Important Opportunistic Infections: Pathogen CD4 Common Presentation Tests Prophylaxis/Treatment Count Pneumocystis jirovecci <200 Dry Cough, Dyspnea on Exertion, - PCP DFA (from PPx: Bactrim 160-800 daily Pneumonia (PCP) (or Fever. Tends to have sub-acute course. Sputum or BAL) Alternate: Dapsone, atovaquone CXR: Diffuse bilateral infiltrates. - Cytopathology from BAL Tx: Bactrim x 21 days May lead to respiratory failure, Alternate: Atovaquone pneumothorax, and death (still - Elevated serum (mild); Clindamycin/ common cause of AIDS-related death) (1,3) B-D-Glucan primaquine (moderate); IV Pentamidine (severe. + Steroids for moderate – severe PCP (PaO2 < 70 or gradient > 35) Mycoacterium Avium <50 Prolonged course of fever. Fatigue, Culture from a Ppx: Azithromycin 1200 mg Complex (MAC) weight loss, diarrhea. sterile site (eg: weekly blood, bone Alternate: Clarithromycin (MAC = water and soil Hepatosplenomegaly. marrow, lymph mycobacteria) node) Tx: Macrolide + Ethambutol +/- Rifabutin Toxoplasma gondii <100 Usually presents with signs of CNS Presumptive dx: PPx: Bactrim 160-800 daily disease (eg: encephalitis compatible – headache/fever/confusion. May have clinical syndrome, Tx: Bactrim, seizures and/or altered mental status) + T. gondii IgG Ab sulfadiazine/pyramethamine and classic Alternate Tx: Regimens Posterior Uveitis imaging findings containing Atovaquone,or (multiple Clindamycin instead of Pneumonitis (rare): fever/cough/dyspnea Sulfadiazine lesions)
Important Opportunistic Infections: Pathogen CD4 Count Common Presentation Tests Prophylaxis/Treatment Pneumocystis jirovecci Pneumonia (PCP) <200 (or Dry Cough, Dyspnea on Exertion, Fever. Tends to have sub-acute course. CXR: Diffuse bilateral infiltrates. May lead to respiratory failure, pneumothorax, and death (still common cause of AIDS-related death) - PCP DFA (from Sputum or BAL) - Cytopathology from BAL - Elevated serum (1,3) B-D-Glucan PPx: Bactrim 160-800 daily Alternate: Dapsone, atovaquone Tx: Bactrim x 21 days Alternate: Atovaquone (mild); Clindamycin/ primaquine (moderate); IV Pentamidine (severe. + Steroids for moderate – severe PCP (PaO2 < 70 or gradient > 35) Mycoacterium Avium Complex (MAC) (MAC = water and soil mycobacteria) <50 Prolonged course of fever. Fatigue, weight loss, diarrhea. Hepatosplenomegaly. Culture from a sterile site (eg: blood, bone marrow, lymph node) Ppx: Azithromycin 1200 mg weekly Alternate: Clarithromycin Tx: Macrolide + Ethambutol +/- Rifabutin Toxoplasma gondii <100 Usually presents with signs of CNS disease (eg: encephalitis – headache/fever/confusion. May have seizures and/or altered mental status) Posterior Uveitis Pneumonitis (rare): fever/cough/dyspnea Presumptive dx: compatible clinical syndrome, + T. gondii IgG Ab and classic imaging findings (multiple lesions) PPx: Bactrim 160-800 daily Tx: Bactrim, sulfadiazine/pyramethamine Alternate Tx: Regimens containing Atovaquone,or Clindamycin instead of Sulfadiazine
Silver-Medicine-Rotation-Guide_Final.docx