OI Flashcards
define opportunistic infection
illnesses caused by various organisms, some of which do not cause diseases in immunocompetent persons
Define primary prophylaxis
initiated to prevent the first episode of OI
define secondary prophylaxis
initiated after treatment of an OI to prevent the second or subsequent episode of an OI
CD4 under 500 at risk for which OI
bacterial skin infection
herpes simplex, zoster
Oral, skin fungal infections
CD4 under 400 at risk for which OI
Kaposi’s sarcoma
CD4 under 300 at risk for which OI
Hairy leukopenia
tuberculosis
CD4 under 200 at risk for which OI
PCP
Cryptococcus
Toxoplasmosis
CD4 under 50 at risk for which OI
MAC
CMV
lymphoma
CD4 under 50 at risk for which OI
MAC
CMV
lymphoma
Which OI predominantly attacks the eyes
cytomegalovirus
Which OI predominantly attacks the mouth and throat
candidiasis
Which OI predominantly attacks the skin
Herpes Simplex
shingles
Which OI predominantly attacks the brain
toxoplasmosis
cryptococal meningitis
Which OI predominantly attacks the lungs
PCP
MAC
Tb
histoplasmosis
Which OI predominantly attacks the gut
cytomegalovirus
cryptosporidiosis
Which OI predominantly attacks the genitals
herpes simplex
human papillomavirus
candiasis
PCP caused by
pneumocystis jiroveci - fungus with protozoal properties
which patients are at greatest risk for PCP
CD4
Clinical presentation of PCP
exertional dyspnea fever nonproductive cough chest discomfort ground glass opacities - x ray/CT hypoxemia
2 diagnostic tests for PCP
bronchoscopy
Silver stain
Prognostic factors for PCP
PaO2 35 abnormal CXR Severity of pulmonary dysfunction at baseline Severity of immunosuppression Large inoculums detected by bronchoscopy
Indications for primary prophylaxis for PCP
CD4
preferred regimen for primary prophylaxis for PCP
Bactrim DS po daily
alternative regimens for primary prophylaxis for PCP
Bactrim DS 3x weekly dapsone 100 mg po daily atovaquone 15000 mg po daily (high fat food) dapsone + pyrimethamine + leucovorin pentamidine 300 mg via neb monthly
PCP treatment
Bactrim
TMP 15-20 mg/kg/day given q 6 or 8 h
SMX 75-100mg/kg/day
dose based on TMP
Bactrim AEs
rash fever N/V crystaluria myleosuppression hyperkalemia
Bactrim AEs
rash fever N/V crystaluria myleosuppression hyperkalemia
Alternative treatments for severe PCP
Pentamidine 3-4 mg/kg IV daily or
Clindamycin 450 mg QID or 600-900 mg IV q6-8h + Primaquine 30 mg base daily
alternative regimens for mild-moderate PCP
dapsone 100 mg po daily + TMP 15mg/kd/day in 3-4 divided doses or
atovaquone 750 mg PO q 12 h
duration of therapy for PCP treatment
21 days
when to use steroids in PCP treatment
PaO2 35
when to start steroids in PCP treatment
within 72 hours of initiating treatment
Duration of therapy of steroids in PCP
21 days - taper PO steroids
IV methylprednisone to PO prednisone
75% of prednisone dose
Regimens used for secondary prophylaxis of PCP
same as primary prophylaxis
When to d/c prophylaxis for PCP
CD4 > 200 for 3 months on HAART
Mode of transmission for MAC
inhalation
ingestion
inoculation of the respiratory or GI tract