This document discusses pulmonary complications that can occur in patients with HIV/AIDS. It describes various bacterial, viral, and fungal infections that can affect the lungs, including Pneumocystis pneumonia, tuberculosis, and pneumonias caused by Streptococcus pneumoniae, Staphylococcus aureus, and other pathogens. It also correlates the risk of specific lung infections with the CD4 count and discusses the typical chest x-ray findings associated with different disease etiologies.
This document discusses various lung disorders related to HIV infection. It notes that HIV-1 is more prevalent globally while HIV-2 is found principally in West Africa. Common transmission routes for HIV include sexual contact, intravenous drug use, and mother-to-child. Those at high risk include homosexuals/bisexuals, intravenous drug users, infants born to infected mothers, and recipients of blood/blood products. The document then discusses various classes of antiretroviral drugs and associated lung diseases like bacterial pneumonias, tuberculosis, and Pneumocystis jiroveci pneumonia, their symptoms, diagnoses and treatments.
This document discusses pulmonary manifestations in HIV patients. It begins with an introduction to HIV transmission and risk groups. It then discusses how HIV affects the lungs, causing direct infection and immune dysfunction. Common pulmonary conditions in HIV patients are described, including opportunistic infections like Pneumocystis pneumonia and tuberculosis, which present differently based on CD4 count. Imaging findings for various lung diseases seen in HIV are provided, with examples of abnormalities seen on chest x-ray and CT for conditions like Pneumocystis pneumonia and bacterial/mycobacterial infections. Risk factors, diagnosis and treatment approaches are also summarized.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
Module 3 opportunistic infections and hiv related conditiDavid Ngogoyo
The document summarizes common opportunistic infections seen in HIV-infected individuals in Kenya. It describes tuberculosis as the major opportunistic infection and a major cause of HIV-related morbidity and mortality. Pneumocystis pneumonia is also discussed, along with its clinical presentation and treatment. Cryptococcal meningitis and toxoplasmosis are two other opportunistic infections covered, along with their diagnosis and management.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
Guidelines for the management of adults with community acquired pneumoniaIbrahim Al Sharabi
This document provides guidelines for managing community-acquired pneumonia (CAP) in adults. It defines CAP and classifies patients into four groups based on treatment location and risk factors. It recommends treatments for each group. The guidelines stratify pathogens by group and recommend initial and alternative antibiotic therapies. It also provides guidance on evaluating non-responsive patients, managing complications, switching to oral therapy, and discharge criteria.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses various lung disorders related to HIV infection. It notes that HIV-1 is more prevalent globally while HIV-2 is found principally in West Africa. Common transmission routes for HIV include sexual contact, intravenous drug use, and mother-to-child. Those at high risk include homosexuals/bisexuals, intravenous drug users, infants born to infected mothers, and recipients of blood/blood products. The document then discusses various classes of antiretroviral drugs and associated lung diseases like bacterial pneumonias, tuberculosis, and Pneumocystis jiroveci pneumonia, their symptoms, diagnoses and treatments.
This document discusses pulmonary manifestations in HIV patients. It begins with an introduction to HIV transmission and risk groups. It then discusses how HIV affects the lungs, causing direct infection and immune dysfunction. Common pulmonary conditions in HIV patients are described, including opportunistic infections like Pneumocystis pneumonia and tuberculosis, which present differently based on CD4 count. Imaging findings for various lung diseases seen in HIV are provided, with examples of abnormalities seen on chest x-ray and CT for conditions like Pneumocystis pneumonia and bacterial/mycobacterial infections. Risk factors, diagnosis and treatment approaches are also summarized.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and differentiates it from healthcare-associated pneumonia. The clinical presentation of CAP is described, including common symptoms like cough and fever. Diagnostic testing for CAP including imaging, cultures, and antigen tests is outlined. The document reviews the typical and atypical bacterial causes of CAP and how comorbidities can influence pathogen selection. Guidelines for empiric antibiotic therapy for outpatient and hospitalized CAP patients are provided, including considerations for multidrug resistant pathogens. Treatment of influenza pneumonia is also summarized.
Module 3 opportunistic infections and hiv related conditiDavid Ngogoyo
The document summarizes common opportunistic infections seen in HIV-infected individuals in Kenya. It describes tuberculosis as the major opportunistic infection and a major cause of HIV-related morbidity and mortality. Pneumocystis pneumonia is also discussed, along with its clinical presentation and treatment. Cryptococcal meningitis and toxoplasmosis are two other opportunistic infections covered, along with their diagnosis and management.
- Community acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside the hospital setting. Diagnosis involves presence of respiratory and systemic symptoms along with new radiological shadows on chest x-ray.
- Severity is classified using CURB-65 criteria to determine if hospital admission is required. Treatment involves antibiotics, with specific regimens depending on risk factors for multidrug-resistant organisms.
- Duration of treatment is typically 5-7 days but may be prolonged for specific cases. Prevention involves smoking cessation, hand washing, vaccination, and controlling underlying conditions like diabetes.
Guidelines for the management of adults with community acquired pneumoniaIbrahim Al Sharabi
This document provides guidelines for managing community-acquired pneumonia (CAP) in adults. It defines CAP and classifies patients into four groups based on treatment location and risk factors. It recommends treatments for each group. The guidelines stratify pathogens by group and recommend initial and alternative antibiotic therapies. It also provides guidance on evaluating non-responsive patients, managing complications, switching to oral therapy, and discharge criteria.
This document provides guidelines for the diagnosis and management of community-acquired pneumonia (CAP). It defines CAP and discusses its epidemiology and common causes. Streptococcus pneumoniae is often the leading cause worldwide, though causes can vary regionally in India. Chest radiography is important for diagnosis but has limitations. Computed tomography is not routinely needed. The role of microbiological testing of blood and sputum in hospitalized patients is outlined.
