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Clinical 2.0 > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

1
Q

what are opportunistic infections

A

infections that are more frequent or more severe because of immunosuppresion

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2
Q

examples of opportunistic infections

A 
pneumocystic carnii pneumonia
candida
aspergillosis 
toxoplasmosis 
CMV
HSV
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3
Q

management of acute OI no ART

A

OI presenting symptoms
start treatment for the OI
start HAART during treatment (usually)

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4
Q

what is immune reconstitution inflammatory syndrome

A

fever, worsening clinical signs of the OI or symptoms of the new OI
occur in the first weeks after starting ART
unmasks new infection the IS was too weak to respond to before

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5
Q

management of OI shortly after initiation (within 12 weeks) of ART

A

subclinical infection unmasked by early immune reconstitution not failure of ART
start treatment of OI and continue ART

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6
Q

OI occurs >12 weeks after initiation of ART in patients with CD4 count > 200 and suppressed HIV RNA

A

may be difficult to determine whether IRIS or new OI due to incomplete immunity
start treatment of OI continue ART
consider modifying ART if CD4 response to ART suboptimal

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7
Q

OI in patient with immunologic and virologic failure on ART

A

start treatment for OI , modify ART for better virlogic control

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8
Q

two fungal OI

A

mucocutaneous candidiasis

pneumocystis carnii pneumonia

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9
Q

clinical manifestation of mucocutaneous candidiasis

A

thrush
esophageal - burning, white plaques
vulvovaginal

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10
Q

treatment for mucocutaneous candidiasis

A

treat 7-14 days oral fluconazole

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11
Q

mucocutanous candidiasis prophylaxis

A

routine prophylaxis not recommended

acute therapu highly effective, could lead to drug resistance, DI

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12
Q

define primary prophylaxis

A

prevention before development of disease

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13
Q

define secondary prophylaxis

A

prevention of reoccurrence - after treatment of OI

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14
Q

how is PCP pneumonia acquired

A

in the environment exposed during early childood

usually have healthy antibodies but may result from reactivation or new exposure

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15
Q

clinical manifestation of PCP

A 
dyspnea, fever, nonproductive cough, chest discomfort 
hypoxemia 
subacute onset 
CXR bilateral infiltrates 
diagnosis with organism in the sputum
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16
Q

treatment of PCP

A

untreated = 100% mortality
TMPSMX iv for 21 days
prednisone for mod-sev to decrease inflammation

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17
Q

when to start ART if not on it and get PCP

A

initiate within 2 weeks of diagnosis if signs of clinical improvement

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18
Q

PCP prophylaxis

A

initiate primary in patient with CD4<200(basically if they have AIDS) or history of oropharyngeal candidiasis
primary/secondary proph for life unless immune reconstitution on ART
only discontinue in patients with ART with sustained increase in CD4>200 for >3months
restart if CD$ drops below 400 or PCP occurs

19
Q

prophylaxis DOC

A

TMPSMX DS 1 tab daily or 3 times a week

20
Q

example of parasitic infection

A

toxoplasma gondii encephalitis

21
Q

how do you acquire toxoplasma gondii

A

primary infection from tissue cysts in raw or undercooked meat or ingestion of sporulated oocyts (from cat feces) in sol water or food
no transmission person to persion

22
Q

who does toxoplasma gondii normally occur in

A

patients with CD4 <50

23
Q

clinical presentation of toxoplasma gondii

A

CNS - fever, headache, seizure

dissemination - other organ involvement

24
Q

diagnosis of toxoplasma gondii

A

CT MRI of brain shows contrast enhacning lesions often with edema
detection of organism with brain biopsy - invasive
toxoplasmosis IgG antibody positive

25
Q

preferred regimen of toxoplasma gondii

A

pyrimethamine +sulfadiazine + leucovorin

but very expensive

26
Q

potential and alternative regimens for toxoplasma gondii

A

alternative: pyrimethamine + clinda + leucovorin - doesnt protect against PCP
potential regimen: TMPSMX can be considered an option if reason not to use preferred

27
Q

duration of treatment for toxoplasma gondii

A

> 6 weeks

28
Q

toxoplasma gondii adjuvant treatment

A

adjunctive corticosteroids if indicated for treatment of cerebral swelling, discontinue as soon as possible
anticonvulsants should be given if history of seizures

29
Q

when to start ART when infected with toxoplasma gondii

A

no set recommendation

many start within 2-3 weeks of toxoplasmosis diagnosis

30
Q

primary prophylaxis for toxoplasma gondii

A

TMPSMX DS 1 tab daily or 3x a week

alternative: dapsone-pyrimethamine + leucovorin, atovaquone

31
Q

when should toxoplasma gondii prophylaxis be given

A

CD4 count <100 cells and positive IgG

32
Q

when to discontinue primary prophylaxis for toxoplasma gondii

A

CD4> 200 for > 3 months on ART

reintroduced if CD4 decreases to <200

33
Q

secondary prophylaxis for toxoplasma gondii

A

pyrimethamine + sulfadiazine + leucovorin

alternatives: pyrimethamine +clinda, atovaquone

34
Q

when should you discontinue secondary prophylaxis for toxoplasma gondii

A

if completed initial therapy and remained asymptomatic and have a sustained increase in their CD4 counts >200 cells after ART >6months

35
Q

treatment of mycobacterial infections

A

concomitant but staggered start of HAART in patients not already on HAART due to AE from medicationa and risk of severe IRIS
start of HAART based on CD4 count

36
Q

significant _____ between antiretrovirals and TB meds

A

drug interactions

37
Q

transmission of mycobacterium avium complex

A

inhalation, ingestion, or inoculation via resp tract or GI

MAC organisms everywher in the environment

38
Q

who is at a major risk of disseminated MAC

A

CD4 count <50

39
Q

diagnosis of disseminated MAC

A

culture of organism from blood, bone marrow, lymph node or other normally sterile tissue or fluid

40
Q

symptoms of disseminated MAC

A

multiorgan infection
pneumonitis, pericarditis, skin abcess….
fever, nigh sweats, weight loss….

41
Q

initial treatment of disseminated MAC

A

> 12 months
at least 2 effective drugs to prevent reisstance
preferred: clarithromycin + ethambutol
alternative*: azithro + ethambutal

42
Q

when to initiate ART in disseminated MAC

A

asap after effective treatment

43
Q

when to use secondary prophylaxis in disseminated MAC

A

lifelong chronic maintenance therapy after completion of intial therapy unless immune reconstitution on ART
consider discontinuation if treated >12mon, no signs of symptoms of MAC, sustained increase in CD4 count to >100 cells

44
Q

primary prophylaxis for disseminated MAC

A

indicated if CD4 <50
azithro 1200mg once weekly
alternative: rifabutin
discontinue when patient of ART with CD4 >100 for >3 months

Clinical 2.0 (24 decks)

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