Term
| What causes PCP, and what type of organism is it? |
|
Definition
Pneumocystis jiroveci (formerly P. carinii)
Fungus with protozoan-like characteristics |
|
|
Term
| What is the most common opportunistic infection in HIV? |
|
Definition
|
|
Term
|
Definition
Usually a non-productive cough with fever and dyspnea.
It is confirmed by microbioloic diagnosis by using a silver stain. |
|
|
Term
| Patient with HIV, comes in with non-productive cough and chest x-ray shows diffuse infiltrates with butterfly pattern. What is the diagnosis? |
|
Definition
| Nothing until you confirm with microbiologic testing. |
|
|
Term
| When do you begin PCP primary prophylaxis? |
|
Definition
| When CD4 count is less than 200 or if there is oropharyngeal candidiasis |
|
|
Term
| What is the first choice for PCP prophylaxis? |
|
Definition
|
|
Term
| When can you stop primary prophylaxis for PCP? |
|
Definition
When CD4 goes above 200 for three or more months.
Restart if it drops below 200 (clock resets) |
|
|
Term
| What is the preferred treatment and duration for moderate-severe PCP? |
|
Definition
| TMP-SMX 15-20mg/kg and 75-100mg/kg TID for 21 days;. |
|
|
Term
| What is the preferred treatment for mild-moderate PCP? |
|
Definition
TMP-SMX 15-20mg/kg and 75-100mg/kg TID for 21 days.
OR
Two Bactrim DS PO TID x 21 days |
|
|
Term
| Can you switch to oral meds in moderate-severe PSP? |
|
Definition
| If the patient responds to therapy, yes. |
|
|
Term
| What are the alternative treatments for moderate-severe PCP? |
|
Definition
Pentamidine 3-4mg/kg daily.
OR
Primaquine 15-30 mg PO daily + Clindamycin 600-900 mg IV Q 6-8 |
|
|
Term
| What are alternate treatments for mild-moderate PCP? |
|
Definition
Dapsone 100mg PO daily and TMP 15mg/k/day PO
OR
Primaquine 15-30mg PO daily
plus Clindamycin 300-450mg PO Q 6-8H
OR
Atovaquone 750mg PO BID with food |
|
|
Term
| When do you use corticosteroids in PCP? |
|
Definition
When PaO2 is below 70mmHG initially.
May have benefit if initial PaO2 is above 70 |
|
|
Term
| What is the secondary prophylaxis for PCP? |
|
Definition
Bactrim DS 1 PO daily
OR
Bactrim SS 1 PO daily |
|
|
Term
| What is the alternate prophylaxis for PCP? (7) |
|
Definition
Bactrim DS PO TIW
Dapsone 50-100mg PO daily
Dapsone 50 + pyrimethamine 50 PO weekly + lecuovorin 25mg PO weekly
Dapsone 200 _ pyrimethamine 75 lecuovorin 25, all weekly
Aerosolized pentamidine 300mg monthly
Atovaquone 1500 mg PO daily
Atovaquone 1500 + pyrimethamine 25 + leucovorin 10 |
|
|
Term
| When do you stop secondary prophylaxis for PCP? |
|
Definition
| Same as primary. When CD4 is above 200 for 3 months. But you MIGHT go longer. |
|
|
Term
| What is the causative agent in Toxoplasmic Encephalitis and what type of organism is it? |
|
Definition
| Parasitic infection by toxoplasma gondii |
|
|
Term
| How do you usually diagnose TE? |
|
Definition
| Usually by CT/MRI with contrast. |
|
|
Term
| When do you begin TE primary prophylaxis? |
|
Definition
|
|
Term
| What is the first choice for TE primary prophylaxis? |
|
Definition
|
|
Term
| What are the alternative treatments for TE primary prophylaxis? (5) |
|
Definition
Bactrim DS PO TIW
Dapsone 50-100mg PO daily
Dapsone 50 + pyrimethamine 50 PO weekly + lecuovorin 25mg PO weekly
Dapsone 200 _ pyrimethamine 75 lecuovorin 25, all weekly
Atovaquone 1500 + pyrimethamine 25 + leucovorin 10 |
|
|
Term
| When do you stop TE prophylaxis? |
|
Definition
| When CD4 is above 200 for 3 or more months. Restart again if CD4 falls below 100-200. |
|
|
Term
| What is the preferred treatment for TE, and how long does it last? |
|
Definition
Pyrimethamine 200mg PO x 1, then 50 to 75mg PO daily, plus sulfadiazine 1000mg to 1500 mg PO QID plus lecuovorin 10-25mg PO daily
All of that for at least six weeks. |
|
|
Term
| What are the six alternative treatments for TE? |
|
Definition
Primethamine (leucovorin) plus Clindamycin QID
TMP-SMX 5/25 per kg IV or PO BID
Atovaquoone 1500 BID with food plus pyrimethanmine (lecuovorin)
Atovaquone 1500 + sulfadiazine 1000-1500 QID
Atovaquone 1500 BID
Pyrimethamine (leucovorin) plus Azithromycin 900-1200 mg PO daily |
|
|
Term
| A patient that has a history of seizures comes in with TE. Do you give prophylactic anti-seizure meds? |
|
Definition
| No. But you treat them if they have a seizure. |
|
|
Term
| When do you use corticosteroids in TE? |
|
Definition
| If they get mass effect. D/c as soon as possible. |
|
|
Term
| What is the preferred secondary prophylaxis for TE? |
|
Definition
| Pyrimethamine 25050 PO daily plus sulfadiazine 2000-4000 mg PO daily plus leucovorin 10-25mg daily |
|
|
Term
| When do you stop secondary prophylaxis for TE? |
|
Definition
| When CD4 is above 200 for 6 months or more. Restart if their CD4 ever drops below 200 again. |
|
|
Term
| What is the causative agent in MAC? |
|
Definition
M. avium AND
M intracellulare |
|
|
Term
| What comes first, symptoms or mycobacteremia in MAC? |
|
Definition
| Symptoms come first weeks before you can find them in the blood. |
|
|
Term
| When do you begin MAC primary prophylaxis? |
|
Definition
| When CD4 drops below 50 and you have ruled out active MAC. |
|
|
Term
| What is drug of choice for primary MAC prophylaxis? |
|
Definition
Azithromycin 1200mg PO once weekly
OR
Clarithromycin 500 PO BID
Or
Azithromycin 600 PO BIW |
|
|
Term
| When do you stop MAC primary prophylaxis? |
|
Definition
| When CD4 gets above 100. Restart if they drop below 50 again. |
|
|
Term
| What is the treatment for MAC? |
|
Definition
At least two drugs. Start with:
Clarithromycin 500 BID + ethambutol 15 |
|
|
Term
| You feel like adding a third drug for treatment of MAC. What should it be? |
|
Definition
| 3rd up to bat is Rifabutin 300 PO daily |
|
|
Term
| You decide you need a 4th drug for treatment of MAC. What are you going to pick? |
|
Definition
Amikacin
OR
Streptomycin
OR
Ciprofloxacin
OR
Levofloxacin
OR
Moxifloxacin |
|
|
Term
| When do you stop secondary prophylaxis of MAC |
|
Definition
Usually, you don't. You can IF
Asymptomatic AND completed 12 months AND CD4 greater than 100 for at least 6 months. Restart if CD4 ever drops below 100. |
|
|
