0071643192.pdf

INFECTIOUS DISEASE

TABLE 8.5. Specific Side Effects for HIV-Associated Medications

DRUG SIDEEFFECT

Didanosine Pancreatitis

Foscarnet Nephrotoxicity, seizures

Indinavir Nephrolithiasis

Lamivudine Cough

Ritonavir Paresthesias

■ Psychiatric
■ Depression, AIDS psychosis

TREATMENT

■ Highly active antiretroviral therapy
■ Treatment of HIV+patients frequently requires discussion with a consultant.
■ Admit AIDS (CD4 <500) with:
■ New fever of unknown origin
■ Hypoxia worse than baseline (or PaO 2 <60)
■ Suspected PCP or TB
■ New CNS symptom
■ Intractable diarrhea
■ Suspected CMV retinitis or herpes zoster ophthalmicus
■ Inability to care for self

SYSTEMIC STDS

A 24-year-old female presents with several days of fever and tenderness

over the dorsum of one wrist and one ankle, with decreased range of mo-

tion of both. She also notes hemorrhagic pustules on her distal extremi-

ties. What is the most likely diagnosis and treatment?

Disseminated GC. Admit for ceftriaxone 1 g daily and possible surgical

drainage, along with empiric coverage for chlamydia.

Gonococcal (GC) Infections

■ Gram-negative diplococcus N. gonorrhoeae
■ Second most common STD (after chlamydia)

SYMPTOMS/EXAM

■ Incubation period: 1–14 days
■ Asymptomatic infection common