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Opportunistic Infections - Coggle Diagram
Opportunistic Infections
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Herpes zoster (shingles)
Acyclovir
PK: poor oral availability, short plasma half-life, excreted unchanged in kidneys
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Syndromic guidelines for genital ulcer disease:
Add acyclovir to benzathine penicillin if HIV status +/unknown, if no response add azithromycin
Pain must be adeqautely treated (simple + opiods)
Post-herpetic neurlagia requires adjunctive therapy together with analgesics
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Common
TB, oesophageal candida, PCP, HSV, cryptococcus, CMV
Incidence increases as CD4 count decreases (<50 most at risk, 50-200 moderate risk)
Bacterial pneumonia
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Usual organisms - Strep. pneumoniae, H. influenzae, S. Aureus, Klebsiella spp
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CMV
CMV retinitis most common site outside of RES/liver, then GIT, lungs, CNS
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Cryptococcal meningitis
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Management:
Amphotericin B (1mg/kg/day) + fluconazole (800mg/day) for 14 days
THEN - fluconazole (400mg/day) for 8 weeks
THEN - 200mg/day for 12
Flucytosine works better with Ampho B but not available in SA
Amphotericin B
MOA: Bind to ergosterol on cell membrane, cause leakage of intracellular cations & proteins
Toxic, resistance very rare, given IV as slow infusion, pretreat with paracetamol/corticosteroids
Dose-related nephrotoxin - reversible, minimised if well hydrated
Fluconazole
PK: excellent oral bio-availability, long half-life, penetrates CSF well, 80% excreted unchanged in urine, weak CYP450 inhibitor
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Screening (Cryptococcal antigen CrAg): HIV infected adults with CD4<100
If positive & asymptomatic (and no active cryptococcal disease in CSF) - 800mg/d for 2wk, 400mg/d 2mth, 200mg/d
Pneumocystis pneumonia
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Management: high dose cotrimoxazole (21 days) + adjunctive corticosteroids (indicated in all hypoxic patients