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document describes the case of a 70-year-old female patient admitted to the ICU with community acquired pneumonia. On examination, she displayed signs of confusion, fever, tachycardia, tachypnea, and hypoxemia. Diagnostic tests found consolidations in her left lung with a pleural effusion. She was given various antibiotic treatments but did not improve. A CT scan later found nonspecific interstitial pneumonia. The document also discusses definitions, causes, clinical features, severity indices, diagnostic testing, and treatment guidelines for community acquired pneumonia.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and distinguishes it from other types of pneumonia. It then discusses the epidemiology, clinical presentation, etiology, symptoms, diagnosis, treatment, and antibiotic resistance patterns associated with CAP. Key points include that CAP affects millions annually in the US with high costs, accurate diagnosis and treatment is important to reduce mortality, and resistance to commonly used antibiotics is a concern.
This document provides information on community-acquired pneumonia (CAP), including its definition, guidelines, incidence, causes, risk factors, evaluation, diagnosis, severity scoring, and laboratory tests. Some key points:
- CAP is defined as an acute lung infection associated with symptoms and radiographic findings outside of a hospital or care facility.
- Guidelines for CAP management have been published by organizations like ATS and IDSA.
- The overall incidence is 3-40 per 1000 people per year, with higher rates among young children and older adults. Mortality can be as high as 10%.
- Common causes include Streptococcus pneumoniae, Haemophilus influenzae, and Legionella species.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
Encephalitis is inflammation of the brain parenchyma that is usually caused by viral infection. Common viruses include herpes simplex virus type 1 and West Nile virus. Clinical features include altered mental status, seizures, and focal neurological deficits. Diagnosis involves CSF analysis showing pleocytosis and identifying the virus through PCR or serology. Treatment involves antivirals for suspected viruses and managing increased intracranial pressure and seizures. Prognosis depends on the specific virus and early initiation of treatment.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
The document discusses community-acquired pneumonia (CAP), including common pathogens, signs and symptoms, diagnosis, and treatment options. The most common pathogens for typical CAP are Streptococcus pneumoniae, while atypical CAP is commonly caused by organisms such as influenza virus, Mycoplasma, and Chlamydia. Signs and symptoms include cough, fever, chills, dyspnea, and fatigue. Diagnosis involves a chest x-ray and labs such as a complete blood count and sputum/blood cultures. Treatment depends on severity and location (outpatient vs inpatient), but generally includes macrolides, fluoroquinolones, or doxycycline.
This document provides information on COVID-19 in children, including its symptoms, risk factors for severe disease, complications, management, and similarities to Kawasaki disease. It discusses the typical clinical manifestations in children such as fever, cough, gastrointestinal symptoms, and dermatological findings. Risk factors for severe COVID-19 include underlying medical conditions and higher viral loads. Imaging may show ground glass opacities while labs can show elevated inflammatory markers and lymphopenia. Management involves supportive care, antibiotics for secondary infections, and Kawasaki disease treatments for overlapping cases.
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
This document provides information on the management of CoViD 19. It discusses the virology of SARS-CoV-2, symptoms of CoViD 19, transmission routes, diagnosis methods including RT-PCR testing and CT scans, treatment approaches based on illness severity from mild to severe pneumonia and ARDS, and those at high risk of severe illness such as older patients and those with underlying medical conditions. Pathology findings include diffuse alveolar damage and lymphocytic infiltrates in severe cases.
Approach to a patient with respiratory infectionSrikant Mohta
This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
This document provides information on the prevention, diagnosis, and treatment of community-acquired pneumonia (CAP). It discusses who is at increased risk for CAP and should receive pneumococcal and influenza vaccines. Key symptoms that should lead to consideration of a CAP diagnosis are discussed. Common causative organisms are Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens; viruses are also often involved. Factors that increase the risk of specific pathogenic organisms are outlined.
The document discusses HIV and its discovery. It describes how HIV was discovered in 1981 when CDC noted an increase in opportunistic infections in previously healthy individuals with impaired immune function. HIV was isolated in 1983. It provides details on the properties of HIV, how it interacts with and infects host cells, the pathogenesis and progression of HIV infection including how it evades the immune system, and diagnostic tests for HIV including viral detection tests and antibody tests.
1. Community acquired pneumonia (CAP) is a major cause of illness and death globally, especially in developing countries, despite availability of vaccines and antibiotics.
2. Streptococcus pneumoniae is the most common cause of CAP, especially in infants and young children, and is responsible for over 1 million deaths annually. Viruses are also a common cause, particularly in infants.
3. Diagnosis of CAP is usually clinical based on symptoms like fever, cough and fast breathing. Laboratory tests can provide some guidance on likely pathogens but often do not identify an exact cause. Empiric antibiotic treatment should be started before establishing an etiology.
This document provides guidelines for the diagnosis and management of pneumonia. It defines different types of pneumonia including community-acquired and hospital-acquired. It outlines symptoms, typical causative organisms, and appropriate initial antibiotic therapy for patients with varying severity. It also provides guidance on evaluating treatment response, determining when patients are clinically stable for discharge, and follow-up after discharge. Risk factors for drug-resistant pathogens and multidrug therapy are discussed.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Presentation1.pptx, radiological imaging of aids diseasesAbdellah Nazeer
This document provides an overview of various neurological, endocrine, respiratory, cardiac, and other organ system manifestations of HIV/AIDS. Key points include:
- 10-20% of AIDS patients initially present with neurological disease, and 40% will develop neurological involvement over the course of the disease. Common central nervous system opportunistic infections include toxoplasmosis, tuberculosis, and cryptococcosis.
- Lung disease is also a major complication, with bacterial pneumonia, Pneumocystis pneumonia, and tuberculosis being particularly common. Non-infectious lung diseases associated with HIV include Kaposi's sarcoma and lymphoma.
