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CDM 3 Exam 3 > Lecture 7 - Opportunistic infections > Flashcards

Lecture 7 - Opportunistic infections Flashcards

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1
Q

Stage 0 CDC

A

negative test to positive test, < 180 days

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2
Q

Stage 1 CDC

A

> 400 CD4
no AIDS defining illness

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3
Q

Stage 2 CDC

A

200-499 CD4
No AIDS defining illness

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4
Q

Stage 3 CDC = AIDS

A

CD4 < 200 or AIDS defining illness

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5
Q

IRIS

A

mild-to-life threatening inflammatory reaction in response to underlying infection following initiation, re-initiation or change of ART therapy

CD4 < 100 or high viral load = risk

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6
Q

IRIS treatment

A

NSAIDs when symptoms considered moderate-severe

if symptoms persist, then prednisone 20-40mg 4-8weeks

Dont interrupt ART or OI treatments in patients with IRIS unless life threatening

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7
Q

Candidiasis info

A

commonly seen as oropharyngeal or esophageal

caused by Candida albicans usually

CD4 < 200

esophageal higher incidence at lower CD4 counts than oropharyngeal

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8
Q

Candidiasis management

A

prophylaxis not recommended

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9
Q

Oropharyngeal Candidiasis treatment

A

pref = oral fluc 100mg QD for 1x2 weeks
Alternative = itraconazole oral x 7X14 days or posaconazole oral suspension

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10
Q

Esophageal Candidiasis treatment

A

pref = oral fluc 100mg QD for 2x3 weeks
Alternative = isavuconazole 200mg x 1 dose, followed by 50mg QD or 400mg 1 dose followed by 100mg QD

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11
Q

Candidiasis monitoring

A

rapid improvement 48-72hrs of symptoms

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12
Q

For ART-naive pts with CD4 < 50, we start ART when after TB treatment initiation?

A

within 2 weeks

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13
Q

Pneumocystis Pneumonia (PCP) info

A

common pts with CD4 < 200

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14
Q

PCP presentation

A

fever
hypxemia
nonproductive cough
chest discomfort

imaging = V important….Chest X ray = “ground glass”

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15
Q

Mild PCP differences

A

Po2 > 70mmHG
Alveolar-Arterial gradient < 35

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16
Q

Moderate-severe PCP differences

A

< 70 mmHG Po2
Alveolar arterial gradient > 35

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17
Q

Primary PCP prophylaxis if….

A

CD4 < 200
CD4 percentage < 14%
CD4 cell count between 200-250 if ART initiation delayed and CD4 count not possible

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18
Q

Preferred PCP prophylaxis dosing

A

Bactrim double strength (800-160) daily or Single strength (400-80) daily

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19
Q

Alternative PCP prophylaxis dosing

A

Bactrim double strength 800-160 TIW
Dapsone 100mg QD or 50mg BID
Atovaquone 1500mg QD w/ food

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20
Q

When to stop PCP prophylaxis

A

CD4 > 200 for > 3 months in response to ART
CD4 cont between 100-200 and Viral load undetectable for >3-6 months

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21
Q

When to restart PCP prophylaxis

A

CD4 < 100 regardless of viral load
CD4 100-200 and detectable viral load

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22
Q

PCP treatment preferred therapy

A

Bactrim 15-20mg/kg in 3-4 doses per day
or
Bactrim DS 2-3 QD

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23
Q

Alternative mild/moderate PCP treatment

A

Dapsone 100mg + Bactrim 15mg/kg/day in 3 doses

Primaquine 30mg QD + clinda 450 q6 or 600q8h

Atovaquone

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24
Q

Alternative moderate/severe PCP treatment

A

Pentamidine 4mg/kg IV QD

Primaquine 30mg QD + clinda 600 Q6 or 900 Q8 IV (or 450 q6/600q8 PO)

