Infectious Diseases IV: Opportunistic Infections

Question 1

Immunocompromised state definition include…

Answer 1

1.Diseases that destroy components of immune response (ie HIV)
2. using systemic steroids for 14+ days at prednisone dose of > 20mg/day
3. Asplenia
4. use of immunosuppressants
5. using cancer chemo, ANC < 500

Question 2

common opportunistic infections include….

Answer 2

PJP or PCP
MAC
toxoplasmosis gondii encephalitis

Question 3

PJP or PCP ppx regimen

Answer 3

Start if CD4 < 200

Preferred: SMX/TMP DS or SS QD
Alternative: Atovaquone or Dapsone-pyrimethamine-Leucovorin

D/c if CD4 > 200 after 3 months

Question 4

Toxoplasma gondii encephalitis ppx regimen

Answer 4

Start if CD4 < 100 and toxoplasma IgG positive

Preferred: SMX/TMP DS QD
Alternative: Atovaquone or Dapsone-pyrimethamine-Leucovorin

D/c if CD4 > 200 after 3 months

Question 5

MAC ppx regimen

Answer 5

Start if not taking ART and CD4 < 50

Preferred: Azith 1200mg QW

D/c if taking fully suppressive ART

Question 6

Thrush Regimen

Answer 6

Preferred: Fluconazole
Secondary Prophylaxis not recommended

Question 7

Cryptococcal meningitis Regimen

Answer 7

Preferred: AmpB + flucytosine
Secondary Prophylaxis: low dose fluconazole

Question 8

Cytomegalovirus (CMV) Regimen

Answer 8

Preferred: Valganciclovir or Ganciclovir
Secondary Prophylaxis: none, keep CD4 count > 100

Question 9

MAC Regimen

Answer 9

Preferred: Clarith or Azithromycin + ethambutol
Secondary Prophylaxis: ^^^^ above ^^^

Question 10

PJP or PCP Regimen

Answer 10

Preferred: SMX/TMP High dose +/- prednisone or Methylpred for 21 days
Secondary Prophylaxis = SMX/TMP DS or SS QD

Question 11

Toxoplasmosis gondii encephalitis Regimen

Answer 11

Preferred: Purimethamine + Leucovorin + sulfadiazine
Secondary Prophylaxis: ^^^^ same as above but lower doses