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Flashcards in Opportunistic Infections Deck (14)
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1
Q

Which organisms can cause opportunistic infections?

A

Bacteria, Fungi, Viruses and protozoa

2
Q

What criteria define immunocompromised state?

5 things

A
  1. Diseases that destroy immune system (HIV CD4 < 200)
  2. Systemic steroids 14 days or longer of pred equivalent of >20mg/day or >2mg/kg/day
  3. Asplenia
  4. Immunosuppressant medications (TNF, methotrexate, etc.)
  5. Chemo that destroys WBC
3
Q

Severe neutropenia (WBC count < ____) is a major risk factor for developing infections.

A

< 500

4
Q

What prophylaxis is recommended for candidiasis in an HIV patient?

A

None (both primary and secondary PPX for candida in the blood is not recommended).

5
Q

What are the 3 main types of opportunistic infections that affect HIV patients?

A
  1. Pneumocystis pneumonia (PCP)- caused by jirovecii organism
  2. Toxoplasma gondii encephalitis
  3. Mycobacterium avium complex (MAC)
6
Q

What CD4 count is an indication to start primary PPX against PCP? What is the preferred treatment? Alternative therapies?

A

CD4 < 200
Preferred: 1 Bactrim tablet daily (DS or SS)
Alternative: Dapsone, aerosolized pentamidine, atovaquone

7
Q

What CD4 count is an indication to start primary PPX against Toxoplasma gondii encephalitis? Preferred and alternative therapies?

A

CD4 < 100
Preferred: Bactrim DS daily
Alternative: Dapsone + pyrimethamine + leucovorin OR atovaqoune

8
Q

What CD4 count is an indication to start primary PPX against MAC? Preferred and alternative therapies?

A

CD4 >50

Preferred: Azi 1200 PO weekly (or 600 BIW), OR clarithromycin 500 BID

9
Q

How to treat oropharyngeal/esophageal candidiasis?

Preferred and alternative

A

Preferred: Fluconazole
Alternative: itraconazole, posaconazole

10
Q

How to treat cryptococcal meningitis?
Preferred and alternative
Secondary PPX?

A

Preferred: Amphotericin B + flucytosine
Alternative: Fluconazole + flucytosine
Secondary PPx: Low dose fluconazole

11
Q

How to treat cytomegalovirus (CMV)?
Preferred and alternative
Secondary PPX?

A

Preferred: Valgancyclovir or gancyclovir
Alternative: Foscarnet, cidofovir
Secondary PPX: Valgancyclovir

12
Q

How to treat MAC?
Preferred and alternative
Secondary PPX?

A

Preferred: Clarithromycin OR Azith + ethambutol
Alternative: Add 3rd or 4th agent: rifabutin, amikacin, streptomycin. moxifloxacin or levaquin
Secondary PPX: Same as treatment

13
Q

How to treat PCP?
Preferred and alternatives
Secondary PPX?

A

Preferred: Bactrim + prednisone X 21 days
Alternative: Atovaquone or pentamidine IV or dapsone + trimethoprim
Secondary PPX: Bactrim or dapsone + pyrimethamine + leucovorin OR atovaquone

14
Q

How to treat toxoplasmosis gondii encephalitis?
Preferred and alternative
Secondary PPX?

A

Preferred: Pyrimethamine + leucovorin +/- sulfadiazine
Alternative: Bactrim, clinda/azi
2’ PPx: Same at lower dose