Infectious Disease IV

Question 1

Immunocompromised states
include:

Answer 1

Diseases
Use of systemic steroids
Asplenia
Use of immunosuppressants
Use of cancer chemotherapy agents

Question 2

Diseases

Answer 2

destroy key components of the immune response,
primarily HIV with a CD4 T lymphocyte count < 200 cells/mm^3

Question 3

Use of systemic steroids

Answer 3

14 days or longer at a prednisone dose
(or prednisone equivalent dose) > 20 mg/day or > 2 mg/kg/day.

Question 4

Asplenia

Answer 4

(lack of a functioning spleen), as with sickle cell disease or following a splenectomy

Question 5

Use of immunosuppressants

Answer 5

for autoimmune conditions or
transplant (e.g., TNF-alpha inhibitors).

Question 6

Use of cancer chemotherapy agents

Answer 6

agents that destroy white blood cells,
particularly with severe neutropenia (ANC < 500 cells/mm^3).

Question 7

Common opportunistic infections requiring primary prophylaxis include:

Answer 7

■ Pneumocystis jirovedi pneumonia (PJP or PCP)
■ Toxoplasmosis gondii encephalitis
■ Mycobacterium avium complex (MAC)

Question 8

Candida infections in the mouth/esophagus (e.g., thrush) are a higher risk in immunocompromised states,

Answer 8

but prophylaxis is not usually recommended.

Question 9

atovaquone, dapsone and pentamidine are options for PCP when?

Answer 9

in the setting of a sulfa allergy.

Question 10

atovaquone and pentamidine are options in the setting of what?

Answer 10

a G6PD deficiency.

Question 11

What is added to all pyrimethamine containing regimens as rescue therapy to reduce the risk of pyrimethamine induced myelosuppression.

Answer 11

Leucovorin

Question 12

Pneumocystis jirovedi pneumonia (PJP or PCP)

Answer 12

CD4 count < 200 cells/mm³ or AIDS-defining illness

Question 13

Pneumocystis jirovedi pneumonia (PJP or PCP)

Preferred treatment

Answer 13

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

Question 14

Pneumocystis jirovedi pneumonia (PJP or PCP)

When to d/c treatment?

Answer 14

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

Question 15

Toxoplasma gondii encephalitis

When to start

Answer 15

Toxoplasma IgG positive and CD4 count < 100 cells/mm³

Question 16

Toxoplasma gondii encephalitis

Preferred treatment

Answer 16

PREFERRED

SMX/TMP DS tab PO daily

ALTERNATIVES

• SMX/TMP DS 3x/week or 1 SS PO daily o r
• Dapsone + pyrimethamine + leucovorin or
• Atovaquone or
• Atovaquone + pyrimethamine + leucovorin

Question 17

Toxoplasma gondii encephalitis

When to d/c

Answer 17

CD4 count > 200 cells/mm^ fo r

> 3 months on ART

Question 18

Mycobacterium avium complex (MAC)

When to start

Answer 18

Initiate if not taking ART and

CD4 count < 50 cells/mm^

Question 19

Mycobacterium avium complex (MAC)

preferred drug

Answer 19

PREFERRED

Azithromycin 1,200 mg PO weekly

ALTERNATIVES

Azithromycin 600 mg PO twice weekly or

Clarithromycin 500 mg PO BID

Question 20

Mycobacterium avium complex (MAC)

when to d/c

Answer 20

Taking fully suppressive ART

Question 21

Candidiasis (thrush)

(oropharyngeal/esophageal)

Appears as a white film in the

mouth/throat

Answer 21

Preferred

Fluconazole

Alternative

Itraconazole, posaconazole

Question 22

Candidiasis (thrush)

secondary prophylaxis

Answer 22

Not usually recommended