opportunistic infections

Question 1

Signs and Sxs of Pneumocystis Carinii Pneumonia

Answer 1

– most common opportunistic infection assoc. with AIDS (very rarely does it occur outside of immunocompromised pts) -fever, cough, SOB (hypoxia: w/o PO2

Question 2

Dx of PCP

Answer 2

• CXR: cornerstone of dx see diffuse or perihelia infiltrates -Wright-Giemsa stain or direct fluorescence AB (DNA) test on induced sputum - bronchoalveolar lavage - Elevated lactase dehydrogenase (LDH): occurs in 95% of cases

Question 3

Risk of getting PCP?

Answer 3

• CD4

Question 4

Prophylaxis of PCP

Answer 4

• continued until CD4 count is above levels used to initiate tx - hx of infection: continue until they have had a durable virologic response to HAART for at least 3-6 months and maintain CD4 count >250

Question 5

Complications of PCP

Answer 5

• increased incidence of pneumothorax, especially with hx of PCP and tx with aerosolized pentamidine

Question 6

MAC (mycobacterium Avian complex) - what it is and dx

Answer 6

• R/O disseminated first if symptomatic - meningeal involvement is most common form of disseminated disease dx: blood cultures will be positive if disseminated

Question 7

Signs and sxs of MAC

Answer 7

• spiking fevers - night sweats - diarrhea - wt loss - wasting - anemia and neutropenia - meningeal signs

Question 8

Risk of MAC occurs?

Answer 8

• when CD4 is less than 50

Question 9

Prophylaxis for MAC

Answer 9

• should be initiated with CD4

Question 10

Kaposi’s sarcoma background

Answer 10

• Moritz Kaposi: 1872 - 4 subtypes - classic K.S. - middle aged men of mediterranean descent - African endemic K.S. - in iatrogenically immunosupressed pts - AIDS related K.S.(most common form seen in U.S.)

Question 11

What will lesions look like and where will they appear in K.S.

Answer 11

• may appear anywhere: most often on face and legs, palate, eyelids, conjunctiva, pinnae, toe webs - look purplish, will be NONBLANCHING, may be papular or nodular, appear more brown in dark skinned people, they are not painful

Question 12

Kaposi’s sarcoma -> visceral disease

Answer 12

• Dermatological Kaposi’s isn’t life threatening - but may progress to visceral disease in about 40% of patients with derm. K.S., thus becoming life-threatening.

Question 13

Signs and Symptoms of KS of intestinal tract

Answer 13

• abdominal pain - diarrhea - intestinal obstruction

Question 14

Signs of KS of lymph system

Answer 14

-swelling of arms or legs

Question 15

KS of the Lungs

Answer 15

• cough, chest pain, SOB, difficulty breathing, extremity swelling, pulmonary blockage (alveoli or vascular system in lungs)

Question 16

Can KS be tx?

Answer 16

• w/ contained skin lesions, tx may not be necessary. Lesions that involve large areas of skin or internal organs, tx is recommended. Tx include: topical meds, surgical removal, freezing with liquid nitrogen, chemo drugs

Question 17

What has been proven to shrink KS lesions in advanced cases where it has affected internal organs? What adverse effects does this have?

Answer 17

• chemotherapy has proven effective - unpleasant SEs as N/V and hair loss - drugs can have damaging affects on the heart and bone marrow, resulting in decrease in number of white blood cells, furthering the risk of acquiring opportunistic infections

Question 18

What are liposomal drugs?

Answer 18

Daunoxome (liposomal form of Daunorubicin) -> tx KS - these are similar to chemo drugs with one exception: they are encased in microscopic fat bubbles which seem to lessen adverse SEs - studies have shown that these forms of drugs last longer and are able to move to the KS affected areas better.

Question 19

What is cryptococcus neoformans? signs and sxs?

