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60 Cards in this Set
- Front
- Back
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AIDS etiology
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decrease in CD4 count by HIV; in US transmitted mostly by men who have sex with men or in heterosexuals; in developing world is transmitted mostly by heterosexuals; takes 5-10 years to drop CD4 from 700 to 200
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principal opportunistic infections in AIDS
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pneumocystis jirovecii, cytomegalovirus, mycobacterium avium, toxoplasma, cryotococcus
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pneumocystis jirovecii pneumonia presentation
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pneumonia, dyspnea on exertion, dry cough, fever, chest pain when CD4>200/uL
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pneumocystis jirovecii pneumonia diagnosis
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bronchoscopy with bronchoalveolar lavage for direct indentification; chest x-ray may be normal or bilateral interstitial infiltrates; elevated serum LDH
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pneumocystis jirovecii pneumonia management
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TMP-SMX (first-line, may cause rash) OR dapsone/trimethoprim OR primaquine/clindamycin; pentamidine (may cause pancreatitis); steroids if severe pneumonia (PaO2<70mmHg or A-a >35mmHg
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pneumocystis jirovecii pneumonia prophylaxis
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used if CD4>200/mm3; TMPSMZ (most effective) OR dapsone OR atovaquone
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CMV retinitis
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blurry vision, double vision, any visual disturbance in patients with CD4<50/uL; treat with oral valganciclovir and intravitreal ganciclovir
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CMV colitis
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diarrhea in patients with CD4<50/uL; treat with oral valganciclovir
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CMV esophagitis
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odynophagia, fever, retrosternal pain; shallow ulcers in distal esophagus seen with upper GI endoscopy; do biopsy; treat with oral valganciclovir
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CMV encephalitis
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altered mental status and cranial nerve deficits with CD4 <50/uL; treat with IV ganciclovir
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CMV prophylaxis in AIDS
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oral valganciclovir for maintenance
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CMV therapy side effects
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ganciclovir: neutropenia; foscarnet: renal toxicity; cidofovir: renal toxicity
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mycobacterium avium complex presentation
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fevers, night sweats, bacteremia, wasting, anemia, diarrhea in patients with CD4<50/uL
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mycobacterium avium complex diagnosis and therapy
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blood culture or culture of bone marrow, liver or other tissue or fluid; treat with clarithromycin + ethambutol +- rifabutin; prophylaxis if CD<100/uL with weekly azithromycin or clarithromycin twice daily
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toxoplasmosis presentation
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brain mass lesion, headache, confusion, seizures, focal neurologic deficits in patient with <100 CD4/uL
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toxoplasmosis diagnosis
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ring enhancing lesion on CT or MRI with edema and mass effect; shrinkage after 2 weeks of therapy is diagnostic; also toxoplasma serology an CSF PCR; brain biopsy may be necessary if no shrinkage
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toxoplasmosis treatment
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pyrimethamine + sulfadiazine; if sulfa allergy substitute with clindamycin; prophylaxis with TMP/SMX OR dapsone/pyrimethamine
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cryptococcosis presentation
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mainly meningitis, fever, headache, malaise in patient with CD4<100/uL
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crytocococcal meningitis diagnosis
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india ink of CSF and specific cryptococcal antigen testing in CSF and serum
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cryptococcal meningitis therapy
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IV ampB 10-14 days followed by oral fluconazole for maintenance; fluconazole is not recommended for general use prophylaxis
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vaccinations in HIV+
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all should receive pneumococcus, influenza and hepatitis B vaccines
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diseases with CD4 200-500/uL
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oral thrush, Kaposi sarcoma, TB, zoster, lymphoma
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diseases with CD4 100-200/uL
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pneumocystis pneumonia, dementia, PML, disseminated histoplasmosis, coccidiomycosis
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diseases with CD4 <100/uL
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toxoplasmosis, cryptococcal meningitis, cryptosporidiosis, disseminated herpes
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diseases with CD4 <50/uL
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CMV, mycobacterium avium complex, CNS lymphoma
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HIV viral load monitoring
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to monitor response to antiretrovirals, determine risk of complications and prognosis; higher load indicates CD4 will drop more rapidly
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nucleoside reverse transcriptase inhibitors
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zidovudine (AZT, ZDV), didanosie, stavudine, lamivudine, emtricitabine, tenofovir, abacavir, zalcitabine
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zidovudine