- Cardiac manifestations include myocarditis, dilated cardiomyopathy, and peric
This document discusses community acquired pneumonia (CAP). It begins by defining CAP and discussing its epidemiology and classification. It then covers the incidence, clinical presentation, radiological manifestations, and typical microbiological findings of CAP. It discusses specific investigations and pathogens involved in severe CAP. Scoring systems for assessing CAP severity, including PSI, CURB-65 and CRB-65, are outlined. Guidelines are provided on treatment based on severity, including empiric antibiotic choice. Risk factors for drug-resistant pathogens and tuberculosis are noted. The document concludes with recommendations for empiric treatment of severe CAP patients admitted to the ICU.
This document discusses community-acquired pneumonia (CAP) in both children and adults. It provides information on the definition, most common causes, symptoms, physical exam findings, diagnostic testing, treatment recommendations, and management of CAP. Specifically, it notes that CAP is a significant cause of morbidity and mortality in children and the elderly. It recommends physical exams, labs, chest x-rays, and severity scores to evaluate patients and determine treatment approach. First-line antibiotic treatment depends on patient factors but usually includes macrolides or doxycycline. Hospitalization is advised if severity criteria are met.
This document describes the case of a 70-year-old female patient admitted to the ICU with community acquired pneumonia. On examination, she displayed signs of confusion, fever, tachycardia, tachypnea, and hypoxemia. Diagnostic tests found consolidations in her left lung with a pleural effusion. She was given various antibiotic treatments but did not improve. A CT scan later found nonspecific interstitial pneumonia. The document also discusses definitions, causes, clinical features, severity indices, diagnostic testing, and treatment guidelines for community acquired pneumonia.
This document provides information on community-acquired pneumonia (CAP). It defines CAP and distinguishes it from other types of pneumonia. It then discusses the epidemiology, clinical presentation, etiology, symptoms, diagnosis, treatment, and antibiotic resistance patterns associated with CAP. Key points include that CAP affects millions annually in the US with high costs, accurate diagnosis and treatment is important to reduce mortality, and resistance to commonly used antibiotics is a concern.
This document provides information on community-acquired pneumonia (CAP), including its definition, guidelines, incidence, causes, risk factors, evaluation, diagnosis, severity scoring, and laboratory tests. Some key points:
- CAP is defined as an acute lung infection associated with symptoms and radiographic findings outside of a hospital or care facility.
- Guidelines for CAP management have been published by organizations like ATS and IDSA.
- The overall incidence is 3-40 per 1000 people per year, with higher rates among young children and older adults. Mortality can be as high as 10%.
- Common causes include Streptococcus pneumoniae, Haemophilus influenzae, and Legionella species.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
Encephalitis is inflammation of the brain parenchyma that is usually caused by viral infection. Common viruses include herpes simplex virus type 1 and West Nile virus. Clinical features include altered mental status, seizures, and focal neurological deficits. Diagnosis involves CSF analysis showing pleocytosis and identifying the virus through PCR or serology. Treatment involves antivirals for suspected viruses and managing increased intracranial pressure and seizures. Prognosis depends on the specific virus and early initiation of treatment.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
The document discusses community-acquired pneumonia (CAP), including common pathogens, signs and symptoms, diagnosis, and treatment options. The most common pathogens for typical CAP are Streptococcus pneumoniae, while atypical CAP is commonly caused by organisms such as influenza virus, Mycoplasma, and Chlamydia. Signs and symptoms include cough, fever, chills, dyspnea, and fatigue. Diagnosis involves a chest x-ray and labs such as a complete blood count and sputum/blood cultures. Treatment depends on severity and location (outpatient vs inpatient), but generally includes macrolides, fluoroquinolones, or doxycycline.
This document provides information on COVID-19 in children, including its symptoms, risk factors for severe disease, complications, management, and similarities to Kawasaki disease. It discusses the typical clinical manifestations in children such as fever, cough, gastrointestinal symptoms, and dermatological findings. Risk factors for severe COVID-19 include underlying medical conditions and higher viral loads. Imaging may show ground glass opacities while labs can show elevated inflammatory markers and lymphopenia. Management involves supportive care, antibiotics for secondary infections, and Kawasaki disease treatments for overlapping cases.
a quick review of the articles issued by WHO, CDC and other medical experts...
>>>
on its epidemiology, etiology, clinical manifestations, diagnosis, management and prevention.
Management Of Community Acquired PneumoniaAshraf ElAdawy
This document provides information on community-acquired pneumonia (CAP), including its definition, classification, pathogens, pathophysiology, diagnosis, and methods for assessing severity. CAP is defined as an alveolar infection developing outside of a hospital within 48 hours of admission. The most common causative pathogens are Streptococcus pneumoniae, Haemophilus influenzae, and atypical bacteria. Severity must be assessed to determine the appropriate site of care, and several prognostic scoring systems are discussed including the Pneumonia Severity Index (PSI), CURB-65, and CRB-65, which stratify patients into risk groups to guide management decisions.
This document provides information on the management of CoViD 19. It discusses the virology of SARS-CoV-2, symptoms of CoViD 19, transmission routes, diagnosis methods including RT-PCR testing and CT scans, treatment approaches based on illness severity from mild to severe pneumonia and ARDS, and those at high risk of severe illness such as older patients and those with underlying medical conditions. Pathology findings include diffuse alveolar damage and lymphocytic infiltrates in severe cases.
Approach to a patient with respiratory infectionSrikant Mohta
This document provides an overview of acute respiratory infections including etiology, classification, clinical presentation, diagnostic evaluation and treatment approaches. It discusses the major syndromes of community-acquired pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia. Evaluation involves history, examination, hematological and microbiological testing. Severity is assessed using CURB-65 or Pneumonia Severity Index to determine site of care. Treatment selection is based on syndrome, severity and likely pathogens.
