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diseases that are infectious > OPPORTUNISTIC ILLNESSES IN IMMUNOCOMPROMISED PATIENTS > Flashcards

OPPORTUNISTIC ILLNESSES IN IMMUNOCOMPROMISED PATIENTS Flashcards

1
Q

At what concentration CD4 cells does AIDS occur

A

< 200 / microliter

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2
Q

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

A

> 500 / microliter

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3
Q

how are opportunistic illnesses suppressed in HIV and other immunocompromised patients

A

with antimicrobial prophylaxis

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4
Q

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

A

true

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5
Q

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

A

M.tuberculosis

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6
Q

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

A

HIV patients

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7
Q

what antibiotic class covers TB

A

rifamycins

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8
Q

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

A

induces CYP450

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9
Q

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

A

rifabutin and rifapentine

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10
Q

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

A

M. avium dissimantes
M.intracellulare stays in lungs

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11
Q

what is the pathogenesis of MAC infection

A

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

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12
Q

how to cover MAC infection

A

clarithromycin or azithromycin + anti TB drugs

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13
Q

what are the 3 viral opportunistic infections covered

A

Cytomegalovirus
Progressive Multifocal Leukoencephalopathy
Kaposi Sarcoma

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14
Q

in AIDS patients, what is Cytomegalovirus usually due to

A

reactivation of latent infection (subacute)

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15
Q

CMV disease arises when what count drops

A

CD4

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16
Q

what is the primary manifestation of CMV

A

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

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17
Q

antiviral coverage for CMV

A

ganciclovir
valganciclovir
foscarnet
cidofovir

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18
Q

how does progressive multifocal leukoencephalopathy occur

A

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

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19
Q

in PML what does JCV do to the brain

A

it destroys white matter of the brain

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20
Q

what causes Kaposi Sarcoma

A

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

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21
Q

what are the 3 fungal infections in opportunistic infections

A

Pneumocystis Pneumonia
Cryptococcosis
Candidiasis

22
Q

what fungus causes Pneumocystis Pneumonia

A

Pneumocystis jirovecii pneumonia (PCP)

23
Q

when does Pneumocystis jirovecii pneumonia (PCP) occur

A

-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

24
Q

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

A

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

25
Q

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

A

pneumonia (fluid in the lungs)

26
Q

2 coverages for Pneumocystis pneumonia and their mechanism of action

A

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

27
Q

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

A

leucovorin

28
Q

what is an opportunistic yeast that causes cryptococcosis in HIV patients

A

Cryptococcus neoformans

29
Q

how is Cryptococcus neoformans transmitted

A

aerosol inhalation that allows yeast spores to germinate in alveoli

30
Q

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

A

deficiency in CD4+ T cells

31
Q

manifestations of cryptococcus

A

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

32
Q

3 coverages for cryptococcus

A

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

33
Q

mechanism of action and ADR for amphotericin B

A

causes leaks in ergosterol-rich fungal membranes
*nephrotoxic

34
Q

mechanism of action and ADR for flucytosine

A

disrupts nucleic acid synthesis
*bone marrow suppression

35
Q

mechanism of action and ADR for fluconazole

A

inhibits ergosterol synthesis
*CYP3A4 inhibitor

36
Q

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

A

candidiasis

37
Q

where does candida colonize

A

they are commensal yeasts of skin, genitals and GI tract

38
Q

when does candidiasis occur

A

when CD4 cells are depleted and Candida can colonize mucocutaneous surface

39
Q

manifestations of candidiasis

A

oropharyngeal and esophageal candidiasis

40
Q

coverages for candidiasis

A

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

41
Q

what are protozoan opportunistic infections

A

-Toxoplasmosis
-cryptosporidiosis
-cystoisosporiasis

42
Q

what causes toxoplasmosis

A

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

43
Q

manifestation of toxoplasmosis

A

CNS mass lesions

44
Q

transmission of toxoplasmosis

A

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

45
Q

treatment for toxoplasmosis

A

-Pyrimethamine + sulfadiazine
-Bactrim

46
Q

cryptosporidiosis is caused by what

A

protozoan GI pathogen Cryptosporidium

47
Q

manifestation of cryptosporidiosis

A

chronic diarrhea disease in HIV patients

48
Q

transmission of cryptosporidiosis and cystoisosporiasis

A

fecal-oral
waterborne

49
Q

treatment for cryptosporidiosis

A

nitazoxanide

50
Q

cystoisosporiasis is caused by what

A

GI protozoan Cystoisospora

51
Q

coverage for cystoisosporiasis

A

Bactrim

52
Q

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

A

Epstein Barr Virus (EBV)
aka HHV4

diseases that are infectious (7 decks)

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