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IOS 11 Exam 3
Opportunistic infections with HIV/AIDS patients
| Question | Answer |
|---|---|
| Opportunistic infections cause ___ death | 90% of deaths in compromised patients and can be directly related to the level of CD4 lymphocytes |
| CD4<200 is considered | AIDS |
| PCP symptoms | Unproductive cough followed by dyspnea on exertion, followed by productive cough, fever, malaise |
| PCP labs | lung maybe normal, but O2 desaturation |
| Definitive Dx of PCP | morphological demonstration (spurtum, bronchoavlar culture) LOC-Bronchoscopy>90% sensitivity |
| Severity scale PCP | Mild=PO>70, DaO2<35 on room ABG, Moderate=PO2<70 DaO2 35-45 on room ABG, Severe=DaO2 >45 on room ABG |
| DaO2=alveolar-arterial oxygen difference | =(150-(PO2/0.8)-PO2 |
| Treatment for PCP | Bactrium 15-20mg/kg/IV or PO divided q6-8hr- for 21 days if allergy or severe infection- pentamine 4mg/kg |
| Bactrium Side effects | Bone marrow suppression, rash monitor CBC and BUN/Scr |
| Pentamine side effects | Hypoglycemia, nephrotoxicity, QT prolongation, pancreatitis |
| Primary Prophylaxis of PCP (oral thrush and CD4<200) | Bactrium 1 DS- until CD4>200 -3 months |
| Secondary prophylaxis of PCP | Begin within 2 weeks of acute therapy-Bactrium 1 DS D/C when CD4>200 over 3 months |
| Toxoplasmosis characteristics | Cat feces and other feline carry host- Patients with CD4<100 and <50 will have CNS |
| Reactivation of toxoplasmosis is | Most common pathogensis of disease |
| Clinical presentation of toxoplasmosis patient | Altered mental status, HA, foal neurological defects, seizures, SIADH |
| Diagnosis of toxoplasmosis is by | MRI or CT contrast |
| Acute treatment of toxoplasmsosis | Sulfadiazine +pyrimethamine +leucovorin for at least 6 weeks- Dexamthason +anticonvulsant should be administered to patient with history of seizures then chronic maintenance |
| Chronic maintenance of toxoplasmosis | (Sulfadizine + Pyrimethamine +leucovorin) or (clindamycin +pyrimethamine + leucovorin) Consider D/C when CD4 >200 for 6 months |
| Primary prophylaxis of toxoplasmosis | AIDS with CD4<100 and can D/C Bactrium when CD4 >200 for at least 3 months |
| CMV is a Herpes virus with Clinical manifestations of | Retinitis-floaters, Esophagitis, Colitis |
| Clinical presentation of CMV | Polyradiculopathy (lower extremity weakness), or Encephalitis (altered sensorium and fever) |
| Diagnosis of CMV retinitis | Zone 1 (2 disc from fovea or 1disc cm from optic nerve), Zone 2 (between zone 1 and equator of globe) ZOne 3-anterior to the equator |
| First line therapy for CMV | Valgancyclovir -giveinduction x2-3 weeks than matintenance indefinate |
| Second line for CMV retinitis | Foscarnet if resistant or cannot tolerate valgancyclovir- Induction x 2-3 weeks then maintenance-indefinate |
| Primary prophylaxis for CMV | Not recommended |
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liza001
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