Immunocompromised Flashcards
timing of IRIS after initiation of ART?
1 month
treatment of IRIS?
continue ART, treat any underlying infection, steroids
asplenia RF for what bugs?
strep pneumo, H flu, Neisseria, Babesia, plasmodium
PJP CD4 count?
<200
PJP diagnosis?
sputum, BAL, PCR Giemsa staining
PJP CT findings?
GGO periphery sparing
PJP tx? and alternatives?
Bactrim, 2- Pentamadine or Dapsone
indications for steroids in PJP?
Pa02<70, A/a gradiest >35
TB CD4 count?
<200
Toxoplasmosis CD4 count?
<100
Toxoplasmosis imaging findings?
multiple nodular, contrast enhancing lesions
Toxoplasmosis dx? staining?
CSF IgG, IgM also seen on Geimsa stain
Toxoplasmosis treatment?
Sulfadiazine, pyrimethamine, Leucavorin
Cryptococcus CD4?
<100
Crypto diagnosis, stain?
india ink, high CSF OP, latex agglutination
Cryptococcus treatment? maintenance?
amphotericin B plus flucytosine/ fluconazole
coccidiodes affect what body parts?
skin and joints
coccidiodes treatment?
ampho B plus flucytosine
Aspergillus CD4 count?
<50
CMV 2 types?
invasive and non invasive
Non invasive CMV signs?
viremia, lymphopenia, thrombocytopenia
Tissue invasive CMV sites?
chorioretinitis, pneumonitis, GI, adrenal
CMV diagnosis? path finding?
PCR/owl eye inclusion bodies
CMV treatment?
Ganciclovir and CMV IgG
CMV tx duration?
duration of viremia or 2 weeks
Maintenance therapy CMV?
oral Ganciclovir 3 months post infection
CMV alternate treatment?
foscarnet
Monotherapy for neutropenic fever?
antipseudomonal B lactam
when to add vanc in neutropenic fever?
lines, PNA, colonization, SSTI
when to add fungal coverage neutropenic fever? antifungal?
no recovery after 4-7 days of treatment/voriconazole
Neutropenic enterocolitis location?
ileum, cecum, ascending colon
Neutropenic enterocolitis symptoms?
fever, pain, water bloody diarrhea
tx of neutropenic enterocolitis
conservative mgmt
Rule out what other organ involvement if candidemia?
eye-endophalmitis
initial treatment of candidemia?
Echinocandin- miafungin, caspofungin
nocardiosis naturally found?
soil
nocardia microbiology? staining?
gram positive thin filament, silver staining
nocardia type of infection?
cavitary diasease
nocardia treatment?
sulfonamides- minocycline
VZV systems it can affect?
skin, vasculature, liver, lung, brain
who is at risk for VZV infection?
patients with compromised cellular immunity- HIV, steroids, immunosuppression, third trimester pregnancy
when to start ART therapy after HIV diagnosis?
within 2 weeks, showing to decrease progression to AIDS expect for patients who present with crypto then it should be delayed until 5 weeks
symptoms of mucormycosis?
black effusions, parencyhmal disease, sinusitis
imagingin findings more commonly found with mucor?
reverse halo sign
diagnosis of mucor? microscopy findings?
biopsy, wide branching angles
tx for mucor?
liposomal ampho B
histoplasma significant features?
can invade reticuloendothelial system, high ferritin level
disseminated histoplasma tx in severely immunocompormised?
liposomal ampho B for 2 weeks
depressed cell mediated immunity(steroids use) puts you at risk for which infiections?
intracellular organisms- mycobacterium, listeria, nocardia, salmonella, rhodococcus
MAC presentation?
chronic cough, nodular opacities with tree in bud appearance, anorexia, weight loss, in immunosuppressed patient
tx for MAC?
clarithromycin, ethambutol, rifabutin
imunocompromised with ring enhancing lesions exposed to cats?
toxoplasmosis
staining for toxoplasmosis?
tachyzoites on giemsa stain
iniital drug regimen for toxoplasmosis?
pyrimethamine, silfadiazine, leucovorin