HIV Flashcards
(58 cards)
True or false
 Even if the ED evaluation is unrevealing, admit all patients with new or changed neurologic signs or symptoms.
True
Since the introduction of ART,__________________ remains the most commonly reported neurologic opportunistic infection
toxoplasmosis encephalitis
In toxoplasmosis encephalitis  unenhanced CT scan, toxoplasmosis typically appears as 
multiple subcortical lesions with a predilection for the basal ganglia and corticomedullary junction
In toxoplasmosis encephalitis  Contrast-enhanced CT scan typically shows
multiple ring-enhancing lesions with surrounding areas of edema
True or false
 MRI is more sensitive than contrast-enhanced CT scan in detecting toxoplasmosis
 True
Admit patients with suspected toxoplasmosis and treat with a combination of
IV pyrimethamine plus
sulfadiazine plus
leucovorin (folinic acid).
Clindamycin is a substitute for sulfadiazine.
trimethoprim-sulfamethoxazole may have equal efficacy
In toxoplasmosis encephalitis occurs most commonly in patients with CD4+ cell counts_______ cells/mm3 as latent bradyzoites acquired early in life reactivate
<100
Cryptococcal infection occurs most commonly in patients with CD4+ counts of______ cells/mm3
<50
Patients with CNS cryptococcosis require hospital admission and the following medications
IV amphotericin B and
oral flucytosine for 14 days, followed by
fluconazole for 8 weeks to clear the CSF
Diagnosis of CNS cryptococcal infection in HIV patients relies on
CSF cryptococcal antigen testing (92% sensitive and 83% specific),
fungal culture (95% to 100% sensitive), or
staining with India ink (60% to 80% sensitive)
Cytomegalovirus on neuroimaging
nonspecific periventricular enhancement
Cytomegalovirus means state of treatment
Ganciclovir
CD4+ T-cell counts of______ cells/mm3 generally have causes of fever similar to those in nonimmunocompromised patients
> 500
CD4+ T-cell counts between__________ cells/mm3 are more likely to have infections that are associated with early immune compromise, including bacterial pneumonia, herpes zoster, and tuberculosis.
200 and 500
CD4+ T-cell counts of________ cells/mm3, the most common causes of fever without obvious localizing findings are early Pneumocystis jirovecii pneumonia (formerly known as Pneumocystis carinii); central line infection; infection with Mycobacterium avium complex, Mycobacterium tuberculosis, or cytomegalovirus; drug fever; and sinusitis. Other causes of fever include endocarditis, lymphoma, and infection with Histoplasma capsulatum or Cryptococcus neoformans.
<200
infection occurs predominantly in patients with CD4+ T-cell counts of ≤100 cells/mm3 who are not on ART or azithromycin prophylaxis.
Persistent fever and night sweats are typical symptoms.
Associated symptoms include weight loss, diarrhea, malaise, and anorexia
Disseminated M. avium complex
Treatment for disseminated mycobacterium avium complex infection
clarithromycin combined with ethambutol and rifabutin
Azithromycin is an alternative therapy
mimics an autoimmune event, with lymphadenitis, fever, and other symptoms starting weeks to months after beginning ART, often during tuberculosis therapy. There is no definitive diagnostic test for this condition. Treatment guidelines advise continuing ART; use nonsteroidal anti-inflammatory agents for mild to moderate cases; in severe cases, use corticosteroids (prednisone 1 to 2 milligrams/kg or equivalent for 1 to 2 weeks)
Immune reconstitution inflammatory syndrome
The most important CMV manifestation is
retinitis
is the most frequently occurring neoplasm, characterized by high-grade, rapidly growing mass lesions.
Non-Hodgkin’s lymphoma
Transmission of HIV occurs through
semen, vaginal secretions,
blood or blood products, and
breast milk, and
in utero by transplacental transmission
__________________occurs 2 to 4 weeks after infection with HIV. Also called___________, this is the initial response to infection, causing symptoms in the majority of those infected. The clini- cal presentation is nonspecific, resembling a flulike or mononucleosis- like syndrome; the diagnosis is missed in about 75% of cases.
Stage 1 or acute HIV infection
acute retroviral syndrome
Symptoms of acute HIV infection typically occur within 1 month of becoming infected, may last for___________, and include ________
2 to 10 weeks
fever (>90%), fatigue (70% to 90%), pharyngitis (>70%), rash (40% to 80%), headache (30% to 70%), and lymphadenopathy (40% to 70%); other reported symptoms are weight loss, headache, and diarrhea.
Seroconversion and detectable antibody response to HIV usually occur ___________ after infection, although delays can be up to ____________
3 to 8 weeks
11 months
