Infectious Diseases IV: Opprotunistic Infections

Question 1

PCP (Pneumocystitis pneumonia)

Answer 1

• Indication: CD4 < 200
• DC: CD4 > 200 (3mo.) + ART

Question 2

PCP primary prophylaxis

Answer 2

• Bactrim DS po Qday
• Alt: dapsone

Question 3

PCP Treatment

Answer 3

• Bactrim + prednisone
• Alt: pentamidine IV

Question 4

Toxoplasmosis

Answer 4

• Indication: Toxo IgG +, CD4 < 100
• DC: CD4 > 200 (3 mo.) + ART

Question 5

Toxo primary prophylaxis

Answer 5

• Bactrim DS po Qday
• Alt: dapsone

Question 6

Toxo treatment

Answer 6

• pyrimethamine+ leucovorin+ sulfadiazi.
• Alt: Bactrim

Question 7

MAC (Mycobacterium avian complex)

Answer 7

• indication: not taking ART, CD4<50
• DC: taking fully suppressive ART

Question 8

MAC primary prophylaxis

Answer 8

• Azithromycin 1.2gm po Qweekly
• Alt: Azithro BIW; Clarithro BID

Question 9

MAC treatment

Answer 9

• Clarithro/Azithro + ethambutol

-Alt: add rifabutin, amikacin, strepto, FQ

Question 10

Candidiasis

Answer 10

• fluconazole
• Alt: Itraconazole

Question 11

Cryptococcal meningitis

Answer 11

• Induction: Amp B+ 5 FC
• Alt: fluconazole + 5 FC

Question 12

Cytomegalovirus (CMV)

Answer 12

• Treatment: Valganciclovir or ganciclovir
• Alt: foscarnet, cidofovir

Question 13

Immunocompromised states

Answer 13

• HIV CD4 < 200
• systemic steroids > 14 days (> 20mg/day)
• Asplenia
• Immunosuppressants
• Cancer chemotherapy

Question 14

Severe neutropenia

Answer 14

• ANC < 500
• major risk factor for infections