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Clin Med I Exam I > Opportunistic Infections > Flashcards

Opportunistic Infections Flashcards

1
Q

Opportunistic infections are always considered?

A

chronic (>21 days)
7 days = acute
7-21= subacute

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2
Q

What are the factors that ↑ risk for fungal infection?

A
  • Severity of impairment of cell-mediated immunity
  • Recent current use of anti fungal medication
  • Risk of exposure
  • Neutropenia (invasive candidiasis and aspergillosis)
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3
Q

What is the ideal number for count of CD4+ T helper cells ?

A

650

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4
Q

What are the two forms of Criptococcus that often cause infection in humans?

A

C. neoformans and C. gattii

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5
Q

Transmission of Criptococcus is via?

What happens to the spores once they enter the body?

A

air droplets and bird droppings

spores are inhaled, lodged into the lung alveoli then disseminate hematogenouly and cause infection

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6
Q

The most common manifestation of cryptococcal infection is ?

A

meningitis

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7
Q

What are the main characteristics of criptococcus infection ?

What is the test of choice to diagnose a Criptococcous infection?

A
  • Malaise (76%)
  • Headache** (73%)
  • Fever
  • N/V
  • Cough/SOB (31%)
  • Altered Mental Status

Cryptococcal antigen in CSF

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8
Q

Criptococcous infection has more tropism to affect what part of the body?

How do you treat a Criptococcous infection?

A

the brain

amphotericin B 80%
fluconazole 50%

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9
Q

Histoplasmosis infection occurs by?

A
  • inhalation

- exposure to chicken coops

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10
Q

How long does it take to see symptoms in Histoplasmosis infection?

What are those symptoms?

A

1-3 months after exposure

main characteristics:

  • fever, weight loss, skin ulcers,
  • hepato-splenomegaly, lymphadenopathy
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11
Q

Histoplasmosis infection likes to affect what areas

A

LUNGS first then connective tissue

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12
Q

What test would you use to diagnose a Histoplasmosis infection?

A

Urine: H Capsulatum antigen

→ sensitivity 95%

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13
Q

How do you treat Histoplasmosis infection

A

-Amphotericin B
→ very nephrotoxic (hypokalemia/magnesia)
→ use central line b/c it can damage peripheral system

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14
Q

Oral Candidiasis is more common with a CD4 below?

What can you contract if your CD4 is below 100?

A

Oral Candidiasis is more common with a CD4 below?
→ 300

What can you contract if your CD4 is below 100?
→ Esophagitis

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15
Q

In most cases of oral candidiasis the strain causing the disease is derived from… ?

A

the patients own flora

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16
Q

The 4 types of Oral Candidiasis are?

A

“HEAP”
-Hyperplastic -raised hard lesion “bump” on tongue

  • Erythematous (distinct redness on hard palate)- may have white spots
  • Angular Cheilitis (confused w/ Pseudomembranous, if you try to remove the spots the it won’t go anywhere)
  • Pseudomembranous
17
Q

How do you treat Oral Candidiasis ?

A

Itraconazole or
Fluconazole (DOC)

  • Avoid topical treatments
  • avoid drug (NYSTATIN)
18
Q

What are the signs you should listen for when taken a patient hx when trying to diagnose Oral Candidiasis ?

A

solids feel like it doesn’t advance and when it does advance its painful

19
Q

Most patients with Oral Candidiasis and esophageal symptoms have ?

A

Esophageal candidiasis but not all patients with esophageal candidiasis have Oral Candidiasis

20
Q

Esophageal Candidiasis is the most common cause of ?

A

dysphagia and odynophagia in AIDS

21
Q

The best test for the detection of Oral Candidiasis is ?

How do you treat Oral Candidiasis?

A
  • EGD- upper GI endoscopy he upper GI tract includes your food pipe (esophagus), stomach, and the first part of your small intestine (the duodenum).
  • Treatment: Fluconazole DOC (use drug via IV if pt is unable to swallow)
22
Q

HIV copies about what number makes it transmittable ?

A

20 copies

23
Q

What is Pneumocystis Jirovecii?

A

its a fungus (NOT PARASITE) with unique tropism for the lung and rarely invading the host by attaching to the alveolar epithelium

24
Q

What are the signs and symptoms of Pneumocystis Jirovecii?

A
  • inflammation in lung → fever (IL-6)
  • interstitial edema → non productive cough
  • diffuse alveolar damage→ SOB (dyspnea)
25
Q

What triggers Pneumocystis Jirovecii?

A

environmental exposure, less often via reactivation latent infection

26
Q

What is the best imaging and lab test to detect Pneumocystis Jirovecii?

What is the preferred treatment?

A
  • imaging: HRCT chest (if normal no PCP)
  • lab test: BAL + immunofluorescence

TMT-SMX

27
Q

Worldwide about 90% of people older than 18 years old are seropositive for ?

A

CMV (in USA and Canada, 50% once infected, carrier life long)

28
Q

CMV affects what parts of the body?

A
  • Mainly Retina
  • CNS and GI tract
  • Rare in lung
29
Q

CMV Retinitis signs and symptoms?

A

-no pain, but floaters, blurry vision, ↓ peripheral vision
-light flashes (sign retina is detaching) or sudden vision loss can occur
→ blindness due to retina detachment 2-6 months if untreated
-usually starts in one eye but often involves both eyes

30
Q

How to diagnosis CMV retinitis ?

A

Perivascular fluffy yellow-white retinal infilitrate +/- hemorrhage

31
Q

Signs and symptoms of CMV in immunocompetent patient ?

What test would you order?

A
  • abnormal LFT’s
  • fever
  • malaise

PCR viral load (blood test)

32
Q

What is Toxoplasmosis and what causes it?

A

A parasite infection caused by T. gondii

33
Q

The annual risk of developing Toxoplasmosis encephalitis among patients with a CD4 less than 100 and seropositive?

The annual risk of developing Toxoplasmosis encephalitis among patients with a CD4 less than 50 and no prophylaxis?

A

The annual risk of developing Toxoplasmosis encephalitis among patients with a CD4<100 and positive serology is 30% and 75% if CD4<50 if they do not receive prophylaxis

34
Q

What are the clinical symptoms of Toxoplasmosis?

What are the clinical signs

A

Symptoms:

  • headache/confusion
  • fever
  • lethargy
  • seizure**
  • Significant wasting**

Signs:

  • Focal sign
  • Fever
  • Altered Mental State
  • Psychomotor Retardation
  • Meningismus (stiff neck and febrile situation)
35
Q

What is the best diagnostic imaging and lab tool to use ? Why?

A

MRI brain (look for more than one lesion)
→ because CNS lymphoma may look similar then obtain IgG serology for T. gondii
→ If LP was done then order cytology for malignant cells and EBV PCR
→ where available order PCR for T. gondii

36
Q

What is the best course of treatment for Toxoplasmosis ?

A
  • Pyrimethamine+Sulfadiazine +Leucovorin

- Brain biopsy just if no clinical or radiological improvement after 14 days of anti-toxoplasma therapy

Clin Med I Exam I (9 decks)

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