Opportunistic infections Flashcards
What are the three mucocutaneous candida infections that people with HIV are susceptible to?
- Thrush
- Esophagitis
- Painful swallowing, obstruction, and substernal chest pain - Vulvovaginitis
- cottage cheese, itchy discharge
What might you see with candida cystitis?
- papillary necrosis
- fungal ball formation
- Abscesses
How do you treat invasive candidiasis?
Fluconazole.
If a bad infection, consider Ampho B or caspofungin IV
How long should you treat a fungal infection for?
2 weeks beyond the last positive culture
What is a draw back of caspofungin (i.e. in what scenario of candida infection would you NOT use it?)
Meningitis–doesn’t penetrate the CSF well
How do you treat candida cystitis?
Just remove the catheter and let it resolve. If an immunocompromised pt, consider an amphotericin bladder wash
How does aspergillus present?
- Allergic bronchopulmonary aspergillosis
2. In immunosuppressed, can have vascular invasion and infarction with hemoptysis
How do you diagnose aspergillus?
- culture
- histology
- galactomannan serology test as an ADJUNCT to errything else
How do you treat aspergillus?
- VORICONAzole
where would you find zygomycosis?
Errywhere. It’s found in decaying matter
Who gets zygomycosis (i.e. mucurmycosis)?
NOT very virulent–
diabetics, hemachromatosis, and leukemia pts
What is the presentation of someone with mucormycosis?
- cerebral abscess
- rhinocerebral mucormycosis causes bad sinusitis
- Can erode through the skull
How do you diagnose mucormycosis?
Pathology
Culture
How do you treat mucormycosis?
HIGH mortality
- POSACONAZOLE
- surgery
- ampho B
- Treat hyperglycemia and acidosis
How does cryptococcus present?
Meningoencephalitis
- headaches, malaise, impaired memory, judgment
- hydrocephalus later on
How do you diagnose crypto?
cryptococcal antigen test. Can confirm with culture/ India ink
Should you start haart therapy or crypto therapy first in an HIV positive pt?
start crypto first because otherwise body will suddenly have a strong immune response to the crypto (IRIS=Immune reconstitution inflammatory syndrome)
How do you treat crypto?
Ampho B and flucytosine is the gold std
–switch to fluconazole after 2 weeks
What does congenital rubella look like?
- hearing impairment
- heart defect
- patent ductus
- cataracts
What does congenital toxo look like?
Bronze skin (jaundice) with red rashes and bruises
- chorioretinitis
- hemolysis
- thrombocytopenia
How do you treat otitis media?
amoxicillin
