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Opportunistic Infections Flashcards

1
Q

What OIs are likely between 350-250 CD4 cell counts?

A

Bacterial skin infections
Varicella Zoster
Kaposi’s sarcoma

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2
Q

What OIs are likely between 250-150 CD4 cell counts?

A

Oral Candiasis (~249)
Pneumocystis carinii pneumonia
Non-Hodgkin’s lymphoma

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3
Q

What OIs are likely between 150-50 CD4 counts?

A

Cryptococcal meningitis

Herpes simplex virus infections

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4
Q

What OIs are likely between 50-0 CD4 counts

A

CMV infections

Mycobacterium-avium complex

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5
Q

What is Carini pneumonia?

A

Organism with protozoal and fungal properties,
Classified as a fungus.
Part of normal colonization in the lungs.
Only immunocompromised are at risk for a disease.

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6
Q

What are the s/sx of Carini pneumonia?

A 
Usually slow onset (days to weeks).
Fever
Fatigue
Dyspnea
Tachypnea
Non-productive cough
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7
Q

What is the most common form of PCP?

A

Pneumonia

Oral thrush is a common co-infection

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8
Q

How do you diagnose PCP?

A

CXR
ABG
Sputum culture

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9
Q

What is the first line treatment for moderate-severe PCP?

A

Bactrim 15-20mg/kg/d IV in 3-4 doses x 21 days

Switch to PO after clinical improvement

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10
Q

What is the first line treatment for mild-moderate PCP?

A

Bactrim 15-20mg/kg/d PO in 3 divided doses or Bactrim DS 2 tabs TID x 21 days

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11
Q

When are adjuvant steroids prescribed in PCP?

A

Pts with severe PCP and PaO2 < 70.

Must be started within 72 hours of treatment

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12
Q

What is the steroid regimen for PCP?

A

Started within 72 hours of treatment.
Mortality rates and rates of respiratory failure are reduced.
If patient is unable to take PO, use IV methylprednisolone (75% of PO prednisone dose)

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13
Q

What is the prednisone dose in PCP?

A

40mg BID days 1-5, then 40mg QD days 6-10, then 20mg QD days 11-21

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14
Q

In what patients do we have primary prophylaxis of PCP?

A 
CD4 < 200, or
CD < 14%, or
A hx of oropharyngeal candidiasis, or
A hx of AIDS-defining illness, or
CD4 > 200 but < 250 if CD4 cell count monitoring (e.q. q3months) is not possible
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15
Q

What is first line primary prophylaxis therapy for PCP?

A

Bactrim DS 1 tab QD
OR
Bactrim SS 1 tab QD

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16
Q

When do we d/c primary prophylaxis therapy for PCP?

A

Patients who have responded to HAART with an increase in CD4 count to >/= 200 for >/= 3 months

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17
Q

What is the difference between primary and secondary prophylaxis therapy for PCP?

A

None, same regimen and reasons to d/c

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18
Q

What is toxoplasmic encephalitis?

A

Toxoplasma gondii.
Intracellular parasite (protozoa).
Passed to humans from raw or undercooked meat and by contact with feces from infected cats.

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19
Q

What are the s/sx of toxoplasmic encephalitis?

A 
CNS infection
Typically assocaited with fever
Seizures
Focal neurological deficits
Other sx associated with encephalitis
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20
Q

How do you diagnose toxoplasmic encephalitis?

A

Serological testing for Toxoplasma IgG
Neuroradiological scans (CT or MRIs)
Brain biopsy

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21
Q

What does IgG show?

A

Past infxn

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22
Q

What does IgM show?

A

Current infxn

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23
Q

When do we take a brain biopsy for toxoplasmic encephalitis?

A

Usually reserved for patients refractory to empiric therapy

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24
Q

What is the 1st line therapy for toxoplasmic encephalitis?

