Opportunistic Infections with AIDS Flashcards
Most Opportunistic Infections and Complications of HIV develop when the CD4 count drops below what?
200
Whats the most common opportunisitc infeciton with AIDS?>
Signs and Symtpoms>
4
Pneumocystis Carinii Pneumonia (PCP)
- Fever
- Cough
- Shortness of breath
- Hypoxia (could be severe, with PO2
What diagnostic testing would we do for PCP in HIV pts?
4
- Chest xray is cornerstone of diagnosis
- Wright-Giemsa stain or direct fluorescence antibody (DNA) test on induced sputum.
- Bronchoalveolar lavage
- Elevated lactate dehydrogenase (LDH)
Occurs in 95% of cases
WHat would we see on the chest XRAY with PCP?
Elevated LDH happens in what percent of PCP cases in HIV pts?
Diffuse or perihilar infiltrates
95%
Risk factors in HIV pts for PCP? 2
Prophylaxis treatment?
How should we continue treatment? 2
Complication with PCP?
(especially in what demogrpahics? 2)
Risk: CD4 250.
Complications:
Pneumothorax, especially with hx of PCP and treatment with aerozolized pentamidine.
Mycobacterium Avian Complex (MAC) has two types that present in HIV pts. What are they?
Which one do we want to rule out first if they are symtpomatic?
HOw do we diagnose it?
Signs and symptoms:
Pulmonary or disseminated
Disseminated
Blood cultures will be positive if disseminated
Spiking fevers Night sweats Diarrhea Weight loss Wasting Anemia and neutropenia Meningeal signs
Risk factors for MAC?
When should we intiated prohylatic treatment?
When mwould we stop prophylatic treatment?
What does it offer protection against and what drugs would we use?
CD4 is below 50
Should be initiated with a CD4
What are the 4 types of Kaposi sarcoma?
- Classic K.S.-middle aged men of Mediterranean descent
- African endemic K.S. (AIDS)
- K,S, in iatrogenically immunosupressed pts
- AIDS related K.S.
What do they look like?
Karposi?
5
Purplish NONBLANCHING May be papular or nodular Appear more brown in dark skinned people Are NOT painful
When do Kaposi sarcomas become life threatening?
Dermatological Kaposi’s is not life threatening.
May progress to visceral disease in about 40% of patients with dermatologic Kaposi’s sarcoma, thus becoming life-threatening.
KS of intestinal tract will present how?
3
KS of the Lymph System
will present how?
KS of the lungs will present how?
6
abdominal pain
diarrhea
intestinal obstruction
swelling in the legs or arms
cough chest pain shortness of breath difficulty breathing extremity swelling pulmonary blockage
Lesions that involve large areas of the skin or internal organs, treatment is recommended. Those treatments include:
Skin Lesions?
4
Advanced cases where KS has affected internal organs, several treatments have proven effective in shrinking the lesion. What is the most common?
Topical medications
Surgical removal
Freezing with liquid nitrogen
chemotherapy drugs
Chemotherapy
(high risk to it though and heavy side effects)
What is DaunoXome?
HOw is it different from chemotherapy drugs?
Liposomal Drugs
These drugs are encased in microscopic fat bubbles which seem to lessen the adverse side effects.
Most common life-threatening fungal infection in AIDS?
Signs and Symptoms?
How do we diagnose it?
Treatment?
Prophylaxis treatment?
Cryptococcus neoformans
meningitis/subtle symptoms
Fever
Headache
Malaise
Diagnosis
Latex agglutination serum/CFS testing for antigen (CRAG)
Treatment:
Amphoericin B (Fungizone, Amphocin)
Prophylaxis:
Fluconazole (Diflucan)
Diarrheal disease in HIV pts caused by what?
What allows this infection to survive outside the body for extended periods
Makes it very resistant to chlorine-based disinfectants?
Whats its most common symptom?
Other symptoms?
What part of the body is most commonly infected?
microscopic parasite Cryptosporidium
Protected by an outer shell
Generally only affects immunocompromised patients
watery diarrhea
Stomach cramps, dehydration, nausea, vomiting, fever, and weight loss
small intestone
Cryptosporidiosis (AKA-”Crypto”) infected patients with CD-4
May be fatal!
HIV patients with CD-4 > 200: 2-4 weeks, however, may remain in carrier state and give to others or infect self if
CD-4 count drops
How is crypto transmitted?
How do we diagnose it?
fecal oral route
Stool specimens for cryptosporidium
Specifically ask for the test (not done on routine O&P on stools)
Acid fast staining, direct fluorescent antibody [DFA], or enzyme immunoassays
Treatment for crypto?
Treatment: There is NO APPROVED TREATMENT for HIV+ patients. If CD-4 count can be improved; they may have remission, but no cure
Most common retinal infection in AIDS patients?
Cytomegalovirus retinitis (CMV)
Signs of CMV?
Symptoms of CMV?
Signs
- Perivascular hemorrhages
- White fluffy exudates
Symptoms
- Usually a painless loss of vision, often unilateral
- Blurred vision
- Floaters
Cytomegalovirus retinitis treatment?
Alternative?
Ganciclovir (Cytovene) given in 2 phases: Induction and Maintenance, due to high relapse rates.
Alternative is foscarnet (Foscavir): less likely to cause neutropenia, but has many other possible adverse effects.
How does hepatic disease present in HIV pts?
What could be low level hepatic disease may be a cause for persistant what?
Often subclinical but is many times co-infected with Hep C and B
Nausea and vomiting
How does biliary disease manifest in HIV pts?
Acalculous cholecystitis with sclerosing cholangitis
What is an AIDS defining illness of the GI tract?
Occurs in individuals with CD4 counts of less than what?
Esophageal Candidiasis
100
Signs and symptoms of Esophageal Candidiasis
Odynophagia (What is this?) - pain Dysphasia (and what is this?)- trouble Weight loss is common Possible N/V Often concomitant thrush Fever is NOT common
A presumptive diagnosis of esophageal candidiasis can usually be made with a recent onset of what?
Especially in the present of what?
What would endoscopy reveal?
2
dysphagia
especially in the presence of thrush, and empiric anti fungal therapy may be started.
- Classic diffuse raised plaques that characteristically can be removed from the mucosa by the endoscope.
- Brushing or biopsy of the plaques shows hyphae that are characteristic of Candida species.
- diffuse raised plaques
- hyphae
Treatment of esophageal candidiasis
1
Alternative
2
- Fluconazole 200 mg as an initial dose, then 100 mg by mouth once daily for 14 days. Intravenous therapy can be given if the patient is unable to swallow pills.
- Alternative (less effective) treatments include itraconazole capsules 200 mg once daily or ketoconazole 200 mg once daily for 14 days.
Whats the window period for HIV time between infection and detectable HIV antibodies?
25
What will increase first: the antibody titer or HIV RNA levels?
HIV RNA will increase before the detectable antibody titer. At peak amounts of HIV RNA the antibody titer starts to rise
After infection when would you test positive for HIV?
5 days to a week
After that you may be able to detect RNA and not antibody until the 3rd week
What is the eclipse phase and when does it occur?
The time between infection and detectable HIV RNA
-0-10 days
What is the acute illness phase?
What is happening in HIV RNA and Antibody titer?
Symptomatic disease often precedes positive antibody test
HIV RNA is at peak levels and antibody titer is rising
