Infectious Disease IV Flashcards
Immunocompromised states
include:
Diseases
Use of systemic steroids
Asplenia
Use of immunosuppressants
Use of cancer chemotherapy agents
Diseases
destroy key components of the immune response,
primarily HIV with a CD4 T lymphocyte count < 200 cells/mm^3
Use of systemic steroids
14 days or longer at a prednisone dose
(or prednisone equivalent dose) > 20 mg/day or > 2 mg/kg/day.
Asplenia
(lack of a functioning spleen), as with sickle cell disease or following a splenectomy
Use of immunosuppressants
for autoimmune conditions or
transplant (e.g., TNF-alpha inhibitors).
Use of cancer chemotherapy agents
agents that destroy white blood cells,
particularly with severe neutropenia (ANC < 500 cells/mm^3).
Common opportunistic infections requiring primary prophylaxis include:
■ Pneumocystis jirovedi pneumonia (PJP or PCP)
■ Toxoplasmosis gondii encephalitis
■ Mycobacterium avium complex (MAC)
Candida infections in the mouth/esophagus (e.g., thrush) are a higher risk in immunocompromised states,
but prophylaxis is not usually recommended.
atovaquone, dapsone and pentamidine are options for PCP when?
in the setting of a sulfa allergy.
atovaquone and pentamidine are options in the setting of what?
a G6PD deficiency.
What is added to all pyrimethamine containing regimens as rescue therapy to reduce the risk of pyrimethamine induced myelosuppression.
Leucovorin
Pneumocystis jirovedi pneumonia (PJP or PCP)
CD4 count < 200 cells/mm3 or AIDS-defining illness
Pneumocystis jirovedi pneumonia (PJP or PCP)
Preferred treatment
SMX/TMP* DS or SS daily or SMX/TMP DS 3x/week
If Sulfa Alergy?
ALTERNATIVES
Dapsone or
Dapsone + pyrimethamine + leucovorin or
Atovaquone or
Inhaled pentamidine
Pneumocystis jirovedi pneumonia (PJP or PCP)
When to d/c treatment?
CD4 count > 200 cells/mm3 for > 3 months on ART
Can consider when CD4 count is 100-200 cells/mm^ and viral load has been undetectable for > 3-6 months
Toxoplasma gondii encephalitis
When to start
Toxoplasma IgG positive and CD4 count < 100 cells/mm3