A

Sulfadiazine + pyrimethamine + leucovorin for >/= 6 weeks

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25
What do we use if pyrimethamine is not available or delayed?
Bactrim 5mg/kg IV BID x 6 weeks
26
When do we use primary prophylaxis for toxoplasmic encephalitis?
CD4 < 100 and toxoplasma IgG +
27
When do we d/c primary prophylaxis for toxoplasmic encephalitis?
After response to HAART and CD4 > 200 x >/= 3 months
28
What is used for secondary prophylaxis of toxoplasmic encephalitis?
Sulfadiazine + pyrethamine + leucovorin
29
When do we d/c secondary prophylaxis for toxoplasmic encephalitis?
After completion of initial therapy, and CD4 > 200 on HAART >/= 6 months
30
What is Cryptococcus meningitis?
Cryptococcus neoformans. Encapsulated yeast. The most common life-threatening fungal infection in AIDs patients. Organism is ubiquitous in the environment and found in soil. Exposure to aged bird droppings may increase the risk of infection.
31
What are the s/sx of Cryptococcus meningitis?
``` Progressive development of fever and/or HA, neck stiffness, photophobia, CNS changes. Disseminated disease (skin, pulmonary) with cryptococcus is common. ```
32
What is the 1st line treatment for Cryptococcus meningitis?
Liposomal ampho B + 5-FU x at least 2 weeks. Followed by fluconazole 400mg qd x 8 more weeks. Then chronic suppression with fluconazole 200mg QD for at least 1 yr
33
What is the primary prophylaxis for Cryptococcus meningitis?
None recommended
34
What is the secondary prophylaxis for Cryptococcus meningitis?
Chronic suppression. | Fluconazole 200mg QD
35
When do we d/c secondary prophylaxis for Cryptococcus meningitis?
After completion of initial therapy, patients must be asymptomatic, and have a sustained increase in CD4 > 100 after HAART x at least 3 months after the 1st year
36
What does MAC/MAI stand for?
Mycobacterium avium complex/infection
37
What is MAC?
Comprised of mycobacterium avium and Mycobacterium intracellulare. Ubiquitous in nature, commonly inhabiting soil and water. Typically begins w/colonization of the intestinal or respiratory tracts after organism ingestion or inhalation, with subsequent development of localized infection and sometimes seeding of the blood.
38
What are the most common s/sx of MAC?
``` Typically a multiorgan system disease in AIDs patients Fever Night sweats Anorexia Weight ```
39
What are the common s/sx of MAC?
``` Diarrhea Abdominal pain Increased LFTs Anemia Neutropenia Thrombocytopenia ```
40
What are the less common s/sx of MAC?
Hepatomegaly Splenomegaly Lymphadenopathy
41
What are the ways to diagnose MAC?
Culture is gold standard, but some pts with - blood cx for MAC will have positive liver, bone marrow or lymph node biopsies, which would confirm the diagnosis. Organism takes 2-6 weeks to grow. Clinical improvement on empiric therapy also helps confirm a presumptive diagnosis.
42
What is the first line treatment for MAC?
Clarithromycin 500mg BID + ethamutol 15mg/kg/d OR When DDIs/intolerance precludes the use of clarithromycin, Azithromycin 500-600mg/d + EMB 15mg/kg/d
43
When do you d/c first line therapy for MAC?
Completion of at least 12 months of treatment, remain asymptomatic and have CD4 count > 100 for > 6 months on HAART, and negative cultures
44
Who should receive primary prophylaxis of MAC?
Pts with CD4 < 50
45
What is the primary prophylaxis therapy for MAC?
``` Azithromycin 1200mg qweek OR Clarithromycin 500mg BID OR Azithromycin 600mg twice weekly ```
46
When do you d/c primary prophylaxis of MAC?
CD4 > 100 for >/= 3 months
47
What is CMV?
Envoloped double-stranded DNA virus that is a member of the Herpesvirus family. It can become latent within infected cells. Transmission occurs through infected body fluids.
48
Where can CMV manifest?
Various different organ systems in immunocompromised hosts, but in AIDs pts - 2/3 of cases are CMV retinitis May also manifest as sophagitis, colitis, or neurologic CMV
49
What may happen if CMV retinitis is not treated?
Rapidly progress to retinal necrosis and permanent blindness
50
WHat are the s/sx of CMV?
Visual changes Flashes of light Blurred vision Blind sports (floaters)
51
How do you diagnose CMV?
Clinical diagnosis | Culture and antigen detection are the most sensitive methods for detecting CMV in histological samples
52
What is the 1st line therapy for CMV retinitis: for sight threatening lesions?
Intravitreal injections of ganciclovir or foscarnet for 14 doses over a period of 7-10 days PLUS Valganciclovir 900mg PO BID x 14-21 days, then once daily
53
What is the 1st line therapy for CMV retinitis: for small peripheral lesions?
Valganciclovir PO 900mg BID x 14-21 days, then once daily
54
What is the 1st line therapy for CMV esophagitis or colitis?
Ganciclovir IV x 21-42 days or until resolution of sx. PO valganciclovir if PO absorption is adequate. Maintenance therapy usually not necessary, but should be considered after relapses.
55
What is the 1st line therapy for CMV neurological disease (PROMPT initiation of treatment)?
Combination of ganciclovir IV + foscarnet IV to stabilize disease and maximize response, continue until symptomatic improvement. Maintenance therapy with PO valganciclovir + IV foscarnet should be continued lifelong unless there is evidence of immune recovery.
56
What is secondary prophylaxis of CMV retinitis?
Suppression | Valganciclovir 900mg once daily
57
When do you d/c CMV therapy?
CD4 > 100 for >/= 3-6 months on HAART
58
When is primary prophylaxis of CMV considered?
Pts with CD4 < 50 and CMV IgG +
59
What is primary prophylaxis therapy for CMV?
Oral ganciclovir or valganciclovir
60
Why do we not use primary prophylaxis for CMV?
High cost Toxicity Development of resistance
61
How is primary prophylaxis monitored?
Fundascopic examinations by an opthalmologist
62
What are Bactrim's ADR?
``` Rash SJS Photosensitivity Fever Leukopenia Thrombocytopenia GI Hepatitis High K ```
63
What is sulfadiazine's ADRs?
``` Rash Fever Leukopenia Hepatitis N/V/D Crystalluria ```
64
What are pyrimethamine's ADRs?
Bone marrow suppression (increasing leucovorin can help with bone marrow suppression) Rash Nausea
65
What are amphotericin's ADRs?
Renal Infusion rxns Fever, Chills, Rigors (give APAP, diphenhydramine, hydrocortisone, meperidine) Decreased K and Mg Lipid formulations less likely to cause these
66
What are fluconazole's ADRs?
GI | LFTs
67
What are clarithromycin's ADRs?
GI | Taste disturbances
68
What are azithromycin's ADRs?
GI
69
what are EMB's ADRs?
Oculotoxicity: optic neuritis and loss of red-green color perception; loss of cisual acuity USE smaller doses of 15 mg/kg/d to avoid
70
What are ganciclovir/valganciclovir's ADRs?
Bone marrow suppression (esp neutropenia) GI LFTs
71
What is 5-FC's ADRs?
Bone marrow suppression Renal GI

Infectious Disease (19 decks)

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