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Bloc G - Infection > May7 M1-HIV > Flashcards

May7 M1-HIV Flashcards

1
Q

(EXAM) most important opportunistic pathogen in HIV patients and its pathology

A

pneumocystis jeroveci. a fungus. gives a pneumonia that gives hypoxia. 10-20% mortality.

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2
Q

(EXAM) drug given in prophylaxis to prevent PCP (pneumocystis jeroveci pneumonia)

A

Septra (the sulfa Abx)

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3
Q

(EXAM) if an HIV patient is infected with PCP (pneumocystis pneumonia), what’s the management

A

Septra and maintain Septra until the patient is immune recovered
(also give CSs for the inflammation)

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4
Q

(EXAM) to what HIV patients do you give Septra prophylaxis

A
  • ALL children (bc higher risk of HIV becoming AIDS + higher risk of PCP)
  • Adults that are getting close to the AIDS level (so not all adults)
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5
Q

(EXAM) opportunistic pathogens in HIV patients other than pneumocystis jeroveci

A
  • mycobacterium avium complex
  • mycobacterium tuberculosis
  • cryptococcus neoformans
  • herpesviruses CMV, HSV, VZV, HHV-8
  • HBV and HBC
  • JCV (virus)
  • toxoplasma gondii
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6
Q

what is slim disease (or runting syndrome)

A

progressive involuntary weight loss seen in patients with HIV infection; may be due to a number of factors acting alone or in combination

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7
Q

(imp) mycobacterium avium complex (MAC): disease it causes in HIV patients

A
  • slim disease
  • disseminated GIT disease and wasting syndrome
  • big lymph nodes block bronchi, especially in IRS
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8
Q

(imp) management of mycobacterium avium complex in HIV pts (prophylaxis and tx)

A
  • prophylaxis: macrolide (azithro or clarithro mycin) for people with certain levels of CD4
  • tx: macrolide (azithro or clarithromycin) + rifabutin and keep until immune system reconstitutes
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9
Q

three main pathogens test for in an HIV patient and that can change the immediate course of the disease

A
  • TB
  • HBV
  • HCV
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10
Q

(imp) mycobacterium TB: disease it causes in HIV patients

A
  • lymphadenopathy, pulm disease, intra-abd disease

- higher burden of TB bacilli in the lung, transmit easier

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11
Q

(imp) cryptococcus neoformans disease it causes in HIV patients

A

-meningitis with very high ICP, etc.

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12
Q

(imp) cryptococcus neoformans infection management in HIV patients

A
  • amphotericin B + fluconazole IV (followed by fluconazole po for weeks to months)
  • lifelong SECONDARY prophylaxis (after infection)
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13
Q

(imp) disease that reactivated CMV causes in HIV patients

A

eye disease (retinitis, uveitis, retinal detachment, visual loss)

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14
Q

(imp) disease that HHV-8 reactivation causes in HIV patients

A

Kaposi’s sarcoma

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15
Q

(imp) disease that HBV, HCV cause in HIV patients

A

progressive cirrhosis

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16
Q

(imp) disease that JCV (JC or John Cunningham virus) causes in HIV patients

A

progressive multifocal leukoencephalopathy

  • an irreversible encephalopathy
  • movement disorder
  • severe neuro problems
17
Q

(imp) disease that toxoplasma gondii causes in HIV patients

A
  • protozoa goes in the brain and causes brain ABSCESSES
  • encephalitis
  • seizures
  • disseminated CNS lesions (ring enhancing abscesses)
18
Q

(imp) management of toxoplasma gondii infection in HIV patients

A
  • tx: sulfadiazine + pyrimethamine + folinic acid (leucovorin) (is a toxic tx)
  • secondary prophylaxis (AFTER tx): sulfadiazine + clindamycin until immune reconstituted
19
Q

(EXAM) 3 categories of HIV patients that have to be treated for sure (more now, but the 3 initial ones)

A
  • children under age 1 and developing AIDS rapidly
  • pregnant women with HIV
  • symptomatic HIV patients (no matter CD4)
20
Q

(EXAM) on top of the 3 categories of HIV patients, who should be treated for HIV

A
  • all patients with CD4 count <350 (moderate immune suppression) or viral load of a log > 5, even if are asymptomatic
  • basically everyone who gets dx (bc if you wait for immune suppression, you get chronic inflam, CVD, heart disease, dementia, etc. in the meantime)
21
Q

(EXAM) severe immune deficiency definition in HIV

A

CD4 count below 200 cells per mL of blood

22
Q

(EXAM) normal immune system definition in HIV

A

CD4 count above 500 cells per mL of blood (IN ADULTS)

in children, 501 is severe immune suppression

23
Q

(EXAM) intestinal infections that cause disorders of the intestines and that are much more common in HIV and immunodeficiencies

A

spora type parasitic infections (intestinal protozoa)

  • giardia lamblia
  • cryptosporidium
  • microsporidia
  • cyclospora
  • isospora
  • emtamoeba histolytica (only parasite to cause bloody diarrhea)
  • (FUNGUS) histoplasma capsulatum
24
Q

(important) mainstay of therapy in HIV nowadays

A

HAART: highly active antiretroviral therapy. is a combination of

  • NRTI (nucleoside RT i)
  • NNRTI (non nucleoside RT i)
  • PI (protease i)
  • FI (fusion i)
  • integrase inhibitors
  • CCR5 R antagonists
25
Q

goals of HAART

A
  • reduce HIV viral load to undetectable levels

- elevate CD4 T helper lymphocyte count

26
Q

(EXAM) 3 main components of HIV in children

A
  • growth failure
  • neurodev deterioration (brain growth, cognitive fct and motor dysfunction)
  • lymphoid interstitial pneumonitis (LIP)
27
Q

(EXAM) what’s LIP

A
  • the hallmark of AIDS caused by HIV, in CHILDREN ONLY (not seen in adults)
  • an immune mediated lymphocitic infiltration of the lungs
  • NOT related to immune suppression
  • related to EBV
28
Q

(EXAM) why LIP is said to not be related to immune suppression

A

because you have an immune mediate lymphocitic infiltration in the lung so it means that the immune system is working

29
Q

(EXAM) treatment of lymphoid interstitial pneumonitis (AIDS defining illness in children with HIV) and how it compares to PCP tx

A

tx is corticosteroids. (for pneumocystis pneumonia, would give Septra + CS)

30
Q

(imp) possible way of HIV transmission that we have to remember

A

occupational exposures (health care or lab workers)

  • percutaneous (stabbed, needles)
  • mucosal (splashing of body fluids)
  • never been a case of non occup exposure of HIV like kid touching needle in a park*
31
Q

(imp?) what to do and not to do if stuck by a non sterile needle in health care setting

A
  • DO: pour chlorhexidine on wound or pour open water on hand to decrease risk of infection (decreases risk a LOT)
  • DONT’: rub the wound (makes the infection go deeper)
32
Q

(exam) how children get HIV

A
  • perinatal exposure (vertical), mostly intra partum
  • sexual abuse
  • blood transfusion
  • teens = sexual intercourse + IVDU

Bloc G - Infection (39 decks)

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