opportunistic infections

what can cause weakened immune system

asplenia

long term steroids >14 days

HIV

immunosuppressants

cancer chemotherapy if severe neutropenia (ANC <500)

what patient population is at risk for oi

transplant patients

criteria for starting PJP prophylaxis

CD4 count <100 or CD4 count <100-200 if HIV RNA level is detectable

PJP prophylaxis

preferred: SMX/TMP DS daily

alternative: Dapsone

Dapson +pyrimethamine +leucovorin

atovaquone

criteria for d/c PJP prophylaxis

CD4 count >200 for >3 months and remains on ART

toxoplasma criteria for starting prohylaxis

toxoplasma IgG positive and CD4 count <100

toxoplasma prophylaxis preferred

preferred: SMX/TMP DS daily

alternative: dapsone + pyrimethamine +leucovorin

atovaquone

mycobacterium criteria for starting prophylaxis

CD4 count <50 and if not taking ART

mycobacterium primary prohylaxis

azithromycin 1200 mg once weekly

candidiasis preferred regimen

fluconazole

oropharyngeal candidiasis

itraconazole

cryptococcal meningitis preferred regimen

amphothericin B + flucytosine

alternative: fluconazole

CMV preferred regimen and alternative

preferred: valganciclovir or ganciclovir

alternative: foscarnet or cidofovir

mycoabcterium preferred regimen

clarithro or azithro + ethambutol

PJP preferred regimen treatment and alternative

preferred: SMX/TMP

alternative: Pentamidine IV

risks of getting toxoplasma

ingestion of undercooked/raw meat, cat feces/litter

toxoplamsa preferred regimen

bactrim or pytimethamine + leucovorim + sulfadiazine