Pneumocystis carinii pneumonia is a common opportunistic lung infection caused by a fungus that takes advantage of weakened immune systems. Symptoms include nonproductive cough, fever, shortness of breath, and weight loss. Treatment involves trimethoprim-sulfamethoxazole and steroids. Mycobacterium avium complex is another opportunistic pathogen causing respiratory infections in immunocompromised individuals. Wasting syndrome is defined by over 10% involuntary weight loss and chronic diarrhea for more than 30 days. Kaposi's sarcoma is an HIV-related cancer affecting blood and lymph vessels. Cryptococcal meningitis presents with fever, headache, and neck stiffness. Highly active antiretro

1. Lecture Day 2

2. PneumocystisCarinii PneumoniaMost common opportunistic infection,80%ommonly found in the lungs of healthy people, but being a source of opportunistic infection it can cause a lung infection in people with a weakened immune systemP. carinii, Pneumocystisjirovecii is a fungus and invades within pulmonary alveoli and forms consolidation in parenchymathe disease attacks the interstitial, fibrous tissue of the lungs, with marked thickening of the alveolar septa and alveoli and leading to significant hypoxia

3. Sx: nonproductive cough fever, chills, SOB, dyspnea, weight loss and night sweatsTx: trimethoprim-sulfamethomexazole, pentamidine and steroids

5. Mycobacterium Avium ComplexAlso, M. intracellulare, , M. scrofulaceum are acid fast bacilli cause respiratory tract infection and increase mortality ratesSx:include fever, fatigue, and weight lossTx: Clarithromycin/Azithromycin, Anti-tuberculosis medication

7. Wasting SyndromeProfound, involuntary weight loss exceeding 10% of baseline body weight and chronic diarrhea for more than 30 days, intermittent feverMay be due to hypermetabolic state, anorexia, diarrhea, malnutrition, GI malabsorption, low food intake Treatment:Symptomatic,diet, control of diarrhea

9. Kaposi’s sarcomaMost common HIV-related malignancyInvolves endothelial layers of blood and lymphatic vesselsFirst noted by Dr. Moritz Kaposi in 1872, a tumor caused by Human herpesvirus 8 Sx: may range from localized cutaneous symptoms to disseminated disease which may appear brownish pink to deep purpleTreatment: palliative, HAART

11. Cryptococcus NeoformansFungal infection that causes meningitis, and symptoms of fever, headache,malaise and stiff neckTx: Amphotericin B, fluconazole

12. Post exposure prophylaxisa course of antiretroviral drugs which is thought to reduce the risk of seroconversion after events with high risk of exposure to HIVTo be most effective, treatment should begin within an hour of possible infection, and no longer than 72 hours post-exposure. Prophylactic treatment for HIV typically lasts four weeks

13. Needle stick Injuries and aidsCDC guidelines generally recommend a PEP protocol with 3 or more antiviral drugs, when it is known that the donor was HIV positivePEP drugs for prevention of HIV infection are given for 4 weeks and may include nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and a single fusion inhibitor. Regardless whether PEP is instituted, follow-up of exposed individuals includes counseling and HIV testing by enzyme immunoassay to monitor for a possible seroconversion for at least 6 months after exposure. Such tests are done at baseline, 6 weeks, 12 weeks, and 6 months, and/or longer.

14. TREATMENTThere is currently no publicly available vaccine for HIV or cure for HIV or AIDS"highly active antiretroviral therapy“(HAART)Drugs that inhibit the reverse transcriptase prevent it from copying the RNA into DNADrugs called protease inhibitors prevent the viral protease from trimming down the large proteins made late during infection

15. HYPERSENSITIVITY

16. Allergy- an inappropriate response of the immune system to normally harmless substancesAtopy- refers to allergic reactions by the actions of IgE antibodies and a genetic predisposition to allergic conditions.Mast cells- also called basophils, are trigerred by IgEs to release chemical mediators to produce allergic reactionsT cells- secrete substances called lymphokines that encourage cell growth, activation, destroys target cells, and stimulate macrophages

17. Antigens are divided into 2 groups:Complete protein antigens-stimulate complete humoral response eg. Animal dander, pollen, horse serumLow molecular weight substances- eg. haptens

18. CHEMICAL MEDIATORS

19. Primary mediatorsfound in mast cellsHistamine- causes erythema, localized edema, pruritus, contraction of bronchial muscle,dilation of small venules and constriction of large ones.

