Opportunistic Infections Flashcards
This OI can manifest at any CD count, even when a patient is on ARV.
Tuberculosis
These OI’s tend to manifest at a CD4 count under 200.
Pneumocystis pneumonia
Oropharyngeal candidiasis
These OI’s tend to manifest at a CD4 count under 100.
Cryptococcal pneumonia + meningitis
Toxoplasmosis
Esophageal candidiasis
These OI’s tend to manifest at a CD4 count under 50.
Disseminated MAC
CMV retinitis
Oropharyngeal candidiasis is preferred to be treated with…
Oral fluconazole - 100mg/day x7-14 days
Esophageal candidiasis can be treated with…
Oral fluconazole - 100-400mg/day x14-21 days
Topical nystatin alone should NOT be used
Pneumocystis pneumonia (PCP) is caused by the fungi…
Pneumocystis Jirovecii
PCP tends to present in immunocompromised hosts as…
Subacute onset syndrome of:
dry cough
fever
exertional dyspnea - hypoxemia
chest discomfort
potentially respiratory failure
Can be identified by chest x-ray, CT, microscopy
PCP prophylaxis is suggested for patients with a CD4 count…
Below 200
Recommended agent for PCP prophylaxis is…
Sulfatrim
Cross coverage for toxoplasmosis + other bacterial infections
Alternative options besides sulfatrim for PCP prophylaxis include…
Dapsone
Pentamidine
Atovaquone
Primary PCP prophylaxis should be discontinued when…
CD4 is over 200 for 3 months, or sometimes when CD4 is between 100-200 and patient is suppressed
PCP treatment first line is with…
Sulfatrim - oral for mild-moderate, IV for severe +/- steroid treatment
Secondary prophylaxis should begin once pt has completed tx
Alternative tx options for PCP include…
Dapsone + TMP, Clindamycin + primaquine
Atovaquone
MAC may present as…
Hepatosplenomegaly - distended abdomen
Malaise, fevers, weight loss, diarrhea, lymphadenopathy, pneumonia
Severe anemia, elevated LFT’s,
MAC prophylaxis is only indicated for patients with…
CD4 count below 50, not on ARV’s or who remain viremic despite ARV tx
MAC prophylaxis is with…
Macrolides - azithromycin
MAC treatment is with…
2+ antimycobacerial drugs: 3-4 considered with CD4 is under 50, high mycobacterial load, +/- absence of effective ART
Clarithromycin
Ethambutol
Rifabutin
MAC treatment duration is for…
12 months, and until CD4 is above 100 for 6 months
Immune reconsitution inflammatory syndrome (IRIS) is a…
Exaggerated inflammatory rxn to a disease-causing microorganism, that can occur once immune system starts to recover following initiation of ARV’s
Mild IRIS can be treated with…
NSAID’s
Symptomatic treatment (ex: inhaled steroids for cough)
OI treatment as necessary
Severe IRIS can be evaluated via…
Corticosteroid may be indicated
Interruption in ARV’s in severe steroid-refractory cases
Specialist involvement
