Chapter 25: ID IV - Opportunistic Infections

Question 1

What are opportunistic infections

Answer 1

Infections that occur when the immune system is unable to respond normally, typically in immunocompromised patients

Question 2

Immunocompromised states include:

Answer 2

• HIV with CD4+ T lymphocyte count < 200 cells/mm3
• Systemic steroids for 14 days or longer at a prednisone dose >/= 20 mg/day or >/= 2 mg/kg/day
• Asplenia
• Use of immunosuppressants
• Use of cancer chemotherapy agents

Question 3

OIs can be prevented with antibiotics, antifungals or antivirals . This is known as

Answer 3

Chemoprophylaxis

Question 4

T/F: Prophylaxis for Candida infections in the mouth/esophagus is not usually recommended

Answer 4

True

Question 5

Severe neutropenia is another major risk factor for developing infections and is determined by an ANC < ___ cells/mm3

Answer 5

500

Question 6

Which drugs are used as alternatives in OI if a patient has a sulfa allergy

Answer 6

Atovaquone, dapsone, pentamidine

Question 7

Which drugs are used as alternatives in OI if a patient has G6PD deficiency

Answer 7

Atovaquone & pentamidine

Question 8

PCP or PJP infection in HIV is indicated by CD4+ count < ___ cells/mm3

Answer 8

200

remember, PCP and PJP have 2 Ps in them

Question 9

Toxoplasma gondii encephalitis (aka Toxo) in HIV is indicated by CD4+ count < ___ cells/mm3

Answer 9

100

remember: Ghandi lived to be 100 years old

Question 10

Mycobacterium avium complex infection in HIV is indicated by CD4+ count < ___ cells/mm3 & treatment should be initiated if:

Answer 10

50

not taking ART

Question 11

In PCP or PJP, primary ppx in HIV should be discontinued when CD4+ count >/= ___ cells/mm3 for >/= __ months on ART

Answer 11

200

3 months

Question 12

In Mycobacterium avium complex, primary ppx in HIV should be discontinued when

Answer 12

taking fully suppressive ART

Question 13

Preferred ppx regimen for PCP or PJP (including frequency)

Answer 13

Bactrim daily

Question 14

Alternative ppx regimens for PCP or PJP

Answer 14

Dapsone 
OR
Dapsone + pyrimethamine + leucovorin
OR
Atovaquone

Question 15

Preferred ppx regimen for Toxoplasma gondii encephalitis

Answer 15

Bactrim

Question 16

Alternative ppx regimens for Toxoplasma gondii encephalitis

Answer 16

Dapsone + pyrimethamine + leucovorin
OR
Atovaquone

Question 17

Preferred ppx regimen for Mycobacterium avium complex (including dose)

Answer 17

Azithromycin 1,200 mg PO weekly

Think of MAC & Z-pak

Question 18

Candidiasis preferred treatment

Answer 18

Fluconazole

Question 19

Candidiasis alternative treatment

Answer 19

Itraconazole

Question 20

Cryptococcal meningitis preferred regimen

Answer 20

Amphotericin B (dexycholate or liposomal) + flucytosine

Question 21

Cryptococcal meningitis alternative regimen

Answer 21

Fluconazole

Question 22

Cytomegalovirus preferred treatments

Answer 22

Valganciclovir or ganciclovir

Question 23

Cytomegalovirus alternative treatments

Answer 23

Foscarnet or cidofovir

Question 24

Mycobacterium avium complex preferred treatment regimen

Answer 24

(Clarithromycin or azithromycin) + ethambutol

Question 25

PCP preferred treatment regimen

Answer 25

Bactrim

Question 26

PCP alternative treatment regimen

Answer 26

Atovaquone or pentamidine IV

Question 27

Toxoplasmosis gondii encephalitis preferred treatment

Answer 27

Pyrimethenamine + leucovorin + sulfadiazine

Question 28

Toxoplasmosis gondii encephalitis alternative treatment

Answer 28

Bactrim