Community acquired pneumonia by dr md abdullah saleemsaleem051
This document provides information on community-acquired pneumonia (CAP), including epidemiology, risk factors, presentation, diagnosis, treatment recommendations, and prevention strategies. It notes that CAP is one of the most common infectious diseases worldwide, with higher rates among the elderly. Common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Clinical assessment and chest imaging are important for diagnosis and management. Antibiotic treatment should be based on likely pathogens and severity of illness. Immunization can help prevent CAP in high-risk groups.
This document provides information on the prevention, diagnosis, and treatment of community-acquired pneumonia (CAP). It discusses who is at increased risk for CAP and should receive pneumococcal and influenza vaccines. Key symptoms that should lead to consideration of a CAP diagnosis are discussed. Common causative organisms are Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens; viruses are also often involved. Factors that increase the risk of specific pathogenic organisms are outlined.
The document discusses HIV and its discovery. It describes how HIV was discovered in 1981 when CDC noted an increase in opportunistic infections in previously healthy individuals with impaired immune function. HIV was isolated in 1983. It provides details on the properties of HIV, how it interacts with and infects host cells, the pathogenesis and progression of HIV infection including how it evades the immune system, and diagnostic tests for HIV including viral detection tests and antibody tests.
1. Community acquired pneumonia (CAP) is a major cause of illness and death globally, especially in developing countries, despite availability of vaccines and antibiotics.
2. Streptococcus pneumoniae is the most common cause of CAP, especially in infants and young children, and is responsible for over 1 million deaths annually. Viruses are also a common cause, particularly in infants.
3. Diagnosis of CAP is usually clinical based on symptoms like fever, cough and fast breathing. Laboratory tests can provide some guidance on likely pathogens but often do not identify an exact cause. Empiric antibiotic treatment should be started before establishing an etiology.
This document provides guidelines for the diagnosis and management of pneumonia. It defines different types of pneumonia including community-acquired and hospital-acquired. It outlines symptoms, typical causative organisms, and appropriate initial antibiotic therapy for patients with varying severity. It also provides guidance on evaluating treatment response, determining when patients are clinically stable for discharge, and follow-up after discharge. Risk factors for drug-resistant pathogens and multidrug therapy are discussed.
This 67-year-old woman with mild Alzheimer's disease presents with community-acquired pneumonia based on symptoms of productive cough, fever, confusion and exam findings of crackles in both lower lung fields and CXR infiltrates. She meets 3 CURB-65 criteria (confusion, RR≥30, age≥65) and 4 IDSA-ATS minor criteria (RR≥30, confusion, BUN>20, PaO2/FiO2<250) warranting consideration of ICU admission given risk of deterioration. Based on her nursing home residence and recent hospitalization, she also meets criteria for possible healthcare-associated pneumonia and should receive broad-spectrum antibiotics with MRSA and Pseudomonas coverage along with diagnostic
Presentation1.pptx, radiological imaging of aids diseasesAbdellah Nazeer
This document provides an overview of various neurological, endocrine, respiratory, cardiac, and other organ system manifestations of HIV/AIDS. Key points include:
- 10-20% of AIDS patients initially present with neurological disease, and 40% will develop neurological involvement over the course of the disease. Common central nervous system opportunistic infections include toxoplasmosis, tuberculosis, and cryptococcosis.
- Lung disease is also a major complication, with bacterial pneumonia, Pneumocystis pneumonia, and tuberculosis being particularly common. Non-infectious lung diseases associated with HIV include Kaposi's sarcoma and lymphoma.
- Cardiac manifestations include myocarditis, dilated cardiomyopathy, and peric
Opportunistic infections are infections that occur more frequently and are more severe in people with weakened immune systems such as those with HIV/AIDS. These infections include fungal, bacterial, viral, and parasitic infections that typically do not seriously affect those with healthy immune systems. Common opportunistic infections in HIV/AIDS patients include Pneumocystis pneumonia, tuberculosis, candidiasis, toxoplasmosis, cryptococcus, and cytomegalovirus. Antiretroviral therapy has significantly reduced the rates of opportunistic infections by suppressing HIV and allowing immune recovery. HIV/AIDS remains a major global public health challenge.
HIV CHEST AND OPPOTUNISTIC INFECTION IN AIDS.pptxJosephmwanika
HIV infection can directly infect lung cells and weaken the immune system's ability to fight pulmonary infections. Common lung manifestations of HIV/AIDS include opportunistic infections like Pneumocystis pneumonia, tuberculosis, and cytomegalovirus pneumonia. Chest imaging plays an important role in the diagnosis and management of these infections. On CT, Pneumocystis pneumonia typically appears as bilateral ground-glass opacity and septal thickening, while tuberculosis may show upper lobe cavitary lesions when CD4 counts are high and disseminated disease at low CD4 counts. Viral infections like CMV commonly cause ground-glass nodules in severely immunocompromised individuals.
This document discusses otolaryngologic manifestations of HIV/AIDS. It begins by explaining how HIV works and disease progression as CD4 counts decline. AIDS is diagnosed when CD4 counts fall below 200 or AIDS-defining conditions occur. Common conditions include Kaposi's sarcoma, non-Hodgkin's lymphoma, herpes zoster outbreaks, recurrent ear/sinus infections, facial palsy, and sensorineural hearing loss. Fungal and atypical bacterial infections increase with immunosuppression. Evaluation with imaging/biopsy is important to identify treatable underlying causes of symptoms like lymphadenopathy. Management involves antiviral/antibiotic therapy and occasionally surgery.
HIV/AIDS is caused by the human immunodeficiency virus (HIV) which weakens the immune system and leaves the body vulnerable to opportunistic infections. It is transmitted through bodily fluids and has become a global pandemic. As the virus destroys CD4+ T cells over time, it progresses from asymptomatic infection to AIDS, defined by specific infections or a low CD4+ count. Common infections include Pneumocystis pneumonia, tuberculosis, toxoplasmosis, and various cancers like Kaposi's sarcoma. There is no vaccine or cure, but antiretroviral treatment can control the virus.
