OPPORTUNISTIC ILLNESSES IN IMMUNOCOMPROMISED PATIENTS

Question 1

At what concentration CD4 cells does AIDS occur

Answer 1

< 200 / microliter

Question 2

At what concentration CD4 cells is there generally not a risk for an AIDS defining opportunistic infection

Answer 2

> 500 / microliter

Question 3

how are opportunistic illnesses suppressed in HIV and other immunocompromised patients

Answer 3

with antimicrobial prophylaxis

Question 4

t or f? Opportunistic illnesses accounted for most of the complications associated with HIV infections

Answer 4

true

Question 5

what bacteria causes tuberculosis either by primary infection or reactivation of a latent TB infection

Answer 5

M.tuberculosis

Question 6

what patients have a higher progression rate from latent TB to active disease

Answer 6

HIV patients

Question 7

what antibiotic class covers TB

Answer 7

rifamycins

Question 8

What does rifamycins do to CYP450 that can decrease the plasma levels of the ART drugs

Answer 8

induces CYP450

Question 9

what 2 drugs replace rifampin in HIV patients due to weaker CYP450 inducer

Answer 9

rifabutin and rifapentine

Question 10

What 2 bacteria are found MAC infections. Which can disseminate and which stays in the lungs?

Answer 10

M. avium dissimantes
M.intracellulare stays in lungs

Question 11

what is the pathogenesis of MAC infection

Answer 11

-disseminated diseases in AIDS patients is mediated by M.avium
-spreads systemically to organs
-M. intracellulare cause of pulmonary disease

Question 12

how to cover MAC infection

Answer 12

clarithromycin or azithromycin + anti TB drugs

Question 13

what are the 3 viral opportunistic infections covered

Answer 13

Cytomegalovirus
Progressive Multifocal Leukoencephalopathy
Kaposi Sarcoma

Question 14

in AIDS patients, what is Cytomegalovirus usually due to

Answer 14

reactivation of latent infection (subacute)

Question 15

CMV disease arises when what count drops

Answer 15

CD4

Question 16

what is the primary manifestation of CMV

Answer 16

retinitis where a lesion occurs near or on the retina and can result in irreversible blindness

Question 17

antiviral coverage for CMV

Answer 17

ganciclovir
valganciclovir
foscarnet
cidofovir

Question 18

how does progressive multifocal leukoencephalopathy occur

Answer 18

Papovavirus JC (JCV) infects the GI tract and remains latent but gets reactivated in HIV patients

Question 19

in PML what does JCV do to the brain

Answer 19

it destroys white matter of the brain

Question 20

what causes Kaposi Sarcoma

Answer 20

HHV 8 that infects B cells and promotes growth preventing apoptosis which forms benign tumors (skin cancer)

Question 21

what are the 3 fungal infections in opportunistic infections

Answer 21

Pneumocystis Pneumonia
Cryptococcosis
Candidiasis

Question 22

what fungus causes Pneumocystis Pneumonia

Answer 22

Pneumocystis jirovecii pneumonia (PCP)

Question 23

when does Pneumocystis jirovecii pneumonia (PCP) occur

Answer 23

-is normally suppressed by immune system via CD4 cells in healthy people
-in AIDS patients arises when immune system can no longer contain the latent organisms

Question 24

how does Pneumocystis jirovecii pneumonia (PCP) cause damage to alveoli

Answer 24

it is a yeast like fungi able to colonize and grow in the alveoli

Question 25

manifestation of pneumocystis pneumonia caused by Pneumocystis jirovecii pneumonia (PCP)

Answer 25

pneumonia (fluid in the lungs)

Question 26

2 coverages for Pneumocystis pneumonia and their mechanism of action

Answer 26

Bactrim and trimetrexate (used with leucovorin to reduce drug toxicity) inhibits folic acid synthesis pentamidine and atovaquone inhibit electron transport (respiration = ATP synthesis)

Question 27

what drug is used in combo with bactrim and trimetrexate to reduce drug toxicity

Answer 27

leucovorin

Question 28

what is an opportunistic yeast that causes cryptococcosis in HIV patients

Answer 28

Cryptococcus neoformans

Question 29

how is Cryptococcus neoformans transmitted

Answer 29

aerosol inhalation that allows yeast spores to germinate in alveoli

Question 30

what allows cryptococcus to disseminate into the bloodstream and CNS in AIDS patients

Answer 30

deficiency in CD4+ T cells

Question 31

manifestations of cryptococcus

Answer 31

-meningoencephalitis -pneumonia -CNS disease that disseminates from the lungs causing CNS lesions (cryptococcoma)

Question 32

3 coverages for cryptococcus

Answer 32

-amphotericin B -Flucytosine (given with amphotericin B) -Fluconazole

Question 33

mechanism of action and ADR for amphotericin B

Answer 33

causes leaks in ergosterol-rich fungal membranes *nephrotoxic

Question 34

mechanism of action and ADR for flucytosine

Answer 34

disrupts nucleic acid synthesis *bone marrow suppression

Question 35

mechanism of action and ADR for fluconazole

Answer 35

inhibits ergosterol synthesis *CYP3A4 inhibitor

Question 36

what is the most frequent opportunistic infection occuring in nearly all AIDS patients that are not on antifungal prophylaxis

Answer 36

candidiasis

Question 37

where does candida colonize

Answer 37

they are commensal yeasts of skin, genitals and GI tract

Question 38

when does candidiasis occur

Answer 38

when CD4 cells are depleted and Candida can colonize mucocutaneous surface

Question 39

manifestations of candidiasis

Answer 39

oropharyngeal and esophageal candidiasis

Question 40

coverages for candidiasis

Answer 40

-azole antifungals (fluconazole = diflucan) -echinocandins (caspofungin, micafungin)

Question 41

what are protozoan opportunistic infections

Answer 41

-Toxoplasmosis -cryptosporidiosis -cystoisosporiasis

Question 42

what causes toxoplasmosis

Answer 42

reactivation of latent tissue cysts of the intracellular protozoan toxoplasma gondii that arises when CD4 counts drop

Question 43

manifestation of toxoplasmosis

Answer 43

CNS mass lesions

Question 44

transmission of toxoplasmosis

Answer 44

contact with cat feces (pregnant woman should avoid litter box)

Question 45

treatment for toxoplasmosis

Answer 45

-Pyrimethamine + sulfadiazine -Bactrim

Question 46

cryptosporidiosis is caused by what

Answer 46

protozoan GI pathogen Cryptosporidium

Question 47

manifestation of cryptosporidiosis

Answer 47

chronic diarrhea disease in HIV patients

Question 48

transmission of cryptosporidiosis and cystoisosporiasis

Answer 48

fecal-oral waterborne

Question 49

treatment for cryptosporidiosis

Answer 49

nitazoxanide

Question 50

cystoisosporiasis is caused by what

Answer 50

GI protozoan Cystoisospora

Question 51

coverage for cystoisosporiasis

Answer 51

Bactrim

Question 52

HIV patients can develop malignant B cell cerebral lymphoma that often present tumors containing cancerous cells infected with what virus

Answer 52

Epstein Barr Virus (EBV) aka HHV4