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50 Cards in this Set

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PCP manifestations
Subacute that worsens over days-weeks
PCP CXR
diffuse, bilateral, symmetrical interstitial infiltrates
PCP characteristic
hypoxemia
PCP CT
patchy ground glass attenuation
PCP diagnosis
Induced sputum, bronchoscopy with bronchoalveolar lavage, transbronchial bipsy
PCP tx + duration
TMP/SMX 21 days
TMP/SMX ADE
steven-johnson syndrome, fever, BM, azotemia, hepatitis, hyperkalemia
PCP alt severe
pentanamine
PCP alt mild-mod
Dapsone + TMP
PCP alt mild-mod
Primaquin + clindamycin
PCP alt mild
Atovaquone
PCP adjunctive
prednisone with po2<70
PCP prophylaxis start
CD4<200
PCP prophylaxis
TMP, alt: dapsone, atovaquone
MAC tx duration
12 months
MAC DOC
clarithromycin + ethambutol
MAC disseminated
clarithromycin + ethambutol + rifabutin
when to consider rifabutin
cd4<50, high load, no good art, DR
MAC prophylaxis start
cd4<50
MAC primary prophylaxis
azithromycin or clarithrymycin
MAC prophylaxis primary alternative
rifabutin or azithromycin + rifabutin
MAC secondary prophylaxis DOC
clarithromycin + ethambuton
MAC secondary prophylaxis alternative
azithromycin + ethambutol +- rifabutin
Cryptococcosis causitative agent
cryptococcosy neoformans
cryptococcus manifestations
headache, meningitis
Cryptococcus diagnosis
CrAg in CSF or serum, elevated opening pressure
Cryptococcus tx duration
induction (2 wks), consolidation(8wks), chronic maintenance
Cryptococcus tx DOC
induction: amphotericin B + flucytosine, consolidation/maintenance: fluconazole
amphotericin toxicity
hypokalemia, hypomagnesemia
flucytosine ade
BM
Cryptococcus primary prophylaxis
n/a
cryptococcus secondary prophylaxis
fluconazole
toxoplasma infection associated
cerebral or disseminated
toxoplasma manifestations
focal encephalitis/neurological abnormaliities
toxoplasma diagnosis
serum + antitoxoplasma IgG, imaging + clinical syndrome + detection
toxoplasmosis doc
pyrimethamine + sulfadiazine + leucovorin
toxoplasmosis duration
6 weeks
toxoplasma gondii alt tx
primethamine + clindamycin + leucovorin, TMP/SMX, atovaquone + sulfadiazine
toxo prophylaxis start
positive toxo IgG and CD4<100
Toxo prophylaxis primary
TMP/SMX alt dapsone + pyremethamine + leucovorin, or atovaquone + pyrimethamine + leucovorin
toxo prophylaxis, secondary
sulfadiazine + primethamine + leucovorin, atovaquone + pyrimethamine + leucovorin
CMV risk
cd4<50
CMV complications
colitis, esophagitis, retinitis, pneumonitis, neurological disease
CMV dx
PCR, antigent assay, blood culture (colon brush not diagnostic)
ab levels not useful, false negs possible.
What is the preferred treatment for retinitis caused by CMV?
sight threatened: gancyclovir io implant + valgancyclovir PO, periperheral lesions: valgancyclovir
cmv retinitis alt tx
gancyclovir, foscaranet, cidofovir, fomivirsen
At what CD4 does prophylaxis for CMV start?
CD4<100-200
CMV prophylaxis tx doc
valganciclovir or foscarnet, ganciclovir implant + PO valgancyclovir
CMV prophylaxis alt
cidofovir IV + probenecid
When to start prophylaxis for:
PCP
MAC
Crypto
Toxo
CMV
PCP: CD4<200
MAC: CD4<50
Crypto: n/a
Toxo: +IgG, CD4<100
CMV: CD4<100-200