Human immunodeficiency virus (HIV) infects about 33.2 million people worldwide, with 22.5 million in sub-Saharan Africa. In the United States, over 1 million people were living with HIV in 2006. HIV was isolated in 1984 and typically takes 8-10 years before clinical AIDS manifestations occur. The virus is a retrovirus that incorporates its RNA genome into the DNA of infected host cells.
HIV/AIDS remains a major global epidemic, infecting over 59 million people worldwide since the 1980s and causing over 20 million deaths. Developing countries account for most new HIV infections, with sub-Saharan Africa the hardest hit region. While there is no cure for HIV, treatment using antiretroviral drugs can control the virus and prevent transmission. Developing an effective HIV vaccine remains challenging due to the virus's ability to mutate and evade the immune system.
This document provides an overview of pneumonia, including its definition, classification, pathophysiology, clinical manifestations, diagnosis, treatment and antibiotic resistance. Pneumonia is an infection of the lungs that can be caused by bacteria, viruses or other pathogens. It is commonly classified as community-acquired or healthcare-associated pneumonia. Clinical diagnosis involves assessing symptoms and chest imaging, while etiologic diagnosis may involve sputum/blood cultures, antigen tests and PCR. Treatment depends on pneumonia severity and risk factors. Antibiotic resistance among pathogens like Streptococcus pneumoniae and gram-negative bacilli is an ongoing concern.
The document summarizes key information about HIV/AIDS, including:
1. HIV has infected 59 million people worldwide, with 20 million deaths. Developing countries account for 64% of cases and 2/3 of new infections.
2. Common early symptoms of HIV infection include fever, fatigue, rash, headache, lymphadenopathy, and gastrointestinal issues.
3. HIV is transmitted through unprotected sex, blood transfusions, needle sharing, and from mother to child during pregnancy, birth, or breastfeeding.
4. While there is no cure for HIV, treatment with antiretroviral drugs can control the virus and prevent transmission.
This document provides information on the management of patients with AIDS. It defines AIDS and describes the history and spread of HIV/AIDS. It discusses the global prevalence of HIV/AIDS, the virus itself, modes of transmission, pathogenesis and clinical manifestations in the different stages of infection. It also covers diagnosis, opportunistic infections, treatment goals, antiretroviral therapy and the management of HIV/AIDS patients.
This document provides guidelines for managing opportunistic mycobacterial infections. It discusses the epidemiology, diagnosis, and treatment of these infections. For pulmonary disease caused by M. kansasii in HIV-negative patients, the guidelines recommend treatment with rifampicin and ethambutol for 9 months based on prospective studies showing high cure rates without relapse. For patients with compromised immunity, treatment should continue for 15-24 months or until sputum cultures are negative for 12 months. Relapses should be retreated with rifampicin and ethambutol for 15-24 months, adding prothionamide and streptomycin for non-responders.
Imaging in pulmonary infections (non bacterial)devrajkandel1
This document provides an overview of imaging features of non-bacterial pulmonary infections. It begins by describing the mechanisms of pulmonary infections and then discusses various types of infections including viral, fungal, protozoal and helminthic origins. For each type of infection, examples of specific pathogens are given along with their typical radiographic and CT imaging appearances. Common findings include areas of consolidation, ground-glass opacities, nodules and reticulation. The document emphasizes how imaging can help identify and characterize different pulmonary infections.
HIV is a retrovirus that causes AIDS by destroying CD4+ T cells. It is transmitted through bodily fluids and can be occupational hazard for surgeons. Universal precautions like proper protective equipment and disposal of contaminated waste are important to prevent transmission. Current antiretroviral therapy uses combination of three or more drugs like nucleoside analogs that inhibit reverse transcriptase and protease inhibitors. This effectively suppresses the virus and prevents opportunistic infections associated with AIDS.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and is spread through airborne droplets. It most commonly affects the lungs but can spread to other organs. Symptoms include cough, fever, night sweats and weight loss. Diagnosis involves sputum tests, chest x-rays and tuberculin skin tests. Treatment requires a multi-drug regimen over several months to cure the infection and prevent drug resistance. Tuberculosis remains a major global health problem, especially in developing countries and among HIV-positive individuals.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
The document discusses pathology associated with HIV and AIDS, including:
1. It provides an overview of the global HIV/AIDS epidemic and prevalence rates over time in South Africa.
2. It describes the clinic-pathologic presentations of different stages of HIV infection, including common infections and conditions associated with different CD4 count ranges.
3. It discusses anatomical and clinical presentations of various opportunistic infections and cancers associated with advanced HIV, including tables outlining cardiovascular, dermatological, neurological, and other manifestations.
4. It presents several images of pathologic findings from HIV-infected patients, such as lesions from toxoplasmosis, Kaposi's sarcoma, lymphoma, and other conditions.
This document summarizes key information about HIV and AIDS, including:
- HIV is a spherical virus that contains two copies of RNA and reverse transcriptase enzyme. It infects CD4+ lymphocytes.
- HIV infection progresses from acute infection to asymptomatic infection to symptomatic infection characterized by opportunistic infections.
- Common opportunistic infections include Pneumocystis jiroveci pneumonia, Candidiasis, Kaposi's sarcoma, and non-Hodgkin's lymphoma.
- Highly active antiretroviral therapy using combinations of reverse transcriptase inhibitors and protease inhibitors can control HIV replication and symptoms. However, no effective vaccine currently exists due to high mutation rates of the virus.
