Saturday, 24 May 2014

HIV

HIV/AIDS :
MC organ system involvement as complication : Pulmonary
MC Opportunistic infection is Pneumonia.
MC cause of Pneumonia Is Pneumocystis Jiroveci.
Mc bacterial cause of Pneumonia : Pneumococcus> H.infuenzae
MC CVS manifestation is Coronary artery disease
MC CNS manifestation is HIV encephalopathy
MC Cause of blindness is CMV Retinitis
MC Malignancy is Kaposi Sarcoma
MC malignancy : SINGLE malignancy(asked once in exam) is Kaposi sarcoma
MC malignancy as a group(or in general, if not otherwise specified ) is Lymphoma
MC Sinusitis is that of Maxillary sinus.
MC Skin Infection is Seborrheic dermatitis> Folliculitis
MC Viral infection assc.with HIV is HSV-1
MC in iv drug abusers with HIV is HCV
MC cause of diarrhea is Cryptosporidium
MC fungal infection is Candida
MC cause of meningitis is Cryptococcus
MC spread by percutaneous route/ needle pricks : HBV>HCV
MC spread by blood transfusion : HCV
MC cause of Pulmonary involement in INDIA(if asked specifically) is TB.
Overall MC opportunistic infection is TB.... it affects virtually all major organ systems.
    It is also MC cause of pulm inv in INDIA;
    however, overall MC pulm inv is PCP. REf : Harrison 18th as well as NACO status paper

MC fungal infection in febrile neutropenia is Candida> aspergillus
Mc fungal infection overall, world & India : Candida albicans;
     same in Immunocompetent and immcompromised
MC cause of Systemic fungal infection in HIV is Cryptococcus.

HIGH YIELD POINTS ON MENINGITIS :
*Neonates :
India : E.coli and other gram neg> Group b Strep> Listeria
In world, it is Group B strep*2months to 2 yr is H.infuenzae
> 2 yr
it is Pneumococcus> Neisseria mening.
*Overall MC cause of menin in all age groups is Pneumococcus
*MC associated with sequelae is H.infuenzae
*Mc assc wid Sensorinueral hearing loss and Subdural effusion in meningitis : H.influenza
*Empirical treatment of choice in neonatal meningitis : Cefotaxime + Amikacin*Antibiotics
Contraindicated in meningitis : Ciprofloxacin (does not cross infamed meninges), Imipenem( Causes seizures)
*DOC for penicillin allergy in meningitis is Chloramphenicol Ref Nelson
*Duration of therapy in meningitis is 21 days
*In US, due to routine H.influenza vaccination since last 20 yrs, it is no longer a common cause.
however, in INdia as well as in whole world, it is still MC cause in 2 mth to 2 yr age group
*steroids in meningitis-
Nelson 18th ed says regarding use of steroids in meningitis:"Data support the use of intravenous dexamethasone,
0.15 mg/kg/dose given every 6 hr for 2 days,in the treatment of children older than 6 wk with
acute bacterial meningitis caused by H. influenzae type b.
However, data are inconclusive regarding the benefit, if any, of corticosteroids in the treatment
of meningitis caused by other bacteria. Therefore, their use is controversial.
Among children with meningitis due H. influenzae type b, corticosteroid recipients had less fever,
lower CSF protein and lactate levels, and a reduction in permanent auditory nerve damage,
as manifested by sensorineural hearing loss, than did placebo recipients, enrolled in randomized,
controlled trials. Corticosteroids appear to have maximum benefit if given 1-2 hr before antibiotics were
initiated. Corticosteroids are not harmless; complications of their use may include gastrointestinal bleeding,
hypertension, hyperglycemia, leukocytosis, and rebound fever, after the last dose.
"*Clinically, steroids are used in meningitis in only TB meningitis & H.influenzae
*Steroids are used in TB meningitis in both established hydrocephalus,
as well as to decrease chances ofdeveloping hydrocephalus(although this point is a controversial one )!

**For NEONATAL SEPSIS the sequence is Klebsiella>E.coli>Group B strep>Staph aureus REF : AIIMS WHO 2010 Protocols
*same organisms for early and late onset
*In young adults, yes Neisseria but questions specifically ask either about children or adults.
In adults it is Pneumococcus..
if they ask young adults/adolescents, it is Neisseria..

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