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Second Chance - Opportunistic Infections

What is the CD4 cell count threshold for Oral Candidiasis?
< 200 cells
< 100 cells
What drug and dose should be used to treat thrush?
Fluconazole 100mg QD x 7 days (14days for esophageal)
Fluconazole 200mg BID x 7 days (14days for esophageal)
Is PPX required if below CD4 cell threshold for oral candidiasis?
No - only when painless, creamy-white plaque-like lesions present
Yes, PPX to prevent occurrence of thrush
Treshold for pneumocystis jirovecii pneumonia?
CD4 cell count <200
CD4 cell count <100
What drug should be used to treat PJP, and what dose? Assume no allergies
Bactrim 15mg/kg/day of TMP + 5x SMP DAILY
Dapsone 100mg PO daily
Atovaquone suspension 1500mg PO daily
What drug should be used to treat PJP, and what dose? Assume sulfa allergy
Bactrim 15mg/kg/day of TMP + 5x SMP DAILY
Dapsone 100mg PO daily
Atovaquone suspension 1500mg PO daily
What drug should be used to treat PJP, and what dose? Assume intolerant to 1st and 2nd line tx
Bactrim 15mg/kg/day of TMP + 5x SMP q6 or 8 hours
Dapsone 100mg PO daily
Atovaquone suspension 1500mg PO daily
Mod-Severe tx of PJP?
PO2 < 70 mm Hg OR AA O2 gradient > 35 mm Hg
Bactrim IV WB dosing x 21 days
Prednisone taper, 40mg BID x5d, 40mg QD x5d, 20mg QD x 10d
How long should PJP be treated for?
Until CD4 cell count > 200 for 3 mo
 
Side effects of using Bactrim?
Rash (7-14days after starting)
Thrombocytopenia
Anemia
Pseudo-elevated SCr (18-20% within few days)
Hyperkalemia
What test needs to be performed before using Dapsone, and why?
G6PD to avoid hemolytic anemia
 
Toxoplasmosis Gondii CD4 threshold to treat and d/c tx?
Treat when below <100 and toxo IgG (+)
D/C when above >200 cells for 3 months
PPX for toxoplasmosis gondii?
Bactrim 1 DS tablet daily
 
PPX for toxoplasmosis gondii if sulfa allergy?
Dapsone/pyremethamine/leucovorin
Sulfadiazine/pyremethanine/leucovrin if infected with toxo
Threshold for Mycobacterium avoid complex PPX?
CD4 Cell Count <50
 
Treat MAC until CD4 cell above what number?
CD4 Count > 100 for at least 3months
 
What can you use to PPX for MAC?
Azithromycin 1200mg PO once weekly
 
Side effect of high-dose azithromycin?
Diarrhea
 
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