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Opportunistic Infections Flashcards

1
Q

Normal CD4 count

A

800-1200 cells/mm3

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2
Q

CD4 counts under _________ and especially under _______ are associated with the development of OIs

A

<500; <200

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3
Q

Which OIs can happen at any CD4 cell count

A

-Mycobacterium TB
-pneumonias
-dermatomal varicella zoster

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4
Q

Infections associated with CD4 < 500

A

-candidiasis
-leukoplakia

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5
Q

Infections associated with CD4 <200

A

-pjp
-CMV retinitis
-Toxoplasmosis
-MAC
-Cryptococcus meningitis or diarrhea
-lymphomas
-Kaposi’s sarcoma

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6
Q

Which infections can increase HIV load

A

-tuberculosis
-syphilis

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7
Q

increased HIV load leads to

A

increase risk of viral transmission and progression

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8
Q

primary prophylaxis

A

prevent first epidose

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9
Q

secondary prophylaxis

A

prevent futher recurrences
(already had an episode)

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10
Q

ART

A

antiretroviral therapy

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11
Q

IRIS

A

-fever
-inflammation
-worsening manifestations of OI

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12
Q

IRIS occurs in the (time frame)

A

first 4-8 weeks of ART

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13
Q

IRIS treatment

A

-treat OI
-mild: nsaids, bronchodilators
-severe: prednisone 1-2mg/kg QD for 1-2 weeks

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14
Q

Most common OI

A
  • oropharyngeal candidiasis
  • esophageal candidiasis
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15
Q

