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Mycobacterium tuberculosis
9%
22/251
Mycobacterium avium complex
5%
12/251
Pneumocystitis jiroveci
37%
93/251
Cryptococcus neoformans
7%
18/251
Cytomegalovirus
36%
91/251
Select Answer to see Preferred Response
This neonate has signs and symptoms of Toxoplasma gondii. Trimethoprim/sulfamethoxazle (TMP/SMX) can be used for prophylaxis against toxoplasmosis in HIV/AIDS, and also provides prophylaxis for P. jiroveci, a fungus. Toxoplasma gondii is a protozoa carried by cysts in meat and cat feces. It crosses the placenta during pregnancy and can cause infection in utero. Thus, pregnant women are advised to avoid cat feces and changing litter boxes. T. gondii causes the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications. Treatment consists of sulfadiazine and pyrimethamine. The same pathogen that causes an infectious disease in neonates can cause brain abscesses in HIV patients; these appear as ring-enhancing lesions on brain imaging. The risk of toxoplasmosis for HIV/AIDS patients is highest when CD4 counts < 100. Pneumocystis may cause a deadly pneumonia, most often at CD4 counts < 200. Chu and Selwyn (2010) discuss diagnosis and initial management of acute HIV infection. Symptoms of acute HIV infection are nonspecific (e.g., fever, malaise, myalgias, rash), making misdiagnosis common. HIV RNA viral load testing is the most useful diagnostic test for acute HIV infection because HIV antibody testing results are generally negative or indeterminate. Chu and Selwyn (2011) also discuss complications of HIV infection. Commonly encountered complications to remember include Pneumocystis jiroveci pneumonia, HIV dementia, an increased rate of myocardial infarction, and candidal infection in the oral cavity leading to dysphagia and odynophagia. Illustration A depicts the characteristic ring-enhancing lesions of toxoplasmosis. Incorrect Answers: Answer 1: TMP/SMX does not provide protection against tuberculosis. All HIV/AIDS patients should receive a yearly PPD and isoniazid, and pyridoxine should be given if the patient has a positive PPD. Answer 2: Mycobacterium Avium Complex may cause infections at CD4 counts < 100. At this CD4 level, clarithromycin and azithromycin are the prophylactic agents. Answer 4: There is no prophylactic regimen for cryptococcal meningitis, which may cause an infection at CD4 counts < 50. Answer 5: There is no prophylactic regimen for CMV retinitis, which may cause infection at CD4 counts < 50.
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