Infections of Immunocompromised Host

Question 1

Top Opportunistic Infections (5 total)

Answer 1

Nocardia
Strongyloides
M. tuberculosis
CMV
Polyoma virus (JC & BK)
Parvo B19

Question 2

Corticosteroid use makes you more prone to what opportunistic infections

Answer 2

Nocardia
Strongyloides

*also Listeria and fungi

Question 3

TNF antagonists and Rituximab/Natalizumab use makes you more prone to what opportunistic infections

Answer 3

M. tuberculosis
Hep B virus
Polyoma virus (JC & BK)

*also fungi

Question 4

SLE makes you more prone to what opportunistic infection and why?

Answer 4

Parvo; low complement and neutropenia/lymphopenia

Question 5

Examples of Gram-positive branching bacteria

Answer 5

Actinomyces

Nocardia

Question 6

Gram-positive/acid fast BRANCHING bacteria with a “beaded” appearance; AEROBIC; lives in the soil; results in Pneumonia, Lung and Brain abscesses; diagnose with sputum or BAL; treat with TMP-SMX

Answer 6

Nocardia

Question 7

Clinical Manifestations of Nocardia

Answer 7

Pneumonia
Lung/Brain/Skin abscesses
Cellulitis

Question 8

Staining properties of Nocardia

Answer 8

Gram +
Acid fast
Branching and “beaded”

Question 9

Treatment for Nocardia

Answer 9

TMP-SMX

*maybe Ceftriaxone

Question 10

Herpes virus (ds DNA); transmitted via blood, sexual contact, ORGAN TRANSPLANTS and possible TORCH infection; seen in AIDS patients with CD4 <50; can cause retinitis, encephalitis, pneumonitis and myelosuppression; diagnose with PCR, biospy (“owls-eyes”) and Serology; treat with Ganciclovir, Valganciclovir or Foscarnet/Cidofovir

Answer 10

CMV

Question 11

AIDS patients are prone to CMV infection with a CD4 below _______

Answer 11

50

Question 12

Clinical manifestations of CMV

Answer 12

Retinitis
Encephalitis
Pneumonitis
Myelosuppression

*usually only immunocompromised hosts

Question 13

Diagnostic tests for CMV

Answer 13

PCR
Biopsy (“Owls-eyes”)
CMV IgM (acute) and IgG (past)

Question 14

CMV (IgM/IgG) indicates as acute or reactivated infection

Answer 14

IgM

Question 15

CMV (IgM/IgG) indicates a previous infection

Answer 15

IgG

Question 16

Treatment for CMV

Answer 16

1st line: Ganciclovir/Valganciclovir

2nd line: Foscarnet/Cidofovir

Question 17

Acyclovir is effective against CMV (True or False)

Answer 17

False (HSV, but not CMV)

Question 18

ssDNA virus that infects ERYTHROBLASTS; transmitted via respiratory droplets or TORCH infection; can result in Hydrops fetalis, Erythema infectiosum (“slapped cheek rash”) or aplastic crisis; treat with transfusions (aplastic crisis) or IVIg (chronic anemia)

Answer 18

Parvo B19

Question 19

Clinical Manifestations of Parvo

Answer 19

Hydrops fetalis
Erythema infectiosum ("slapped cheek rash")
Aplastic Crisis (sickle cell anemia)

Question 20

Treatments for Parvo

Answer 20

NO effective antivirals (no polymerase)
Transfusions (aplastic crisis)
IVIg (chronic anemia)

Question 21

Polyomavirus; associated with HIV/AIDS patients or those who take Natalizumab; causes Progressive Multifocal Leukoencephalopathy

Answer 21

JC virus

Question 22

Clinical Manifestations of JC virus

Answer 22

Progressive Multifocal Leukoencephalopathy

Question 23

Polyomavirus; associated with Kidney & Bone marrow transplant patients; causes nephropathy, hemorrhagic cystitis and graft dysfunction

Answer 23

BK virus

Question 24

Clinical Manifestations of BK virus

Answer 24

Nephropathy
Hemorrhagic cystitis
Graft dysfunction

Question 25

Intestinal nematode (round worm); transmitted by skin penetration (bare feet) and autoinfection; can cause abdominal pain, diarrhea, eosinophilia and pulmonary complications and MENINGITIS; treatment is Ivermectin and Albendazole

Answer 25

Strongyloides

Question 26

Clinical Manifestations of Strongyloides

Answer 26

Asymptomatic
Abdominal pain/Diarrhea
Eosinophilia
Pulmonary complications
MENINGITIS

Question 27

Treatments for Strongyloides

Answer 27

Ivermectin

Albednazole