Candida species normally inhabit

A

-GI tract
-oropharynx
-female genital tract

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16
Q

majority of candida infections are caused by

A

Candida albicans

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17
Q

Candida albicans is usually susceptible to

A

fluconazole

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18
Q

Oropharyngeal candidiasis is commonly known as

A

thrush

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19
Q

Treatment of Thrush

A

fluconazole 200mg loading dose, followed by 100-200mg PO QD x 7-14 days

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20
Q

Alternative treatments for thrush

A

topical agents
-Nystatin suspension
-clotrimazole troches lozenage

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21
Q

Esophageal candidiasis treatment

A

fluconazole 200mg IV or PO QD x 14-21 days

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22
Q

Vulvovaginal candidiasis:
uncomplicated treatment

A

-fluconazole x 1 dose
- topical azoles x 3-7 days
- ibrexafungerp BID x 1 day

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23
Q

Vulvovaginal candidiasis:
complicated treatment

A

fluconazole 100-200mg PO QD x 7days
or
topical antifungals x 7days

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24
Q

candidiasis prophylaxis

A

NOT recommended

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25
Cryptococcus neoformans affects
aids patients and CD4 counts <100
26
Cryptococcal Meningitis symptoms
-usually present for weeks or months -neck stiffness -photophobia -behavioral changes -impaired memory
27
Cryptococcal Meningitis diagnosis
CSF analysis - increased ICP
28
Cryptococcal Meningitis when to start ART
Delay ART until induction (first 2 weeks) possibly the total consolidation phase to avoid IRIS
29
Cryptococcal Meningitis preferred induction
2 weeks followed by consolidation -Amphotericin B 3-4mg/kg IV QD + flucytosine 25mg/kg PO QID for 2 weeks
30
Cryptococcal Meningitis preferred consolidation
over 8 weeks, followed by maintenance - fluconazole 800mg PO QD
31
Cryptococcal Meningitis preferred maintenance
fluconazole 200mg PO QD for 1 year or longer
32
Cryptococcal Meningitis treatment phases
-induction -consolidation -maintenance
33
Histoplasmosis presentation
- cough and dyspnea -GI issues
34
Histoplasmosis affects
-CD4 counts <200 in endemic areas -cleaning chicken coops -caves
35
Histoplasmosis when to start ART
start together ASAP
36
Histoplasmosis preferred treatment mild-moderate disease
itraconazole 200mg PO TID x 3 days, then 200mg PO BID for atleast 12 months
37
Histoplasmosis preferred treatment severe disease
-liposomal amphotericin B 3mg/kg IV QD for at least 2 weeks -then itranconazole 200mg PO TID x 3 days -then itranconazole 200mg PO BID for at least 12 months
38
Histoplasmosis primary prophylaxis
-CD4 count < 150 -itranconazole 200mg PO QD -may stop in patients on ART for 6 months
39
Histoplasmosis Secondary prophylaxis
-severe or disseminated or CNS infection -itranconazole 200mg PO QD for at least 12 months
40
Mycobacterium avium Complex (MAC) risks
-CD4 < 50 -viral despite ART -previous or concurrent OIs
41
MAC pathogenisis
transmitted through inhalation, ingestion, or inoculation through the respiratory and GI tract
42
MAC symptoms
-gradual onset for several months -disseminated multi-organ infection -night sweats, weight loss, malaise
43
MAC diagnosis
-anemia -elevated liver alkaline phosphatase
44
MAC involves _____ drugs
2
45
MAC preferred treatment
-clarithromycin 500mg PO BID + ethambutol 15mg/kg PO QD or -Azithromycin 500-600mg PO QD + ethambutol 15mg/kg PO QD
46
MAC in severe disease add
rifabutin may consider 4th drug
47
MAC disseminated MAC treatment duration
at least 12 months
48
MAC Primary prophylaxis is recommended for
CD4 count < 50 and not recieving ART
49
MAC primary prophylaxis treatment
azithromycin 1200mg PO once weekly
50
MAC secondary prophylaxis
at least 12 months clarithromycin 500mg PO BID + ethambutol 15mg/kg PO +/- rifabutin 300mg PO QD
51
Pneumocystis jirovecii pneumonia (PJP) pathogenisis
-fungus -spread airborne
52
Pneumocystis jirovecii pneumonia (PJP) risk factors
-advanced HIV (CD4 count <200) -unaware of HIV status -CD4 count < 100
53
Pneumocystis jirovecii pneumonia (PJP) presentation
-subacute onset -dyspnea, fever, non-productive cough, chest discomfort -hypoxemia
54
Pneumocystis jirovecii pneumonia (PJP) diagnosis
-hypoxemic - CXR: butterfly pattern, 'ground glass'
55
Pneumocystis jirovecii pneumonia (PJP) when to initiate ART
w/in 2 weeks of diagnosis
56
Pneumocystis jirovecii pneumonia (PJP) preferred treatment moderate-severe disease
Bactrim 15-20mg/kg day TMP component IV divided q6-8h 21 days
57
Pneumocystis jirovecii pneumonia (PJP) alt treatment moderate-severe disease
-primaquine + clindaymycin PO -pentamidine 4mg/kg IV
58
Pneumocystis jirovecii pneumonia (PJP) Steroid use in moderate to severe
-po2 <70mmHg -start w/in 72h -prednisone 40mg BID x 5 days, then 40 mg PO QD x 5 days, then 20mg QD x 11days
59
Pneumocystis jirovecii pneumonia (PJP) preferred treatment mild-moderate disease
-bactrim 15-20 mg/kg PO TID -bactrim DS 2 tabs PO TID
60
Pneumocystis jirovecii pneumonia (PJP) alt treatment mild-moderate disease
-dapsone 100mg PO QD + bactrim TID -primaquine 30mg PO once + clindamycin -atovanquone 75mg PO BID
61
Pneumocystis jirovecii pneumonia (PJP) Dapsone requires testing of
G6PD
62
Pneumocystis jirovecii pneumonia (PJP) primary prophylaxis for
-CD4 100-200 -HIV RNA level detectable -CD4 <100 -bactrim
63
Pneumocystis jirovecii pneumonia (PJP) Secondary prophylaxis is for
EVERYONE -bactrim
64
Toxoplasma gondii pathology
-severely immunocompromised pts -caused by protozoa found in undercooked meat, cat poop
65
Toxoplasma gondii greatest risk
CD4 count < 50
66
Toxoplasma gondii presentation
-focal encephalitis: HA, fever, focal neurologic deficits, fever -seizure, stupor, and coma
67
Toxoplasma gondii diagnosis
CT or MRI w/ one or more ring-enhancing lesions
68
Toxoplasma gondii treatment duration
at least 6 weeks
69
Toxoplasma gondii ART starts
Wait 2-3 weeks
70
Toxoplasma gondii preferred treatment acute infections
6 weeks -pyrimethamine 200mg PO x 1 followed by weight-based dosing or -bactrim 5mg/kg BID
71
Toxoplasma gondii pyrimethamine weight-based dosing
<60kg : pyrimethamine 50mg POQD + sulfadiazine 1000mg PO q6h + leucovorin 10-25mg PO QD >60kg: pyrimethamine 75mg PO QD + sulfadiazine 1500mg PO q6h + leucovorin 10-25mg PO QD
72
Toxoplasma gondii preferred treatment chronic disease
-Bactrim DS PO BID or -pyrimethamine 50mg POQD + sulfadiazine 3000-4000mg PO q6h + leucovorin 10-25mg PO QD
73
Toxoplasma gondii preferred prophylaxis
bactrim DS PO QD

therapeutics V (19 decks)

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