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25
Common Medication pearls of Bactrim, Dapsone, Primaquine
Hemolytic anemia in G6PD deficiency
26
Medication pearls of Atovaquone
must take w/ food Bad taste with liquid $$$$
27
Who are corticosteroids indicated for in PCP?
moderate to severe PaO2 < 70 on room air or > 35 Alveolar-arterial gradient begin within 72hrs of PCP management
28
Corticosteroids PCP dosing schedule
D1-5 = 40mg BID D6-10 = 40mg QD D11-21 = 20mg QD IV Methylpred can be recommended at 75% of prednisone dose
29
what screening dictates Toxoplasma treatment?
T.gondii immunoglobulin G screening
30
Toxoplasma presentation
Headache, confusion, motor weakness, fever may lead to seizures,coma, or death if untreated
31
Toxoplasma diagnosis
Serologic testing for IgG culture CSF, urine, blood Can also use imaging but hard to distinguish
32
Toxoplasma preferred prophylaxis is....
Bactrim DS 1QD
33
what's required to be indicated for toxoplasma prophylaxis
< 100 CD4 and + Toxoplasma IgG
34
Alternative toxoplasma prophylaxis treatments....
Bactrim DS TIW Bactrim SS daily Dapsone 50mg/200mb QD + pyrimethamine/leucov weekly Atovaquone 1500mg QD
35
When to stop Toxoplasma prophylaxis....
CD4 > 200 for > 3 months in response to ART CD4 100-200 and Viral load is undetectable for atleast 3-6 months
36
Toxoplasma preferred treatment
< 60kg = pyrimethamine 200mg PO, then 50mg QD + sulfadiazine 1000mg q6h + leucovorin 10-25mg qd > 60kg = pyrimethamine 200mg, then 75mg qd + sulfadiazine 1500 q6h + leucovorin 10-25mg qd duration 6 weeks continue maintenance therapy once complete therapy
37
Toxoplasma alternative treatment
pref: Bactrim 5mg/kg pyrimethamine + leucovorin + clinda Atovaquone 1500mg QD + sulfadiazine or pyrimethamine & leucovorin or neither
38
Toxoplasma maintenance treatment
Pref: pyrimethamine 25-50 QD + sulfadiazine 2-4g QD + leucovorin 10-25mg alternative: Clinda + pyrimethamine + leucovorin Bactirm DS QD/BID Atovaquone 750-1500mg BID + sulfadiazine or pyrimethamine & leucovorin
39
When are corticosteroids recommended for Toxoplasma adjunctive treatments?
HIV-infected children with CNS toxoplasmosis if.... CSF protein > 1000 or focal lesions with substantial mass effect or edema
40
Who should get anticonvulsants with Toxoplasmosis ?
Pts with history of seizure, not indicated as prophylaxis
41
When to D/c maintenance therapy for toxoplasmosis
1. successfully completed initial therapy 2. asymptomatic of signs and symptoms of TE 3. CD4 count > 200 for > 6 months
42
Cryptococcosis info
90% in pts with CD4 < 100
43
Cryptococcosis presentation
Fever Malaise Headache Neck stiffness Photophobia
44
Cryptococcosis diagnosis
CSF analysis CSF pressure > 25 Antigen test
45
Cryptococcosis prophylaxis
not recommended, doesn't occur often
46
Cryptococcosis treatment phases
induction > 2 weeks consolidation > 8 weeks Maintenance > 1yrs
47
Induction preferred regimen Cryptococcosis
Luposomal Ampho 3-5mg/kg + flucytosine 25mg/kg Ampho deoxycholate 0.7-1.0mg/kg + flucytosine 25mg/kg 2 weeks
48
Induction alternative Cryptococcosis
Ampho B lipid complex 5mg/kg IV + flucytosine or fluc 800 Ampho B alone Fluc + flucytosine Fluc 1200 QD IV/PO 2 weeks
49
Preferred Consolidation Cryptococcosis therapy
Fluc 800mg QD > 8 weeks can reduce to 400mg QD if 2 week CSF cultures are negative
50
Alternative consolidation cryptococcosis therapy
Itraconazole 200mg PO BID > 8 weeks
51
Maintenance Cryptococcosis therapy
Fluc 200mg QD for at least 1 year
52
When to d/c maintenance cryptococcosis therapy
complete 2 earlier phases, and maintenance for atleast 1 year Asymptomatic of signs/symptoms of cryptococcal infections CD4 > 100 for > 3 months with suppressed viral load
53
MAC presentation and diagnosis
Fever diarrhea night sweats fatigue, weight loss Diagnosis: isolation of MAC from sterile fluid/tissue culture
54
MAC prophylaxis
not recommended for adults/adolescent who immediately initiate ART
55
Who should get MAC prophylaxis
Viremic pts, not receiving or no option for ART, CD4 < 50 Rule out disseminated MAC disease before starting
56
Preferred MAC prophylaxis
Azithromycin 1200 QW Clarithromycin 500 BID Azithromycin 600 BIW Alternative: Rifabutin 300 QD
57
MAC treatment
Clarithromycin 500 BID + ethambutol 15mg/kg Azithromycin 500-600 QD + ethambutol 15mg/kg to prevent/delay resistance
58
When can you add 3rd or 4th drug for MAC treatment?
People with HIV w/ CD4 < 50, high mycobacterial loads, absence of ART Rifabutin 300 QD Fluoroquinolone ( Levo 500 or moxi 400) inject AGs (amikacin or streptomycin)
59
MAC monitoring
improvement within 2-4 weeks after start therapy dec mycobacteria failure = no response 4-8 weeks, then test for resistance
60
When to D/c MAC maintenance therapy
1. successfully completed at least 12 months therapy 2. no signs and symptoms of MAC disease 3. CD4 > 100 for 6 months in response to ART

CDM 3 Exam 3 (9 decks)

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