleen. Increased sinopulmonary infections. Normal T cell count
X linked (Bruton) Agammaglobulinemia
Tx: regular IVIG
Recurrent sinupulmonary infection beginning at 6 mo, PCP, varicella, candida infections in young child.
SCIDs
Tx: treat infections as they arise
Definitive Tx: Bone marrow transplant
Recurrent sinopulmonary infections, atopic diseases, sprue-like condition with fat malabsorption
IgA deficiency
Risk anaphylaxis with blood transfusions
Risk: vitiligo, thryroiditis, RA
Recurrent skin infections with Staph - cold abscesses
Hyper IgE Syndrome
Tx: dicloxacillin or cephalexin
ppx abx
Immunodeficiency - T cells low + thrombocytopenia and eczema
Wiskott-Aldrich Syndrome
Tx: Bone marrow transplant
Lymph nodes with purulent material leaking out, aphthous ulcers, inflammation of nares. Granulomas may become obstructive in the GI or urinary tract. Odd combination of infections with: Staph, Burkholderia, Nocardia, Aspergillus
Lab: nitroblue tetrazolium or dihydrorhodamine testing abnormal
Chronic Granulomatous Disease
Low B cell, normal T cells in adults
CVID
Low B cells, normal T cells in young male children
X linked (Bruton) agammaglobulinemia
Low B cells and T cells, AIDS defining illness in young child
SCID
atopic disorders, celiac disease, anaphylaxis with blood transfusion
IgA deficiency
Cold abscess in skin - staph
Hyper IgE syndrome
Normal T cells and B cells, low platelets, eczema
Wiskott-Aldrich Sn
LN with purulent material leaking from them - Staph, Burkholderia, Nocardia, Aspergillus
Chronic Granulomatous Disease
