Sandbox/AL

Disease	Description	Clinical Findings	Diagnosis	Prophylaxis	Treatment
Pneumocystis Pneumonia	Caused by the fungus Pneumocystis jirovecii. 90% of cases occurred among patients with CD4+ <200 Incidence among HIV patients: 2-3 cases per 100 person-year	Subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. Tachypnea, tachycardia, and diffuse dry rales are found in the physical examination.	Clinical presentation, blood tests, or chest x-rays are not pathognomonic for PCP.	Start TMP-SMX prophylaxis when CD4+ <200 cells/µL or history of oropharyngeal candidiasis. Discontinue prophylaxis when CD4+ is >200 cells/µL for >3 month.	TMP-SMX Administer adjunctive corticosteroids in patients with pO2 <70 mm Hg or arterial-alveolar O2 gradient >35 mm Hg
Toxoplasma gondii Encephalitis	Caused by the protozoan Toxoplasma gondii The greatest risk of disease occurs among patients with a CD4+ <50 cells/µL Primary infection occurs after eating undercooked meat containing tissue cysts or ingesting oocysts that have been shed in cat feces and have sporulated in the environment	Focal encephalitis with headache, confusion, or motor weakness and fever	Diagnosis is done with IgG antibodies. CT scan or MRI of the brain will typically show multiple contrast-enhancing lesions, often with associated edema. Definite diagnosis requires a brain biopsy.	Start TMP-SMX prophylaxis when CD4+ <100 cells/µL Discontinue prophylaxis when CD4+ is >200 cells/µL for >3 month.	Administer: Pyrimethamine, PLUS Sulfadiazine, PLUS Leucovorin
Cryptosporidiosis
Microsporidiosis
Mycobacterium tuberculosis
Table adapted from Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents