Immuno quick associations Flashcards by Autumn Brubaker

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

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Pain with swallowing
Endoscopy - pseudohyphae
CD4 less than 200

Candida esophagits

Tx: PO or IV fluconazole, nystatin swish and swallow, oral amphotericin

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Cough, night sweats, weight loss +/- bloody sputum
CXR: cavitary lesions
CD4 less than 200

Treat: RIPE
PPD positive at 5 mm induration

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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

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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

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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

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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

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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

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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

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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

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Progressive CNS demyelination
PCR on CSF positive for JC Virus
CD4 less than 100

Progressive multifocal leukoencephalopathy (PML)

Tx: HAART

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Vascular tumors on skin and internal organs (lungs -> hemoptysis)
CD4 less than 250

Kaposi’s sarcoma

HHV 8

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Abnormal pap smear

CD4 less than 200

Cervical cancer

HPV

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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

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weight loss >10% from baseline, chronic diarrhea, weakness, fever
CD4 less than 100

Wasting syndrome

Tx: HAART, improved nutrition
Appetite stimulants - megesterol

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Intelectual decline, ataxia, apathy

CD4 less than 200

AIDS dementia

Tx: HAART

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ART class causes lactic acidosis

NRTI

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ART class causes GI intolerance

Protease inhibitors

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ART class causes rash

NNRTIs

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ART class causing hyperglycemia, DM, lipid abnormalities

Protease inhibitors

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ART drug causing bone marrow suppression with megaloblastic anemia

zidovudine

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ART drug potentially fatal hypersensitivity reaction

abacavir

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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