20. Prostaglandins- are composed of unsaturated fatty acids, produce smooth muscle contraction, vasodilation and increased capillary permeability.

21. 2. Secondary mediatorsa. Leukotrienes- released by mast cells that initiate inflammatory response, cause smooth muscle contraction,bronchial constriction and mucus secretion on the pathways.b. Bradykinin- polypeptide that causes increase vascular permeability, vasodilation, hypotension, and smooth muscle contraction and stimulates nerve cell fibersc. Serotonin- released during platelet aggregation causing contraction of bronchial smooth muscle

22. HYPERSENSITIVITYIs a reflection of excessive or aberrant immune responseIt does not usually occur with first exposure to an allergen, but with re-exposure after sensitization in a predisposed individual

23. TYPES of hypersensitivitiesType I/ Anaphylactic Characterized by edema in tissues , larynx and hypotensionIt is immediate and mediated by IgE antibodiesExample:asthma, urticaria,allergic rhinitis,

25. Type II/ CytotoxicOccurs when the system mistakenly identifies a normal constituent of the body as foreignInvolves binding of IgG and IgM antibodies resulting to destruction of cellsExample: myasthenia gravis, idiopathic thrombocytopenic purpura, hemolytic anemia

26. Type III/Immune ComplexInvolves immune complexes formed when antigens bind to antibodiesExample: Systemic Lupus Erythematosus, Rheumatoid arthritis

27. Type IV/Delayed typeAlso called cellular hypersensitivity, occurs 24-72 hours after exposure to an allergenExample: contact dermatitis, mantoux test, transplant rejection

28. ALLERGIC DISORDERS

29. Allergic RhinitisAlso called hay fever, pollinosisSensitization begins with exposure and on re-exposure the nasal mucosa reacts followed by edema formation and leukocyte infiltrationSx: nasal congestion, watery nasal discharge, sneezing,nasal itchingMgt: Avoid allergens, antihistamine, adrenergics, mast cell stabilizers, corticosteroids

31. Contact DermatitisOr dermatitis venenata, a type IV hypersensitivityAcute or chronic skin inflammation that results from direct skin contact with chemicals or allergens80% are due to excessive exposure to irritantsSx: itching, burning, erythema, vesicles, edema, followed by weeping crusting , drying and peeling of the skin

33. Atopic DermatitisA type I hypersensitivity, affects mostly childrenSx: pruritus and hyperirritability of the skinChronic with remission and exacerbationMgt: wearing cotton fabrics, using mild detergent, avoiding allergens, moisturizer,

35. Food AllergyIgE mediated hypersensitivityMost common: seafood, legumes, nuts, egg, milk and chocolateSX: urticaria, wheezing, cough, laryngeal edema, swelling of lips, tongue, abdominal pain, cramps, vomiting, diarrheaMgt: elimination of allergen, H1 and H2 blockers, antihistamine, corticosteroids

36. Serum sicknessA type III hypersensitivity, traditionally results from administration of antisera of animal sourcesSx: usually begin 6-10 days after administration includes: inflammation of injection site, lymphadenopathy, tender joints, peripheral neuritis, vasculitisMgt: Antihistamines and corticosteroids

37. Latex AllergyReaction to natural rubber proteins derived from the rubber tree (Heveabrasiliensis) found in Africa and Southeast Asia. Implicated with rhinitis, conjunctivitis and contact dermatitisPrevention:nonpowdered, low-protein latex and nonlatex gloves.