Kania Flashcards
List the common opportunistic infections (OIs) that can occur in patients with human immunodeficiency virus (HIV) infection.
- Candida
- Cryptococcus neoformans
- Histoplasmosis
- Disseminated Mycobacterium avium complex disease (MAC)
- Pneumocystis pneumonia (PJP)
- Toxoplasma encephalitis
- Tuberculosis
- Cytomegalovirus (CMV) retinitis
These infections are often associated with immunocompromised states, particularly in HIV patients.
What are the clinical manifestations of oropharyngeal Candida infection?
- Painless creamy white, plaque-like lesions on tongue or in mouth
- Dry mouth
- Taste alterations
These symptoms typically indicate an opportunistic infection in HIV patients.
What are the clinical manifestations of esophageal Candida infection?
- Common with oropharyngeal Candida
- Fever
- Retrosternal burning pain or discomfort
- Dysphagia
- Odynophagia
- Lesions down esophagus
Esophageal involvement is a more severe form of Candida infection.
What are the clinical manifestations of vulvovaginal Candida infection?
- White, thick discharge
- Vaginal itching
- Burning
This form of Candida infection is common in women with HIV.
What are the symptoms of Cryptococcus neoformans infection?
- Meningitis symptoms
- Neck stiffness
- Photophobia
- Increased intracranial pressure (ICP)
These are serious manifestations that may require immediate medical attention.
What are the common clinical manifestations of Histoplasmosis?
- Asymptomatic and self-limited pulmonary disease
- Fever
- Weight loss
Often seen in individuals exposed to bird droppings or working in specific environments.
What are the clinical features of Mycobacterium avium complex (MAC) infection?
- Disseminated multi-organ infection
- Night sweats
- Weight loss
- Fever
- Diarrhea
- Malaise/fatigue
These symptoms indicate advanced disease and are common in late-stage HIV.
What are the symptoms of Pneumocystis jirovecii pneumonia (PJP)?
- Dyspnea
- Fever
- Non-productive cough
- Chest discomfort that worsens over weeks
- Hypoxemia (pO2 <70)
- Elevated LDH >500
PJP is a critical infection often seen in patients with a significantly compromised immune system.
What are the clinical manifestations of Toxoplasma gondii infection?
- Focal encephalitis
- Headache
- Focal neurological deficits
- Fever
- Coma and seizures in progression
- MRI shows ring-enhancing lesions in gray matter
This infection can lead to severe neurological complications in immunocompromised patients.
Define primary prophylaxis of opportunistic infections (OIs).
Administration of anti-infective to prevent first episode of an OI in a patient living with HIV based on CD4 count.
This is crucial in managing the health of HIV patients.
Define secondary prophylaxis of opportunistic infections (OIs).
Administration of anti-infective to prevent further reoccurrences of an OI in a patient with HIV after treatment for OI.
This helps prevent relapse in patients previously treated for OIs.
When should primary prophylaxis for Mycobacterium avium complex (MAC) be initiated?
CD4 count <50 AND not receiving ART or ART not working
Early intervention can prevent MAC onset in at-risk patients.
What is the preferred anti-infective therapy for prophylaxis treatment of Mycobacterium avium complex (MAC)?
Azithromycin 1,200 mg PO once weekly
This regimen is effective for preventing MAC in HIV patients.
When can prophylactic anti-infective therapy for Mycobacterium avium complex (MAC) be discontinued?
Patient continuing on suppressive ART regimen
Continuous ART can help maintain the immune system.
what is used for secondary prophylaxis of MAC and when do we restart
clarithromycin 500 mg BID + ethambutol 15mg/kg PO daily +/- rifabutin 300 mg PO daily (or azithro)
restart if CD4 <100
continue on treatment till CD4 >100 x 6 months
when should primary prophylaxis begin in PJP
CD4 <100-200 if HIV RNA detectable
CD4 <100 regardless HIV RNA
What is the preferred anti-infective therapy for Pneumocystis jirovecii pneumonia (PJP) prophylaxis?
- TMP-SMX DS or SS PO daily
- TMP-SMX DS PO MWF
- Atovaquone 1500 mg PO daily with food
- Dapsone 100 mg PO daily
- Pentamidine 300 mg IV monthly
These options provide multiple alternatives for PJP prophylaxis.
When can prophylactic anti-infective therapy for PJP be discontinued?
CD4 count >200 for >3 months on ART or CD4 count >100 if HIV RNA suppressed for >3 months
Monitoring CD4 counts is essential in managing HIV.
secondary prophylaxis in PJP and when to restart
Bactrim DS or SS PO daily
restart if CD4 < 100
When should primary prophylaxis for Toxoplasma gondii be initiated?
Toxoplasma IgG positive with CD4 count <100
This identifies patients at high risk for Toxoplasma infections.
What is the preferred anti-infective therapy for prophylaxis of Toxoplasma gondii?
TMP-SMX DS PO daily
This treatment is standard for preventing Toxoplasma in immunocompromised patients.
