Opportunistic Infections

Question 1

Criteria for initiating primary PCP prophylactic therapy?

Answer 1

Criteria
. CD4+ < 200 cells/mm3-OR-
. CD4% <14% -OR-
. CD4+> 200and <250 cells/mm3, cART delayed, lack monitoring

Question 2

Which alternative may be used in patients with sulfa allergy for primary PCP therapy?

Answer 2

. Dapsone

Question 3

Gene testing for which deficiency should be done prior to initiating dapsone or primaquine?

Answer 3

G6PD deficiency

Question 4

Which agent may be used first line for primary PCP therapy?

Answer 4

Bactrim DS QD

Question 5

Which alternatives may be used in patients with sulfa allergy for primary PCP therapy with mild-moderate hypoxemia?

Answer 5

. Dapsone
. Primaquine
. Atovaquone w/food

Question 6

Which alternatives may be used in patients with sulfa allergy for primary PCP therapy with moderate-severe hypoxemia?

Answer 6

. IV pentamidine
. Primaquine PO + clindamycin PO/IV

Question 7

Corticosteroids as primary PCP therapy should be initiated within _____ hours

Answer 7

72 hours

Question 8

Dosing bactrim for PCP therapy is based on the (sulfamethoxazole/trimethoprim) component

Answer 8

Trimethoprim

Question 9

Secondary PCP therapy should be initiated when in comparison to primary therapy?

Answer 9

After 21 days of primary therapy

Question 10

CD4 count < ___ cells/mm^3 have the greatest risk of infection by toxoplasmosis gondii?

Answer 10

50

Question 11

True or false: Dapsone may be used as monotherapy in TE primary therapy

Answer 11

False. Dapsone by itself does not cover toxoplasmosis gondii, should be administered with pyrimethamine

Question 12

Which regimen should be initiated first line in cute TE therapy?

Answer 12

Pyrimethamine 200 mg PO x 1, then 50 mg (≤60 kg) or 75 mg (>60 kg) PO daily + sulfadiazine 1,000 mg (≤60 kg) or 1,500 mg (>60 kg) PO q6h + leucovorin 10–25 mg PO daily (can ↑ 50 mg or BID)

Question 13

Duration of acute TE therapy

Answer 13

≥ 6 wks or until clinical or radiologic improvement

Question 14

When may chronic TE therapy be discontinued? Restarted?

Answer 14

Discontinuation:
*Free of s/sx
*CD4+ > 200 cells/mm3 x > 6 mo. on cART
Restart:
CD4+ < 200 cells/mm3

Question 15

Mycobacterium avium-intracellular complex (MAC) primary therapy?

Answer 15

. Azithromycin PO 1200mg/week or azithromycin 600mg PO twice weekly
. Clarithromycin 500mg PO BID

Question 16

Why may azithromycin be a preferred agent over clarithromycin?

Answer 16

Azithromycin has lower risk of QTc prolongation. Clarithromycin is a substrate and strong inducer of CYP3A4, more side effects

Question 17

When may MAC therapy be discontinued? Restarted?

Answer 17

Discontinuation:
*Completed ≥ 12 mo therapy and
*No s/sx MAC dx and
*CD4+ >100 cells/mm3 x > 6 mo. in response to cART
Restart: CD4+ < 100 cells/mm3 and unable to suppress on cART

Question 18

True or false: Clarithromycin is the preferred macrolide due to the lack of drug-drug interactions and increased tolerability

Answer 18

False

Question 19

Length of phase I cryptococcosis induction therapy

Answer 19

At least 2 weeks

Question 20

What is the first line induction therapy for C. neoformans-associated meningitis?
A. Amphotericin B deoxycholate + fluconazole
B. Amphotericin B deoxycholate + flucytosine
C. Liposomal Amphotericin B + flucytosine
D. Liposomal Amphotericin B + fluconazole

Answer 20

C. Liposomal Amphotericin B + flucytosine

Question 21

PCP transmission

Answer 21

Inhaled fungus

Question 22

Identify a common risk factor associated with acquisition of Cryptococcus spp.
a. Touching a contaminated fomite (object)
b. Inhalation of pathogen in aerosolized droplets
c. Ingestion of contaminated raw pork
d. Person-to-person in crowded spaces
e. Exposure to pigeon guano (feces)

Answer 22

e. Exposure to pigeon guano (feces)