Part 2 Flashcards
% of vertical transmission in untreated HIV infection?
25-35 %
< 1% with effective tx
After exposure to trans;issible TB with infection, which % develop primary disease vs latent TB ?
5% primary TB
95% latent TB
Antimicrobial prophylaxis in oncology : cipro ?
Recommended in those at high risk of FN or prolonged profound neutropenia (>7d and ANC < 0.1)
Candida parapsilosis and Candida lustianiae sensibility ?
C parapsilosis
- Variable sensibility to echinocandins
C lusitaniae
- R to ampho B
Can TST and IGRA exclude active TB ?
No neither can separate LTBI from active TB
They can be both negative in active TB
Candidemia tx if CNS infection ?
Ampho B +/- flucytosine
Candidemia tx if pregnancy ?
Ampho B
CD4 count and TB in HIV patients?
Can occur at any CD4 counts
CD4 count if oral hairy leukoplakia ? (associated with EBV)
200-500
CD4 count in non invasive candidiasis ?
CD4 200-500
Chikungunya incubation ?
< 2w
Clinical presentation of dengue ?
Fever, maculopapular rash, retro-orbital pain, myalgias, thrombocytopenia
CMV retinitis / colitis and HIV patient : CD4 count ?
< 50
Consideration in the diagnosis of latent TB if patient is immunosupressed ?
TST and IGRA may be negative if immunosuppressed
Cutaneous KS seen with what CD4 count ?
200-500
Caused by HHV8
Dengue : incubation ?
< 2 weeks
Does this patient have early HIV infection ? Best LR ?
- Genital ulcers LR 5
- Weight loss, vomiting, swollen LNs LR 4
- Fever LR 3
Duration of tx for staph aureus bacteremia ?
Uncomplicated 14 days IV
Complicated 4-6 weeks IV
Endemic and non endemic fungi in HIV patients : which CD4 ?
< 200
Coccidiosis, histoplasmosis, blastomycosis, aspergillosis, cryptococcus
Fever in returned traveler : biphasic fever ddx ?
dengue
HHV8 infection complication in HIV patients ?
Cutaneous KS
HIV and MAC infection : treatment ?
Clarithromycin + ethambutol or azithro + ethambutol x 12 mos
HIV and PJP : how do you TREAT if proved infection ?
- TMP SMX 15-20 mg/kg IV x 21 days
Other alternatives for moderate to severe : primaquine and clinda IV or pendamidine IV
+ for severe only:
- Prednisone 40 PO BID x 5d then
20 PO BID x 5d
then 20 OD x 11d
HIV and toxoplasma infection tx?
Sulfadiazine/Septra + primethamine x 6 wk +/- chronic maintenance if ongoing clinical or radiographic disease
How do you diagnose lyme disease if early disseminated or late manifestations ?
Serology for dx rather than PCR
How do you diagnose Lyme disease if erythema migrans ?
Typical lesions are sufficient for clinical diagnosis
How do you diagnose malaria ?
-Thick and thin blood smear x 2 separated by at least 6 hours over 24 hour period
- Rapid detection test (RDT)
How do you treat active TB in HIV patients ?
Tx is the same as for HIV negative patients
How do you treat complicated malaria ?
IV artesunate x 48h then PO
- atovaquone proguanil OR
- doxycycline OR
- clindamycin
If artesunate not available : IV quinine
Should admit to ICU
How do you treat latent TB ? What is the first and second line regimen ?
First line
- Rifampin daily x 4 months
Second line
- Isoniazid daily x 9 months
How do you treat latent TB and HIV ?
Preferred regimens :
- 3HP : weekly INH + rifapentine for 3 months
- 3HR : daily INH + rifampin for 3 months
- Alternative INH x 6-9 months
How do you treat lyme disease ?
Usually doxycycline x 10 days
If neurological x 14-21 days
If carditis : ceftri first
If arthritis : doxy x 28 days
How long should you do PJP prophylaxis ?
Continue prophylaxis until CD4 count stabilizes > 200 for at least 3 months
How long should you treat candidemia ?
2 weeks from first negative blood culture (if no metastatic focus)
Indications for admission for lyme disease ?
PR > 300, other arrhythmias, myopericarditis
Interferon gamma release assay : affected by BCG ?
Not affected by BCG
Intrapartum care for HIV pregnant patient ?
- Always continue ARV
- If VL > 1000 copies/mL near delivery : IV zidovudine and scheduled C/S
- Zidovudive for everyone in Ontario
Leptospirosis incubation and transmission?
2-26 days, around 10 days
Transmitted by animal waste
MAC in HIV patient : CD4 count ?
< 50
NHL > HL, MM, leukemia in HIV patients : CD4 count ?
< 200
PJP infection in HIV patient : CD4 count ?
< 200
PJP prophylaxis in pregnancy?
Prophylaxis with TMP SMX recommended during pregnancy
Supplement with folic acid during first trimester (NT defects)
PJP prophylaxis with which CD4 count ?
If CD4 < 200
PML caused by JC virus and HIV patient : CD4 count ?
< 100
Post partum for HIV pregnant patients ?
- If maternal VL suppressed within 4w of delivery : infant given AZT (zidovudine) x 4wks
- If maternal VL not suppressed at birth, infant given presumptive 3 drug ART
- Breastfeeding NOT recommended for mothers living with HIV in US/Canada
Post travel fever with longer incubation periods > 2 weeks : ddx?
Malaria, TB, hepatitis, HIV, enteric fever due to salmonella spp
Post travel fever with short incubation period < 2 weeks : ddx ?
Malaria, dengue, chikungunya, traveller’s diarrhea, viral URTI, influenza
Sensibility C albicans / dubliniensis / tropicalis ?
SENSITIVE to all azoles
Sensibility of C krusei ?
Resitant to fluconazole
S to echinocandins
S to ampho B
Sensitivity of C glabrata ?
VARIABLE to fluconazole
S echinocandins
S ampho B
Should you treat pregnant woman with latent TB ?
Not until after delivery unless high risk of TB reactivation, and use 4R regimen
Should you treat pregnant women with active TB ?
YES as elevated risk of TB disease and significant associated morbidity to both woman and fetus
Risk of untreated < adverse effects drugs
Side effects of rifampin ?
Drug interaction, rash, hepatitis
Side effects of ethambutol ?
Eye toxicity, rash
Side effects of isoniazid ?
Rash, hepatitis, neuropathy
Side effects of pyrazinamide ?
Hepatitis, rash, arthalgia
Toxoplasmosis in HIV patients : CD4 count ?
< 100