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NRTI; leukopenia, anemia, gastrointestinal
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didanosine
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NRTI; pancreatitis, peripheral neuropahty
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stavudine
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NRTI; peripheral neuropathy
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lamivudine
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NRTI; nothing additional to placebo
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emtricitabine
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NRTI; nothing additional to placebo
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tenofovir
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NRTI; nucleotide instead of nucleoside
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abacavir
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NRTI; hypersensitivity reaction; discontinue immediately and don't restart
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zalcitabine
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NRTI; pancreatitis, peripheral neuropathy, lactic acidosis
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protease inhibitors
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nelfinavir, indinavirm ritonavir, saquinavir, amprenavir, lopinavir, atazanavir; all cause hyperlipidemia, hyperglycemia and elevated liver enzymes plus specific effects
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nelfinavir
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PI; GI side effects
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indinavir
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PI; nephrolithiasis, hyperbilirubinemia
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ritonavir
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PI; severe GI disturbance
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saquinavir
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PI; GI effects
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lopinavir
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PI; diarrhea
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atazanavir
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PI; diarrhea, asymptomatic hyperbilirubinemia
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non-nucleoside reverse transcriptase inhibitors
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noncompetitive inhibitors; efavirenz, nevirapine, delavirdine
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efavirenz
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NNRTI; neurologic effects, somnolence, confusion, psychiatric
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nevirapine
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NNRTI; rash, hepatotoxicity
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delavirdine
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NNRTI; rash
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when to start antiretroviral therapy
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CD4 <350/uL or viral load by PCR-RNA >55,000 by RNA
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which antiretrovirals to start with
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2 NRTI + PI or NNRTI
2 NRTI + efavirenz 2 NRTI + 2 PI |
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antiretroviral contraindicated in pregnancy
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efavirenz
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what is considered adequate therapy
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any combo that decreases viral load near or to undetectable amounts and increases CD4; in the first month viral load should drop at least 50%
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HIV management in pregnant women
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25-30% of children will be truly HIV+ if no treatment is given; recommended is AZT + NRTI + PI; C-section indicated if viral load >1,000 at time of delivery; should not breastfeed
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HIV post-exposure prophylaxis
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recommended AT + lamiduvine + nelfinavir OR any fully suppressive combo for 4 weeks
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Q fever
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coxiella by inhalation and found in placenta of cattle, sheep and goats; can cause febrile illness, atypical pneumonia, hepatitis, hepatomegaly, endocarditis; diagnose with specific serology; treat with doxycyline
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Rocky Mountain spotted fever
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ricketsia transmitted by wood tick in south, upper south and midwest; abrupt onset fever, headache, erythematous maculopapules with centripetal spread and neurological deficits; differential with syphilis; serology and biopsy; treat with doxycyline
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tetanus etiology and presentation
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neurotoxin by C. tetani in 1-7 days; tonic spasms, respiratory arrest, dysphagia, stiff body, lockjaw, arm flexion and leg extension
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tetanus diagnosis and treatment
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clinical diagnosis; tetanus toxoid (10-year boosters), surgical debridment; tetanus immunoglobulin antitoxin, 10-14 days of penicillin
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aspergillosis etiology
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most common is aspergilus fumigatus causes pulmonary disease in immunocompromised; risk factors are neutropenia <500, steroids and cytotoxics
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aspergillosis presentation
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allergic asthma-like signs, mycetoma with hemoptysis
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aspergillosis diagnosis
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abnormal chest x-ray and aspergillus in sputum; eosinophilia and elevated IgE; positive skin testing; if invasive, biopsy necessary
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aspergillosis treatment
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allergic: steroids and asthma medications, not antifungals; mycetoma: surgical removal; if invasive: voriconazole and caspofungin
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