Opportunistic Infections Flashcards
Which organisms can cause opportunistic infections?
Bacteria, Fungi, Viruses and protozoa
What criteria define immunocompromised state?
5 things
- Diseases that destroy immune system (HIV CD4 < 200)
- Systemic steroids 14 days or longer of pred equivalent of >20mg/day or >2mg/kg/day
- Asplenia
- Immunosuppressant medications (TNF, methotrexate, etc.)
- Chemo that destroys WBC
Severe neutropenia (WBC count < ____) is a major risk factor for developing infections.
< 500
What prophylaxis is recommended for candidiasis in an HIV patient?
None (both primary and secondary PPX for candida in the blood is not recommended).
What are the 3 main types of opportunistic infections that affect HIV patients?
- Pneumocystis pneumonia (PCP)- caused by jirovecii organism
- Toxoplasma gondii encephalitis
- Mycobacterium avium complex (MAC)
What CD4 count is an indication to start primary PPX against PCP? What is the preferred treatment? Alternative therapies?
CD4 < 200
Preferred: 1 Bactrim tablet daily (DS or SS)
Alternative: Dapsone, aerosolized pentamidine, atovaquone
What CD4 count is an indication to start primary PPX against Toxoplasma gondii encephalitis? Preferred and alternative therapies?
CD4 < 100
Preferred: Bactrim DS daily
Alternative: Dapsone + pyrimethamine + leucovorin OR atovaqoune
What CD4 count is an indication to start primary PPX against MAC? Preferred and alternative therapies?
CD4 >50
Preferred: Azi 1200 PO weekly (or 600 BIW), OR clarithromycin 500 BID
How to treat oropharyngeal/esophageal candidiasis?
Preferred and alternative
Preferred: Fluconazole
Alternative: itraconazole, posaconazole
How to treat cryptococcal meningitis?
Preferred and alternative
Secondary PPX?
Preferred: Amphotericin B + flucytosine
Alternative: Fluconazole + flucytosine
Secondary PPx: Low dose fluconazole
How to treat cytomegalovirus (CMV)?
Preferred and alternative
Secondary PPX?
Preferred: Valgancyclovir or gancyclovir
Alternative: Foscarnet, cidofovir
Secondary PPX: Valgancyclovir
How to treat MAC?
Preferred and alternative
Secondary PPX?
Preferred: Clarithromycin OR Azith + ethambutol
Alternative: Add 3rd or 4th agent: rifabutin, amikacin, streptomycin. moxifloxacin or levaquin
Secondary PPX: Same as treatment
How to treat PCP?
Preferred and alternatives
Secondary PPX?
Preferred: Bactrim + prednisone X 21 days
Alternative: Atovaquone or pentamidine IV or dapsone + trimethoprim
Secondary PPX: Bactrim or dapsone + pyrimethamine + leucovorin OR atovaquone
How to treat toxoplasmosis gondii encephalitis?
Preferred and alternative
Secondary PPX?
Preferred: Pyrimethamine + leucovorin +/- sulfadiazine
Alternative: Bactrim, clinda/azi
2’ PPx: Same at lower dose
