Infectious Disease IV Flashcards
What is considered to be the immunocompromised state?
- CD4 count < 200
- Systemic Steroids for < 14 days (prednisone equivalent of > 20 mg/day or > 2 mg/kg/day)
- Asplenia (no spleen)
- On other immunosuppressants
- On cancer chemo with severe neutropenia
What is the Criteria for starting Prophylaxis for Pneumocystis Jirovecii Pneemonia (PJP)?
- CD4 count < 200 or AIDS illness
What is the Criteria for starting Prophylaxis for Toxoplama Gondii Encephalitis?
- Toxoplasma IgG + AND
- CD4 count < 100
What is the Criteria for starting Prophylaxis for Mycobacterium Avium Complex (MAC)?
- NOT recommended if ART is started immediately
- If not taking ART; CD4 count < 50 and no active MAC infections
What is the Primary Prophylaxis Regimen for PJP?
- SMX/TMP DS or SS daily [Preferred]
- Dapsone or Dapsone + Pyrimethamine + Leucovorin or Atovaquone [Alts]
In what setting should someone not get SMX/TMP for their ** Prophylaxis**?
- Sulfa Allergy –> Dapsone, Atovaqunoe, Pentamidine are the options
- G6PD Deficiency –> Atovaqunoe or Panetamidine
What is important to know about Leucovorin?
- Added to all Pyrimethamine containing regimens as a rescue therapy = reduces myelosuppression
What is the Primary Prophylaxis Regimen for Toxo?
- SMX/TMP DS Daily [Preferred]
- Dapsone + Pyrimethamine + Leucovorin or Atovaquone [Alts]
What is the Primary Prophylaxis Regimen for MACs?
- Azithromycin 1200 mg weekly
What is the criteria for Discontinuing the prophylaxis for PJP?
- CD4 count > 200 for > 3 months and remains on ARTs
What is the criteria for Discontinuing the prophylaxis for Toxo?
- CD 4 count > 200 for > 3 months and remains on ARTs
What is the criteria for Discontinuing the prophylaxis for MACs?
- Taking fully suppressive ART
what is the preferred treatment regimen for someone with Candidasis (Oral/Esophagel); also known as Thrush?
- Fluconazole
What is an alternative treatment regimen for Candidasis (Oral/Esophagel); also known as Thrush?
- Oral: Itraconazole, Posaconazole
- Esophagel: Voriconazole, Isavuconazole, or Echinocandin
What is the Secondary Prophylaxis for Candidasis (Oral/Esophagel); also known as Thrush?
- NONE
What is the preferred treatment regimen for someone with Cyrptococcal Meningitis?
- Lipo Amp B + Flucytosine
What is an alternative treatment regimen for Cyrptococcal Meningitis?
- Fluconazole + Flucytosine OR
- Amp B + Flucytosine
What is the Secondary Prophylaxis for Cyrptococcal Meningitis?
- Fluconazole (low dose)
What is the preferred treatment regimen for someone with Cytomegalovirus?
- Valganciclovir or Ganciclovir
What is an alternative treatment regimen for someone with Cytomegalovirus?
- Foscarent or Cidofovir (if toxicities or resistance)
What is the Secondary Prophylaxis for someone with Cytomegalovirus?
- NONE
- For HIV, continue ART and maintain CD4 count > 100
What is the preferred treatment regimen for someone with Mycobacterium Avium Complex (MAC)?
- (Clarithromycin or Azithorymycin) + Ethambutol
What is an alternative treatment regimen for someone with Mycobacterium Avium Complex (MAC)?
- Add a 3rd or 4th agent (using Rifabutin, Amikacin, Strptomycin, Moxifloxacin, or Levofloxacin)
What is the secondary prophyaxis for someone with Mycobacterium Avium Complex (MAC)?
- Same as treatment (Azithormycin)