This document provides an overview of tuberculosis (TB), including its definition, causes, pathogenesis, clinical presentation, investigations, types, treatment regimens, and relationship to HIV/AIDS. TB is caused by mycobacteria, commonly Mycobacterium tuberculosis, which can affect any organ but typically affects the lungs. It is transmitted via airborne droplets from someone with active pulmonary TB. Primary infection may result in latent TB or active TB, depending on immune response. Symptoms vary based on location of infection. Diagnosis involves chest x-ray, sputum smear, and Mantoux test. Treatment involves a combination of bactericidal and bacteriostatic drugs. Multi-drug resistant TB can develop if treatment is not completed
This document discusses HIV/AIDS and its effects on the periodontium. It begins with an overview of HIV, how it is transmitted, and its pathogenesis. It then describes various oral manifestations of HIV infection, including oral candidiasis, hairy leukoplakia, Kaposi's sarcoma, non-Hodgkin's lymphoma, and periodontal diseases. Diagnosis and treatment approaches for each condition are provided. The document emphasizes that proper oral hygiene and treatment can help support periodontal health in HIV-positive individuals.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Pulmonary complications
www.aidsknowledgehub.org
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia
Advanced ART Training for Adults and Adolescents – Ukraine, 2004
2. Цель занятия
• Цель занятия: рассмотреть вопросы
касающиеся заболеваний органов дыхания у
пациентов с ВИЧ инфекцией.
• Задачи:
усвоив материал занятия, Вы будете:
– Знать причины инфекционного и неинфекционного
поражения лёгких
– Уметь предполагать этиологию поражения лёгких в
зависимости от количества CD4
– Знать особенности рентгенологических изменений
в зависимости от этиологии поражения лёгких
– Уметь проводить лечение и профилактику
поражений лёгких
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
3. Respiratory illnesses in persons
with HIV infection & AID
Bacterial infections: Viral infections:
Pneumococcal pneumonia Cytomegalovirus
H. influenzae pneumoniae Herpes simplex virus
Klebsiella pneumonia
Staphylococcal pneumonia Possible complications:
M. tuberculosis pneumoniae Lymphocytic interstitial pneumonitis
MAC pneumonia
Fungal infections:
Possible complications: Pneumocystis pneumonia
·Lung abscess Cryptococcosis
·Empyema Histoplasmosis
·Pleural effusion Aspergillosis
·Pericardial effusion
·Pneumothorax Other conditions:
Kaposi's sarcoma
Lymphoma
WHO HIV/AIDS Treatment and Care Protocols of HIV/AIDS in EurasiaCommonwealth of Independent States.March.2004
Regional Knowledge Hub for the Care and Treatment for countries of the www.aidsknowledgehub.org
4. CAUSE of PULMONARY DISODERS
WITH HIV
• The single major prospective study of pulmonary
complications of HIV was discontinued in the
pre-HAART era – 1995. Data from 3 years
(1992-1995) showed 521 infections:
- PCP – 232 (45%),
- Pyogenic bacteria – 220 (42%),
- Tuberculosis – 25 (5%),
- CMV – 19 (4%),
- Aspergillus – 12 (2%), and
- Tryptococcosis – 7 (1%)
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
5. Pneumonia etiology correlated
with CD4 count
CD4 count S. pneumoniae, M. tuberculosis, S.
>200 aureus (IDU), Influenza
cells/mm3
CD4 count Above + P. carinii, cryptococcosis,
50-200 cells/ histoplasmosis, coccidioidomycosis,
mm3 Nocardia, M. kansasii, Kaposi’s
sarcoma
CD4 count Above + P. aeruginosa, Aspergillus,
<50 MAC, CMV
cells/mm3
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
6. Uncommon association of chest X-ray
changes and etiology of pneumonia
Consolidation Nocardia, M. tuberculosis, M. kansasii, Legionella,
B. Bronchiseptica
Reticulonodular Kaposi’s sarcoma, toxoplasmosis, CMV, leishmania,
infiltrates lymphoid interstital pneumonitis
Nodules Kaposi’s sarcoma, Nocardia
Cavity M. kansasii, MAC, Legionella, P. carinii, lymphoma,
Klebsiella, Rhodococcus equi
Hilar nodes M. kansasii, MAC
Pleural effusion Cryptococcosis, MAC, histoplasmosis,
coccidioidomycosis, aspergillosis, anaerobes, Nocardia,
lymphoma, toxoplasmosis, primary effusion lymphoma
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
7. Correlation of Chest X-ray Changes
and Etiology of Pneumonia
Consolidation Pyogenic bacteria, Kaposi’s sarcoma, cryptococcosis
Reticulonodular P. carinii, M. tuberculosis, histoplasmosis,
infiltrates coccidioidomycosis
Nodules M. tuberculosis, cryptococcosis
Cavity M. tuberculosis, S. Aureus (IDU), Nocardia, P.
aeruginosa, cryptococcosis, coccidioidomycosis,
histoplasmosis, aspergillosis, anaerobes
Hilar nodes M. tuberculosis, histoplasmosis,
coccidioidomycosis, lymphoma, Kaposi’s sarcoma
Pleural effusion Pyogenic bacteria, Kaposi’s sarcoma, M. tuberculosis
(congestive heart failure, hypoalbuminemia)
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
8. Bacterial infection: Gram-negative bacilli
• Course: Acute, purulent sputum
• Frequency: uncommon (except with nosocomial
infection or neutropenia)
• Setting: P. auruginosa is relatively common in
late-stage disease, cavitary disease, or chronic
antibiotic exposure (median CD4 50 cells/mm3)
• Typical findings: Lobar or bronchopneumonia
• Diagnosis: Sputum GS and culture (sensitivity
is >80%, but specificity is poor)
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
9. Bacterial infection: Haemophilus influenzae
• Course: Acute, purulent sputum
• Frequency: 100-fold higher then healthy
controls
• Setting: most infections are caused by
unencapsulated strains
• Typical findings: bronchopneumonia
• Diagnosis: Sputum GS and culture
(sensitivity of culture is 50%; prior
antibiotics usually preclude growth)
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
10. Bacterial infection: Legionella
• Course: Acute mucopurulent sputum
• Frequency: uncommon.