Answer 19

• most common life-threatening fungal infection in AIDS -> meningitis - signs and sxs: meningitis/ subtle sxs: fever,, HA, malaise

Question 20

Dx and Tx of cryptococcus neoformans

Answer 20

• latex agglutination serum/CSF testing for AG (CRAG) Tx: amphotericin B (Fungizone, Amphocin) prophylaxis: fluconazole (Diflucan)

Question 21

Cryptosporidiosis (Crypto)

Answer 21

• diarrheal disease caused by microscopic parasite Cryptosporidium - can live in the intestine of humans and animals and passed in the stool - Protected by an outer shell that protects it: allows it to survive outside of the body for extended periods, makes it very resistant to chlorine-based disinfectants - one of the most common causes of waterborne diseases in humans in the US - Parasite is found in every region of US and throughout the world. - ** Generally only affects immunocompromised pts

Question 22

Sxs of Crypto

Answer 22

• most common: watery diarrhea -stomach cramps, dehydration, N/V, fever, wt loss - some pts asymptomatic - small intestine is most commonly infected - sxs begin 2-10 days following infection - non-immunocompromised sxs last 1-2 weeks - HIV pts w/ CD4 200: 2-4 weeks, however, may remain in carrier state and give to others or infect self if CD4 count drops

Question 23

Pathogenesis of crypto parasites

Answer 23

• millions of crypto parasites are released in each BM from infected pts: transmission through fecal oral route, swimming or bathing in contaminated water, drinking contaminated water (most filtration systems don’t filter crypto spores)

Question 24

Dx of crypto

Answer 24

• stool specimens for cryptosporidium - specifically ask for the test (not done on routine O&P on stools) - Acid fast staining, direct fluorescent Ab (DFA), or enzyme immunoassays

Question 25

Tx of crypto

Answer 25

- no approved tx for HIV+ pts, if CD-4 count can be improved, they may have remission but no cure

Question 26

CMV signs and sxs

Answer 26

- most common retinal infection in AIDS pts - signs: perivascular hemorrhages sxs: usually a painless loss of vision, often unilateral, blurred vision, floaters

Question 27

Tx of CMV retinitis

Answer 27

- ganciclovir (cytovene) given in 2 phases: induction and maintenance, due to high relapse rates - alt: foscarnet (Foscavir): less likely to cause neutropenia, but has many other possible AEs

Question 28

GI manifestations in AIDS

Answer 28

- candidal esophagitis: very common in HIV pts, suggestive sxs are tx and only non-responsive pts are give endoscopy - Hepatic disease: autopsy shows that liver is very frequent site for disease/neoplasms, many of these are subclinical, co-infection with Hep B and C is common, low level hepatic disease may be cause for persistent N/V - Biliary Disease: acalculous cholecystitis with sclerosing cholangitis

Question 29

Esophageal candidiasis Signs and sxs

Answer 29

- is an AIDS defining illness, as opposed to oral candidiasis. occurring in individuals with CD4 counts less than 100

Question 30

Dx of esophageal candidiasis

Answer 30

- a presumptive dx can usually be made with a recent onset of dysphagia, especially in the presence of thrush, and empiric anti fungal therapy may be started - if pt fails to improve clinically after 3-7 days of therapy, an endoscopy should be performed for a definitive dx - endoscopy reveals: classiv diffuse raised plaques that characteristically can be removed from mucosa by the endoscope. - brushing or bx of the plaques show hyphae that are characteristic of Candida species.

Question 31

Tx of esophageal candidiasis

Answer 31

- fluconazole 200 mg as initial dose, then 100 mg by mouth once daily for 14 days, IV therapy can be given to pt if pt is unable to swallow pills. - alt (less effective) txs include itraconazole capsules 200 mg once daily or ketoconazole 200 mg once daily for 14 days

Question 32

Acute (Primary HIV) period: Window phase

Answer 32

- its the time between infection and detectable HIV abs (before 25 days)

Question 33

Acute (primary HIV) period: Eclipse phase

Answer 33

- time between infection and detectable HIV RNA (0-10 days)

Question 34

Acute (primary HIV) period: acute illness phase

Answer 34

- symptomatic disease: often precedes positive AB test (b/t day 15 and day 25), when HIV RNA peaks