infectious disease IV: Opportunistic infections Flashcards
EOR exam 5
what are opportunistic infections?
- Immunocompromised patients are predisposed to OI’s which occur when the immune system is weak and unable to respond normally to invading bacteria, fungi, viruses, and protozoa.
what are considered to be immunocompromised states?
- HIV with a CD4 T lymphocyte count < 200 (defining criteria for AIDS)
- Use of systemic steroids for 14 days or longer at a prednisone equivalent dose of >20 mg/day or > 2 mg/kg/day
- Asplenia (Lack of functioning spleen)
- use of immunosuppressants for autoimmune conditions or post transplant
- Use of cancer chemotherapy agents particularly if severe neutropenia (ANC <500)
Transplant patients have a high risk of ?
- Viral infxns especially CMV
a. ppx with letermovir ( for kidney and bone marrow recipients)
b.valganciclovir (for any solid organ transplant recipient) - Pneumocystis jirovecii pneumonia PJP/ PCP
a. ppx can be used for patients with HIV
When should primary prophylaxis for pneumocystis jirovecii (PJP) be started in an HIV patient?
- CD4 count < 200 cells/ mm3 ★
- Or AIDS defining illness
What is the preferred ppx regimen for PCP prophylaxis in HIV patients?
- SMX/TMP DS or SS daily★
What is the alternative ppx regimen for PCP prophylaxis in HIV patients?
- Bactrim DS 3x a week or
- Dapsone★ or
- Dapsone + Pyrimethamine + Leucovorin★ or
- Atovaquone★ or
- Atovaquone + pyrimethamine + leucovorin
- Inhaled pentamidine
When can PCP prophylaxis be discontinued in HIV patients?
- CD4 count > 200 cells/mm3 for >3 months and remains on ART ★
When should primary prophylaxis for Toxoplasma gondii encephalitis be started in an HIV patient?
- Toxoplasma IgG positive and
- CD4 count < 100 cells/mm3 ★
What is the preferred ppx regimen for Toxoplasma gondii in HIV patients?
- SMX/TMP DS daily ★
What is the alternative ppx regimen for Toxoplasma gondii in HIV patients?
- SMX /TMP DS 3x/week or ss daily or
- Dapsone + Pyrimethamine + Leucovorin ★ or
- Atovaquone ★ or
- Atovaquone + Pyrimethamine + leucovorin
When can toxoplasma gondii prophylaxis be discontinued in HIV patients?
- CD4 count > 200 for > 3 months and remains on ART
When should primary prophylaxis for Mycobacterium avium complex (MAC) be started in an HIV patient?
- Not recommended if ART is started immediately
- Initiate if not taking ART, CD4 count <50 and no active MAC infection ★
What is the preferred ppx regimen for MAC in HIV patients?
- Azithromycin 1,200 mg weekly ★
What is the alternative ppx regimen for MAC in HIV patients?
- Azithromycin 600 mg twice weekly or
- Clarithromycin 500 mg BID
When can MAC prophylaxis be discontinued in HIV patients?
- Taking fully suppressive ART
What are options for PCP in the setting of a sulfa allergy ?
- Atovaquone ★
- Dapsone ★
- Pentamidine ★
What are options for PCP in the setting of a G6PD deficiency ?
- Atovaquone ★
- Pentamidine ★
why and when is leucovorin added to treatment regimens?
- Added to all pyrimethamine containing regimes.
- Used as rescue therapy to reduce the risk of pyrimethamine induced myelosuppression
How should thrush be treated in patients with HIV, even if the disease is mild?
- Systemic treatment is preferred★
What is the preferred treatment regimen in treating Candidiasis (thrush) in immunosuppressed patients?
- Appears as a white film in the mouth/throat
- Fluconazole ★
What is the alternative treatment regimen in treating Candidiasis (thrush) in immunosuppressed patients?
- Oropharyngeal: Itraconazole ★, posaconazole, topicals (clotrimazole troche, nystatin)
- Esophageal: Voriconazole, isavuconazonium or an echinocandin (caspofungin)
What is used for secondary ppx in Candidiasis in immunosuppressed patients?
- Not usually recommended ★
What is the preferred treatment regimen in treating cryptococcal meningitis in immunosuppressed patients?
- Amphotericin B (Liposomal preferred) + flucytosine ★
What is the alternative treatment regimen in treating cryptococcal meningitis in immunosuppressed patients?
- Fluconazole★ + flucytosine or
- Amphotericin B + fluconazole