• Setting: HIV-associated is debated
• Typical findings: bronchopneumonia;
sometimes multiple infiltrates in
noncontiguous segments
• Diagnosis: Sputum culture; urinary
antigen
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
11. Bacterial infection: Nocardia
• Course: Chronic or asymptomatic;
sputum production
• Frequency: Uncommon
• Setting: Frequency higher with chronic
corticosteroid use (median CD4 50
cells/mm3)
• Typical findings: Nodule or cavity
• Diagnosis: Sputum or fiberoptic
bronchoscopy; GS
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
12. Bacterial infection: Staph. aureus
• Course: Acute, subacute, or chronic purulent
sputum
• Frequency: Uncommon, except with injected
drug use and tricuspid valve endocarditis with
septic emboli
• Typical findings: Bronchopneumonia, cavitary
disease, septic emboli with cavities ± effusion
• Diagnosis: Blood, sputum GS and
culture(sputum culture is sensitive, but specificity
is poor). Blood cultures are nearly always
positive with endocarditis
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
13. Bacterial infection: Strept. pneumoniae
• Course: Acute, purulent sputum ±pleurisy
• Frequency: common, all stages; 100-fold higher
then healthy controls
• Setting: higher with low CD4 and with smoking
• Typical findings: Lobar or bronchopneumonia
±pleural effusion
• Diagnosis: Blood cultures often positive,
sputum GS, Quellung, culture (sensitivity of
culture is 50%; prior antibiotics usually preclude
growth)
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
14. Fungal infection: Aspergillus
• Course: Acute or subacute
• Frequency: Up to 4% of AIDS patients
• Setting: usually advanced HIV infection (median
CD4 count 30 cells/mm3); about 50% have
severe neutropenia (ANC <500/mm3) ± chronic
steroids; disseminated disease is uncommon
• Typical findings: Focal infiltrate; cavity - often
pleural-based, diffuse infiltrates or
reticulonodular infiltrates
• Diagnosis: Sputum stain and culture;
falsepositive and false-negativecultures
common. Best tests:Tissue pathology or sputum
smear and typical CT and clinical features
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
15. Fungal infection: Candida
• Course: Chronic or subacute
• Frequency: Common isolate, rare cause of
pulmonary disease (median CD4 count 50 cells/
mm3)
• Typical findings: Bronchitis; rare cause of
pneumonia (some say it does not exist)
• Diagnosis: Recovery in sputum or FOB
specimen is meaningless (up to 30% of all
expectorated sputumand FOB cultures in
unselected patients yield Candida sp.); must
have histologic evidence of invasion on biopsy
WHO HIV/AIDS Treatment and Care Protocols for countries of the Commonwealth of Independent States.March.2004
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
16. Fungal infection: Coccidioides immitis
• Course: Chronic or subacute
• Frequency: Up to 10% of AIDS patients in
endemic area
• Setting: usually advanced HIV infection (median
CD4 count 50 cells/mm3); disseminated disease
in 20% to 40%
• Typical findings: Diffuse nodular infiltrates,
focal infiltrate, cavity; hilar adenopathy
• Diagnosis: Sputum, induced sputum, or FOB
stain and culture; KOH of expectorated sputum
is rarely positive; serology positive in 70%; blood
cultures positive in 10%
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
17. Fungal infection: Cryptococcus
• Course: Chronic, subacute, or symptomatic
• Frequency: Up to 8% to 10% in AIDS patients
• Setting: late-stage HIV infection (median CD4
count 50 cells/mm3); 80% have cryptococcal
meningitis
• Typical findings: Nodule, cavity, diffuse or
nodular infiltrates
• Diagnosis: Sputum, induced sputum, or FOB
stain and culture; serum cryptococcal antigen
usually positive; CSF analysis indicated if
antigen or organism found at any site
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
18. Fungal infection: Histoplasma
capsulatum
• Course: Chronic or subacute
• Frequency: Up to 15% of AIDS patients in endemic area
• Setting: usually advanced HIV infection with
disseminated histoplasmosis (median CD4 count 50
cells/mm3)
• Common features: Fever, weight loss,
hepatosplenomegaly, lymphadenopathy
• Typical findings: Diffuse nodular infiltrates, nodule,
focal infiltrate, cavity, hilar adenopathy
• Diagnosis: Best test for diagnosis and followup of
treatment is serum and urine polysaccharide antigen
assay, with yield of 85% (blood) and 97% (urine).
Serology positive in 50% to 70%; yield with culture of
sputum – 80%, marrow – 80%; blood cultures positive in
60% to 85%
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
19. Fungal infection: Pneumocystis jiroveci
(previously known as Pneumocystis carinii)
• Course: Acute or subacute
• Presentation:
- Usually present with cough, shortness of breath and
fever
- Often patients have features of respiratory failure
(shortness of breath and cyanosis)
- Occasionally patients have no chest signs
• Frequency: Very common in late stages of
HIV infection (>95% have CD4 <200 cell/mm3)
• Setting: infrequent in patients compliant with
TMP-SMX prophylaxis
WHO HIV/AIDS Treatment and Care Protocols for countries of the Commonwealth of Independent
States.March.2004
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
20. PCP severe PCP
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
22. Fungal infection: Pneumocystis jiroveci
(previously known as Pneumocystis carinii)
• X-ray findings:
- Interstitial infiltrates with characteristic ground glass
appearance;
- Negative X-ray in early stages, about 15% to 20%;
- Atypical findings in 20% (upper lobe infiltrates, focal
infiltrates, nodules, cavitary disease, or mediastinal
lymphadenopathy)
• Diagnosis: Cytology of induced sputum (mean yield of 60% in
proven cases) and bronchoalveolar lavage (mean yield of 95%)
• Treatment and prophylaxis: see D3-3
John G. Bartlett. Medical management of HIV infection, 2003
WHO HIV/AIDS Treatment and Care Protocols for countries of the Commonwealth of Independent States.