When can prophylactic anti-infective therapy for Toxoplasma gondii be discontinued?
CD4 count >200 for >3 months on ART or CD4 count >100 and HIV RNA suppressed >3 months
Monitoring is crucial for determining treatment duration.
secondary prophylaxis for toxoplamsa gondii, when do we stop and restart
stop when CD4 > 200 x 6 months
restart if CD4 <200
What is the preferred anti-infective therapy for oropharyngeal Candida infection?
- Fluconazole 200 mg load then 100-200 mg PO daily x 7-14 days
- Nystatin suspension 100,000 units/mL 5 mL swish and swallow QID x 7-14 days
- Clotrimazole troches 10 mg 5 times/day for 7-14 days
These treatments are effective for managing Candida infections.
What is the preferred anti-infective therapy for esophageal Candida infection?
Fluconazole 200 mg load then 200-400 mg IV or PO daily x 14-21 days
This regimen is necessary for treating more severe Candida infections.
What is the preferred treatment for vulvovaginal Candida infections?
- Uncomplicated: fluconazole 150 mg PO one dose
- Topical azoles for 3-7 days
- Severe: fluconazole 100-200 mg PO daily x >7 days
- Azole refractory: boric acid 600 mg vaginal suppository daily x 14 days
Different treatments are tailored based on the severity of the infection.
What is the treatment regimen for Mycobacterium avium complex (MAC) infection?
- Clarithromycin 500 mg PO BID + ethambutol 15 mg/kg PO daily x 12 months
- Azithromycin 500-600 mg PO daily + ethambutol 15 mg/kg PO daily (if intolerant to clarithromycin)
- Rifabutin 300 mg PO daily if severe
- Add a 4th drug if high risk mortality
- levofloxacin, moxifloxacin, amikacin, strepto, linez
Early aggressive treatment is crucial for managing MAC infections.
What is the treatment for moderate-severe Pneumocystis jirovecii pneumonia (PJP)?
- Trimethoprim-sulfamethoxazole 15-20 mg/kg/day IV of TMP q6-8h x 21 days
- Primaquine 30 mg PO once daily + clindamycin
- Pentamidine 4 mg/kg IV once daily infused over 1 hr
- Prednisone 40 mg PO BID x 5 days then 40 mg daily x 5 days then 20 mg daily x 11 days (if pO2 < 70)
This treatment is essential for managing severe cases of PJP.
what is the treatment for mild-moderate PJP?
Bactrim 15-20 mg/kg/day trimethoprim in TID
Bactrim DS TID
alt:
dapsone 100 mg daily
primaquine 30 mg daily +TMP 15mg/kg/day
atovaquone 750 mg BID
G6PD should be checked before which drugs
dapsone
primaquine
What is the treatment for Toxoplasma gondii acute infection?
- Pyrimethamine 200 mg PO x 1 followed by weight-based dosing x 6 weeks
- BW < 60 kg: pyrimethamine 50 mg PO daily + sulfadiazine 1000 mg PO q6h + leucovorin 10-25 mg PO daily
- BW > 60 kg: pyrimethamine 75 mg PO daily + sulfadiazine 1000 mg PO q6h + leucovorin 10-25 mg PO daily
or TMP-SMX5 mg/kg trimethoprim IV or PO BID x 6 weeks
This regimen is critical for treating acute Toxoplasma infections.
What is the treatment for chronic Toxoplasma gondii infection?
- Pyrimethamine 25-50 mg PO daily + sulfadiazine 2000-4000 mg PO daily + leucovorin 10-25 mg PO daily
- TMP-SMX DS PO BID
This treatment is necessary for managing chronic infections.
What is the treatment regimen for Cryptococcus neoformans infection?
- Induction: Amphotericin B 3-4 mg/kg IV once daily + flucytosine 25 mg/kg PO QID x 2 weeks
- Consolidation: Fluconazole 400-800 mg PO daily x 8 weeks
- Maintenance: Fluconazole 200 mg PO daily x 1 year or longer
The treatment phases are critical for managing cryptococcal meningitis.
What is the treatment for mild-moderate Histoplasmosis?
Itraconazole 200 mg PO TID x 3 days then BID x 1 year
This regimen is used for less severe cases of Histoplasmosis.
What is the treatment for severe Histoplasmosis?
- Liposomal amphotericin B 3 mg/kg IV daily x 2 weeks
- Then itraconazole 200 mg PO TID x 3 days then BID x 1 year
Severe cases require more aggressive treatment.
What is the primary prophylaxis for Histoplasmosis?
CD4 count <150 and at high risk due to occupational exposure; Itraconazole 200 mg PO daily
Prophylaxis is crucial for individuals at high risk of exposure.
What is the secondary prophylaxis for Histoplasmosis?
Continuation of maintenance therapy after 1 year; Itraconazole 200 mg PO daily
This helps prevent relapse in patients previously treated for Histoplasmosis.
