Opportunistic Infections of Immunocompromised

Question 1

CD4 immunity protects against

Answer 1

Fungi, mycobacterium, viruses, protazoan

Question 2

Non OI (opportunistic infection) that occur at any CD4 count

Answer 2

1. VZV
2. Bacterial penumonia
3. Crytosporidium
4. TB

Question 3

Is oral trush from Candida an OI?

Answer 3

NO (candida esophagitis is though)

Question 4

What is IRIS (immune reconstitution inflammatory syndrome)?

Answer 4

When you start taking ART, you have a brisk increase in CD4 counts, which could allow your immune system to respond to any pathogens you had lying around your body (CMV, TB) that you couldn’t respond to before because your CD4 counts were so low
Can present as hypersensitivity rxn (fever, lymphadenopathy)

Question 5

How do you treat IRIS?

Answer 5

Continue ART, usually self limited

Question 6

What kind of HIV patients get PCP

Answer 6

90% occur with CD4

Question 7

Are most people exposed to PCP?

Answer 7

Yes, this bacteria lives in the soil so by childhood most people have PCP antibodies. In the immunocompromised this bacteria becomes more of a problem.

Question 8

Can you culture PCP?

Answer 8

No, so you need to identify the organism microscopically to diagnose

Question 9

What are the sx of PCP?

Answer 9

nonspecific (fever, nonproductive cough, chest catching or tightness)

Question 10

What do you see on CXR for PCP

Answer 10

1. Normal in 20-25% of cases! (get a high res CT to confirm. + CXR shows ground glass appearance)
2. Diffuse, increased interstitial infiltrates
3. Pleural effusion uncommon

Question 11

How do you dx PCP?

Answer 11

1. Cysts or trophozoites in tissue/body fluid
2. Induced sputum via ned saline: sensitive
   * 3. Monoclonal antibody:(DFA=direct fluoresent antibody test): sensitive
3. Bronchoalveolar lavage (BAL): high sensitivity
4. PCR for PCP: sensitive, not specific

Question 12

Tell me about TMP/SMX treatment of PCP. What are the side effects

Answer 12

Trimethoprim/sulfamethoxazole
Use for 21 days
Side effects: n/v, fever, rash, neutropenia, thrombocytopenia,

Question 13

Tell me ab out IV Pentamidine in the treatment for PCP? Side effects?

Answer 13

Only used as prophylaxis, no treatment
More toxic than TMP/SMX.
Side effects: hypoglycemia (fatal), hepatotoxicity, renal problems, pancreatitis, hypotension, prolonged QT interval, low Mg2+.