March.2004
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
23. Viruses infection: CMV
• Course: Subacute or chronic
• Frequency: Common isolate, rare cause of
pulmonary disease
• Setting: Advanced HIV infection (median CD4
count 20 cells/mm3)
• Typical findings: Interstitial infiltrates
• Diagnosis: Yield with FOB is 20% to 50%,
culture requires more than 1 week; shell culture
1 to 2 days; diagnosis of CMV pneumonitis
(disease) requires CMV seen on cytopath or
biopsy, progressive disease, and no alternative
pathogen
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
24. Viruses infection: HCV, VZV, RSV,
parainfluenza
• Course: Acute
• Frequency: Rare causes of pneumonia
• Typical findings: Diffuse or nodular pneumonia,
bronchopneumonia
• Diagnosis:
– Culture of sputum or FOB commonly yields HSV as a
contaminant from upper airways
– RSV is rare in adults but has increased frequency in
immunosuppressed host, is easily detected with DFA
stain of respiratory secretions
(John G. Bartlett. Medical management of HIV infection, 2003)
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
25. Viruses infection: influenza
• Course: Acute, purulent sputum
• Frequency: Frequency and course minimally
different from patients without HIV infection
• Setting: Bacterial super-infection is common
with S. pneumoniae, S. aureus and H.
influenza
• Typical findings: Bronchopneumonia,
interstitial infiltrates
• Diagnosis: Culture of throat, nasopharyngeal
aspirates, washing, and serology;
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
26. Mycobacterium avium complex (MAC)
• Course: Chronic or asymptomatic
• Frequency: Moderate for disseminated disease
but uncommon for pulmonary disease
• Setting: late stage HIV (median CD4 20
cells/mm3)
• Typical findings: Variable
• Diagnosis: Sputum, FOB, or induced sputum
AFB stain and culture; must distinguish from
MTB (DNA probe or radiometric culture
technique); MAC may colonize airways without
causing pulmonary disease; requires 1 to 2
weeks for growth in Bactec system
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
27. Mycobacterium kansasii
• Course: Chronic or asymptomatic
• Frequency: Uncommon
• Setting: Late-stage HIV (median CD4 50
cells/mm3)
• Typical findings: Cavitary disease,
nodule, cyst, infiltrate, or normal chest Х-
ray
• Diagnosis: Sputum, induced sputum, or
FOB, AFB stain and culture
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
28. Kaposi’s sarcoma (KS)
• Course: Asymptomatic or chronic progressive
cough and dyspnea
• Frequency: Moderately common in patients
with cutaneous KS and advanced HIV disease
• Typical findings: Interstitial, alveolar, or
nodular infiltrates, hilar adenopathy (25%), scan
usually negative, pleural effusions (40%); gallium
• Diagnosis: FOB often shows discolored
endobronchial nodule(s); yield of histopathology
from transbronchial or transthoracic biopsy is only
20% to 30%. Pulmonary infiltrate on x-ray with
negative gallium scan is highly suggestive
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
29. Lymphocytic interstitial pneumonia (LIP)
• Course: Chronic or subacute
• Frequency: Uncommon in adults
• Setting: median CD4 - 200-400 cells/mm3
• Typical findings: Diffuse reticulonodular
infiltrates, resembles PCP on chest x-ray
• Diagnosis: Requires tissue for
histopathology; yield with FOB biopsy is
30% to 50%; open lung biopsy often
required
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
30. Lymphoma
• Course: Chronic or asymptomatic
• Frequency: Uncommon, but may be
presenting site
• Typical findings: Interstitial, alveolar, or
nodular infiltrates; cavity, hilar adenopathy,
pleural effusions
• Diagnosis: Requires tissue for
histopathology; yield with FOB biopsy is
poor; open lung biopsy often required
John G. Bartlett. Medical management of HIV infection, 2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
31. Treatment (except pneumocystis)
Gram-negative Need in vitro susceptibility tests. Long-term ciprofloxacin
bacilli usually results in relapse and resistance to P.
aeruginosa.
Staph.aureus -MSSA: Nafcillin/oxacillin, cefuroxime, TMP-SMX,
clindamycin
-MRSA: Vancomycin
Haemophilus Oral: Amox-CA, azithromycin, TMP-SMX,
influenzae fluoroquinolone, cephalosporin; Intravenous: Cefotaxime,
ceftriaxone
Aspergillus Amphotericin B or itraconazole or caspofungin
Candida Fluconazole or amphotericin B
C.immitis Fluconazole, itraconazole, or amphotericin B
Cryptococcus Fluconazole without CNS involvement amphotericin B
H.capsulatum Itraconazole or amphotericin B
Legionella Fluoroquinolone, macrolide, doxycycline
John G. Bartlett. Medical management of HIV infection,
2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
32. Treatment (except pneumocystis)
CMV Ganciclovir, foscarnet or cidofovir
HSV, VZV, RSV, HSV, VZV: Acyclovir
parainfluenza RSV: Ribavirin (?)
Influenza Amantadine/ramantadine neuramidase inhibitors:
Oseltamivir or zanamivir
Asp.pneumonia 1)Clindamycin 2)Beta-lactam + Betalactamase inhibitor
KS -Liposomal daunorubicin or doxorubicin
-Taxol
-Adriamycin, bleomycin/vincristin, or vinblastin
LIP Prednisone (?)
Lymphoma 1)CHOP 2)BACOD + G-CSF
Str.pneumoniae PO: Amoxicillin, macrolide, cefpodoxime,
fluoroquinolone
IV: Cefotaxime, ceftriaxone, fluoroquinolone
John G. Bartlett. Medical management of HIV infection,
2003
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org