Opportunistic Infections Flashcards
what’s a CD4 count for no unusual infections to occur?
above 500
what’s the CD4 range where there is an increased risk for certain infections like shingles, thrush, bacterial and sinus and lung infections, TB, diarrheal infections from cryptosporidium?
200-500
What CD4 count increases risk for Pneumocystis Pneumonia with preventative chemoprophylaxis recommended?
less than 200
At what CD4 count should you start preventative tx for MAC and toxoplasmosis and cryptococcus meningitis?
less than 100
when are you at risk for cytomegalovirus and MAI
less than 50
Route of transmission for Cryptococcis, what type of microbe, clinical approach, tx
aerosolized pigeon poop also in soil often acquired in infancy
yeast
biopsy granuloma
treat with anti-fungal like fluticanozole
Route of transmission for Histoplasmosis, what type of microbe, clinical approach, tx
bird poop found in mid-west, east/southeast especially; ohio and mississippi
dimorphic fungi
coin lesion on chest xray and mimics TB, in immunocompromised the alveoli will fill with yeast and chest xray presents with semi-opaque groundglass appearance (fuzzy but not fibrotic)
treat with azoles
Coccidioidomycosis
Desert fever found in San Joaquin valley or Tuscon a lot from aerosolized poop
dimorphic fungi
Pt. presents with erythema nodosum rash (red nodules on shins) mimicing cancer, granulomas
Treat with azoles
Blastomycosis
Found in the great lakes/southeast, a lot in North Carolina
occurs in skin from spores
Treatment: azoles
Pneumocystis Jirovecii
Acquired during childhood from aerosolized rat/mouse urine
Chest Xray ground glass appearance or get a Bronchial Alveolar Lavage to assess fluid with BAL GMS (sulfur staining)
Treatment: IV Bactrim—this kills organism but also might make body recognize it as antigen and neutrophils recruited, so corticosteroids given before the bactrim to suppress that response that will make hypoxia worse.
Why is it important to get CD4 count up when treating a microbial infection?
If the CD4 count is compromised that indicates immunocompromised status. Both the innate and adaptive immune system need to be intact to properly fight off infection.
