Opportunistic infections

Question 1

What are the three mucocutaneous candida infections that people with HIV are susceptible to?

Answer 1

1. Thrush
2. Esophagitis
   - Painful swallowing, obstruction, and substernal chest pain
3. Vulvovaginitis
   - cottage cheese, itchy discharge

Question 2

What might you see with candida cystitis?

Answer 2

1. papillary necrosis
2. fungal ball formation
3. Abscesses

Question 3

How do you treat invasive candidiasis?

Answer 3

Fluconazole.

If a bad infection, consider Ampho B or caspofungin IV

Question 4

How long should you treat a fungal infection for?

Answer 4

2 weeks beyond the last positive culture

Question 5

What is a draw back of caspofungin (i.e. in what scenario of candida infection would you NOT use it?)

Answer 5

Meningitis–doesn’t penetrate the CSF well

Question 6

How do you treat candida cystitis?

Answer 6

Just remove the catheter and let it resolve. If an immunocompromised pt, consider an amphotericin bladder wash

Question 7

How does aspergillus present?

Answer 7

1. Allergic bronchopulmonary aspergillosis

2. In immunosuppressed, can have vascular invasion and infarction with hemoptysis

Question 8

How do you diagnose aspergillus?

Answer 8

1. culture
2. histology
3. galactomannan serology test as an ADJUNCT to errything else

Question 9

How do you treat aspergillus?

Answer 9

1. VORICONAzole

Question 10

where would you find zygomycosis?

Answer 10

Errywhere. It’s found in decaying matter

Question 11

Who gets zygomycosis (i.e. mucurmycosis)?

Answer 11

NOT very virulent–

diabetics, hemachromatosis, and leukemia pts

Question 12

What is the presentation of someone with mucormycosis?

Answer 12

• cerebral abscess
• rhinocerebral mucormycosis causes bad sinusitis
• Can erode through the skull

Question 13

How do you diagnose mucormycosis?

Answer 13

Pathology

Culture

Question 14

How do you treat mucormycosis?

Answer 14

HIGH mortality

• POSACONAZOLE
• surgery
• ampho B
• Treat hyperglycemia and acidosis

Question 15

How does cryptococcus present?

Answer 15

Meningoencephalitis

• headaches, malaise, impaired memory, judgment
• hydrocephalus later on

Question 16

How do you diagnose crypto?

Answer 16

cryptococcal antigen test. Can confirm with culture/ India ink

Question 17

Should you start haart therapy or crypto therapy first in an HIV positive pt?

Answer 17

start crypto first because otherwise body will suddenly have a strong immune response to the crypto (IRIS=Immune reconstitution inflammatory syndrome)

Question 18

How do you treat crypto?

Answer 18

Ampho B and flucytosine is the gold std

–switch to fluconazole after 2 weeks

Question 19

What does congenital rubella look like?

Answer 19

1. hearing impairment
2. heart defect
3. patent ductus
4. cataracts

Question 20

What does congenital toxo look like?

Answer 20

Bronze skin (jaundice) with red rashes and bruises

• chorioretinitis
• hemolysis
• thrombocytopenia

Question 21

How do you treat otitis media?

Answer 21

amoxicillin