HIV & Opportunistic Infections
CD4 <200 with subacute dyspnea, dry cough, bilateral ground-glass opacities; elevated LDH
What is Pneumocystis jirovecii pneumonia (PJP)?
Prosthetic valve endocarditis within 2 months of surgery
What is Staphylococcus epidermidis?
A 72-year-old man hospitalized for stroke develops fever and new infiltrates 3 days after admission. He has dysphagia and witnessed aspiration. What is the most appropriate empiric antibiotic coverage?
What is ceftriaxone?
Healthcare worker with positive IGRA and normal CXR
What is latent tuberculosis infection?
A 24-year-old college student presents with fever, neck stiffness, and altered mental status. LP shows neutrophilic pleocytosis, low glucose, high protein. What adjunctive therapy should be given before or with the first dose of antibiotics?
What is dexamethasone?
CD4 <50, fever, night sweats, anemia, elevated alkaline phosphatase; blood cultures positive for acid-fast organisms
What is disseminated Mycobacterium avium complex (MAC)?
Colon cancer association; causes endocarditis
What is Streptococcus gallolyticus (bovis)?
A patient with severe community-acquired pneumonia is admitted to the ICU. He has hypotension requiring vasopressors. What additional therapy reduces mortality in this scenario?
What are systemic corticosteroids for severe CAP with septic shock?
Patient on RIPE therapy develops visual changes
What is ethambutol-induced optic neuritis?
A 68-year-old man with diabetes presents with meningitis. CSF shows gram-positive rods. What organism must be covered empirically in this patient?
What is Listeria monocytogenes?
HIV patient with headache and opening pressure 32 cm H₂O; India ink positive
What is Cryptococcus neoformans meningitis?
A 68-year-old man with a history of bioprosthetic aortic valve replacement 6 months ago presents with fever and malaise. Blood cultures grow Enterococcus faecalis in 2 out of 2 sets. TTE shows no vegetation. He remains bacteremic after 72 hours of appropriate antibiotics. What is the next best step in management?
What is transesophageal echocardiography (TEE)?
A 60-year-old smoker presents with weight loss and cavitary right upper lobe lesion. Three sputum AFB smears are negative. NAAT is negative. What is the next best step?
What is bronchoscopy with BAL and biopsy?
HIV patient with CD4 40 diagnosed with pulmonary TB. When do you initiate ART?
What is initiate ART within 2 weeks of starting TB therapy?
Exception?
A 45-year-old man with headache and fever undergoes LP. Opening pressure is normal. He has papilledema on exam. What was the missed step prior to lumbar puncture?
What is brain imaging before LP due to increased ICP risk?
New ART initiation → worsening TB symptoms due to immune recovery
What is immune reconstitution inflammatory syndrome (IRIS)?
Persistent MRSA bacteremia despite vancomycin; next step
What is switch to daptomycin?
A hospitalized patient treated for community-acquired pneumonia improves clinically by day 3 but remains febrile. They have required 2 L NC for the last 4 days. WBC 15 > 12. What is the next best step?
What is continue current therapy without broadening antibiotics?
Three sputum AFB smears negative, but high suspicion for TB?
What is obtain NAAT testing?
A 34-year-old woman presents with headache and fever. LP shows:
Opening pressure: normal
WBC: 120 (90% lymphocytes)
Glucose: low
Protein: elevated
MRI shows basilar meningeal enhancement. What is the most likely diagnosis?
What is tuberculous meningitis?
HIV patient with CD4 48 develops headache. CSF shows positive cryptococcal antigen and opening pressure 30 cm H₂O. What is the most important immediate management step beyond antifungals?
What is serial lumbar punctures to reduce intracranial pressure?
valvular dysfunction in IE that leads to HF/surgical indication
What is acute severe regurgitation?
A 64-year-old man with COPD is admitted with severe community-acquired pneumonia requiring mechanical ventilation. He is started on ceftriaxone and azithromycin. Blood and sputum cultures remain negative. On hospital day 4, he is afebrile, hemodynamically stable, and oxygen requirements are improving. What is the appropriate duration of antibiotic therapy?
What is 5 total days of therapy?
Thin elderly woman with chronic cough and nodular bronchiectasis in the right middle lobe and lingula
What is Mycobacterium avium complex (Lady Windermere syndrome)?
A 52-year-old man presents with fever, confusion, and new-onset seizure. MRI shows bilateral temporal lobe hyperintensities. CSF PCR for HSV returns negative on hospital day 1. What is the next best step?
What is continue IV acyclovir and repeat HSV PCR in 3–7 days?