6. Opportunitistc In*fections, Jimenez

OBJECTIVE: Understand the guiding principles around OI prevention and management

OBJECTIVE: Recognize common OIs and causative pathogens in patients with HIV

Pneumocystic Pneumonia - P. jirovecii (fungus)

PCP Imaging

butterfly pattern on chest xray

ground glass opacities on CT scan

PCP Treatment

tmp-smx

dose: 15-20 mg/kg/day (large dose)

start within 2 weeks of diagnosis

Tmp-Smx ae

rash (30-55%)

fever (30-40%)

leukopenia (30-40%)

thrombocytopenia (15%)

hepatitis (20%)

we manage these symptoms as much as possible while keeping them on the med

PCP Supportive Care

add steroids ASAP if patients have hypoxemia

PCP treatment alternative and ae

IV Pentamidine

fever and rash still

PCP prophylaxis

tmp-smx

PCP prophylaxis alternative

dapsone or atovaquone

Toxoplasma gondii Encephalitis cause

Toxoplasma gondii parasite often in undercooked meat or raw shellfish

TE ae

headache, confusion, motor weakness, fever

TE Lab Imaging

muletiple enhancing lesions in grey matter assocaited with edema

brain biopsy needed for definitive diagnosis

TE Treatment

pyrimethamine + sulfadiazine +leucovorin

TE Alternative Treatment

pyrimethamine + clindamycin + leucovorin

tmp-smx

TE supportive care

add corticosteroids only if there is a mass

add anticonvulsant if history of seizures

Mycobacterium avium complex symptoms

fever, night sweats, weight loss, fatigue, diarrhea, abdominal pain

MAC Treatment

azithromycin or clarithromycin + ethambutol + a 3rd drug (macrolide, usually rifabutin)

Cryptococcosis

caused by Cryptococcus neoformans

Cryptococcosis Treatment

FIRST: liposomal ampho B IV + flucytosine

THEN: fluconazole PO

LP to relieve the symptoms

INITIATION IS DEFERRED FOR 4-6 WEEKS

Ampho B toxicity

nephrotoxic

but the liposomal formulation is less toxic

a liter of NS perfusion will decrease risk of toxicity

K and Mg supplementation proactively

Flucytosine AE

bone marrow suppression

Transmission for PCP, TE, and MAC are NOT

person to person

OBJECTIVE: Design a treatment regimen for the treatment of common OIs

OBJECTIVE: Effectively determine if antimicrobial prophylaxis is warranted based on the OI and patient factors

OBJECTIVE: Explain the relationship between OIs, ART, and IRIS

OBJECTIVE: Select the appropriate time to initiate ART in the setting of an OI

OBJECTIVE: Identify important issues related to antimicrobial agents used in the treatment

and prevention of OIs